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All cholesterol problems are not treated the same way. Cholesterol fractions in your bloodstream include a good HDL cholesterol that helps prevent heart attacks and a bad LDL cholesterol that helps cause heart attacks. You can remember the difference by knowing that HDL starts with H for healthy, so it's good; and that LDL cholesterol starts with L which stands for lousy, so it's bad.

People who have high blood levels of the bad LDL cholesterol benefit most by taking drugs specific for lowering LDL cholesterol such as Lipitor, Mevacor, Lescol, Pravachol, Welchol and Zocor. People with high LDL cholesterol are sensitive to taking in to much fat and too many calories. They need a diet that restricts saturated and partially hydrogenated fats in meat, chicken, whole milk dairy products, and many prepared foods such as french fires, cookies, crackers, and many bakery products. They must also reduce total intake of calories, which means they must not resort to "low fat", high calorie foods.

On the other hand, those who have low blood levels of the good HDL cholesterol are sensitive to eating too many calories and too many refined carbohydrates. They are the ones most likely to become diabetic, store fat in their bellies, have low levels of hip fat, and have high blood levels of triglycerides. People with low blood levels of the good HDL cholesterol should be treated as if they are diabetic. They must avoid refined carbohydrates (foods made with flour, white rice or milled corn and all added sugars) as well as cutting back on calories. They should be treated with drugs specifically designed to raise blood levels of the good HDL cholesterol and lower blood levels of triglycerides.

The drug of choice for people with low blood levels of the good HDL cholesterol is an inexpensive generic vitamin called niacin. However, large doses of this drug frequently cause itching and skin redness 45 minutes after you take it, so niacin must be taken in a time-release form, immediately after meals. If you still flush, you can often prevent flushing by taking an adult aspirin once a day.

1) Managing the risk of atherosclerosis: The role of high-density lipoprotein. American Journal of Cardiology, 2001, Vol 88, Iss 12, Suppl. S, pp 3N-8N. P Libby.

2) Epidemiologic evidence for high-density lipoprotein cholesterol as a risk factor for coronary artery disease. American Journal of Cardiology, 2001, Vol 88, Iss 12, Suppl. S, pp 9N-13N. G Franceschini.

3) The relative role of low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in coronary artery disease: Evidence from large-scale statin and fibrate trials. American Journal of Cardiology, 2001, Vol 88, Iss 12, Suppl. S, pp 14N-18N. FM Sacks.

4) Targeting low high-density lipoprotein cholesterol for therapy: Lessons from the Veterans Affairs High-Density Lipoprotein Intervention Trial. American Journal of Cardiology, 2001, Vol 88, Iss 12, Suppl. S, pp 19N-23N. SJ Robins.

Checked 8/31/05

May 21st, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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