HealthBeat News

Cholesterol Questions

Dr. Myatt and Nurse Mark field a lot of questions from Wellness Club Members – and some of the most frequent concern cholesterol. They have asked me to devote this newsletter to answering some of those questions.

Cholesterol seems to be a subject on everybody’s lips recently, with medical scientists recommending even lower standards for cholesterol, and the pharmaceutical companies promoting an ever-increasing number of powerful cholesterol-lowering drugs. But what is this cholesterol stuff that everyone talks about, why do we have it, do we need it, and what can we do about it?

You might be excused if you think, because of all the “bad press” about the evils of cholesterol that it is a nasty, deadly foreign substance that should be avoided at all costs. Nothing could be further from the truth, let’s get clear on one thing: cholesterol is essential to life. We cannot live without it. It makes up about 80% of our body’s cell walls! This vital substance is synthesized by the liver and is used by the body as a building block for such essential things as steroid hormones, and bile acids in addition to cell membranes. Cholesterol also a precursor to Vitamin D in the skin, and without cholesterol we could not absorb the essential fat-soluble vitamins A, D, E and K from the food we eat. Cholesterol also gives the skin it’s ability to shed water and is essential to the growth and maintenance of the nervous system. So we really do need cholesterol – it is not the bad thing that some would have us believe it is.

Having said that, it is important to know that there are several kinds of cholesterol.

First is the “bad” cholesterol that we have all heard about, LDL or Low Density Lipoprotein. LDL carries most of the cholesterol in the blood, and this is the stuff that is the main source of accumulation and blockage and damage in the arteries. The more LDL you have, the greater your risk for Coronary Heart Disease (CHD.) Also getting plenty of attention lately is VLDL or Very Low Density Lipoprotein – which does the same things as LDL in terms of transporting fats (triglycerides and cholesterol) from the liver to the body’s cells.

Next is the “good” cholesterol, HDL or High Density Lipoprotein. It might be described as the “anticholesterol” as it’s job is to collect cholesterol in the blood and transport it back to the liver where it ends up being eliminated from the body. HDL can thereby keep LDL from building up on the walls of the arteries. HDL / LDL ratios are considered in many ways a better indicator of “cholesterol health” and CHD risk than simple, overall “cholesterol levels.”

Finally, there are Triglycerides, which aren’t exactly cholesterol – they are a form of fat that is carried through the bloodstream. Most of the body’s stored fat is in the form of triglycerides found in fat tissue. High levels of triglycerides in the blood do not by themselves cause atherosclerosis or CHD, but lipoproteins rich in triglycerides also contain cholesterol – which may cause atherosclerosis in people with high triglycerides. High triglyceride levels may be a warning sign of CHD risks.

Most people create plenty of cholesterol in their liver – remember, it is an important substance for normal body functioning. Conventional medical wisdom would have us believe that we should limit our dietary intake of cholesterol for this reason. That may be partially true, in that if the body is not producing enough HDL or “good” cholesterol to prevent the buildup of LDL (“bad”) cholesterol with it’s atherosclerotic effects or if the LDL receptors in the liver are not functioning properly then it might be wise to limit intake of cholesterols. On the other hand, Dr. Myatt’s research is leading her to believe that much of the “cholesterol problems” we are seeing today are related to dietary imbalances and deficiencies than to simple consumption of foods that contain this substance. In particular, trans fats are being found to be extremely harmful, creating a whole cascade of damaging effects throughout the body.

There are a number of mechanisms that the body uses to control cholesterol production, use, and therefore blood levels of cholesterol. The most important of these is in the liver where there is a chemical receptor that senses LDL, and when it has detected “enough”, tells the liver to stop making any more cholesterol. Damage to this important feedback control mechanism can occur through normal aging which reduces the number and efficiency of the LDL receptors, and several disease states – most importantly diabetes, and also low thyroid function. It is because of this feedback mechanism (when it is functioning properly) that eating foods high in cholesterol need not be risky – the intake of cholesterol in the diet simply tells the liver to stop making it’s own!

What can be done if you have been told that you have “high cholesterol?” First, if a conventional doctor has found your cholesterol levels to be “high” (and there is plenty of differing opinion on what “high” really is!) he or she has probably advised you to start taking a “statin” drug – and probably sent you off with a prescription for whatever is the day’s statin-of-choice and a recommendation to “eat less cholesterol – cut down on the fats!” If you do a little research on your own, you will discover that these statin drugs have some very worrisome side-effects, and that there are dozens, maybe even hundreds, of “natural” remedies, all claiming to be “the best” for safely lowering cholesterol levels. Dr. Myatt and Nurse Mark chuckle when they get emails and questions from Wellness Club members asking if they have heard about the latest and greatest pill or potion or “cure” – they’ve heard ’em all! There are a half-dozen or so things that have been well-proven to reduce LDL cholesterol levels, perhaps another half-dozen that might be helpful, and a whole basket-full of poorly-researched, unproven remedies that rely on anecdotal “patient success stories” in their glowingly inflated sales pitches. Beware – there are health hucksters and hustlers out there, preying on people’s fears and hopes!

So, let’s look at the things that we know can positively affect LDL cholesterol levels.

Perhaps the most important is Niacin.This substance has been known since the 1950’s to be a highly effective cholesterol lowering agent. We now know that niacin not only lowers LDL cholesterol, but also Lp(a), triglyceride, and fibrinogen (a blood protein that causes clot formation) levels, while it simultaneously raises beneficial HDL cholesterol levels. The Coronary Drug Project, an intensive and extensive evaluation of cholesterol-lowering drugs demonstrated that niacin was the only cholesterol-lowering agent that actually reduced overall mortality. It’s effects were also found to be very long lived, protecting patients in the study long after they had stopped taking it. Like any substance, niacin is not without it’s problems and cautions. It’s side effects are well known, the most common being a “niacin flush” – an uncomfortable flushing or hot feeling experienced by some people after taking standard niacin. Niacin can also be toxic to the liver when taken in a “time release” form that was developed to avoid the problem of the “niacin flush” that made some patients reluctant to use it. It can also impair blood sugar control, and should be used under medical supervision in people with diabetes. It is also important to monitor both cholesterol levels and liver enzyme levels every three months or so while using niacin. Dr. Myatt recommends a form of niacin called inositol hexaniacinate, AKA No-Flush Niacin as she has found this form of niacin to be very well tolerated. If niacin is so great, why don’t the drug companies sell it, and why doesn’t my doctor tell me to take it you ask? Well, though the evidence supports the use of niacin, it has also been victim of a lot of misinformation – your doctor may be ill-informed about it’s benefits, while he or she has certainly been told all about the “benefits” of the offerings of the drug companies. Niacin is a widely available “generic” substance, meaning it cannot be patented, and the drug companies do not stand to make from it the massive profits that the other cholesterol-lowering drugs have generated for them. As a result, one rarely sees niacin advertised in the way that the expensive statin drugs are. Still, it should be considered as the first choice in a cholesterol-lowering treatment.

Next in importance should be Red Rice Yeast. This substance is actually the result of a fungus that grows on white rice, turning it a red color. It has been known for centuries, and used as a colorant in oriental cuisine, and to make a form of red sake (rice wine.)  The active component here is a compound called mevinolin, which is identical to the prescription drug, lovastatin. The drug companies created lovastatin in the laboratory in 1987 using a fungus, Aspergillus terreus. The active ingredient in red Rice Yeast was discovered and isolated a decade earlier. Red Rice Yeast has been proven to be just as effective as the modern statin drugs at lowering LDL cholesterol. Taken in high doses, it can have some of the same risks as the modern statin drugs – namely a risk of liver damage and also of rhabdomyolysis, a condition that includes muscle deterioration. Anyone taking this or any statin drug should have a baseline liver enzyme check and have their liver enzymes checked periodically thereafter. Both risks are small (about 2%) but present. The good news is that it is thought that there is a synergistic effect obtained from other related compounds in Red Rice Yeast which allows much smaller doses to be effective. A typical dose of statin drug would be in the range of 20-80mg/day while a typical dose of Red Rice Yeast would be about 2.5-10mg/day. Neither Red Rice Yeast or statin drugs should be taken with grapefruit juice, as this can cause a dangerous buildup of the statins in the body.

Another well-established and effective cholesterol-lowering agent is garlic. Garlic has a very wide spectrum of beneficial effects, from lowering blood pressure to serving as a highly effective antibiotic and stimulating the immune system. Here however we are interested in garlic’s proven ability to lower LDL cholesterol when taken in appropriate doses of preparations that contains the the ingredient allicin. Allicin is the product of the substance alliin and the enzyme alliinase, and is fragile, dissipating quickly and easily during processing. A minimum therapeutic intake of allicin is considered to be about 4000 mcg. That is the equivalent to about one to four cloves of whole fresh garlic (depending on the size of the clove.) It is true that simply eating garlic (and it’s cousin onion) can have an excellent effect for lowering LDL cholesterol, blood pressure, and blood fibrinogen levels. You must remember though that this cannot be cooked garlic or onion, as cooking quickly destroys the active ingredient allicin. Anyone looking to buy garlic supplements should be aware of the German Commission E, a panel of experts which sets standards for dosage requirements to allow for therapeutic claims. Check the label to make sure the supplement you are considering meets their standards for strength and purity.

Policosanol is a “new kid on the block” in terms of cholesterol control, but is looking promising. “Policosanol” refers to a group of eight solid alcohols derived from sugar cane wax. Octacosanol is the major constituent of policosanol and proponents of this substance claim that Octacosanol is remarkably safe and effective at reducing cholesterol levels, and at reducing platelet aggregation. Dr. Myatt and her team are actively researching this substance, and if it proves to be everything that it claims to be, look for it to be made available through the Wellness Club just as soon as “the dragon lady” – oops, I mean Dr. Myatt – (“the dragon lady” is what our supplement suppliers call her because of her exacting quality standards) – pins down just where to obtain the very highest quality product. For now, it appears that this product might be in a bit of a shortage, and therefore more expensive than it perhaps should be, because the main source of supply is the sugar cane fields of Cuba. The leaves and rinds of citrus fruits also contain octacosanol, as does wheat germ oil – these may prove to be an alternate source for this promising substance.

Vitamin C has a well-studied positive effect at lowering total cholesterol and triglyceride levels while raising beneficial HDL levels. Vitamin C supplementation is valuable for many other reasons – it is an powerful antioxidant, and an immune enhancer. If you are considering using higher doses of vitamin C, use buffered vitamin C to avoid stomach upset. You should also know that Dr. Myatt’s Maxi-Multi contains 1200 mg of this important vitamin in the recommended daily dose.

Fiber has a time-honored place in any cholesterol-lowering regimen. High intakes of soluble fiber have been shown time and again to lower both overall and LDL cholesterol levels. Unfortunately, such high intakes of fiber can cause gastrointestinal upset in many people, and this causes them to not take effective doses. Psyllium and oat bran are two of the most-studied, and are easily available to add to the diet. You should NOT take psyllium if you are presently taking the prescription drugs digitalis or nitrofurantoin. Another form of fiber that is demonstrating great promise as a cholesterol-lowering aid is chitosan which is a substance made from the shells of shellfish. Chitosan has the effect of binding fat and cholesterol in the digestive tract. It is so effective at this that it will absorb as much as seven to eight times it’s own weight in fat and bile which are then passed through the bowel and excreted. Because of it’s fat-binding ability, chitosan is valuable as a weight loss aid as well as a cholesterol-normalizing agent. There are just a couple of caveats regarding chitosan: first, like any other fiber, chitosan can interfere with the absorption of certain nutrients and trace minerals. These should be taken at times other than when the chitosan is taken. Secondly, because chitosan is derived from the exoskeletons (shells) of shellfish, people with seafood allergies should use caution.

No cholesterol-lowering program would be complete without a discussion of diet. Rather than dire warnings and restrictive regimes that drastically limit fat intake, Dr. Myatt puts her patients on “The Super Fast Diet” for cholesterol control. Her patients find this to be a rich, balanced, satisfying diet, and they are pleasantly surprised to find that not only do their cholesterol levels normalize in short order, but so does their weight. This nutrient-rich diet has people feeling better, looking better, and performing better, and their lab results are the proof of it’s effectiveness.

That is the top half-dozen, proven, tested, effective cholesterol-lowering supplements and agents. They are not the only things in our armamentarium (that’s a medical word for “bag of tricks”!) though. Some of the “lesser lights” are not as well proven, or not as specifically effective at lowering cholesterol, but they may still be very valuable as a part of a coordinated cholesterol-lowering and health improving plan. Some of those include:

Artichoke has been studied since the 1930’s and found to have excellent effects on both atherosclerotic plaque and cholesterol and LDL levels. It is also highly protective, and may even be regenerative to the liver. It also possesses antioxidant properties. It is a valuable addition to a person’s daily supplementation. Dr. Myatt makes this available in combination with Milk Thistle which is a potent liver protector with regenerative properties and a powerful antioxidant and Turmeric which is a marvelous anti-inflammatory, antioxidant, liver-protective (on a par with milk thistle), anti-tumorgenic herb that also helps maintain normal blood viscosity.

Turmeric has been shown in a number of studies to have cholesterol-lowering effects of it’s own.  This, in addition to it’s other benefits as described above make it a “must do” in any daily supplementation program. Turmeric also inhibits platelet aggregation (med-speak for blood clotting) and serves as a natural cox-2 inhibitor like the prescription drug Vioxx.

Gugulipid is an ancient remedy that is being “rediscovered” by the western medical establishment. Gugulipid is made from the resin of the commiphora mukul tree of north central India and has been used for thousands of years to alleviate problems associated with obesity, acne, viral infections, and other ailments. It has also been shown in some limited but significant studies to reduce cholesterol and LDL levels and increase HDL levels within three to four weeks. It is certainly worth considering adding this to a cholesterol-lowering regimen.

Green Tea has also been the subject of some promising and even exciting research. Green tea serves as a potent antioxidant, preventing the oxidation of LDL in the arteries. The cholesterol-lowering effects of Green tea have been shown in numerous animal and human studies. Green tea catechins act to limit the rise in blood cholesterol according to a 1996 Japanese study. Further, Green tea has been shown to elevate HDL, and serves as a natural ACE inhibitor, lowering blood pressure. These benefits can be obtained by drinking up to 10 cups of Green tea daily, or taking one to two capsules of Green tea extract daily.

Fish Oil has been shown to reduce high levels of triglycerides by an average of 35%. It does not appear to reduce cholesterol to that extent, but it does offer benefits when as part of an integrated therapy program. Scientific studies have demonstrated that alpha-linolenic acid (from flax or perilla oil) reduces the incidence of atherosclerosis, stroke, and second heart attacks. One study showed a 70% reduction in second heart attacks in those consuming this type of fatty acid.

Vitamin E protects us from more than 80 diseases and illnesses, including protecting us from the inhibiting the effects of oxidation of LDL and the development of atherosclerotic disease. Studies have also shown it to be effective as some hypocholesterolemic (cholesterol-lowering) drugs. Anyone considering adding vitamin E to their regimen should also add Selenium which works with vitamin E to prevent LDL oxidation. Both of these nutrients are found in Dr. Myatt’s Maxi-Multi.

Finally, Soy has been shown to confer numerous benefits through it’s isoflavones, genistein, daidzein, and glycitein. According to a study completed in 1997, “Potential mechanisms by which soy isoflavones might prevent atherosclerosis include a beneficial effect on plasma lipid concentrations, antioxidant effects, antiproliferative and antimigratory effects on smooth muscle cells, effects on thrombus formation, and maintenance of normal vascular reactivity.” Bottom line: if you want to reduce your risk of heart disease and elevated cholesterol levels, it is worth adding soy to your diet.

So, we’ve talked about the first line, and “the helpfuls”, now let’s talk about the bogus, the time wasters, and the scams.

Coral Calcium – promoted as the cure for every thing from cancer to high cholesterol to bad breath to spiritual weakness. Many of it’s top promoters are facing criminal prosecution. Avoid it. If you need calcium supplements, consider something real, like Calcium D-Glucarate or Calmag Amino+ Vit D & Boron. It won’t do much for your cholesterol levels, but it will help your bones.

Various teas have been touted as total cholesterol cures, no doubt riding on the coattails of accepted Green Tea studies. Don’t believe them – Green Tea is an important part of a cholesterol-control program, but teas are not the whole answer!