High Cholesterol

What is cholesterol?

Cholesterol is a fatty substance in the body that serves several vital roles. It is a building block for various hormones and bile acids; and it plays a major role in stabilizing cell membranes. While proper cholesterol levels are important to good health, the evidence overwhelmingly demonstrates that elevated blood cholesterol levels greatly increase the risk of death due to heart disease. (See also Atherosclerosis.)

Cholesterol is transported in the blood by lipoproteins. The major categories of lipoproteins are very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). VLDL and LDL are responsible for transporting fats (primarily triglycerides and cholesterol) from the liver to body cells, and elevations of either VLDL or LDL are associated with an increased risk of developing atherosclerosis, the primary cause of heart attack and stroke. In contrast, HDL is responsible for returning fats to the liver, and elevations of HDL are associated with a low risk of heart attack.

Currently, experts recommend that your total blood cholesterol level should be less than 200 mg/dl from a fasting blood sample. The HDL level should be greater than 40 mg/dl. The LDL level limit is based on your current health history and risk factors:

  • Less than 100 mg/dl for people who have coronary heart disease. These people have had a myocardial infarction, has angina or a revascularization procedure, such a coronary bypass surgery. The same limit applies to people who have not had one of these cardiac events, but have atherosclerosis outside of the heart, such as the carotid arteries or other peripheral arterial disease, diabetes, or an elevated 10-year risk estimate, as determined by a physician.
  • Less than 130 mg/dl for people who do not have coronary heart disease or equivalent risk for it, but have two or more risk factors. Risk factors include age, low activity, smoking, and being over weight.
  • Less than 160 mg/dl for people who have no or one risk factor for coronary heart disease.

For every 1% drop in LDL levels, there’s a 2% drop in the risk of heart attack. By the same token, for every 1% increase in HDL, the risk of heart attack drops 3-to-4%.

The ratio of your total cholesterol to HDL and the ratio of LDL to HDL are clues that indicate whether cholesterol is being deposited into tissues or is being broken down and excreted. The ratio of total cholesterol to HDL should be no higher than 4.2, and the LDL to HDL ratio should be no higher than 2.5.

Another important lipoprotein to be aware of is a form of LDL called lipoprotein (a), or Lp(a). This form of LDL has an additional molecule of an adhesive protein called apolipoprotein. That protein makes the molecule much more likely to stick to the artery walls and cause damage. New research suggests that high Lp(a) levels constitute a separate risk factor for heart attack. For example, it appears that high Lp(a) levels are 10 times more likely to cause heart disease than high LDL levels. Lp(a) levels lower than 20 mg/dl are associated with low risk of heart disease; levels from 20-to-40 mg/dl pose a moderate risk, and levels higher than 40 mg/dl are considered extremely risky. Elevated blood cholesterol is usually without symptoms but may be associated with conditions like high blood pressure, angina, and heart disease. It is currently recommended that the total blood cholesterol level be less than 200 mg/dl. In addition, it is recommended that the LDL cholesterol be less than 130 mg/dl, the HDL cholesterol be greater than 35 mg/dl, and triglyceride levels be less than 150 mg/dl.

What causes high cholesterol?

Elevated cholesterol levels are usually reflective of dietary and lifestyle factors, although it can also be due to genetic factors.

What dietary factors are important in lowering high cholesterol?

Eat less saturated fat and cholesterol by reducing or eliminating the amounts of animal products in the diet. Increase the consumption of fiber-rich plant foods (fruits, vegetables, grains, legumes, and raw nuts and seeds). See also ATHEROSCLEROSIS. When attempting to lower cholesterol through diet it is important to eat a variety of cholesterol-lowering vegetables including celery, beets, eggplant, garlic and onion, peppers and root vegetables. In addition, dandelion root and Jerusalem artichoke contains the fiber inulin which improves production of antioxidant enzymes while decreasing total cholesterol and triglyceride levels, and raising concentrations of beneficial HDL cholesterol.

Diets rich in legumes, including peanuts, are being used to lower cholesterol levels and soy protein has been shown in some studies to be able to lower total cholesterol levels by 30% and to lower LDL, or “bad” cholesterol, levels by as much as 35-40%. Nuts and seeds, particularly almonds and walnuts, are also quite useful in fighting against heart disease by lowering cholesterol through their fiber, monounsaturated oil, and essential fatty acid content. Hazelnuts have an exceptional concentration of copper, a key component in the intracellular form of an important antioxidant enzyme called superoxide dismutase, which disarms free radicals that would otherwise damage cholesterol and other lipids. Ground flax seed lowers two cholesterol-carrying molecules, apolipoprotein A-1 and apolipoprotein B.

Other foods that have shown beneficial effects on lowering cholesterol include avocados, cocoa butter, Brewer’s yeast, royal jelly, shiitake mushrooms, saffron, turmeric, honey, shellfish, alfalfa sprouts .

What nutritional supplements should I take for high cholesterol?

Foundation Supplements. There are three products from Natural Factors that I think are critical in supporting good health:

  • MultiStart (age and gender specific multiple vitamin and mineral formulas). Follow label instructions.
  • Enriching Greens – a great tasting “greens drink” containing highly concentrated “greens” like chlorella, spirulina, wheat grass juice, barley grass juice, etc., and herbal extracts. Take one serving (one tablespoon) in 8 ounces of water daily.
  • RxOmega-3 Factors – A true pharmaceutical grade fish oil supplement. Take two capsules twice daily if you have high blood cholesterol levels.

Cholesterol Formula with Sytrinol from Natural Factors. Based latest clinical research, it looks like the absolute best natural approach to lowering cholesterol levels is the combination of plant sterols and Sytrinol -a special extract of citrus peel standardized to contain greater than 30% polymethoxylated flavones. This mixture provides a comprehensive formula that addresses high cholesterol, high LDL cholesterol (the “bad” cholesterol), and high triglyceride levels. This formula also contains a significant anti-inflammatory component, as inflammation has been shown to be a risk factor for heart attack.

Blood cholesterol levels are derived from two sources: endogenous synthesis (made by the body) and from dietary sources. Plant sterols work to lower cholesterol levels primarily by blocking the absorption of dietary cholesterol and the reuptake of bile acids made from cholesterol in the liver. Plant can inhibit absorption of cholesterol in the small intestine by up to 50%, and lower LDL blood cholesterol by up to 14%.

Sytrinol works by blocking the enzymes in the liver responsible for manufacturing cholesterol and triglyceride production. For example, the polymethoxylated flavones in the extract have been shown to decrease the production of apolipoprotein B, a structural protein needed for endogenous synthesis of LDL cholesterol.

Clinical results have shown that Sytrinol exerts effects very similar to statin drugs, but without side effects. Specifically, it has been shown to lower total cholesterol levels up to 30%, LDL cholesterol levels up to 27% and triglyceride levels up to 34% within four to twelve weeks of use. Here is a chart illustrating the effects of the special citrus peel extract”

For best results, the recommended dosage is 400 mg of sterols plus 150 mg of Sytrinol twice daily. This translates to two capsules twice times daily.

Niacin (vitamin B3) is the most well-researched natural cholesterol lowering agent. In fact, several studies have shown niacin to produce better overall results than cholesterol-lowering drugs. Niacin typically lowers total cholesterol by 18%, LDL by 23% and triglycerides by 20% while raising HDL levels by 31%. Niacin is available as a prescription agent, yet despite its advantages, niacin accounts for only 7.9 percent of all prescriptions to lower cholesterol. One reason is it produces a bothersome side effect. Flushing of the skin typically occurs twenty to thirty minutes after niacin is taken. Other occasional side effects of niacin include gastric irritation, nausea and liver damage. To reduce the side effect of skin flushing you can use some of the newer time-released formulas including the prescription version Niaspan or take the niacin just before going to bed. Most people sleep right through the flushing reaction. Taking cholesterol lowering agents at night is best because most of the cholesterol manufactured by the liver happens at night. Another approach to reduce flushing is to use inositol hexaniacinate. This form of niacin has long been used in Europe to lower cholesterol levels and also to improve blood flow in intermittent claudication – a peripheral vascular disease that is quite common in diabetes. It yields slightly better clinical results than standard niacin, but is much better tolerated, in terms of both flushing and, more importantly, long-term side-effects. If you start out with trying inositol hexaniacinate and it does not work, try regular niacin. My experience is that some people will only respond to the regular niacin.

If regular niacin is being used, start with a dose of 500 mg at night before going to bed for one week. Increase the dosage to 1,000 mg the next week and 1,500 mg the following week. Stay at the 1,500 mg dosage for two months before checking the response – dosage can be adjusted up or down depending upon the response. If you are using a time-release niacin product, like Niaspan, start out at the full dosage of 1,500 mg at night.

Garlic can lower total cholesterol by about 10-12%, lower LDL by 12-15%, and raise HDL levels by 10-12%. Based on a great deal of clinical research, the recommended daily dose of a commercial garlic product should provide a total allicin potential of at least 4,000 mcg. Garlic Factors from Natural Factors provides nearly twice this level per tablet. The alternative is at least 4,000 mg of fresh garlic-roughly one or two cloves.

How do I know if the recommendations are working?

Within the first two months, either niacin or Sytrinol typically produce reductions in total cholesterol level of 50 to 75 mg/dl in patients with initial total cholesterol levels above 250 mg/dl. In cases in which the initial cholesterol level is above 300 mg/dl, I would recommend using both Sytrinol and niacin and it may take four to six months before cholesterol levels begin to reach recommended levels. Once the cholesterol level is reduced below 200 mg/dl, reduce the dosage of the niacin by 50% and recheck levels after two months. If the cholesterol levels creep up above 200 mg/dl, raise the dosage back to the full recommendation. If the cholesterol level remains below 200 mg/dl, then withdraw the niacin completely and check the cholesterol levels in two months. Re-institute supplementation if levels creep up over 200 mg/dl. If they maintain below 200 mg/dl you may be able to discontinue the Sytrinol as well.