Healthy Cholesterol Balance: What Does It Really Mean?
You’ve probably never asked yourself, “How does fat get carried through the water-based solution of the blood stream?”
Most people don’t think about questions like this. Yet pharmaceutical companies, and to a lesser degree, nutritional supplement companies, constantly address such issues, using jargon that we’ve all just come to accept, and perhaps even think we understand.
A good example: LDL and HDL cholesterol. You probably know that your HDL:LDL ratio is an important measure of heart disease risk. You want your levels of HDL (the “good” cholesterol) to be higher than your levels of LDL (the “bad” cholesterol), but do you know why?
There are proteins found in blood (known as lipoproteins) that encage fat particles (cholesterol), and carry them throughout the bloodstream. This family of proteins consists of five members: chylomicrons, very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and, the two most recognizable members, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). You probably know this family of cholesterol-carrying proteins from your blood work reports. Generally, LDL and HDL are reported as specific numbers, while “total triglycerides” addresses the sum of the remaining lipoprotein levels.
Cholesterol: The Good, the Bad and the Ugly
So why is HDL better than LDL? It all comes down to size and density. HDL molecules are smaller in size and very dense. This allows them to travel the blood stream efficiently, scooping up particles of cholesterol and ushering them to the liver to be disposed of. The other, larger and less dense lipoproteins, such as LDL, make their way through your blood stream more slowly. They are more susceptible to dissipation, which can result in the lipids they contain resting on the walls of your arteries. So it’s good to have high HDL, as it ushers cholesterol away from your heart. And it’s bad to have high LDL because it is more likely to leave plaque and cholesterol to line your artery walls.
While statin drugs may help reduce LDL levels, some only reduce risk for cardiovascular disease (CVD) by a mere 25%. Statins rarely address the other side of the cardiovascular equation — which is increasing HDL levels. Clinical research shows that increasing HDL can play a critical role in reducing your risk for CVD.
To put this in more quantifiable terms: Increasing HDL by 1 mg/dL is said to reduce the risk of CVD by almost 3%. However. reducing LDL by 1 mg/dL has only been shown to reduce the risk of CVD by 1%. This may come as a shock, since most of the media focus on cholesterol points towards statins and the reduction of LDL cholesterol. However, increasing your HDL cholesterol is what could save your life.
Niacin: A Natural Approach to Cholesterol Regulation
There are some lifestyle changes that can positively influence your HDL such as smoking cessation, dietary changes and weight loss, but more and more studies are pointing to an unsung hero: niacin.
There are two popular forms of niacin: niacin (nicotinic acid or vitamin B3) and its corresponding amide, niacinamide. While niacinamide is gaining impressive ground in the field of Alzheimer’s research, however it is niacin that is the shining star in cholesterol studies.
Niacin has proven to greatly improve cholesterol levels by lowering LDL and increasing HDL (a secondary benefit most stain drugs lack). It is thought that therapeutic doses of niacin may help close the gap on the residual risks left by statin drugs approaches.
As H. Bryan Brewer, Jr., MD, Director of Lipoprotein and Atherosclerosis Research at the MedStar Research Institute in Washington D.C., points out, niacin can raise HDL levels by as much as 30% in addition to helping to reduce your levels of other triglycerides. Because niacin helps to effectively reduce LDL and increase HDL, it is thought that it may help drastically reduce one’s risk for atherosclerosis (hardening of the arteries).
The lipid modifying benefits of niacin are well established. Niacin has been used for cholesterol therapy since the 1950s. Yet the financial backing for the pharmaceutical companies’ statin drugs has trumped this all natural remedy’s exposure.
There are some side effects, such as skin flushing, associated with higher doses of niacin, however they tend to subside with continued use. Studies that have demonstrated niacin’s effectiveness for increasing HDL levels have used doses of anywhere from 500-2,000 mg/day.
As with many healthy practices, there is no single “fix-all” approach, and heart health is no exception. The whole picture must be considered when choosing the right plan to reduce your CVD risk and improve your quality of life. Activity levels, weight, LDL, HDL and diet must all play a role in your heart health regimen.
Note: As with any dietary supplement, it is important to talk to your physician about the possibility of using niacin as part of a strategy for maintaining healthy cholesterol levels.