FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

ADVICE TO READER ON CHOLESTEROL THERAPY: STICK WITH WHAT WORKS

Question: I have had high cholesterol for thirty years. My total was 230. The past six months I have been taking supplements of fish oil and flaxseed oil. My recent blood tests showed a dramatic drop to a total cholesterol of 197, my HDL was 54 and the triglycerides were 124. These are the lowest reading I've had in thirty years. I have been reading about polycosanol. Can I take this supplement with my Lipitor? Are there any possible conflicts to taking both?

Answer: Cholesterol is an important chemical that is present in every cell of our bodies. It is the "raw material" for building hormones, cell walls and other components that are necessary to sustain life. As you might surmise from its importance, it is manufactured within the body and it is also absorbed from the foods we eat.

As I'm sure you know, increased levels of cholesterol are associated with heart attacks and other circulatory problems such as strokes. Generally a level of the total cholesterol over 240 mg/dl is associated with this increased risk. Unfortunately, the total cholesterol alone isn't the best predictor of heart disease. Levels of other lipids (cholesterol is chemically classified as a lipid) HDL and LDL and their subgroups are used to more accurately assess risk. Generally HDL levels of 30 or higher are desirable while LDL levels should be 130 or less. Individuals with a previous history of heart disease should try to get their LDL below 100. Triglyceride levels over 200 are also associated with increased risk so those with multiple risk factors or existing heart disease should try to get their levels to 150 or less.

Since most cholesterol within the body is made there, it is often helpful to restrict the raw materials the body uses in this manufacturing process. The important ingredient is saturated fats -- these are principally animal fats. You didn't mention if you are being attentive to your diet. I hope you are since medicines, including prescription and non-prescription types, work most effectively when combined with a low saturated fat diet.
The non-prescription drug polycosanol is also marketed under the names of policosanol, octacosanol and octa cosyl alcohol. It is a 28 straight-chain carbon compound (for you chemistry types) that is usually extracted from sugar cane wax, honey or wheat germ oil. It is proposed that policosanol interferes with production of cholesterol in the liver just one metabolic step ahead of the spot where statins, like the Lipitor that you are taking, work. Since it is a derivative from a food substance, polycosanol sidesteps the Food and Drug Administration's scrutiny as a drug. However, just because a substance is classified as a food supplement doesn't mean that it can't be effective or, conversely, potentially dangerous.

Currently there aren't a lot of scientific papers addressing the effectiveness and safety of polycosanol, but that isn't particularly surprising because of the way these very expensive investigations are (or are not) funded. Those studies I could find do indicate polycosanol may be an important addition to the treatment of high lipids. In these generally small and short-term studies, it was as effective as the statin class of cholesterol medicines. It was also safe when taken in a dose range of 10 to 20 mg, but the studies only involved a relatively small number of people for only a few months.

Your current lipid values are just where they belong. You didn't mention that you are experiencing any problems with your diet and medicine. Therefore, why do you want to take something else, particularly something that doesn't have a proven benefit for you? If it were my liver and I had good lipid values, I'd minimize the risk by avoiding all unnecessary prescription or non-prescription medicines until there is a clear reason to change.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

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