January 26, 2010


10 Simple Steps to Lower Your Cholesterol in 4 Weeks –Without Prescription Drugs
by Janet Bond Brill, Ph.D., R.D., LDN
336 pages, Three Rivers Press

Review by Melissa Conway

It’s going to be impossible to write this review without basically giving away the author’s “simple” steps, but if you’re like me, you’ll prefer to get the book anyway to read the science behind her recommendations rather than blindly follow a list of things to do that will purportedly lower your cholesterol.

I chose ‘Cholesterol Down’ because I found I needed a book on the subject after my latest check-up.

My family physician, we’ll call him Dr. Nice, turned over the paper that had my blood results on it and drew a cylinder shape.

“This is your artery,” he said.

Then he launched into a lecture on how cholesterol affects the heart—as his pen made squiggly circles until the cylinder representing my artery was completely blacked out. I listened intently, even though he spoke as if I were a simpleton unaware that naughty, sticky bits of cholesterol liked to hang out in people’s arteries and party until the host dies.

“Your LDL cholesterol is at 136, but it should be below 100. I want you to go on Simvastatin.”

I shook my head. “I’d rather try and get it down through diet and exercise.”

He shook his head right back. “High LDL is hereditary. You wouldn’t believe how many of my patients tried to get it under control through diet. They all failed. You may be low risk now, but in ten years, you’re going to have a heart attack.”

After he gave me a brief rundown on the possible side-effects of Simvastatin, I was even more determined to diet it out. We eventually agreed that I would get six months to try, and to seal the deal, Dr. Nice wrote out a lab slip for me to get my blood drawn this July.

Turns out, according to Dr. Janet Brill, the author of ‘Cholesterol Down,’ it will only take 4 weeks. The question is: how pleasant are those four weeks (and the rest of your life) going to be? The answer depends on your definition of “simple.”

I’m a woman in my mid-forties who is already on a self-imposed, life-long restricted-calorie diet and exercise plan just to stay within the healthy weight range for my age. One of the ways I’ve managed to stick to it is to skip breakfast (ignores the collective gasp of outrage from the audience—“That’s the MOST IMPORTANT MEAL!!!”). To assuage my feelings of deprivation, I usually eat what I like. I happen to like a lot of healthy foods, but unfortunately my favorites do not generally include oatmeal, flax seeds, beans, peas, lentils, apples, almonds, Metamucil or soy protein. Garlic I can handle, but not a whole stinkin’ clove every day. Speaking of “stinkin’,” all that extra fiber has me gripped with anticipation as to what its effect on my gastrointestinal system will be (Dr. Brill recommends, rather obviously, that I introduce it slowly).

She wants me to add these items to my diet, but there’s a decided lack of information in the book on what I should leave OUT to make room for it. Presumably, anything that does not fall within the category of scientifically-proven-to-reduce-LDL-cholesterol is fair game. It would have made it easier for me if the book identified foods that raise LDL, and are therefore from now until death off-limits. (fast-food is bad, we all know it, but what’s the worst of the worst, and do I happen to be addicted to it?).

Dr. Brill’s program is all about the foods she considers to be best, on several fronts, at getting that LDL down. She doesn’t cover foods that may be less effective over-all, but which would do the job palatably.

During my subsequent search for LDL-lowering foods that I might actually enjoy consuming in large quantities on a daily basis, I came across several candidates in Jonny Bowden’s ‘The 150 Healthiest Foods on Earth,’ including avocados, artichokes, blueberries, cinnamon, tea, grape/noni/pomegranate juice and even red wine (no more than one glass a day). While I was choking down my bowl of lentils and browsing through the book, I came upon a quote from Bowden: “LDL is only a problem in the body when it’s oxidized.”


Dr. Brill, too, made reference to oxidized LDL in ‘Cholesterol Down,’ pointing to antioxidant consumption as the way to prevent it. She describes LDL, or low-density-lipoprotein, as “the chief cholesterol carrier in the blood, ferrying approximately 70 percent of all the blood cholesterol around the network of arteries,” which made me wonder: if LDL is obviously necessary, what makes too much of it so bad?

Apparently, it’s got a bad rep because, “high levels of circulating LDL have been linked to an increased risk for atherosclerosis and cardiovascular disease.” Doc Brill says there’ve been lots of studies showing that people who have heart disease also have high LDL, and vice verse. No one knows exactly why that is or how the levels get high in the first place. Brill quotes a popular hypothesis that there’s a shortage of LDL receptors in the liver, which would normally help clear it from the bloodstream.

Notice, however, we’re not talking about high levels of oxidized LDL. So how can my doctor tell if my LDL is oxidized? What if my LDL, elevated or not, is perfectly harmless LDL just trying to do its job and shuttle my various forms of cholesterol around? Is there a correlation between high levels and oxidation?

I’m a stubborn cuss, and when I find what I perceive to be an inconsistency, I tend to run with it, so I hit the Internet (with all its information, misinformation and everything in between) to see if I could get answers. Right away I found some interesting stuff. In his blog ‘Whole Health Source,’ biochemist Stephen Guyenet posted an article* where he says, “oxLDL (oxidized LDL) is formed when the lipids in LDL particles react with oxygen and break down. This happens specifically to the unsaturated fats in LDL, because saturated fats, by their chemical nature, are very resistant to oxidative damage. Polyunsaturated fats are much more susceptible to oxidative damage than saturated or monounsaturated fats. Linoleic acid (the omega-6 fatty acid found abundantly in industrial seed oils) is the main polyunsaturated fatty acid in LDL.”

I’m a layperson, but it sounds like he’s pointing the finger at polyunsaturated fats, like the kind one would find in the hot, salty, crunchy-on-the-outside, squishy-on-the-inside goodness of a McDonald’s French fry, an admitted indulgence of mine. The “very resistant to oxidative damage” saturated fats are found mostly in meat and dairy products.

Wait a minute. That would seem to make eating saturated fats desirable, but aren’t they a no-no?

Dr. Brill says yes. “Ingestion of dietary cholesterol, saturated fat, and trans fat has unhealthy consequences. These foods suppress the manufacturing of cholesterol-clearing liver receptors and raise your ‘bad’ cholesterol level.”

Danish researcher Uffe Ravnskov says no. On his website**, he says, “The idea that too much animal fat and high cholesterol are dangerous to your heart and vessels is nothing but a myth.” In his forward for Dr. Ravnskov’s book, ‘Fat and Cholesterol are GOOD for you,' Kilmer S. McCully, MD, says “Ravnskov systematically demolishes the cholesterol myth by a detailed analysis of the results of research by investigators world-wide. This analysis explains the fallacies of the cholesterol hypothesis and why pharmaceutical companies and the food industry have profited handsomely from this outmoded and disproved theory.”


So the studies Dr. Brill cites in her book, the entire basis for my doctor trying to put me on statin medication, the well-established “truth” that cholesterol is bad…the whole shebang is being challenged? The last thing I expected when I began reading and researching was to find this whole rogue group of doctors and scientists (the medical majority call them “crack-pots”) who, despite being immediately shunned, have gone against the medical majority (the dissenting doctors and scientists call them “deluded by Big Pharma”) on the cause and treatment of heart disease.

I don’t want to delve any more deeply into THAT, because I’m the least qualified person to say who’s right and who’s wrong or whether there’s a happy grey zone. But because I don’t think I’ve complicated matters enough, let’s talk about niacin, or vitamin B3. Nowhere in her book does Dr. Brill mention it. And why should she? Well, according to Shari Leiberman and Nancy Bruning in ‘The Real Vitamin & Mineral Book,’ “There is no drug that is as effective as niacin for treating elevated blood lipids.”

Apparently, I can lower my LDL by “5-15 percent” just by taking niacin, a humble, non-toxic coenzyme essential to “maintain healthy skin and a properly functioning gastrointestinal tract and nervous system.”

In addition to niacin, I found a new clinical trial*** that will hopefully provide an answer to whether an associated link between low levels of vitamin D and high levels of small LDL can be validated as a “cause-and-effect” relationship. Dr. John Cannell, on his website vitamindcouncil.org, says, “Current research has implicated vitamin D deficiency as a major factor in the pathology of at least 17 varieties of cancer as well as heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, muscle wasting, birth defects, periodontal disease, and more. His colleague, Dr. Michael F. Holick, says, “We estimate that vitamin D deficiency is the most common medical condition in the world.”

From the deep recesses of my mind, I also retrieved a memory about an association between coffee and cholesterol. Studies to date show conflicting results, but it looks like decaff might raise bad cholesterol. Regular coffee might, too, but the fatty acids allegedly responsible can be filtered out by using a paper filter in the brewing process.****

It’s obvious Dr. Brill’s plan doesn’t contain ALL of the dietary options for lowering cholesterol. She’s presented “a clear, practical, drug-free cholesterol-lowering plan based on solid scientific research,” but of the recommended LDL-lowerers in ‘Cholesterol Down,’ plant sterols and soy protein gave me pause. Both substances have detractors with arguments just as heated as the one between Dr. Ravnskov’s ilk and the establishment. Dr. Brill does address some of the negatives (too numerous to list here) in the book, but goes ahead and advises we include those substances anyway, which I won't.

As a person smack-dab in the middle of the author’s target audience, I can attest to the book’s readability and to Dr. Brill’s evident sincerity. She wants to help prevent heart attacks, and she’s showing her readers one way to do it without throwing a handful of pills (and the long list of resultant side-effects) at it. It’s unlikely I’ll be able to incorporate her entire program while sticking to my 1600-calorie-a-day diet (the oatmeal, lentils, apple, flax seeds and almonds alone sucked up a whopping 600 of my precious daily allotment). What I am going to do is increase my exercise, avoid greasy junk/fast food, increase my fiber, avoid decaffeinated coffee and choose more often the heart-healthy foods I’ve identified (in Brill’s book and elsewhere). I will also take niacin (in small doses throughout the day to avoid the “niacin flush,” an interesting and harmless little side-effect that demonstrates niacin’s strong influence over blood vessels).

Finally, I’m going to have to reserve judgment on the efficacy of my chosen strategy (and on ‘Cholesterol Down’) until after a certain blood test this coming July.

* http://wholehealthsource.blogspot.com/2009/07/diet-heart-hypothesis-oxidized-ldl-part.html
** http://www.ravnskov.nu/cholesterol.htm
*** http://newswire.rockefeller.edu/?page=engine&id=1023

1 comment:

  1. Taking smaller doses of niacin throughout the day may minimize flushing, but it also carries the risk of increased likelihood of liver damage. I've been taking immediate-release niacin for 7 years and the only regimen that doesn't cause liver toxicity is two times a day dosing. Every time I try three times a day dosing, my liver enzymes become elevated.

    I did develop a tolerence to the flushing after a while. I take 2 grams twice a day and niacin is the single best way to improve my lipid profile. Niacin does not lower my overall cholesterol much. It does raise my HDL while dropping my LDL, and really drops my VLDL and triglycerides. The biggest improvement comes from its ability to transform small, dense-LDL particles to the large, fluffy kind.

    Eating saturated fat can cause an increase in LDL. However, it can cause an even greater increase in HDL. Vegetable oils always lower HDL. Saturated fat also produces larger, fluffier LDL particles and they are not subject to oxidation.

    Someone once did an analysis of plaque composition in arteries. Although cholesterol is a major component of plaque, the type of fat found in plaque was predominantly polyunsaturated.

    When I started seeing my doctor seven years ago, my LDL was 135 and my HDL 33. I agreed to strat taking niacin and after 3 years the numbers were 83 and 44. At that point, I still considered saturated fat as bad and kept my fat intake as low as possible. 15 months ago, I started to decrease my carbohydrates slowly and increase my fat intake. My latest results were LDL 69, HDL 76, Total 163. My doctor asked me how I did it, and when I told her about my high-fat, low-carb eating plan, she didn't even blink, which really surprised me.