Cholesterol

Things that make cholesterol go up and down
How to lower your cholesterol
Nutraceuticals to help lower cholesterol
Heart healthy supplements
Additional options
Drug/Nutrient interactions

Cholesterol: What you Need to Know

Cholesterol is a steroid manufactured by the liver. It is used by the body to synthesize various hormones including sex hormones (estrogen, progesterone, testosterone) and adrenal hormones (cortisol, aldosterone, dehydroepiandosterone.) In the presence of sunlight cholesterol in the skin is turned into vitamin D.

The liver manufactures approximately 1000 mg of cholesterol per day. What is not used is converted into bile salts and excreted from the body via the intestinal tract.

Things that make cholesterol go up and down.

Sometimes, when the diet is low in fiber, it is possible to reabsorb cholesterol through the intestinal wall, causing the level of cholesterol in the blood to rise.

Most fibers, by the way, are types of carbohydrates that we can’t digest because we lack the necessary enzymes to break them down into sugar. Some fibers are water soluble. They dissolve in water and set up a kind of gel-filtration system in the gut, binding with cholesterol and some fats, and carrying them out of the system. The right kind of soluble fiber is found in apples, berries, pears, and citrus. It is also found in oatmeal, oatbran, legumes, garlic and onions.

The level of cholesterol in the blood can also increase because of stress. During times of stress the body is typically manufacturing adrenal hormones (cortisol, aldosterone,) and the body assumes that more of these hormones may be needed so it allows more cholesterol to be released into circulation. Unfortunately, because our stress tends to be emotional rather than physical, this extra cholesterol doesn’t get used up. One way to use the cholesterol released during stress is to exercise.

Cholesterol also rises with age. For example, when women go through menopause their cholesterol will tend to increase, probably because it is no longer being used to synthesize estrogen and progesterone.

And, cholesterol rises along with body weight, which brings us to one of the most important factors associated with high cholesterol: overeating!

One important fact to keep in mind: cholesterol is not bad per se. It is not poison. Of and by itself, it will not kill you. In fact, it is required for survival. You have very high levels of cholesterol in your brain, and it is supposed to be there. Too little and you will have problems with depression. Very low cholesterol is also associated with malnutrition and compromised immunity.

For most of us the problem with a high cholesterol level comes about because of a lack of antioxidants in the diet. If we don’t consume enough fruits and vegetables (which are high in antioxidants) and if we consume too many processed foods which may be high in rancid fat and trans fatty acids, the cholesterol in the blood often becomes rancid and ends up as plaque in artery walls.

If you blood pressure is high, there will be stress on the lining of the blood vessels leading to tiny cracks, which the body must then patch so the blood vessels don’t burst. One of the substances the body uses to patch these injuries is a cholesterol containing substance called “lipoprotein (a).”

Vitamin C is needed for the production of collagen or connective tissue and when we are deficient in vitamin C we are more at risk for blood vessel injury. As the level of vitamin C in the blood goes down, the level of lipoprotein (a) goes up. The body keeps itself prepared with the equivalent of joint compound to repair injured blood vessels. This is the beginning of atherosclerosis or clogged arteries.

How low should your cholesterol be?

In general, a total cholesterol between 160 and 200 mg/dl is considered ideal.

Caution: Less than 160 mg/dl may be an indication of malnutrition or underlying disease. The lowest cholesterol levels are associated with the greatest risk of all-cause mortality. In contrast, in women over the age of 65, longevity is associated with a cholesterol level above 250 mg/dl. Be aware also that low cholesterol levels are associated with depression, suicide, and a compromised immune system. References

How to lower your cholesterol level, but only if you need to....

	Don’t skip meals. (Skipping meals can raise cholesterol.) Eat at least 3 times per day. If you are not that hungry, eat lightly or have one or two pieces of fruit.
	If you are overweight, limit your caloric intake at any given meal to a maximum of 500 calories. Excess calories can be converted into fat and cholesterol, regardless of where those calories come from. Guideline: If all the food you are consuming at one meal won’t fit on one dinner plate, it is too much food. (If you need to lose weight use a salad plate.)
	If you are overweight, limit your starch intake at any given meal to a maximum of 200 calories. (Less if you are overweight.) This would be the equivalent of 2 slices of bread or 2/3 cup of rice. If you have syndrome X, or Type II diabetes, you may want to decrease your starch intake even further. When selecting starches choose whole grains (unprocessed foods) frequently. Limit consumption of white flour, white sugar, white rice, white pasta, mashed potatoes.Good choices: oatmeal, barley, millet, whole rye, brown rice, legumes.
	Avoid processed meats such as bologna, sausage, hotdogs. Processed meats are high in fat and it is often rancid fat.
	Limit your intake of fatty meats and high fat cheeses, and other foods high in what is referred to as saturated fat. Saturated fat tends to make blood cells “sticky.” Sticky cells are more apt to clump together and clot, or become part of the plaque in artery walls.
	Avoid deep-fat fried foods, including foods that are batter-dipped and fried. (Examples: Fried chicken, French fries, potato chips, breaded veal cutlets.)
	Avoid hydrogenated fats. These are found in packaged, processed foods. (Read labels!) Items such as crackers and cookies are made with oil, but oils left standing on a shelf in the supermarket will quickly go rancid. To prevent that from happening, the food industry “hydrogenates” the fat. This process turns a liquid oil into a solid fat by adding hydrogen to the molecule. The oil becomes saturated with hydrogen. It changes from a liquid into a solid, and as a result of the transformation it has a much longer shelf life. The process of hydrogenation twists the shape of the molecule from a cis-fatty acid to a trans-fatty acid. Trans fatty acids are not common in nature. They are common in the American food supply and are believed responsible for putting Americans at increased risk for heart disease.

Do include some Omega-3 fats in your diet:

(Omega-3 oils inhibit platelet stickiness, and help to lower triglycerides.)

	Cold water fish (salmon, sardines, halibut, herring)
	Walnuts (Have a handful a day… 6-10 walnut halves.)
	Ground flax seed… two tsp or more per day. It can be added to your oatmeal, salad, sprinkled on cottage cheese, or mixed with another nut butter such as almond butter. Keep refrigerated!
	Do have 3-5 servings of fresh fruit daily, especially apples, berries, pears or citrus.
	Do have vegetables daily (especially greens.) They can be cooked or raw. Top salads with a dressing made with olive or flax oil, or a mixture of the two.
	Do exercise.
	Do relax. (Stress increases cholesterol.)
	Do include 2-3 servings a day of low fat protein in your diet. (Such as cottage cheese, fish, skinless poultry, fat-free cheese, omega-3 eggs, or lean meat.)

Nutraceuticals to help lower your cholesterol:

Note: Work with a clinical nutritionist or nutritionally oriented cardiologist to determine which supplements may be best for you to take, and for how long. Do not continue to use supplements “forever” without discussing your needs with your health care advisor.

Psyllium capsules Six capsules before bed with 1-2 full glasses of water. Take separately from other supplements or medications. Psyllium is a water soluble fiber that binds with cholesterol in the gut and carries it out of the system.

Lecithin One - two capsules daily.

Garlic One – two cloves daily. Slice cloves and swallow entire clove without chewing. Garlic lowers LDL & triglycerides and has blood thinning properties.

Flax seed oil capsules or Omega-3 capsules. Start with one capsule a day, and increase to 2-3 capsules a day. (Recommended brand for Omega-3: DaVinci Laboratories “Omega-3 1000.” It contains a small amount of vitamin E which acts as a preservative.) Omega-3 fats appear to increase HDL and lower triglycerides.

Note: Oil-based capsules are best kept refrigerated. If your current brand of Omega-3 fish oil has a fishy smell or aftertaste, throw out the bottle and buy fresh. Like garlic, fish oil has blood-thinning properties. (See additional information on essential fatty acids below.)

Caution: Alcohol will raise HDL, but unfortunately it will also raise triglycerides and blood pressure. The safest way to increase HDL while lowering LDL is to substitute protein for carbohydrate. Example: Instead of spaghetti for dinner, have fish and vegetables.

Heart healthy supplements:

Buffered vitamin C 500-1000 mg

Natural Vitamin E 400 I.U. (mixed tocopherols) (Vitamin E inhibits platelet stickiness, so, like garlic and fish oil it has blood-thinning properties.)

B-Complex 10 mg or more

Note: These can be taken as part of a good high-potency multiple, or in addition to a low-potency multiple. (Suggested brand for high potency multiple: DaVinci Laboratories “Spectra, without copper and iron.”)

Additional options for lowering cholesterol…

Soy Protein Numerous clinical trials have shown that soy protein helps to lower cholesterol by, on average, 12.9%. Twenty-five grams of soy is considered to be the amount of soy needed to significantly lower cholesterol levels. Food sources of soy protein include soy milk, tofu, Soy Protein Isolate (Suggested brand: Vitamin World. Their flavored soy protein powder can be mixed with skim milk or soy milk, plus fruit, to make a tasty breakfast drink. And, it doesn’t have added sugars.)

Not up to that much soy on a daily basis? Keep in mind that if you consume some soy in addition to making several other changes, and using other supplements, it can still confer benefits even at lower levels.

Beta-Sitosterol is a plant sterol, reportedly free of side effects, that has been shown to reduce total cholesterol by 10-15% and LDL by 19%. The dosage used was 6 grams. It apparently works by blocking cholesterol absorption from the intestine.

Policosanol significantly lowers total cholesterol and LDL. Should be 60% octacosanol. Typical dosage 5-10 mg, 2 times per day. Possible side effects: sleepiness, weight loss, skin rash, dizziness.

Cholestsure (From DaVinci Laboratories) Contains red rice yeast, CoQ10, policosanols, guggal, chromium and EPA.

Stanol Esters (from soy beans and pine trees) Decrease LDL by 10-15 %.

Sterols (from soy beans, corn oil, rice bran & wheat germ.) Decrease LDL by 10-15%. Prevent chholesterol absorption in the gut. No effect on HDL. Dosage: 1.3 grams total plant sterol esthers divided over 2 or more servings per day.

Activated charcoal can be used for short periods of time to lower cholesterol. It is not recommended long term because it will adsorb minerals as well as cholesterol.

Caution: One of the most effective nutraceuticals for lowering cholesterol is niacin. It can decrease LDL by 10%, triglycerides by 25%, and raise HDL by 35%. However, we do not recommend niacin because it can be toxic to the liver. Especially avoid timed release niacin, which has been known to cause hepatitis.

Herbal Products to lower cholesterol:

Cholestin (Monascus purpureus)[red rice yeast] works as well as statin drugs.
Action: HMG COA reductase inhibitor
Dosage: 1200 mg. 2 X daily
Side effects: Possible liver enzyme elevation & myositis. None recorded.

Note: In 1997 the FDA brought action against the Pharmanex company concerning its right to sell Cholestin as a dietary supplement, because Cholestin contains a naturally occuring chemical equivalent of lovastatin. On April 2, 2001, the Utah Federal District Court ruled in favor of the FDA, and Cholestin could no longer be sold as a dietary supplement within the United States.

Note: Currently, red rice yeast is being used in dietary supplements, but in small enough doses that it cannot be classified as a drug.

Cholesture (mentioned above) [from DaVInci Laboratories] contains some red rice yeast and it also constains CoQ10. Read Drug/Nutrient interactions, below.

Drug/Nutrient interactions

Let's talk about "3-hydroxy 3-methylglutaryl coenzyme A reductase inhibitors"....

And what – (you may be wondering) - is a "3-hydroxy 3-methylglutaryl coenzyme A reductase inhibitor"? (HMG-CoA reductase inhibitor for short.) You probably know it better as a cholesterol lowering medication, or a statin drug.

Some background....

Your liver manufactures cholesterol from a substance called Acetyl CoEnzyme A, a substance which can be formed from carbohydrates, fats, or proteins. Basically, if you take in an excess of calories -- it doesn't really matter where those excess calories come from -- you can turn the excess into either fat or cholesterol.

For a variety of reasons (that we won’t go into at the moment,) an excess of cholesterol in the blood has become associated with increased risk for heart disease, and the current preferred mode of treatment for this (preferred by most physicians) is to take a statin drug.

The problem....

Cholesterol lowering medications work by inhibiting an enzyme involved in the production of cholesterol. (That's the HMG CoA Reductase I referred to earlier.) Ah, but here's the rub. That same enzyme is required for the production of a chemical called CoEnzyme Q10, (or CoQ10.)

CoQ10 is necessary for the production of energy, and it is required for survival. The liver needs CoQ10, which is why -- if one is on a statin drug – your doctor is supposed to monitor liver enzymes looking for indications of trouble. The heart also needs CoQ10, and when it is not available in sufficient quantities, the individual is at increased risk for congestive heart failure.

FYI... Congestive heart failure is said to be rampant in America, and many health professionals believe that one of the causes is the deficiency of CoQ10 brought on by cholesterol lowering medications.

The moral of this story is….

If you are going to take a cholesterol lowering medication, include CoQ10 among your daily supplements. Suggested dosage: 100 mg. You will also need to take 100-400 I.U. of a natural vitamin E with mixed tocopherols.

If you’ve already read the beginning of this article you know that changes in behavior in terms of food, exercise, and stress management can bring your cholesterol into a desirable range. There are also numerous nutraceuticals that can help to reduce your cholesterol without the side effects of prescription medications.

What you need to know about essential fatty acids…

Our bodies have the ability to manufacture fat, as many of us are all too aware. But there are certain structures of fat that we can’t manufacture in the body. These are called “essential fatty acids,” and they must be consumed in food.

Linoleic acid (LA) is an omega-6 fatty acid. It is plentiful in the food supply in vegetables oils. Some sources include: evening primrose seed (72%), peanut oil (31%), canola oil (19-26%), olive oil (8%).

Gamma-linolenic acid (GLA) is also an omega-6 fatty acid. It is a derivative of LA. The typical diet provides very little GLA, and if one’s body lacks the necessary enzyme to convert LA to GLA, a deficiency may result. Sources of GLA include: borage oil (20-24%), evening primrose oil (8-10%), and black current oil (15-17%).

Alpha-linolenic acid (ALA) is an omega-3 fatty acid. It is found in flax seed (18-22%), flax seed oil (50-60%), walnuts, and canola oil. It is found in small amounts in other nuts.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are derivatives of ALA. They are found in cold water fish, including: salmon, tuna, sardines, halibut, swordfish, mackerel, and herring. Halibut, swordfish and tuna can only be eaten occasionally because they are high in mercury. Also, since most of the salmon we consume these days is farm raised, and therefore fed differently than it would be in the wild, it is not an appreciable source of these essential fatty acids. So, unless you consume nuts and flax seed regularly, a fish oil supplement is recommended.

A concentrated fish oil supplement will contain 30% EPA and 20% DHA.

Selected References

Cooke, JP. (1998.) Nutraceuticals for cardiovascular health. Am J Cardiol. Nov 19, 82 (10A): 43S-46S

Debusk, Ruth. (2002.) Diet, Simvastatin, and the need for supplemental antioxidants. The Integrative Medicine Consult. March, 38,47.

Duits, N. and Bos, F.M. (1993.) Depressive symptoms and cholesterol-lowering drugs. The Lancet. Jan. 9, 341: 114.

Engelberg, Hyman. (1992.) Low Serum cholesterol and Suicide. The Lancet. March 21, 339: 727-729.

Hanaki, Y. et al. (1993.) Coenzyme Q10 and coronary artery disease. Clinical Investigator. 71:S112-S115.

Hibbeln, Joseph et al. (1997.) Do plasma polyunsaturates predict hostility and depression? In Nutrition and Fitness: Metabolic and Behavioral Aspects in Health and Disease, World Rev. Nutr. Diet. 82: 175-186.

Morgan, Ross. (1993.) Plasma cholesterol and depressive symptoms in older men. The Lancet. January 9, 341: 75-79.

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