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What
is High Cholesterol?
Cholesterol
is a fat related substance made in the liver. It is a steroid molecule
and the source for all steroid reproductive hormones like testosterone
and estrogens. Our body needs it as it is also used in cell membranes.
Although they are not the only major risk factors, high LDL and
low HDL are associated with a high risk of heart disease. LDL is
also commonly referred to as the ‘Bad’ cholesterol and
HDL is the ‘Good’ cholesterol. The LDL/HDL ratio is
more important than total cholesterol.
The standard definition
of high cholesterol is having an excess of cholesterol in the blood,
usually more than 200 mg/dl (5mmol/L), although many doctors are
now citing 180 mg/dl as the maximum. For the LDL/HDL ratio, the
lower the number is the better, most doctors recommend a value of
3 or less. For example, you may have a total cholesterol level that
is considered quite high at 208, but have a LDL of 136 and a HDL
of 73. By calculating the ratio 136/73, the value we end with is
1.8, and considered to be quite good.
High Cholesterol
is also known as Hypercholesterolemia, Dyslipidemia, and Hyperlipoproteinemia.
High cholesterol
is linked with atherosclerosis (hardening of the arteries due to
plaque), a condition that does not cause immediate symptoms, but
is chronic and debilitating. It can contribute to overall morbidity
and mortality; why it is frequently termed when combined with heart
disease ‘the silent killer’.
High amounts of
cholesterol in the liver can be due to having too much of a compound
called homocysteine, made from the amino acid methionine. High homocysteine
levels are a separate marker for heart disease, but are a key indicator.
Homocysteine can cause oxidation of LDL, which is highly contributing
factor to the formation of arterial atherosclerotic plaques.
Symptoms
of high cholesterol
There are no true symptoms associated with high cholesterol, but
some things may be indicators. Corneal arcus- light coloured or
whitish rings around the iris. In the elderly or people over 60
it is common and called arcus senilis, but in younger individuals
it may be indicative of high cholesterol and triglycerides. Gallstones
are frequently made up of cholesterol, and can be associated with
a high fat diet.
A history of angina
or any other cardiovascular symptoms, especially heart attacks,
are late warning signs of cholesterol problems.
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Diagnosis
and Pharmaceutical Interventions
Diagnosis is always
made with a blood test. A complete lipid profile (total cholesterol,
HDL, LDL and triglyceride levels) after fasting overnight is considered
normal screening for adults over 20 years old. Screening for high
cholesterol may be done every 5 years starting at age 20, and then
every year starting at age 35 for males and 45 for females.
C-reactive protein,
a marker for cardiovascular disease and atherosclerosis, is a test
that should be done for those with high cholesterol as it increases
risk of inflammation of coronary artery endothelial lining. Assessment
of Cardiovascular risk will include evaluation of homocysteine levels.
Elevated cholesterol
combined with abnormalities in blood sugar warrant attention and
other diagnostic testing. Blood insulin levels may be obtained.
Elevated blood insulin levels are indicative of insulin resistance
syndrome, a condition similar to Type 2 Diabetes.
Treatments
Pharmaceutical interventions
Statin drugs used to treat High Cholesterol are atorvastatin (Lipitor),
lovastatin (Mevacor), simvastatin (Zocor, Lipex).These are also
known as HMG-CoA reductase inhibitors.
Common side effects
from this class of medications are skin rashes and bowel changes.
Somewhat common are muscle aches associated with electrolytes changes,
known as myopathy. This can lead to rhabdomyolysis, the breaking
down of muscle tissue and resulting in kidney damage. These medications
can effect liver function, so there is a potential for various liver
problems. Liver function tests should be done by anyone considering
statin medications before initiating treatment and regularly thereafter.
These medications
should not be used by women who are pregnant or are planning to
get pregnant, or anybody with an active liver disease.
Statin medications
are known to deplete CoQ 10, a nutrient known to be beneficial for
the heart. Supplementation of 30-100 mg per day is recommended during
use of statin medications.
The other group
of medications seldom used are bile salt sequestrating agents like
Questran or fibric acid derivatives like Bezafibrate. Because they
cause excretion of bile acids, which are needed for absorption of
fats and fat soluble vitamins, these medications may interfere with
normal fat absorption and thus may prevent absorption of vitamins
such as A, D, E and K.
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Lifestyle
and Dietary Modifications
Dietary changes
are the best, and should be the first, method of lowering cholesterol.
Diet has been researched as a factor in cholesterol and heart disease
for several decades and many countries.
The first dietary
change should be to eliminate trans-fatty acids and reduce all saturated
fat.
Diets high in saturated fats (red meat or animal meat, such as beef,
pork, veal, and poultry, especially poultry skin) have been shown
to increase cholesterol and heart disease. This includes saturated
fat from dairy products. Hidden sources of fat can be found in processed
foods, especially as trans-fatty acids and hydrogenated oils. These
trans-fatty acids are harmful to the body and are much worse than
saturated fats for heart disease. Trans-fatty acids and hydrogenated
oils actually inhibit the formation and utilization of the good
fatty acids. Trans-fatty acids are found in abundance in margarine
and vegetable shortening, but are rarely found in nature. Fish contain
good fats, called essential fatty acids, which are beneficial to
the body and have a positive effect on cholesterol and also have
a range of other positive health effects.
Eggs in the diet
have had much controversy, and now it is believed they have little
effect on blood lipids; however it is not totally clear. Frying
eggs (or any fried foods) contribute to a higher fat content and
increased risk of heart disease. For individuals with a current
or a history of high cholesterol or heart disease it is still a
good idea to limit eggs.
Vegetarians have
lower cholesterol and less heart disease than people who eat meat,
in part because they avoid animal fat. Vegans (people who eat no
meat, dairy, or eggs) have the lowest cholesterol levels. Switching
from a standard diet to a vegan diet, along with other lifestyle
changes, has been reported to reverse heart disease.
Diets high in fibre
have been shown to reduce cholesterol, especially water soluble
fibre found in oats, barley, beans, fresh fruits and some vegetables.
Lifestyle modifications
Quitting smoking is one thing you can do for your health that will
help not only reduce your risk of heart disease but improve overall
health. Smokers have lower levels of HDL, the ‘good’
cholesterol. Smoking is the number one risk factor associated with
several chronic diseases, in including several forms of cancer,
osteoporosis, and chronic obstructive pulmonary diseases. Being
overweight contributes to a number of chronic diseases, and obesity
increases the risk of cardiovascular disease. Shedding extra weight
improves the ratio of LDL/HDL, and decreases the risk of Metabolic
Syndrome
Exercise, even moderate
walking, can reduce cholesterol and improve the LDL/HDL ratio. Recommend
30 minutes walking, at least 5 times a week.
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Nutritional
Factors Shown to be Beneficial
Niacin
Niacin, vitamin B3, is the most studied vitamin for cholesterol,
and has demonstrated better overall results than most prescription
medications. Despite this it is still relatively underused by health
care professionals. Niacin effects blood levels by reducing LDL,
and elevates HDL levels. It is considered to be the best agent for
raising HDL by the Coronary Drug Project, a study done over the
course of 15 years. It was also found in that study that the overall
mortality was reduced significantly in the niacin group; even a
year after treatment had ended.
Niacinamide
Niacinamide is another
form of niacin used for health conditions, but is not effective
for blood lipids. Inositol hexaniacinate is a form of niacin that
causes less flushing with the same therapeutic effect.
Niacin can cause
skin flushing and stomach discomfort. There are forms of niacin
on the market that are ‘timed’ or ‘sustained’
released to reduce the flushing some experience but these products
are damaging to the liver. The inositol hexaniacinate form of niacin
is not associated with these side effects, and is not damaging to
the liver. But even though it has not had any adverse effected reported,
it should be avoided with people with a known chronic liver disease.
Doses of niacin,
as inositol hexaniainate, to treat cholesterol and blood lipids
is 500 mg three times a day for 2 weeks, then increase to 1000 mg
three times a day, with meals.
Pantetheine
Pantetheine is a stable form of pantethinic acid, vitamin B5. It
is involved in the movements of fats to and from cells, and it is
needed to make cholesterol. It is not understood why it works to
lower cholesterol, but it lowers total cholesterol, LDL’s
and elevates HDL’s.
The dose of pantetheine
is 300 mg three times a day.
Red
Yeast Rice Extract
Red yeast rice extract contains a chemical ingredient that is very
similar, if not the same, as the medication lovastatin. But red
yeast rice has been used in China as a traditional therapeutic food.
The advantage is that along with lovastatin, it has other plant
sterols that reduce the adverse side effects of statin medications.
Red yeast rice extract
lowers total cholesterol as well as triglycerides.
Dose of red yeast
rice extract is 1.2-2.4 grams. Because it is so similar to some
statins, which deplete the body’s Co enzyme Q10, supplementation
is indicated, 30- 100 mg a day. It also should not be used by women
who are pregnant or are planning to get pregnant, or anybody with
an active liver disease. Concurrent use of red yeast rice extract
and statin medication is not advised.
Policosanol
Policosanol is made from sugar canes. It works on the same enzyme
that statin medications work on but in a different way. Unlike statin
medications it does not have the same liver toxicity; in fact it
has very few side effects. It has been compared to the stain medication
lovastatin and was found to produce better results.
It lowers cholesterol,
LDL, increases HDL and improves the HDL/LDL ratio. It is also been
shown to be effective in treating other forms of heart disease.
Doses of policosanol
for cholesterol treatment are 5-10 mg twice a day.
Guggul
Guggul is produced
from a tree resin, Commiphora mukul and it has been used in ayurvedic
medicine to treat heart conditions and obesity. Not only does it
lower the LDL, but VLDL (very low density lipoprotein) as well,
and raises HDL. It also helps regulate thyroid gland function; as
hypothyroidism can be a secondary cause in problems with high cholesterol.
Dose is 250-500
mg of standardized guggal with 25 mg of guggal sterones taken 2-3
times a day.
Fish Oils
Fish oils are high
in EPA and DHA, omega 3 fatty acids. Although they are fats, they
are essential for cell membranes and brain tissue; they improve
the fluidity of the cell membrane to allow for better cell to cell
communication. Fish oils lower triglyceride levels and decreases
the viscosity, the ‘stickiness’ of the blood which in
turn reduces the risk of atherosclerotic plaques. It has been suggested
that taking fish oils may increase the LDL’s level initially,
but in current scientific studies this is rarely seen, and in fact
a reduction of LDL’s is reported.
Doses of fish oil
range from 3-5 grams a day.
Garlic (Allium
Sativa)
Garlic has been used as medicine since the times of Hippocrates.
It has been shown to lower LDL level due in part by the activity
of allicin. Garlic was one of the few herbs approved to treat cholesterol
by the German Commission E, a group set up to regulate the use,
efficacy and safety of common herbs.
Doses of allicin
containing garlic preparations should be are typically 900 mg per
day (providing 5,000 to 6,000 mcg of allicin), divided into two
or three administrations.
Vitamin
E
Vitamin E has been used for the prevention of heart disease and
may increase levels of HDL’s and improve the ratio of it to
LDL. It has been shown to protect LDL and cholesterol from free
radical damage, which is a major contributing factor to the formation
of atherosclerosis. Vitamin E is a general term for a chemical class
known as the tocopherols and tocotrienols. These compounds are antioxidant
and can help reduce the oxidation process that occurs with atherosclerotic
plaques. They seem to better in a combination of mixed tocopherols
instead of alpha tocopherol, which most vitamin supplements consist
of alone.
Doses of Vitamin E are 400- 800 IU a day.
Vitamin
C
Vitamin C also appears to protect LDL cholesterol from free radical
damage. It is not clear at this time whether Vitamin C lowers total
cholesterol, or more specifically LDL. Some health care practitioners
recommend 1 gram per day of vitamin C. However, it has been suggested
that most protection against cardiovascular disease from vitamin
C is likely to occur with as little as 100 mg per day.
Co-Enzyme
Q10
CoQ10 is a substance involved in the production of energy; it works
as an electron carrier in the mitochondria of cells. It is considered
to be very close in action as Vitamin E, and can protect against
several forms of heart disease. Since many treatments for high cholesterol
act on the chemical cholesterol pathway, CoQ10 may be indicated
as an adjunct treatment.
Dose 30-100 mg a
day.
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Recommended
NaturalMeds Products for High Cholesterol
Vitamin
E Mixed tocopherols
Vitamin E is a fat-soluble vitamin that is one of the body's chief
antioxidants, helping to protect cell membranes against oxidation.
This product has the addition of mixed tocopherols, of which Vitamin
E is related.
Dose: 2 softgels with food a day Pack size:
50 softgels
CoQ10
30 mg
Coenzyme Q10 is essential to human life. It plays a role in energy
production cycles that converts food into energy. Research indicates
that supplementation with this nutrient may support normal heart
function and provide antioxidant protection. It is best taken with
food, especially with a food that contains fat as it improves absorption.
Dose: 3 capsules with meals a day Pack size:
30 and 60 capsules
Ultimate
Omega
Eicosapentaenoic acid (EPA) and docasahexaenoic acid (DHA), the
two main components of Omega-3 from fish oil, are essential nutrients
for growth and development throughout the human life cycle. These
oils have been studied for the positive cardiovascular effects and
reduction of disease. Ultimate Omega contains 700 mg of EPA and
500 mg of DHA.
Dose: 2 capsules Pack size: 60 capsules
EPA
This particular formula is highly concentrated in EPA, having 850
mg per capsule. It also contains 200 mg of DHA.
Dose: 2 capsules Pack size 60 capsules
Vitamin
C Ascorbic acid crystals
Vitamin is an astounding nutrient, as supplementation not only helps
with immune function but as an antioxidant protects against free
radical damage associated with cholesterol. Powdered forms of vitamin
C are easy to take.
Dose: ½ teaspoon two to threes times
a day Pack size: 8 ounces (226.796 g)
Guggul Extra
Strength
Guggal Extra Strength is a standardized extract of Commiphora mukul,
which has shown remarkable in promoting healthy lipids. This formula
is combined with magnesium for heart health, vitamin B6 and folic
acid to help reduce homocysteine, and trifla, an ayurvedic digestive
tonic.
Dose: 1-2 capsule a day Pack size: 90 capsules
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