Managing Your Cholesterol Naturally

By Dennis Goodman, MD.

Thanks to the excellent educational efforts of organizations like the American Heart Association (AHA), we've learned a lot about cholesterol and how it affects our health.

We know that high cholesterol levels increase our risk for heart attacks and strokes and that lowering our cholesterol will reduce this risk and keep our hearts and blood vessels healthy. We've also learned that diet, weight loss, and exercise will all help us in our quest to improve our cholesterol profile.1

However, there are still some misconceptions about cholesterol. For example, did you know that not all cholesterol is harmful? There are both "good" and "bad" forms of cholesterol, and it is the balance between the two that is critical to heart health. And while reducing total or "bad" cholesterol has been the primary focus of past cholesterol management strategies, not enough attention has been paid to the significant benefit of raising HDL. Recent research indicates that raising HDL ("good cholesterol") levels may provide even greater protection against cardiovascular disease. It is estimated that every 1% increase in HDL can decrease the risk for heart disease by 2% in men and 3% in women.2 For example, if your HDL is 36 mg/dl and it increases by 4 mg/dl (approximately 10%), this translates into a 20-30% reduction in risk of heart disease. Several studies have proven that low HDL cholesterol levels are an independent risk factor of heart disease. This is especially important because we've also learned that despite good efforts to change their diet and exercise habits, some people's cholesterol levels are still undesirable.

Prescription drugs to lower cholesterol are now available and have proven very successful. Multiple studies have shown that statins' effectiveness in reducing LDL cholesterol has resulted in highly significant reductions in heart attacks and strokes. However, while these medications do lower total cholesterol levels, they also may have side effects. Statin drugs can cause elevations in liver enzymes, an indication of liver irritation.3,4 They are associated with myopathy, a disorder of muscle inflammation and muscle degeneration,5,6 and they have even been linked to a rare, and at times, fatal condition called rhabdomyolysis.6,7 Additionally, statin drugs significantly reduce CoQ10 levels in the body, a deficit that can lead to heart disease.8-10 Statin drugs are known to have relatively little effect on good (HDL) cholesterol levels. Finally, it should be noted that several recent articles and books from reputable sources are addressing statin overdosing in patients.

Thankfully, there are safe and effective solutions available that can help you manage your cholesterol levels naturally. As a practicing cardiologist, I know the importance of increasing HDL and lowering LDL, therefore I have worked to develop a formula which combines essential vitamins and minerals, at levels recommended by the AHA, with important amino acids, potent antioxidants, and traditional herbal extracts. It has been clinically shown to increase good cholesterol levels by up to 23%.11

In this issue of "Ask the Doctor" we will discuss how this formula can help you boost your good cholesterol levels, as well as how other natural ingredients, such as pantethine and phytosterols, can be an effective alternative to prescription cholesterol lowering medications.

But first, we need to review what we know about cholesterol and heart disease.

What exactly is cholesterol?

Cholesterol is a soft, waxy, fat-like substance found in every cell of the body. We need cholesterol to help digest fats, strengthen cell membranes, insulate nerves, and make hormones.

Cholesterol is made primarily in the liver, but it is also produced by cells lining the small intestine and by individual cells in the body. While our body makes all of the cholesterol we actually need (about 1,000 milligrams a day), we also get additional cholesterol from foods we eat.12,13 The highest sources of cholesterol are egg yolks and organ meats such as liver and kidney. No plant derived food contains cholesterol, not even peanut butter or avocado, even though these foods are high in fat. However, all foods from animal sources such as meats, poultry, fish, eggs, and dairy products contain cholesterol.14

How does cholesterol cause heart disease?

Although cholesterol serves many important functions in the body, too much cholesterol in the bloodstream can be dangerous. When blood cholesterol reaches high levels, it builds up on artery walls, increasing the risk of blood clots, heart attack, and stroke.14

The heart is a muscle, and like all muscles, needs a constant supply of oxygen and nutrients. The bloodstream transports these nutrients to the heart through the coronary arteries. If the coronary arteries become narrowed or clogged by cholesterol and fat deposits (atherosclerosis) and cannot supply enough blood to the heart, the result is coronary heart disease (CHD). If not enough oxygen-carrying blood reaches the heart muscle, a sharp, sudden chest pain (angina) may occur. If the blood supply to a portion of the heart is completely cut off by total blockage of a coronary artery, the result is a heart attack. This is most often caused from a blood clot forming on top of an already narrowed artery.15

What are LDL and HDL cholesterol?

Cholesterol and other fats can't dissolve in the blood therefore, they can't travel on their own. They have to be transported to and from the cells by special carriers called lipoproteins. The two major lipoproteins are low density lipoproteins (LDL) and high density lipoproteins (HDL). LDL is most often referred to as the "bad" cholesterol whereas HDL is known as the "good" cholesterol.13,15

LDLs carry cholesterol throughout the body to the cells. LDLs cause atherosclerosis by clogging up our arteries with the continual buildup of fat. HDL, on the other hand, prevents this fat buildup within arterial walls, by carrying it away from the arteries, to the liver where it is eventually processed and eliminated.13,15

Both LDL and HDL have been recognized by the American Heart Association as strong and independent risk factors that can impact heart health. While high levels of LDL are associated with increased risks of cardiovascular disease (potentially leading to heart attack or stroke), high HDL can positively impact heart health, drastically reducing your risk of heart disease. In fact, studies have shown that raising your good cholesterol reduces cardiovascular disease risks more than lowering bad cholesterol alone. As a result, the AHA along with the National Cholesterol Education Program (NCEP) have established the following guidelines to keep your heart healthy:16

• HDL levels above 40 for men and above 50 for women (above 60 is optimal)
• LDL levels between 100 and 159 (preferably less than 130)
• Total cholesterol (HDL and LDL) under 200

What are triglycerides?

Triglycerides are fats used as fuel by the body and as an energy source for metabolism. Triglyceride levels fluctuate easily, changing after every meal. Increased levels are almost always a sign of too much carbohydrate and sugar intake. Triglycerides in high amounts make the blood more sluggish and less capable of transporting oxygen, particularly through the smallest blood vessels. High triglycerides is yet another independent risk factors for cardiovascular disease, leading to a heart attack or stroke.13,15

There are several medications physicians can prescribe for people with elevated triglyceride levels. Some of the most effective are the statins, but keep in mind there are some potentially dangerous side effects associated with their use.

Natural medicine has thankfully found other options. Both the HDL boosting combination and the LDL lowering pantethine and plant sterols blend mentioned earlier can safely and effectively lower triglycerides.11,13,15

What is this "HDL-boosting" formulation you've developed and how does it work?

In my many years of practice as a cardiologist, I've met a multitude of patients with undesirable cholesterol levels. And while numerous prescription medications have been developed to lower bad cholesterol, there are few medications that target good cholesterol. Patients with naturally low good cholesterol (HDL< 40), who are not able to significantly alter their HDL levels through diet and exercise, have had limited medical options to help reduce their already increased risk of heart disease.

Therefore, I researched medical literature where I found multiple nutrients that have been clinically shown to favorably alter good cholesterol levels. My formulation combines heart healthy vitamins and minerals, including vitamins C, E, B6, B12, niacin, folic acid, magnesium and selenium, with protein-building amino acids, powerful antioxidants, such as coenzyme Q10 (CoQ10), alpha lipoic acid (ALA), N-acetyl cysteine (NAC), and policosanol, and extracts of hawthorn, garlic, grape seed, soy isoflavones, all of which have been shown to beneficially affect heart health.

The effects of this HDL-boosting combination were evaluated in an open label pilot study conducted at Scripps Memorial Hospital in 2002. The trial involved 50 patients, with varying cardiovascular health histories, who were evaluated prior to the study, then again at three and six months.11

After three months of supplementation, good cholesterol levels increased in all groups and the overall lipid profile (i.e., HDL, HDL-2, triglycerides, homocysteine) had improved. The changes were more pronounced at the six-month time point, where good cholesterols rose by more than 11% and levels of HDL-2 (the best cholesterol) rose up to 24.4%. Additionally, the supplement helped reduce triglycerides levels by approximately 30%. These changes were even more impressive in "at risk" groups (i.e., those with HDL levels of less than 40) where total HDL increased by 23% after six months, HDL-2 rose by 50%, and triglycerides decreased by nearly 40%. Decreases in homocysteine, an amino acid found in the blood that has been inversely linked to cardiovascular health, were observed as well.11 And since we know that an increase in HDL - as little as one percent - can reduce heart disease risk by two to three percent, these findings have significant implications for the prevention and treatment of cardiovascular disease.2

Below is a chart which highlights the benefits of a few key HDL-boosting ingredients:

IngredientEffect on Heart Health
Vitamin CAn antioxidant clinically associated with increased HDL and HDL-2 cholesterol levels.17 Also reduces arterial stiffness and inhibits platelet aggregation - two factors known to promote atherosclerosis.18
Vitamin EAnother powerful antioxidant, which protects against the formation of atherosclerotic plaques.19 Also shown to reduce total cholesterol levels.20
NiacinLowers total cholesterol, LDL cholesterol, and triglyceride levels, while raising the HDL cholesterol.19 Also shown to increase HDL-2 levels (the best cholesterol).21
Vitamin B12Reduces homocysteine levels.19
Coenzyme Q10 (CoQ10)A fat-soluble nutrient present in the mitochondria of virtually all cells and an essential factor for cellular energy production.22 Also a powerful free-radical scavenger, clinically shown to provide protection for the inner lining of the arteries by inhibiting LDL oxidation23 and increasing good cholesterol levels.24
PolicosanolA unique mixture of essential alcohols, including octacosanol, tetracosanol, hexacosanol and triacontanol, derived from sugar cane.25 Improves cholesterol levels by reducing the amount produced by the body and increasing the amount eliminated from the body (We'll talk more about the mechanics of this when we discuss plant sterols). Additionally, provides protection for arteries and blood vessels by inhibiting platelet aggregation. In one study, supplementation resulted in a 14% increase in HDL and 23% decrease in LDL cholesterol over an 8-week period.26
Hawthorn Berry ExtractSupports the muscle strength of the heart, helping to maintain healthy heart rhythm.27 Also used to control high blood pressure and relieve mild or stable angina (chest pain).
Garlic BulbA powerful antioxidant that possesses wide-ranging cardiovascular health benefits. Traditionally used to reduce both cholesterol and blood pressure levels.28 Clinically shown to raise good cholesterol levels, particularly HDL-2 cholesterol.29 Also inhibits LDL oxidation and platelet aggregation.30
N-Acetyl-L-Cysteine (NAC)A derivative of the amino acid, cysteine. NAC helps boost levels of glutathione, one of the body's most powerful cellular antioxidants. Also increases good cholesterol levels.31
Alpha Lipoic Acid (ALA)An antioxidant and vital cofactor necessary for the production of cellular energy. ALA helps recycle other important antioxidants, including vitamins C and E, CoQ10, and glutathione. Also helps control cholesterol and high blood pressure levels and maintain healthy blood flow and heart contraction.32
Soy IsoflavonesSoy protein-enriched diet has been shown to decrease LDL and triglyceride levels and significantly increase HDL cholesterol levels.33,34

What exactly is HDL-2 ?

It has been well-documented that high levels of HDL cholesterol are inversely related to coronary artery disease risk. What is less well-known is that there are subtypes of HDL, most notably HDL-2 and HDL-3, each of which offers unique protection.

HDL-3, the smaller form, is produced by the liver and intestines. This subtype is responsible for scavenging or "scooping up" free cholesterol from the blood vessel walls. The cholesterol carried by HDL-3 is then chemically modified, forming a new larger-sized and more buoyant subtype, known as HDL-2. HDL-2, or "mature HDL", transports the cholesterol to the liver for processing and elimination. The HDL molecules are then recirculated in the blood stream to continue scavenging more cholesterol.

Research suggests that HDL-2, because it moves the cholesterol away from peripheral sites (like the arterial wall), provides more heart-protection than the HDL-3 form.2 It is also theorized that the larger-size holds a greater number of receptor sites, allowing HDL-2 to carry a larger amount of cholesterol to the liver.




Does the "HDL-boosting" combination affect LDL levels?

Although supplementation did not result in a significant reduction in LDL, antioxidants such as the ones found in this formulation can help stabilize LDL and prevent build up in the arterial wall.19,23,30 This stabilization of LDL can not always be easily measured.

The clinical trial measured both LDL and lipoprotein a (Lp(a)) levels. Lp(a) is a subfraction of LDL cholesterol. If HDL-2 is the best HDL, then Lp(a) could be considered the worst LDL cholesterol. This subfraction is an indicator of inflammation, and studies suggest that high levels of Lp(a) can speed up blood clot formation leading to blockage in the coronary arteries.

The study found that although the reduction in Lp(a) did not reach statistical significance, there was a general trend towards Lp(a) reduction.11 It is my belief that an extension of the study may have lead to significant results.

Is the combination safe?

Yes. The formula combines essential vitamins and minerals, at levels recommended by the American Heart Association (AHA), with amino acids, antioxidants, and botanicals, all of which have been used safely for years. The six-month pilot study, which involved 50 patients with varying cardiovascular histories, found no serious adverse effects following supplementation and demonstrated the combination is safe to use with statin drugs.11

In fact, both this HDL-boosting combination and the pantethine and plant sterol combination, clinically shown to reduce total and LDL cholesterol levels, have very safe profiles. Let's discuss this second combination in greater detail now.

What is pantethine and how does it lower cholesterol?

Pantethine, a form of pantothenic acid (also known as vitamin B5) is found in small amounts in foods such as liver, salmon, and yeast. Pantethine lowers cholesterol by blocking its production.35

Cholesterol synthesis, or the production of cholesterol in the human body, is an incredibly complex process. It involves many biochemical reactions and enzyme activity requiring several steps. 13,15

Studies have shown that pantethine safely and effectively inhibits several of these enzymes and coenzymes. It blocks the activity of one coenzyme involved in cholesterol synthesis, HMG-CoA, by about 50%. This results in significantly lower cholesterol production. But, that's not all. To compensate for the lowered cholesterol production, the liver pulls LDL out of the bloodstream.36-41 The end result? Studies have shown that on average, pantethine can lower total cholesterol levels by 16%,42,43 LDL cholesterol levels by 14%,42 serum triglycerides by 38%,44 and can raise HDL cholesterol by 10%.42

What are plant sterols and how do they lower cholesterol levels?

Plant sterols are the fats of plants. They are found in nuts, vegetable oils, corn, and rice. Plant sterols are structurally similar to cholesterol and are able to act as a stand-in for cholesterol and block its absorption.45,46

The liver receives about 800 mg of cholesterol every day from intestinal absorption. Cholesterol is absorbed from the intestines through receptor sites-special channels that are shaped exactly like cholesterol molecules. The cholesterol enters these channels and is then absorbed into the bloodstream.15 Because plant sterols look like cholesterol, they fit perfectly into these channels. The cholesterol, being blocked from absorption, remains in our intestines where it is eventually excreted.45,47

If we eat enough plant sterols, the amount of cholesterol transported from the intestinal tract to the liver is greatly reduced. And, just like pantethine's effect on the liver, this cholesterol reduction causes the liver to pull LDL cholesterol out of the blood, reducing both total and LDL cholesterol levels.47-50

Should only people with actual heart disease or those with high cholesterol levels be concerned about cholesterol?

No, recent studies have shown that reducing bad and raising good cholesterol in people without heart disease greatly reduces their risk for ever developing CHD, including heart attacks and atherosclerosis. This is true for those with high total cholesterol levels and for those with average cholesterol levels.51.52

Because of the potential side effects, physicians today generally do not prescribe statin drugs to people without actual heart disease or significantly high LDL cholesterol levels. Rather, they recommend dietary and lifestyle changes be implemented first. However, as we've discussed, these changes are in some instances not enough to favorably alter undesirable cholesterol profiles. Fortunately, the HDL-boosting combination and the LDL-lowering pantethine and plant sterols blend can naturally and very effectively help those people with heart disease, uncontrolled cholesterol levels, high triglyceride levels (or all three) as well as those of us just wanting added "health insurance" for our hearts.

Conclusion

Americans have listened, learned, and most importantly, taken to heart the vast and vital information on the need to keep our cholesterol levels under control. The result? More and more Americans are lucky enough to live long healthy lives. The Centers for Disease Control recently released a report stating that the average American life expectancy has reached a new high of 76.9 years, thanks in no small measure to fewer people who are dying from heart disease.53

The authors of this report stated that we could push our life expectancy even higher. We can attain healthy, old age by eating right, exercising regularly, and taking other simple steps to promote good health and prevent serious illness and heart disease.54 Taking the HDL-boosting combination or the all-natural pantethine and plant sterols LDL-lowering blend are simple, yet powerful steps, to keep our hearts and blood vessels healthy for a long, long time.

Cholesterol References

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39. Cighetti G, Del Puppo M, Paroni R, et al. Pantethine inhibits cholesterol and fatty acid synthesis and stimulate carbon dioxide formation in isolated rat hepatocytes. Journal of Lipid Research. 1987;28:152-161.

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44. Hiramatsu K, Nozaki H, Arimori S. Influence of pantethine on platelet volume, microviscosity, lipid composition and functions in diabetes mellitus with hyperlipedemia. Tokai Journal of Experiemental Clinical Medicine. 1981;6: 49-57.

45. Plant sterols and sterolins. Monograph. Alternative Medicine Review. 2001;6:203-206.

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47. Normen L, Dutta P, Lia A, Andersson H. Soy strerol esters and betasitostanol esters as inhibitors of cholesterol absorption in human small bowel. American Journal of Clinical Nutrition. 2000;71:908-913.

48. Jones P, Ntanios FT, Raeini-Sarjaz M, Vanstone CA. Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men. American Journal of Clinical Nutrition. 1999;69:1144-1150.

49. Maki KC, Davidson MH, Umporowicz DM, et al. Lipid responses to plantsterol enriched reduced fat spreads incorporated into a National Cholesterol Education Program Step I diet. American Journal of Clinical Nutrition. 2001;74:33-43.

50. Pelletier X, Belbraouet S, Mirabel D, et al. A diet moderately enriched in phytosterols lowers plasma cholesterol concentrations in normocholesterolemic humans. Ann Nutrition Metabolism. 1995;39:291-295.

51. Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA. 1998;279:1615-22.

52. Lowe G, Rumley A, Norrie J, Ford I, et al. Blood rheology, cardiovascular risk factors, and cardiovascular disease: the West of Scotland Coronary Prevention Study. Thromb Haemost. 2000;84:553-538.

53. Centers for Disease Control. National Center for Health Statistics. Life expectance hits new high in 2000; mortality declines for several leading causes of death. News Release. October 10, 2001.

54. The American Heart Association. About Cholesterol. Available at: http://www.americanheart.org/cholesterol/about_check.html. Accessed July 25, 2005.




Author Dennis Goodman, medical doctor.




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