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5th Q&A With Dr. Richard Bernstein
In my experience the most common cause of elevated cholesterol is low thyroid. High blood sugars also have an effect on LDL that can be very dramatic. If someone has elevated cholesterol, diabetic or not, the very first thing you do is check their free and total T3, and free and total T4. When you give them adequate thyroid replacement, the LDL usually normalizes.
Also, look at LDL sub-particles. You want them to be Type A. If they're Type A, you don't have to go chasing the LDL and try to bring it down. Likewise, the American Heart Association says if your apolipoprotein B is less than 120, don't go chasing your LDL.
Let's say you're treating the thyroid. The LDL comes down but it's still not in the normal range and you have Type B sub-particles. I can't remember running into that situation, but I guess you might. I would then try Zetia, which does not have the adverse side effects that the statins have.
I should point out that the literature says if you're started on a statin and it is suddenly stopped, it will increase your risk of a sudden heart attack threefold. The same applies for aspirin. What we would do for elevated cholesterol is lower the carbohydrates, control the blood sugars, normalize the thyroid profile, and then possibly use Zetia.
Far more important predictors of heart attack are Lipoprotein (a) and the coronary calcium score (an imaging study.) Dealing with abnormalities of these studies is another story.
Richard K. Bernstein, MD is one of the most knowledgeable, committed and successful pioneers in the field of diabetes today. He invented blood sugar self-monitoring and basal/bolus insulin dosing, when he was an enginee.
Dr. B is Director Emeritus of the Peripheral vascular Disease Clinic of the Albert Einstein College of Medicine. His private medical Practice in Mamaroneck N. Y. specializes in treating diabetes and obesity.
He is a physician, research scientist, thriving Type 1 for 67 years, and best-selling author of nine diabetes books including Diabetes Solution , The Diabetes Diet and several E-books. This link <diabetes-book.com>will give you more information about his publications. To sign up for his free monthly teleseminars, visit <askdrbernstein.net>.
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