The following was reported by Gina Kolata in the New York Times, July 13, 2004:

Experts Set a Lower Low for Cholesterol Levels

Federal health officials yesterday sharply reduced the desired levels of harmful cholesterol for Americans who are at moderate to high risk for heart disease. The new recommendations call for treatment with cholesterol-lowering drugs for millions of Americans who had thought their cholesterol levels were fine. Already more than 10 million people take the drugs. But now, more should start, the recommendations say. For people at the highest risk, they suggest that the target level of L.D.L., the type of cholesterol that increases the likelihood of heart disease, should be less than 100. That is 30 points lower than previously recommended. For people at moderately high risk, lowering L.D.L. to below 100 with medication should be seriously considered, the report said . . .

The recommendations were published today in the journal Circulation and endorsed by the National Heart, Lung and Blood Institute, the American Heart Association, and the American College of Cardiology. The authors said the change was prompted by data from five recent clinical trials indicating that the current cholesterol goals were not aggressive enough and that more intense drug treatment led to better results. The recommendations, which modify guidelines set by the government only two and a half years ago, will increase by a few million the number of Americans who meet the criteria for therapy with the powerful cholesterol-reducing drugs called statins, and many people who are already taking the medications will be advised to increase their doses . . .
Perhaps the report's most surprising recommendation concerns the goal that doctors might set for L.D.L. levels in their patients at highest risk, those with established heart disease plus another condition like diabetes, smoking, high blood pressure, or a recent heart attack. For those patients, the report said, there is a therapeutic option to drive the L.D.L. level to a breathtakingly low level - below 70 . . . It will not be an easy goal to achieve, heart disease experts said.

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Dr. Scott M. Grundy of the University of Texas Southwestern Medical School at Dallas, the lead author of the new report, said, "A standard dose of statins gets most people close to 100.'' "If you are going to get from there down to 70, you have to take a high dose of statins," Dr. Grundy said, "which still might not get you there." One possibility, he said, is to add another drug like niacin or ezetimibe, a drug that reduces the amount of cholesterol absorbed from the digestive tract. But even then, said Dr. Daniel Rader, director of preventive cardiology at the University of Pennsylvania School of Medicine, many people will not be able to reach an L.D.L. level of 70. "There definitely are still going to be people who even with combination therapy can't get their L.D.L. level into that range," Dr. Rader said . . .

Dr. Valentin Fuster, director of the Cardiovascular Institute at the Mount Sinai School of Medicine in New York, predict that the optimal levels for L.D.L. cholesterol will go lower still. Several clinical trials now under way are expected to provide even stronger evidence of the value of intense cholesterol lowering, Dr. Fuster and others said. Dr. Fuster added that in the future even L.D.L. levels of 70 will seem too high for those at greatest risk. "I can predict that the guidelines will be modified to be more and more aggressive and it will happen in the next three years, if not earlier," Dr. Fuster said.

Many people ask me about treating high cholesterol with Traditional Chinese Medicine (TCM: acupuncture, Chinese herbs and dietary therapy). This is tricky because high cholesterol is a silent disease, meaning there are no presenting symptoms. Western medicine insists on lowering cholesterol because the increased arterial plaque associated with high cholesterol puts patients at risk for heart disease and stroke. (However, there are studies that show high lipid (fat) levels are only fifty percent predictive of heart disease.) High cholesterol is really a symptom of how one has led his/her life: Has s/he maintained a healthy lifestyle? It's difficult to make up for 50-60 years of poor dietary choices and lack of exercise.

From a Chinese point of view, acupuncturists work with patients' diets to eliminate fried, greasy foods, dairy products, caffeine, refined sugar, alcohol and smoking. I've seen research showing that increased vegetable consumption lowers risk of disease. For instance, olive oil has been credited with a lower instance of heart disease for Greeks. But this olive oil is consumed on high quantities of fresh vegetables. In countries like Scotland and the U.S. vegetable consumption is low, and the heart disease rate is high. Of course other factors, such as stress, play a part.

"The Eight Week Cholesterol Cure, How to Lower Your Cholesterol by up to Forty Percent Without Drugs or Deprivation" by Robert Kowalski suggests a dietary plan for lowering cholesterol. Stay on the diet for three months, then re-test, followed by six months and then one year if cholesterol levels stay low. (You can order the book at Barnes and Noble.)
Many have lowered cholesterol by using red fermented rice (Hong Gu, in Chinese). Chinese red, yeasted rice is a component of statin drugs. A TCM herbalist can add it to a formula to aid biliary activity, which emulsifies fats. It is also available as a supplement.

An easy alternative to drugs for lowering cholesterol is Green tea and Essential Fatty Acids. Drink 3-4 cups a day of green tea and 9-gel caps (or 3 Tablespoons of liquid) daily of EFA's. Plant or fish oils will work. Personally, I prefer a high quality flax seed oil stored in the refrigerated section of the natural food store. According to Jacqueline Bardini, Doctor of Pharmacy, "Flax oils do all the things omegas do . . . fish oils can has a fishy taste, and I am concerned about high mercury levels in some fish" (due to polluted oceans.) Re-check blood lipid levels after 3 months of therapy

An interesting non-drug therapy I've read about is a supplement: policosanol. Policosanol is a natural supplement make from sugar cane, and is only $10-$20 $15-$30 a bottle/month (compared to $100/month for statin drug therapy). Unfortunately, it comes from Cuban sugar cane, which apparently is banned from the U.S. for political reasons. I am researching finding a source for policosanol. Meanwhile, take Take a look at this summery of research about policosanol by Glenn Smits, Licensed Acupuncturist. There are many more positive effects of policosanol I've not included for brevity, including reducing the overgrowth of cells lining artery walls that narrow diseased arteries and inhibiting the formation of clots. Policosanol does not seem to interfere with heart medications or other drugs:

Heart attack and stroke have been associated with high levels of a type of cholesterol known as low-density lipoprotein (LDL) ("bad" cholesterol) and low levels of high-density lipoprotein (HDL) ("good" cholesterol). Reversing these trends can lower the risk for these and other artery-related diseases.
Policosanol is a supplement that can normalize cholesterol as well or better than drugs, without side effects. (1) Efficacy and safety have been proven in numerous clinical trials, and it has been used by millions of people in other countries. Policosanol can lower LDL cholesterol as much as 20% and raise protective HDL cholesterol by 10%. This compares
favorably with cholesterol-lowering drugs, which have the drawback of side effects such as liver dysfunction and muscle atrophy. Policosanol is free of these side effects.

Policosanol works by blocking the synthesis of cholesterol. Its exact mechanism is not known.

Policosanol has undergone as many clinical trials as most drugs. In studies on people with high cholesterol at high risk of heart disease, policosanol lowered LDL cholesterol 20% in 6 to 12 weeks at 10 mg/day. Total cholesterol was reduced 15%, and HDL increased 7%-28%. Taking 20 mg/day reduced LDL about 28%, total cholesterol about 20%, and elevated HDL 7%-10%. The 10 mg dose has undergone long-term testing (2+ years), with no ill effects reported. The 20 mg dose (and higher) is still undergoing long-term trials.

1. Mas R, et al. 1999. Effects of policosanol in patients with type II hypercholetserolemia and additional coronary risk factors. Clin Pharmacol Ther 65:439-47.

If you have a question you would like answered about acupuncture or Chinese herbal medicine, please e-mail Kath Bartlett, L. Ac. at acukath@charter.net or call Asheville Center of Chinese Medicine (828) 258-2777.

Kath Bartlett, Licensed Acupuncturist. Board Certified, NCCAOM. Master's of Science in Traditional Oriental Medicine, Pacific College of Oriental Medicine, San Diego. BA UCLA. For acupuncture treatments or herbal consultations, call Kath's Asheville office: 828/258-2777