Some cardiologists have philosophized about Western civilization’s love-hate relationship with cholesterol. For what’s basically a form of grease, it’s certainly more valuable than gold. After all, to surgically by-pass a pea-sized morsel of cholesterol will set your insurance company back about $50K. In fact, this tiny amount of cholesterol lodged in just the right place can kill you with a heart attack or paralyze you with a stroke. So on one hand, here’s the food industry developing more imaginative ways to feed us salted fat, and on the other, the pharmaceutical industry creating cholesterol-lowering medications we’re supposed to gobble up like M and M’s.
Many patients at WholeHealth Chicago request a blood test called a Comprehensive Cardiovascular Risk Profile, which measures all the blood fats described in this article, plus other risk factors as well. When they learn of elevated cholesterol, they’re not pleased with the though of a daily medication, or a diet of tasteless chicken breasts, steamed rice and vegetables. Of course, we kindly explain, there are many more options available. Let’s see what we can teach you about high cholesterol…
What is High Cholesterol?
Cholesterol is a waxy fatlike substance found in every cell in the body, but concentrated in the brain, liver, and blood. It is present in all foods derived from animal sources, but not in plants. Essential to the body, cholesterol supports such vital functions as cell formation, nerve insulation, hormone production, and digestion.
In itself, cholesterol isn’t harmful. In fact, the body produces all the cholesterol it needs. But an excess level of cholesterol in the bloodstream can lead to blocked arteries, increasing the risk of a heart attack or stroke.
The subject of cholesterol involves complex biochemistry, so doctors focus simply on “total cholesterol” and on two types that the body produces: so-called “bad” cholesterol (LDL), which brings cholesterol into the system, and “good” cholesterol (HDL), which helps clear it out. Cholesterol is either absorbed in the food you eat (25%) or manufactured in the liver (75%). There are four possible mechanisms to lower cholesterol levels:
Make lifestyle changes, especially dietary ones, which will have a positive impact on your cholesterol;
Use supplements/medications to block the absorption of cholesterol through the intestine;
Use supplements/medications to block the liver from manufacturing cholesterol;
Increase fiber in your diet, which will stimulate the liver to destroy excess cholesterol.
As cholesterol travels through the circulatory system, the body will use it in a variety of ways, including cell wall structure and hormone manufacture. Any cholesterol that is not utilized, broken down by the liver, or excreted, is left to circulate through the bloodstream, where unfortunately it builds up along the walls of arteries. These deposits mark the first stage of atherosclerosis, or narrowing of the arteries. Over time, this condition can impede blood flow and trigger the formation of dangerous and obstructing blood clots.
Experts disagree whether high blood cholesterol levels will inevitably lead to heart disease in every person, since many other factors play a role, including age, gender, exercise, smoking, and genetic predisposition. But there is substantial evidence to support the view that the better your overall blood cholesterol profile, the better your odds of avoiding heart disease.
While there is no clear threshold where your blood cholesterol level passes from “safe” to “dangerous”, some guidelines are available. Cholesterol is measured in milligrams per deciliter (mg/dl) of blood. In general, a total cholesterol level of 200 mg/dl or higher, an LDL level of 100 mg/dl or higher and an HDL level of 45mg/dl or lower is associated with heart disease. If a person has known coronary artery disease, then desirable levels drop even lower: total cholesterol below 150 mg/dl, LDL below 80 mg/dl while HDL still should stay higher than 45 mg/dl. Interestingly, HDL levels above 65 mg/dl are thought to have a protective effect on the heart and can “cancel out” another risk factor, like a high LDL, all other factors being normal.
Other potentially dangerous fats are triglycerides, lipoprotein (a) and VLDL (very low density lipoprotein). VLDL is a triglyceride-rich lipoprotein produced by the liver. Once VLDL reaches the bloodstream, it will convert to LDL. Abnormal elevations of any of these will increase your risk of developing heart disease.
Key Symptoms
High cholesterol itself causes no obvious symptoms, but it may lead to other conditions–angina, heart attack, stroke, high blood pressure–that do have recognizable signs.
When blood levels are very high, cholesterol may appear as yellow nodules beneath the skin of the elbows or knees, or under the eyes.
What Causes High Cholesterol?
A person’s genetic makeup plays a role in determining cholesterol levels. But for many people, a diet rich in saturated fat and dietary cholesterol is another critical factor in raising cholesterol levels. (The saturated fat in food actually affects cholesterol levels more than dietary cholesterol.) On the other hand, a diet high in carbohydrates and sugar is responsible for elevated triglyceride levels.
Smoking, excess weight, and a lack of exercise also contribute to the problem. In some cases, diabetes or other metabolic disorders can raise blood cholesterol and triglycerides regardless of how little fat or dietary cholesterol is consumed.
Treatment and Prevention
Generally, dietary and other lifestyle changes are the first step to take toward lowering high cholesterol levels. In addition, a number of nutritional and herbal remedies can help. Prescription drugs are available to lower total cholesterol levels, but anyone taking a cholesterol-lowering drug needs to be monitored by a physician who will check for adverse reactions and to assess how effective the drug is. A good rule of thumb is to consider a drug only if you can’t lower cholesterol levels sufficiently with self-treatment measures.
How conventional medicine treats high cholesterol.
Since elevated blood cholesterol is free from symptoms, for most people it is discovered during a routine check-up. Sometimes, high cholesterol is caused by a second medical condition, like diabetes, an underactive thyroid gland, or liver disease. Your doctor will check for these routinely because treatment of these conditions may lower your cholesterol to a normal range. Fortunately, only a small percentage of people with high cholesterol learn of it after some damage has been done, like a heart attack or a stroke.
Your doctor’s approach to your high cholesterol will take into account factors other than the numbers themselves. Obviously higher levels of total and LDL (‘bad’) cholesterol will mean more aggressive therapy, but also included in his decision making process are the presence of high blood pressure, diabetes, obesity, a family history of heart disease, and tobacco use. Ideally, (if longevity is your aim) you want your total cholesterol below 200, your HDL above 60 and your LDL below 100. And you want to eliminate (or at least control) as many of the other risk factors as possible.
With no other risk factors present, if your cholesterol is in the borderline range of 200-240 mg./dl, your doctor may suggest meeting with a dietician to learn the details of reducing saturated fat in your diet. Often a change in your eating habits, especially when combined with regular exercise, will be enough to bring your cholesterol below 200, and your LDL closer to the desired 100. With diet therapy alone, your doctor will likely wait at least three months before retesting your levels.
If your total cholesterol is well over 240 mg/dl and your LDL over 120 mg/dl, your doctor might suggest starting medications along with immediate changes in your eating habits.
By far, the most commonly used family of medicines to lower cholesterol are the statin drugs also known as HMG-CoA reductase inhibitors. These include such familiar names as Pravachol, Lipitor, Lescol, Mevacor, and Zocor. These medications block an enzyme called HMG-CoA reductase used within the liver to manufacture cholesterol.
The statin drugs are liked by both patients and doctors because of convenient one-a-day dosing and relatively few side effects. The most common side effect is a harmless elevation of liver enzymes, so that your doctor will monitor these along with your (now hopefully falling) cholesterol levels. If excessive elevation in liver enzymes does occur, it disappears when the medicine is discontinued. Very rarely, these medicines can damage muscles, producing a potentially fatal condition called rhabdomyolysis. Granted that ‘fatal’ sounds decidedly grim, people worry about this side effect unnecessarily. In actual fact, the odds of developing life threatening rhabdomyolysis are one chance in 5,700,000.
The niacin (vitamin B-3) group of medications is less commonly used because of the popularity of the statin family but these have been around for almost fifty years. Unlike the statin drugs, niacin has the advantage of not only lowering total and LDL cholesterol, but lowering triglycerides and raising HDL (‘good’) cholesterol as well. The major side effect is a harmless but decidedly annoying facial flushing. Certain forms of over-the-counter timed release niacin reduces the flushing side effect but have been associated with liver damage. The safest forms of niacin are inositol hexaniacinate (see nutritional supplements below) and the prescription drug Niaspan.
The third family of lipid lowering drugs are termed bile acid binding resins and include cholestyramine (Lopid) and colestipol (Colestid). These act by reducing the liver’s manufacture of LDL but are rarely used either because of inconvenience (you dissolve a powder in water several times a day) or side effects (gas, bloating).
How Supplements Can Help
Just a reminder: If you have a serious medical condition, it’s always a good idea to talk to your doctor before beginning a program of supplements.
The most effective cholesterol lowering supplements are plant sterols and stanols, inositol hexaniacinate, red yeast rice, and gugulipid. The plant sterols and stanols prevent the absorption of dietary cholesterol through the intestine, and not being absorbed themselves, pass harmlessly out of the body in the bowel movement. The specific action of how inositol hexaniacinate, a form of the B vitamin niacin, lowers total and LDL levels, raises HDL levels and lowers triglycerides is uncertain. Red yeast rice acts in the liver to block cholesterol formation. Because red yeast rice acts exactly like the ‘statin’ cholesterol lowering drugs, it should never be taken with them. Unfortunately, the courts recently ruled that red yeast rice should be reclassified as a drug and its manufacturer was compelled to remove the produce from drug and health food store shelves.
Gugulipid, derived from a gummy tree resin, seems to break down “bad” cholesterol and perhaps even boost “good” cholesterol.
Product recommendations
Plant sterols: Basikol
This has been developed by the European nutriceutical company Arkopharmica and has been shown in clinical studies to reduce total cholesterol by an average of 14%. It’s a rather tasty vanilla powder that can be eaten directly, sprinkled over food, mixed into (non-fat) yoghurt, or dissolved in water.
Niacin: Niacinol (Tyler Encapsulations)
Tyler is a state of the art supplement company whose products are only available to health care practitioners. Niacinol is their brand of inositol hexaniacinate, each capsule containing 500 mg., taken two or three times a day
Guggulipid: Guggulplex (PhytoPharmica)
PhytoPharmica’s products are mainly developed by superstar nutritional physicians like Michael Murray, N.D. and Alan Gaby, M.D. Guggulplex contains not only standardized guggulipid but also additional amounts of niacin. If the above three products fail to lower your cholesterol, you will likely need a ‘statin’ drug.
Policosanol is a natural product derived from wax of the common honeybee. Several studies have shown that policosanol can effectively lower both total and bad cholesterol, while raising good cholesterol. Its mechanism of action seems similar to that of the widely prescribed statin drugs. In addition, acting somewhat like aspirin, policosanol can block platelet aggregation and thus may be useful in preventing both heart attacks and strokes. Remarkably free from side effects (rarely some bloating has been reported), policosanol is now available in health food stores.
Policosanol: Cholarest (Metagenics)
This excellent new product was recently licensed to Metagenics by its original developer (Apisol ™). Each softgel contains 10 mg. of policosanol and according to published reports, should be effective in reducing cholesterol as much as 20%.
Vitamins E and C, taken together or along with enteric-coated garlic capsules, are beneficial and safe–even if they are used over long periods in conjunction with a cholesterol-lowering prescription drug. Although vitamins E and C don’t lower cholesterol levels directly, they help protect the body from “bad” cholesterol (LDL) by preventing it from precipitating along the inner linings of your blood vessels. Studies on garlic are inconclusive, but many nutritionally oriented physicians suggest trying it as a cholesterol lowering herb.
Vitamin E: Essential E (Tyler)
A high quality mix of natural tocopherols, 400 I.U. per capsule
Vitamin C: Ultra Potent C (Metagenics)
1000 mg. of highly absorbable Vitamin C with bioflavonoids
Psyllium, a water-soluble fiber from the husks of psyllium seeds, seems to lower cholesterol by binding substances called bile acids in the intestines. Bile acids are produced in the liver from cholesterol and needed for digestion. If there aren’t enough bile acids, the liver will manufacture more, and recruit cholesterol circulating in the bloodstream in order to do so.
Psyllium husks are available at your local drug store. Metamucil is the standard brand but the drug store’s “house brands” produce the same results
How to Take the Supplements
You can start with the inositol hexaniacinate. This is really a no-flush form of the B vitamin niacin, which has been regularly used by conventional doctors as a cholesterol-lowering agent for almost 50 years. Although it was initially thought that you couldn’t combine niacin with the conventional “statin” drugs, one recent study showed that using the two together literally stopped the progression of atherosclerosis in its tracks.
You can also immediately begin to include plant stanols and sterols by switching from your current butter or margarine to Benecol (a plant stanol) or Take Control (a plant sterol). For the calorie conscious, there are “light” versions of each of these products. Two tablespoonfuls of either of these are about 90 calories and can be expected to lower cholesterol by 10-14%. Alternatively, the nutritional products Basikol and Kholesterol Blocker are in health food stores. The first is a tasty powder, the second is in capsule form. Using either in the dose suggested by the manufacturer will provide 800 mg of sterols and you can expect a 14% reduction in cholesterol levels.
As an addition to inositol hexaniacinate, you can use gugulipid, an Ayurvedic herb prescribed in India to reduce cholesterol. (Several manufacturers actually combine gugulipid with niacin.) Alternatively, you can start the new policosanol which seems to act similarly to ‘statin’ drugs.
In addition, take vitamin C and vitamin E daily. If you think you’re not getting enough soluble fiber in your diet, include a scoop of psyllium every morning.
Try the inositol hexaniacinate/psyllium/sterol-stanol combination for 6-8 weeks, then get your cholesterol level rechecked. If the result is not satisfactory, add either guggulipid or policosanol. Continue this program for another 8 weeks and recheck again.
If your cholesterol is still too high, you’ll very likely need prescription medication. Before starting any of the prescription drugs, however, drop everything except the psyllium, stanol-sterol and vitamins C and E. If your doctor chooses one of the statin drugs, definitely add coenzyme Q10 a natural antioxidant that will become depleted by long term use of these medications
Coenzyme Q-10 50 mg. (Physiologics)
Owned by Whole Foods, Physiologic products are distributed only to health care practitioners. This is very high quality pharmaceutical grade Co Q-10
Self-Care Remedies
Try to reduce your intake of saturated fat and dietary cholesterol, both of which come chiefly from animal sources. Also, limit your total fat intake to no more than 30% of your daily calories. Among the foods to avoid are beef, butter, and whole-milk dairy products, as well as coconut, palm, and hydrogenated oils (found in processed foods). Monounsaturated oils (olive or canola) are good substitutes for butter.
Increasing the amount of high-fiber foods–fruits, vegetables, grains, and legumes–you eat will aid in cholesterol reduction. A daily serving of oatmeal or oat bran may also make a noticeable difference.
Fish is the best substitute for red meat. Studies show that the oil found in tuna, salmon, and other varieties of cold-water fish, known as omega-3 fatty acids, can actually lower blood cholesterol.
People who are more than 20% overweight should shed extra pounds to reach a healthy weight.
A program of regular vigorous (aerobic) exercise, such as walking, running, or swimming, has been shown to increase levels of HDL (“good”) cholesterol.
Consider drinking one or two alcoholic beverages a day–but not more. Research indicates that moderate alcohol consumption can boost HDL. If you drink wine, opt for red wine over white; red is an excellent source of flavonoids called proanthocyanidins, which help prevent blocked arteries. If you are a nondrinker, however, you should not begin drinking for its therapeutic effects. And you should definitely avoid alcohol if you have a current or past history of alcoholism.
Quit smoking. Smoking not only increases total cholesterol and reduces HDL, but contributes to heart disease.
When to Call a Doctor
If you haven’t had your cholesterol measured at recommended intervals. Blood cholesterol levels should be measured at least once every five years–more often if total cholesterol is 200 mg/dl or higher. Checking your cholesterol levels is especially important if you are at high risk for coronary artery disease or if high cholesterol runs in your family.
If a combination of dietary changes, supplements, and exercise fails to lower high cholesterol significantly within several months. Your doctor may recommend trying a prescription drug for lowering cholesterol.
Recommended laboratory test
KRONOS Cardiovascular Risk Profile
This is an extremely comprehensive profile measuring levels of virtually all factors associated with heart disease, including a full lipid profile, homocysteine, fibrinogen, C-reactive protein, and Lipoprotein(a). Since this test is not in the realm of ‘alternative medicine,’ most health insurance companies will reimburse you, at least partially, toward the cost of this test.
Supplement Recommendations
From David Edelberg, M.D. at WholeHealth Chicago: Keep in mind that supplements have to work with changes in diet and exercise to achieve the best effect for controlling cholesterol. Start on a program that combines supplements with lifestyle changes. Then, after three or four months, check your cholesterol levels again. You’ll probably be very pleasantly surprised by the result. In fact, tape the result to your refrigerator for your family to see. Or to a prominent spot on the office bulletin board.
How to Take the Supplements
Supplements with a proven track record for lowering blood cholesterol include inositol hexaniacinate, red yeast rice, garlic, gugulipid, psyllium, and pantethine.
You can start with the inositol hexaniacinate. This is really a no-flush form of the B vitamin niacin, which has been regularly used by conventional doctors as a cholesterol-lowering agent for almost 50 years. Although it was initially thought that you couldn’t combine niacin with the conventional “statin” drugs, one recent study showed that using the two together literally stopped the progression of atherosclerosis in its tracks.
As an alternative to inositol hexaniacinate, you can use gugulipid, an Ayurvedic herb prescribed in India to reduce cholesterol. (Several manufacturers actually combine gugulipid with niacin.)
In addition, add vitamin C and vitamin E daily. Although such antioxidants don’t directly lower cholesterol, they’re important because each prevents LDL (“bad”) cholesterol from blocking arteries. Also, if you think you’re not getting enough soluble fiber in your diet, including psyllium helps block some cholesterol absorption.
Try the inositol hexaniacinate/psyllium combination for 6-8 weeks, then get your cholesterol level rechecked. If the result is not satisfactory, add garlic and panthethine, a form of vitamin B5 that reduces the amount of cholesterol manufactured by the liver. These can safely be added to any regimen. Continue this program for another 8 weeks and recheck again.
If your cholesterol is still too high, drop everything except the psyllium, and vitamins C and E; and start the red yeast rice. The action of this supplement in the body is similar that of the statin drugs, and so should be taken with coenzyme Q10 a natural antioxidant that gets depleted by the statin drugs.
Re-starting the inositol hexaniacinate or the gugulipid should be done only under medical supervision.
Of special note:
Feeling constantly stressed may play a role in cholesterol metabolism. If you believe chronic anxiety is an issue in your life, consider adding kava (250 mg 2 or 3 times a day), a natural and nonsedating tranquilizer.
Although depression is not linked to high cholesterol, it certainly has been associated with increased susceptibility to heart disease. St. John’s wort (450 mg twice a day) is widely used by European physicians as a first treatment to improve mood and sense of well-being. The Healing Path for High Cholesterol provides more extensive therapeutic information about this condition. Important:
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.
Supplements
Inositol hexaniacinate 500 mg., one capsule three times a day, without regard to meals
Product: Niacinol (90 caps) Plant stanols 800 mg. two scoops (800 mg.) daily, without regard to meals
Product: Basikol Guggulipid 500 mg., one capsule three times a day, without regard to meals
Product: Guggulplex Policosanol 10 mg. one capsule twice a day with Food
Cholarest Vitamin E Product: Essential E 400 I.U. one capsule daily
Vitamin C Product: Ultra Potent C 1000 mg one tablet daily
Coenzyme Q-10 Product: Co Q 10 50 mg one capsule daily
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.
Be well,
David Edelberg, MD