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Cholesterol

Diet &
Nutritional Supplements

Diet: What you eat is important! Learning to eat right may take some effort. Eating a whole food diet means avoiding foods with sugar and white flour. It also means balancing your diet with protein, whole grain breads, fruits, and vegetables.

Don't be afraid of fat! Why are people on fat-free diets dying of heart disease? Studies have shown that a high sugar intake contributes more to high cholesterol than does fat! So avoid fat-free foods; they are loaded with sugar.

In nature, sweet foods have vitamins and minerals in them. These vitamins and minerals are necessary for the proper assimilation and metabolism of the sugars in the foods. Food processing takes many vitamins and minerals out of foods. But your body still needs the vitamins and minerals for proper metabolism and will rob your reserves to provide them. This leaves many people vitamin and mineral deficient. To stops this harmful process, buy and eat only unsweetened cereals, avoid sodas, don't put sugar in your coffee, and don't eat sweets regularly. By avoiding sugar in these ways, you can cut your sugar intake by half. Practicing moderation and adopting a whole foods diet may not be the easiest things to do, but the benefits are great.

 

Cholesterol is sort of a cousin of fat. Both fat and cholesterol belong to a larger family of chemical compounds called lipids. All the cholesterol the body needs is made by the liver. It is used to build cell membranes and brain and nerve tissues. Cholesterol also helps the body produce steroid hormones needed for body regulation, including processing food, and bile acids needed for digestion.

People don't need to consume dietary cholesterol because the body can make enough cholesterol for its needs. Only foods of animal origin contain cholesterol.

Cholesterol is transported in the bloodstream in large molecules of fat and protein called lipoproteins. Cholesterol carried in low-density lipoproteins is called LDL-cholesterol; most cholesterol is of this type. Cholesterol carried in high-density lipoproteins is called HDL-cholesterol.

LDL-cholesterol and HDL-cholesterol act differently in the body. A high level of LDL-cholesterol in the blood increases the risk of fatty deposits forming in the arteries, which in turn increases the risk of a heart attack. Thus, LDL-cholesterol has been dubbed bad cholesterol.

On the other hand, an elevated level of HDL-cholesterol seems to have a protective effect against heart disease. For this reason, HDL-cholesterol is often called good cholesterol.

 

Cholesterol , fatty lipid found in the body tissues and blood plasma of vertebrates; it is only sparingly soluble in water, but much more soluble in some organic solvents. A steroid, cholesterol can be found in large concentrations in the brain, spinal cord, and liver. The liver is the most important site of cholesterol biosynthesis, although other sites include the adrenal glands and reproductive organs. By means of several enzymatic reactions, cholesterol is synthesized from acetic acid; it then serves as the major precursor for the synthesis of vitamin D3, of the various steroid hormones, including cortisol, cortisone, and aldosterone in the adrenal glands, and of the sex hormones progesterone, estrogen, and testosterone. Cholesterol is excreted from the liver in the form of a secretion known as bile; it sometimes crystallizes in the gall bladder to form gallstones. The insolubility of cholesterol in water is also a factor in the development of atherosclerosis (see arteriosclerosis), the pathological deposition of plaques of cholesterol and other lipids on the insides of major blood vessels, a condition associated with coronary artery disease. This buildup of cholesterol in the blood vessels may constrict the passages considerably and inhibit the flow of blood to and from the heart. Recent research has shown that the relative abundance of certain protein complexes, called lipoproteins, to which cholesterol becomes attached may be the real cause of cholesterol buildup in the blood vessels. High-density lipoprotein (HDL) carries cholesterol out of the bloodstream for excretion, while low-density lipoprotein (LDL) carries it back into the system for use by various body cells. Researchers believe that HDL and LDL levels in the bloodstream may be at least as important as cholesterol levels, and now measure both to determine risk for heart disease. Reducing consumption of foods containing cholesterol and saturated fat has been found to lower blood cholesterol levels.

 

Eligibility for Cholesterol Drugs Skyrockets Under New Guidelines

The National Cholesterol Education Program (NCEP) reports provide recommendations for the management of LDL ("bad") cholesterol using cholesterol-lowering drugs in patients at higher risk for heart disease. The report guidelines consider factors such as cholesterol levels, age, family history, high blood pressure, and presence of diabetes. The third and most recent report by the program redefines guidelines for eligibility for cholesterol drugs based on "bad" cholesterol levels and other factors.

A study in Circulation: Journal of the American Heart Association determined the possible impact of the revised recommendations on Americans, using a sample of almost 14,000 people. These individuals, who all had some cardiovascular risk factors, were assessed for eligibility for cholesterol drugs under the previous program guidelines, as well as the new guidelines. The revised guidelines suggest that people with much lower LDL cholesterol levels can receive drug treatments.

Under the new guidelines, almost two-and-a-half times as many Americans are eligible for drug treatment for high cholesterol and heart-disease risk. Approximately 15 million individuals were eligible for cholesterol drugs under the previous guidelines, but 36 million will now be eligible. The estimated increases in eligibility by category include a 200% increase for all those under age 45 and a 150% increase among men.

The long-term side effects of cholesterol drugs are largely unknown, especially in younger patients. If you have high cholesterol, talk to your doctor of chiropractic about conservative treatment approaches instead of taking drugs, especially if you are younger and have only marginally high cholesterol.

Reference:

Fedder DO, Koro CE, L'Italien GJ. New National Cholesterol Education Program III Guidelines for primary prevention lipid-lowering drug therapy: Projected impact on the size, sex, and age distribution of the treatment-eligible population. Circulation: Journal of the American Heart Association 2002:105, pp. 152-156.

 

 

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Nature's Little Helpers

Nutritional supplements, diet and exercise helps keep cholesterol levels normal.

by Donna Werner, DC, CCSP

As people increasingly rely on fast food as dietary staples and become more sedentary, blood levels of cholesterol rise correspondingly, along with other cardiovascular and systemic problems related to levels of high dietary fat. Heart disease, diabetes and hypertension are seen more prevalently than ever before and at younger ages.

Since early in the 20th century, scientists have realized that the intake of fat and cholesterol is directly correlated with atherogenic disease. Around 1940, it was determined that animal protein was more atherogenic than plant protein. In the intervening years, scientists have worked toward finding ways to help people lower their cholesterol levels and thus the diseases that accompany high blood cholesterol.

But not all fats are bad. High-density lipoproteins  commonly known as HDL-actually remove cholesterol from the blood, while low-density lipoproteins (LDL) help to transport cholesterol throughout the body. Having a proper balance of HDL and LDL is what is essential for good health. To reduce the chance of heart disease and other cardiovascular complications, total cholesterol levels should be less than 200 mg/dL, with LDL levels measuring less than 130 mg/dL and HDL measuring 60 mg/dL or more.

Patients should be told that they need to begin with the simplest ways of lowering cholesterol  through diet and exercise. Studies have shown that people who exercise regularly often have lower levels of blood cholesterol than those who are sedentary. Make an assessment of your patients diet. Begin by having them cut out saturated fats, which include the fats in grain fed red meats, cheeses or fats that are hard at room temperature, such as margarine. Try to substitute foods that are low in saturated fats. Monounsaturated fats include olive, and peanut oils, all oils that stay liquid at room temperature. Polyunsaturated fats  also known as essential fatty acids  are found in plants such as soybeans, corn, sunflowers and safflower.

For years, pharmaceutical companies have developed pharmacological compounds to lower blood cholesterol. While many of these are very effective, some can result in unpleasant side effects. Muscle pain and weakness have been reported with many of the statins. Other side effects commonly seen with anti-lipemic agents include gastrointestinal disturbances, such as nausea or constipation, headaches, skin rash and chest pain. For people wanting to avoid the adverse reactions and drug interactions seen with pharmaceutical approaches, or for those simply seeking a more natural way to lower their blood cholesterol, there are many nonpharmacologic choices in the supplement arena.

 

Vitamin E

Vitamin E has many functions within the body, including protecting against free radicals, stimulating the immune system and counteracting the effects of prostaglandin-mediated disorders. This compound, composed of four different tocopherol molecules and four different tocotrienol molecules, is better described as an antioxidant than a vitamin, since it does not act as a cofactor for enzymatic reactions, as most vitamins do, and a deficiency of it does not result in disease.

The tocopherols have long been known for their antioxidant capacity and are seen primarily in corn, soybean and olive oils. More recently, tocotrienols, which are less common, were identified and are seen particularly in palm, rice bran and barley oils.

The statins, one of the most common classes of anti-lipidemic drugs, work on an enzyme known as HMG CoA-reductase, which is a key component of excess cholesterol in the blood. These drugs block the site that this enzyme attaches to, leading to excess amounts of circulating HMG CoA-reductase, which is believed to be a possible reason for some of the side effects seen with statins. On the other hand, tocotrienols, one group of molecules that comprise vitamin E, act by breaking down HMG CoA-reductase thereby reducing the livers ability to produce cholesterol but without the side effects seen with pharmacological therapies.

Recent studies have demonstrated that when vitamin E is added to drug therapy with a statin, the overall effect in lowering total cholesterol and LDL is even greater than when using one or the other alone. Studies have also shown that children prone to heart disease and high cholesterol levels benefit from natural antioxidants, such as vitamin E and vitamin C.

 

Carotenoids

Another well-established group of antioxidants is the carotenoids, with beta-carotene being the most widely known. Carotenoids are natural plant pigments found in many fresh fruits and vegetables; some researchers believe that beta-carotene supplements may not convey the same benefits as when it is acquired directly from fresh foods. In addition to lowering both total cholesterol and LDL levels, beta-carotene is believed to protect people from stroke, cancer and cataracts, as well as boosting the immune system.

Garlic

Another purported natural remedy for high cholesterol is garlic. While studies are sometimes contradictory and inconclusive, a meta-analysis of five studies which was reported in the Annals of Internal Medicine in 1993 indicated that tablets containing doses between 600 and 900 mg of garlic  roughly equal to a half to one whole clove  lowered total cholesterol about nine percent. Some studies have even indicated that garlic may play a role in reducing blood pressure.

Critics point out that most studies on garlic have only included a few subjects, and that some of those studies show no difference between people taking garlic and those taking placebo. There has also been no conclusive determination on the active component in garlic that causes these effects, although researchers suspect that either allicin or adenosine, both of which seem to reduce blood clotting in in vitro studies, may be the causative agent behind garlics cardiovascular benefits.

Since garlic does appear to have anti-coagulant properties, patients who are already on a blood thinner or who have a known bleeding disorder should avoid it.

 

Soy

As early as 1967, clinical studies demonstrated that soy protein helps to lower levels of LDL cholesterol. In the past year or so, the Food and Drug Administration has even allowed certain foods containing soy to tout their health benefits in their labeling.

For years, scientists have recognized that Asian countries demonstrate a lower incidence of cardiovascular disease when compared to their Western counterparts. But as with garlic, the mechanism of action in soy remains elusive.

 

Essential Fatty Acids

Essential fatty acids, compounds that the body requires but cannot manufacture by itself, are found in a variety of foods. Cold-water fish contains high levels of omega-3 and omega-6 oils, two of the essential fatty acids (EFAs), yet cooking may alter the benefits of these oils. Steaming or microwaving helps to preserve its benefits, and fish-oil capsules may provide a source of pure, unaltered EFAs. While claims are often made that fish oil lowers cholesterol, more recent studies indicate that its effects may be indirect by improving endothelial function rather than actually having an effect on LDL, HDL or total cholesterol levels. It does, however, appear to improve arterial dilatation and thereby blood flow that is often impaired in people with hypercholesterolemia.

Another source of EFAs is flaxseed oil, which provides omega-3, omega-6 and omega-9, as well as linoleic and alpha-linoleic acid. In addition to lowering cholesterol and preventing the formation of blood clots, flaxseed oil is instrumental in reducing inflammation, improving the immune response and decreasing prostaglandin levels. Flaxseed oil also comes without the odor often accompanying fish oil capsules.

When using flaxseed oil in cooking, it should be added last to preserve its effects, since heat appears to destroy its beneficial properties; using it in cold dishes appears to be best. If used in capsule form, those that are cold-processed and refrigerated are the most effective.

 

Phytosterols

Phytosterols are compounds that chemically resemble cholesterol, and, therefore, able to inhibit the absorption of cholesterol. While no effect is seen on HDL or triglyceride levels, lowering of total cholesterol and LDL levels have been demonstrated in clinical studies with the administration of phytosterols. Saturated phytosterols, such as sitostanol, appear to be more effective in lowering plasma levels of cholesterol than their unsaturated counterparts. To date, phytosterols have demonstrated no side effects, and appear to be a safe and effective means of lowering cholesterol levels.

 

Red Yeast Rice

Used in China for almost 3000 years, red yeast rice  a by-product of fermented rice  is gaining recognition as another method of lowering cholesterol. In a multicenter study, patients following dietary recommendations of the American Heart Association and given red yeast rice showed significant reductions in cholesterol levels over a group treated with diet alone. In addition, once the red yeast rice was discontinued, serum lipid levels rapidly returned to pre-treatment levels. A small percentage of patients experienced some type of side effect, the most common being headache, bloating and gas.

 

Chromium

At a recent American College of Nutrition meeting, new research findings were presented linking chromium picolinate with lowering cholesterol levels. When data from five studies were combined, total blood cholesterol levels dropped an average of 20 points, and these results were seen in patients not receiving any other type of lipid-lowering agent. Treatment with chromium usually took up to two months to demonstrate its effects.

 

CoEnzyme Q-10

CoEnzyme Q-10  also known as CoQ-10  is another compound being touted for a host of benefits, including its cholesterol-lowering capabilities. A crucial component of the cycle that produces energy in the body, CoQ-10 is believed to be active in many metabolic processes including nerve conduction, muscular energy and cellular synthesis. Its function as an antioxidant is how it derives its reputation for decreasing cholesterol levels. CoQ-10 has also been beneficial in treating patients suffering from congestive heart failure and other cardiac disorders.

 

Flavonoids

Plant flavonoids, another powerful group of antioxidants, are found in abundance in grape seed and the bark of the maritime pine. The active compounds appear to be procyanidins, and mixtures of these compounds with differing chemical structures are referred to as procyanidolic oligomers, or PCOs for short. These compounds provide a variety of cardiovascular benefits, including lowering LDL and total cholesterol levels, shrinking cholesterol deposits on the arterial walls and reducing the incidence of aortic lesions. PCOs may have even stronger antioxidant effects than either vitamin E or vitamin C, and no side effects have been noted.

 

Conclusion

Many supplements on the market offer combinations of the above products. It may be wise to check out the suppliers reputation and history, in addition to any studies they or their affiliates may have performed to back up their claims of efficacy and safety on their products. Review any prescription medications or other supplements you may be taking for possible interactions or side effects.

Any type of cholesterol-lowering regimen should include dietary modifications to increase fresh, unprocessed foods, restrict saturated fats and limit sodium intake, as well as an exercise program tailored to meet your needs, taking into account lifestyle, physical restrictions and fitness level.

 

References
Physicians Desk Reference. 2000.

Kritchevsky D. Soy Intake and Cholesterol Reduction. J Nutr 125: 589S-593S, 1995. www.ag.uiuc.edu/~stratsoy/expert/abs2.html

American Academy of Family Physicians Health Facts. Cholesterol: What You Can Do To Lower Your Level. familydoctor.org/healthfacts/029/

Health implications of dietary fiber  Position of American Dietetic Association. J Am Diet Assoc. 1997; 97:1157-1159. www.eatright.org/adap1097.html

Vitamin E: What it is and what it does. www.veris-online.org/whatefb.htm

Vitamin E with Tocotrienols For Lowering Total Cholesterol. www.vitasentials. com/e400toco.htm

Neunteufl T, Kostner K, Katzenschlager R, et al. Additional Benefit of Vitamin E Supplementation to Simvastatin Therapy on Vasoreactivity of the Brachial Artery of Hypercholesterolemic Men. Veris Newsletter March 1999, 15(1).

Germano C. Tocotrienols In Health & Disease: A Novel Antioxidant In The Treatment Of Hypercholesterolemia & Cancer. www.solgar.com/nutrition_library/articles/tocotrienols.html

Niacin for Cholesterol Lowering. Heart Information Network. www.heart info.com/niacin.html

Heart Watch: Is Garlic Good for Your Health? Massachusetts Medical Society. www.allhealth.com/heartwatch/may98/nejm/0,4802,2166_ 124188,00.html

Study Finds Soy Diet Lowers Cholesterol. Whole Food News. May 25, 2000. www.wholefoodnews.com/news/soy_diet.html

Sirton CR, Manzoni C, Gianazza E, et al. Soy and Heart Disease: Hypocholesterolemic Effects of Soy. Second International Symposium on the Role of Soy in Preventing and Treating Chronic Disease. September 15-18, 1996. www.soyfoods.com/symposium/oa4a_1.html

Green DR. Flax Seed Oil. www.lose-weight-loss.com/flax_seed_oil_text.htm

Flax Seed Oil Recipes and Usage. Natural Wellness. www.natural wellnessnw.com/flaxseed.htm

Fish Oil May Be Good For Arteries. Reuters Health Information. Feb 1, 2000. www.cholesterol.com/news/20000201-3037.html

Jones PJ, MacDougall DE, Ntanios F, Vanstone CA. Dietary phytosterols as cholesterol-lowering agents in humans. Can J Physiol Pharmacol 1997 Mar 75:3 217-27. www.clarinet.fi/~yuhanki/medlineKolestop-1.html

Bonovich K, Colfer H, Davidson M, et al. A Multi-Center, Self-Controlled Study of Red Yeast Rice In Subjects With Elevated Cholesterol. www. allok.com/estudy_ryr1.html

COENZYME Q-10  Transforming food into energy. The Nutrition Connection. www.thenutritionconnection.com/coenzyme.htm

Wellness Guide to Dietary Supplements. UC Berkeley Wellness Letter. www.berkeleywellness.com/supplements/dsSupCoenzymeQ10.html

Passwater RA. Carotenoids: More Than Just Beta-Carotene. www.solgar.com/nutrition_library/healthy_living/carotene_intro.html

Grieger L. Beta-Carotene and Heart Disease. www.heartinfo.org/nutrition/betcaro033100.htm

Grape Seed Extract  The Way to Prevent Number one Killer? www. mileshampton.com/seed.html

Grape Seed Extract and Other Sources of PCOs. www.beckerpharm. com/TheDoctor/grapeseed.htm

About The Author
Donna Werner, DC, CCSP, is a frequent contributor for Chiropractic Products.

 

 

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