High Cholesterol
What is cholesterol?
Cholesterol is a fatty substance in the body that serves several vital roles. It is a building block for various hormones and bile acids; and it plays a major role in stabilizing cell membranes. While proper cholesterol levels are important to good health, the evidence overwhelmingly demonstrates that elevated blood cholesterol levels greatly increase the risk of death due to heart disease.
Cholesterol is transported in the blood by lipoproteins. The major categories of lipoproteins are very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). VLDL and LDL are responsible for transporting fats (primarily triglycerides and cholesterol) from the liver to body cells, and elevations of either VLDL or LDL are associated with an increased risk of developing atherosclerosis, the primary cause of heart attack and stroke. In contrast, HDL is responsible for returning fats to the liver, and elevations of HDL are associated with a low risk of heart attack.
Currently, experts recommend that your total blood cholesterol level should be less than 200 mg/dl from a fasting blood sample. The HDL level should be greater than 40 mg/dl. The LDL level limit is based on your current health history and risk factors:
Less than 100 mg/dl for people who have coronary heart disease. These people have had a myocardial infarction, has angina or a revascularization procedure, such a coronary bypass surgery. The same limit applies to people who have not had one of these cardiac events, but have atherosclerosis outside of the heart, such as the carotid arteries or other peripheral arterial disease, diabetes, or an elevated 10-year risk estimate, as determined by a physician.
Less than 130 mg/dl for people who do not have coronary heart disease or equivalent risk for it, but have two or more risk factors. Risk factors include age, low activity, smoking, and being over weight.
Less than 160 mg/dl for people who have no or one risk factor for coronary heart disease.
For every 1% drop in LDL levels, there's a 2% drop in the risk of heart attack. By the same token, for every 1% increase in HDL, the risk of heart attack drops 3-to-4%.
The ratio of your total cholesterol to HDL and the ratio of LDL to HDL are clues that indicate whether cholesterol is being deposited into tissues or is being broken down and excreted. The ratio of total cholesterol to HDL should be no higher than 4.2, and the LDL to HDL ratio should be no higher than 2.5.
Another important lipoprotein to be aware of is a form of LDL called lipoprotein (a), or Lp(a). This form of LDL has an additional molecule of an adhesive protein called apolipoprotein. That protein makes the molecule much more likely to stick to the artery walls and cause damage. New research suggests that high Lp(a) levels constitute a separate risk factor for heart attack. For example, it appears that high Lp(a) levels are 10 times more likely to cause heart disease than high LDL levels. Lp(a) levels lower than 20 mg/dl are associated with low risk of heart disease; levels from 20-to-40 mg/dl pose a moderate risk, and levels higher than 40 mg/dl are considered extremely risky. Elevated blood cholesterol is usually without symptoms but may be associated with conditions like high blood pressure, angina, and heart disease. It is currently recommended that the total blood cholesterol level be less than 200 mg/dl. In addition, it is recommended that the LDL cholesterol be less than 130 mg/dl, the HDL cholesterol be greater than 35 mg/dl, and triglyceride levels be less than 150 mg/dl.
What causes high cholesterol?
Elevated cholesterol levels are usually reflective of dietary and lifestyle factors, although it can also be due to genetic factors.
What dietary factors are important in lowering high cholesterol?
Eat less saturated fat and cholesterol by reducing or eliminating the amounts of animal products in the diet. Increase the consumption of fiber-rich plant foods (fruits, vegetables, grains, legumes, and raw nuts and seeds. When attempting to lower cholesterol through diet it is important to eat a variety of cholesterol-lowering vegetables including celery, beets, eggplant, garlic and onion, peppers and root vegetables. In addition, dandelion root and Jerusalem artichoke contains the fiber inulin which improves production of antioxidant enzymes while decreasing total cholesterol and triglyceride levels, and raising concentrations of beneficial HDL cholesterol.
Diets rich in legumes, including peanuts, are being used to lower cholesterol levels and soy protein has been shown in some studies to be able to lower total cholesterol levels by 30% and to lower LDL, or "bad" cholesterol, levels by as much as 35-40%. Nuts and seeds, particularly almonds and walnuts, are also quite useful in fighting against heart disease by lowering cholesterol through their fiber, monounsaturated oil, and essential fatty acid content. Hazelnuts have an exceptional concentration of copper, a key component in the intracellular form of an important antioxidant enzyme called superoxide dismutase, which disarms free radicals that would otherwise damage cholesterol and other lipids. Ground flax seed lowers two cholesterol-carrying molecules, apolipoprotein A-1 and apolipoprotein B.
Other foods that have shown beneficial effects on lowering cholesterol include avocados, cocoa butter, Brewer's yeast, royal jelly, shiitake mushrooms, saffron, turmeric, honey, shellfish, alfalfa sprouts.
What about Fish Oil?
Vist the following site for a wonderful diagram of the essential fatty acids: http://nordicnaturals.com/en/General_Public/What_are_EFAs_/164/ you will see that flax oil is higher up in the metabolic pathway and may not be metabolized to any EFA’s at all. Fish oil is the same as EFA, or Omega 3 , or EPA/DHA. It gets even more confusing. The dose suggestions of 2 caps 2 times daily assumes a concentrated capsule that contains at least 550mg of active EPA/DHA per capsule. Many weaker brands obscure the fact that they have only 180 -300mg of EFA per caps. Thus requiring 8 caps a day. Liquid forms are available and 1 teaspoonful a day is sufficient dosing.
What about Niacin?
Niacin (vitamin B3) [Slo-Niacin, Niaspan] is the most well-researched natural cholesterol lowering agent. In fact, several studies have shown niacin to produce better overall results than cholesterol-lowering drugs. Niacin typically lowers total cholesterol by 18%, LDL by 23% and triglycerides by 20% while raising HDL levels by 31%. Niacin is available as a prescription agent, yet despite its advantages, niacin accounts for only 7.9 percent of all prescriptions to lower cholesterol. One reason is it produces a bothersome side effect. Flushing of the skin typically occurs twenty to thirty minutes after niacin is taken. Other occasional side effects of niacin include gastric irritation, nausea and liver damage. To reduce the side effect of skin flushing you can use some of the newer time-released formulas including the prescription version Niaspan or take the niacin just before going to bed. Most people sleep right through the flushing reaction. Taking cholesterol lowering agents at night is best because most of the cholesterol manufactured by the liver happens at night.Start with a dose of 500 mg at night before going to bed for one week. Increase the dosage to 1,000 mg the next week and 1,500 mg the following week. Stay at the 1,500 mg dosage for two months before checking the response - dosage can be adjusted up or down depending upon the response. Alternate method is to take Niacin just after morning meal and are driving to work (the flush will come on in 10-15min while you are driving). You then can turn up the A/C controls to blast you with cold air until it passes, usually 2-3 minutes.
What about Stanols/Sterols?
Because they are structurally similar to cholesterol, stanols (and sterols) can displace cholesterol from the "packages" that deliver cholesterol for absorption from the intestines to the bloodstream. This displaced cholesterol is then excreted from the body. This action not only interferes with the absorption of cholesterol from food, it has the additional (and probably more important) effect of removing cholesterol from substances made in the liver that are recycled through the digestive tract.
Numerous double-blind, placebo-controlled studies, ranging in length from 30 days to 12 months and involving a total of more than 1,000 people, have found that sterol/stanols and their esters are effective for improving cholesterol profile The combined results suggest that these substances can reduce total cholesterol and LDL ("bad") cholesterol by about 10% to 15%. They do not, however, have much of an effect on HDL (“good”) cholesterol, nor on triglycerides.
For example, in a double-blind, placebo-controlled study, 153 people with mildly elevated cholesterol were given sitostanol esters in margarine (at 1.8 or 2.6 g of sitostanol per day), or margarine without sitostanol ester, for a total of one year. The results in the treated group receiving 2.6 g per day showed improvements in total cholesterol by 10.2% and LDL cholesterol by 14.1%—significantly better than the results in the control group. Neither triglycerides nor HDL cholesterol levels were affected.
Even people already taking standard medications to improve cholesterol profile (specifically, drugs in the statin family) appear to benefit when they additionally use stanols/sterols. According to one study, if you are on statins and start taking sterol ester margarine as well, your cholesterol will improve to the same effect as if you doubled the statin dose.
Stanols or sterols also appear to be safe and effective for improving cholesterol profile in people with type 2 (adult-onset) diabetes.
What about Policosanol?
Policosanol is a mixture of waxy substances generally manufactured from sugarcane. It contains about 60% octacosanol, along with many related chemicals. In some cases, the terms octacosanol and policosanol are used interchangeably.
Numerous studies enrolling a total of many thousands of individuals purported to show that the substance policosanol, made from sugarcane, can markedly improve cholesterol profile. However, the single Cuban research group behind these studies has a financial connection to the product. It wasn’t until 2006 that independent research groups began to report their results on the use of policosanol for hyperlipidemia. Currently, five such independent studies have been reported, enrolling a total of about 380 people, and in not one of these studies has policosanol proved to be more effective than placebo.
What about Red Yeast Rice?
Red yeast rice is a traditional Chinese substance made by fermenting a type of yeast called Monascus purpureus over rice. Various formulations of this product have been used in China since at least 800 AD as a food and also as a medicinal substance within the context of Traditional Chinese Herbal medicine. This ancient preparation contains naturally occurring substances similar (and, in some cases, identical) to cholesterol-lowering prescription drugs in the “statin” family. The prescription Mevacor contained the same statin.
Red yeast rice is thought to be effective for lowering cholesterol, presumably because of its statin constituents. An 8-week, double-blind, placebo-controlled trial of 83 people with high cholesterol evaluated red yeast rice. At the end of the 8-week treatment period, levels of total cholesterol decreased significantly in the red yeast rice group as compared to the placebo group. Benefits were also seen in LDL (“bad” cholesterol) and triglycerides as well. No significant differences were noted in HDL (“good” cholesterol) levels from baseline or between groups. In another 8-week study of 79 people, use of red yeast rice was noted to improve the LDL/HDL ratio, along with several other measures of cardiac risk.
What about CoQ10?
Coenzyme Q 10 (CoQ 10), also known as ubiquinone, is a major part of the body's mechanism for producing energy. The name of this supplement comes from the word ubiquitous, which means "found everywhere." Indeed, CoQ 10 is found in every cell in the body. It plays a fundamental role in the mitochondria, the parts of the cell that produce energy from glucose and fatty acids. Japanese scientists first reported therapeutic properties of CoQ 10 in the 1960s. Some evidence suggests that CoQ 10 might assist the heart during times of stress on the heart muscle, perhaps by helping it use energy more efficiently. CoQ 10's best-established use is for congestive heart failure. Ongoing research suggests that it may also be useful for other types of heart problems, Parkinson's disease, and several additional illnesses. It is generally used in addition to, rather than instead of, standard therapies. People with CHF have significantly lower levels of CoQ 10 in heart muscle cells than do healthy people.32 This fact alone does not prove that the supplements will help CHF; however, it prompted medical researchers to try using CoQ 10 as a treatment for heart failure.
The largest study was a 1-year, double-blind, placebo-controlled trial of 641 people with moderate to severe congestive heart failure. Half were given 2 mg per kilogram body weight of CoQ 10 daily; the rest were given placebo. Standard therapy was continued in both groups. The participants treated with CoQ 10 experienced a significant reduction in the severity of their symptoms. No such improvement was seen in the placebo group. The people who took CoQ 10 also had significantly fewer hospitalizations for heart failure. Similarly positive results were also seen in other double-blind studies involving a total of more than 270 participants. One double-blind study found that in people with heart failure so severe they were waiting for a heart transplant, use of CoQ 10 improved subjective symptoms.
CoQ 10 supplementation might also be of value for counteracting side effects of certain prescription medications. particularly the statins.
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