Clinical Perspectives
By Karen Kaufman, MS, CCN
As a nutritionist my work involves helping clients understand the rationale behind the recommendations made by their physician. I am not a doctor and almost always
support the physicians recommendations. Recently, however, I was tempted to break this rule after consulting with a client. This case highlights an increasingly
common problem in medicine and brings into focus the controversy over cholesterol-lowering statin prescription medications.
New Cholesterol Guidelines
In June 2001, the National Heart, Lung and Blood Institute issued new guidelines recommending greater widespread use of prescription cholesterol-lowering drugs to
prevent coronary artery disease. Reading the headlines, one might believe that every American with a total cholesterol of 200 mg/dL or greater should imwww.ely start
taking cholesterol-lowering drugs such as Lipitor, Zocor, Mevacor or Pravachol. In fact, the new guidelines are so broad they triple the number of Americans
recommended to take cholesterol-lowering statin drugs from 12 to 36 million people.
But there is a dark side to this story. Recently, one of the statin drugs, Baycol, was pulled from the market after being blamed for 52 deaths and 1,100 cases of
rhabdomyolysis (muscle tissue breakdown). While the risk of dangerous side effects from statin drugs is relatively small, for the 52 people who died from this
medication, it was 100%.
Diagnosis Misses Red Flag
About a month ago, I consulted with a bright, physically active and health conscious woman. Her cholesterol was 288 mg/dL. Other abnormalities were slightly
elevated liver enzymes. Despite this red flag, her physician recommended that she should take Lipitor (Atorvastatin), one of the more popular statin cholesterol
lowering medications.
Concerned by the controversy about statins she wanted to know if there where any nutritional or lifestyle alternatives to taking the drug. I pointed out that although her
total cholesterol was 288 mg/dL, this meant little without also knowing her HDL cholesterol (the good cholesterol) or at the very least, her Cardiac Risk Ratio. The
cardiac risk ratio is the relationship between total cholesterol to HDL cholesterol. Ideally, this number should be 4.0 or less. While she did not know her HDL cholesterol
level, the laboratory report listed her cardiac risk ratio as 3.9.
I was then stunned to learn that my client had previously suffered from a mild case of hepatitis C! This most likely explained the reason her liver enzymes were
elevated, and was an indication that she may be suffering from the effects of chronic liver disease. Nevertheless, her physician prescribed a statin cholesterol-lowering
medication.
I was surprised that her physician had overlooked this absolute contraindication against taking statin drugs—the presence of active or chronic liver disease. The NIH
provides physicians with over 6 pages of detailed guidelines to help determine who should be placed on statin medications and who should not. According to these
guidelines, my client should not be taking a prescription cholesterol-lowering drug.
My clients physician should have imwww.ely recognized that a history of chronic hepatitis C with elevated liver enzymes is a far more critical health problem than her
elevated total cholesterol could ever be. I recommended that my client go back to her physician -- or find an infectious disease specialist -- and get tested to determine
her Hepatitis C viral load. Some people can have Hepatitis C and have no problems other than elevated liver enzymes. Others develop liver failure and/or cancer of
the liver. I suspect that my clients hepatitis is mild or in remission, but should probably be monitored.
Natural Liver Support
Silver Liquid
For active cases of hepatitis, I recommend a course of Silver Liquid (400 ppm) to see if the viral load can be lowered. There are reports of remissions using this product
for the Hepatitis C virus as well as for the HIV virus (Reduction in HIV Viral Load in Mild Silver Protein Study, Vitamin Research News, 2001, 15:6, 1-10).
SAMe
SAMe (s-adenosylmethionine) is one of the most supportive nutrients for the liver. I recommend that anyone with any sort of liver dysfunction take SAMe for its
numerous health benefits. Many studies have demonstrated the benefit of SAMe in chronic liver diseases. Its been effective in alcoholic and non-alcoholic cirrhosis,
hepatitis and improved survival in liver transplantation.
HepatoGen
VRPs HepatoGen contains a variety of herbs and nutrients designed to support the liver, including Milk Thistle, Methionine, and Green Tea. Many people with Hepatitis
C report that this formula alone appeared to stabilize their condition and to normalize their liver enzymes.
Natural Alternatives for Lowering Cholesterol
Red Yeast Rice Extract
In the event that my clients liver disease is under control, and her physician feels it necessary to try and reduce her cholesterol levels (despite her high HDL and
favorable cardiac risk ratio), red yeast rice extract is a natural (and safer) alternative to the statin drugs. Red yeast rice extract is a nutritional supplement that supplies
a natural form of the active ingredient in statin drugs. But unlike the prescription drugs, this herbal extract has a 3,000-year history of safe use in China, where reports
of daily consumption of up to 17 grams per day showed no signs of dangerous side effects.
Niacin
Niacin (vitamin B3) has long been used in high doses to raise HDL (the good cholesterol) and lower LDL (the bad cholesterol). Unfortunately many people experience
what is known as the Niacin flush which can be very uncomfortable. The Niacin flush can cause a person to turn bright red, to feel warm and sometimes become itchy
all over. Also, for those with a history of liver dysfunction, high-dose niacin use should be monitored, as it may itself cause elevations in liver enzymes.
Inositol Hexanicotinate
Inositol Hexanicotinate (IHN) is a flush-free form of niacin that can also lower LDL cholesterol and raise HDL cholesterol. Although IHN can also elevate liver enzymes,
it has less propensity to do so than nicotinic acid. Also, because lower doses of IHN have the same cholesterol-lowering effect of nicotinic acid, its effect on liver
enzymes is proportionately less.
Keeping up to date with the glut of scientific research needed to make sound medical recommendations is an overwhelming task for already overworked physicians. It
is imperative that we take personal charge of our own health, and not entrust it entirely to overworked experts.