What is Cholesterol?
Cholesterol is an essential component of every cell in your body and is needed to manufacture hormones and other life-giving substances. Although cholesterol is obtained through high-fat and/or high-cholesterol foods, approximately 85 percent of cholesterol in the body is manufactured by the liver and, to a lesser degree, the small intestine. Cholesterol circulates in the bloodstream in carrier packages called lipoproteins, which have fat (lipid) inside and protein outside.
There are two types of lipoproteins that transport cholesterol in the blood:
Low-density lipoprotein (LDL) cholesterol, considered the “bad” cholesterol, is a sticky, fat-like substance that can adhere to the walls of the arteries. When someone has a high level of LDL, the excess can be deposited onto the artery walls, creating blockages and resulting in the increased risk of heart disease.
High-density lipoprotein (HDL) cholesterol, considered “good” cholesterol, works to remove LDL cholesterol from the arteries and transport it back to the liver to be metabolized. If you have a low level of HDL, you have increased risk of heart disease.
We all have been told, or have read, that excessive cholesterol in the blood accumulates in the artery walls. However, there appears to be more to the story. Research over the past decade has shown that much of the artery problem caused by cholesterol is the result of oxidation. Oxidation occurs when free radicals (unstable negatively charged molecules) damage cells of the body. Free radicals are the byproduct of energy production by the body’s cells, as well as the exposure to pollutants and radiation.
The Harmful Effects of Oxidized Cholesterol
Oxidized cholesterol (particularly LDL cholesterol) then initiates inflammation and eventual plaque build-up in the blood vessel wall, which inhibits blood flow through the arteries. This oxidation leads to inflammation and damage in the artery walls.
Your body has a defense mechanism against free radicals and oxidation. Substances called antioxidants are an integral part of that defense mechanism. Antioxidants neutralize or reduce the effects of cell damaging free radicals. Though your body has naturally occurring antioxidant enzyme systems, you also need antioxidants from foods, particularly plant foods such as fruits, vegetables, and legumes.
Elevated fats in the blood also help contribute to atherosclerosis and heart disease risk. These fats in the blood are known as triglycerides. Triglycerides come from the diet or are manufactured by the liver. Elevations are common in those with increased blood sugar levels as seen in diabetes or insulin resistance. A high level of these fats can restrict blood flow and make one more susceptible to stroke.
Are Statins Over-Prescribed?
In the July 13, 2004, issue of Circulation: Journal of the American Heart Association, the National Institute of Health’s National Cholesterol Education Program (NCEP) published new guidelines for LDL cholesterol levels. According to the NCEP, “These options include setting lower treatment goals for LDL (‘bad’) cholesterol and initiating cholesterol-lowering drug therapy at lower LDL thresholds.” These new recommendations were based on the review of five major clinical trials using a group of cholesterol lowering drugs known as “statins.”
The science behind these new conclusions was challenged by more than three dozen physicians, epidemiologists, and other scientists, together with the Center for Science in the Public Interest (CSPI). In a letter that detailed their objections, physicians and scientific researchers urged the National Institute of Health (NIH) to seek an independent panel to re-review the studies. They wrote:
“There is strong evidence to suggest that an objective, independent re-evaluation of the scientific evidence from the five new studies of statin therapy would lead to different conclusions than those presented by the current NCEP. The studies cited do not demonstrate that statins benefit women of any age or men over 70 who do not already have heart disease.”
In the letter, doctors from the CSPI also cited concerns that were raised after one study showed statin therapy significantly increases the risk of cancer in the elderly. In addition, researchers noted, three of four studies involving people with diabetes showed that these patients got no significant benefit from increased statin use.
And there was another alarming discovery as well. Eight of the nine authors of the new LDL recommendations had financial ties to manufacturers of statin drugs, including the pharmaceutical companies Pfizer, Merck, Bristol-Myers Squibb, and AstraZeneca. (Normal medical publishing requires the disclosure of financial ties associated with the authors of a study.)
Authors of the CSPI letter summarized their suspicions about the NCEP report by stating, “The sad fact is that these lifestyle recommendations are being largely ignored, partly because the ‘experts,’ many of whom have conflicts of interest through their relationships with statin manufacturers, focus ever more attention on lowering cholesterol with expensive drugs.” The response from the Acting Director of the National Institutes of Health National Heart, Lung, and Blood Institute was to declare that the scientific basis was adequate and there was no conflict of interest from panel members.
Risk factors for heart disease you can change:
- High blood pressure
- High blood cholesterol
- Physical inactivity
- Blood sugar balance
- Omega 3 fatty acid level
- Reaction to stress*
- Nutrient deficiencies such as magnesium*
- Cardiovascular blood risk factors*
Dr Stengler tests for blood risk factors go well beyond regular cardiovascular blood tests and include:
C-Reactive Protein – A marker of inflammation in the body, including the blood vessel walls. It is considered the best predictor of heart disease.
Homocysteine – Build-up of this toxic metabolite increases plaque formation in the artery walls. Genetics, low thyroid, B vitamin deficiencies, and high animal protein diet increase the level.
Lipoprotein (a) – A more specific cholesterol marker and a stronger risk factor than LDL cholesterol.
Fibrinogen – Plays an important role in blood clotting. Elevated levels increase the risk of stroke and coronary artery disease.
Apolipoprotein B – A type of lipid which binds to LDL cholesterol and accelerates plaque formation.
Apolipoprotein A-1 – Found in HDL cholesterol and provides a protective effect against heart disease.
Apolipoprotein B and Apolipoprotein ratio – An overall predictor of heart disease risk.
Glucose/hemoglobin A1C – Diabetes predisposes one to early heart disease.
Insulin -Elevation of this hormone is seen with “syndrome X”-a condition characterized by rising blood sugar and insulin levels. Spiked Insulin levels increases arterial inflammation, as well as triglyceride, cholesterol, and blood pressure levels. It also contributes to weight gain.
Iron– Excessive iron in the body produces free radicals and oxidative damage.
Omega 3 fatty acid index – High levels of omega 3 fatty acids reduced the risk of heart attack and stroke.
Toxic metals – Heavy metals such as lead increase risk of heart disease.
Fungal overgrowth– Contribute to inflammation.
Hormone Imbalances(such as cortisol, estradiol, testosterone) – Imbalances contribute to inflammation of the arteries.
Treatment for High Cholesterol
Cholesterol-lowering drugs are very commonly prescribed by North American doctors. For example LipitorTM, a common cholesterol-lowering drug, was the second most prescribed drug in the United States in 2005. The purpose of these drugs is to prevent and treat heart disease by slowing or halting the build-up of plaque in the arteries. The accumulation of plaque, known as atherosclerosis, results in the blockage of blood flow and increases the risk of a heart attack or stroke. Plaque accumulation in the heart arteries is of particular concern: it contributes to high blood pressure and reduces the amount of oxygen that reaches the heart, a dangerous situation.
Cholesterol-lowering drugs are also prescribed as a preventive measure. They can help people who have suffered from previous heart attacks. According to guidelines set by the National Institute of Health, an estimated 65 million people have high cholesterol, and approximately 37 million, or one in five adults, are eligible for cholesterol-lowering therapy. [Read Dr. Stengler’s article: Beware! Your Cholesterol Numbers Might Not Mean What You Think!]
Diet and Lifestyle Changes
Improved diet and increased exercise are both important in the natural treatment of high cholesterol. For some people, changes in diet and lifestyle will be sufficient to normalize their cholesterol levels. For others, these changes will help, but specific nutritional supplements will also be required.
1. Reduce saturated fat in the diet to be less than 7 percent of daily calories. Saturated fat is found mainly in beef, veal, poultry (especially in dark meat, and when the skins are present). Saturated fat is also found in most dairy products except nonfat yogurt and cheese, and skimmed milk. Small amounts of saturated fat are found in coconut and palm oils, which should be used sparingly. Avoid products that contain trans fatty acids, which are found in deep-fried foods, bakery products, packaged snack foods, margarines (except margarines containing plant stanols or plant sterols), crackers, and vegetable shortening. If trans fats are present above 0.5 grams per serving, they will be listed on the label package. They are linked to cardiovascular disease since they raise LDL cholesterol and triglycerides, and reduce HDL cholesterol. Cook with organic olive or canola oil.
2. Consume two servings a week of heart healthy omega 3 fatty acids found in fish such as anchovies, Atlantic herring, sardines, tilapia, and ocean or canned salmon. (For best seafood choices, see the nonprofit website www.oceansalive.org, which lists the safest fish to eat.)
3. Consume 5 to 7 servings of fruits and vegetables daily. They contain fiber that helps lower cholesterol as well as antioxidants that prevent cholesterol oxidation.
4. Regularly consume foods containing soluble fiber such as beans, barley, oats, peas, apples, oranges, pears, as they contain soluble fiber which reduces the absorption of cholesterol from the intestines into the bloodstream. For example, a daily bowl of oatmeal can reduce total cholesterol by as much as 23%. It has also been shown to reduce the “bad” LDL cholesterol, while leaving beneficial HDL cholesterol alone. In addition, oats are a rich source of tocotrienols. These relatives of the vitamin E family prevent the oxidation of LDL cholesterol (which prevents LDL cholesterol from sticking to artery walls and causing plaque buildup) and reduce the production of cholesterol by the liver.
5. Consume nuts rich in monounsaturated fatty acids such as almonds and walnuts. For example, a study conducted at the Lipid Clinic in Barcelona, Spain, showed that a walnut-rich diet reduced total cholesterol by as much as 7.4% and LDL cholesterol by as much as 10%. Other studies have found that walnuts significantly increase the elasticity of the arteries, which is a marker of healthier blood vessels. The Food and Drug Administration (FDA) allows walnuts to carry the health claim that “eating 1.5 ounces per day of walnuts as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.”
6. Consume ground flaxseeds (up to a quarter cup daily with 10 ounces of water) as they have been shown to reduce total and LDL cholesterol.
7. Consume 20-30 grams daily of soy protein daily (in food or protein powder form).
8. Reduce simple sugar in the diet (which has been shown to decrease the good HDL cholesterol). By cutting back on simple sugar, you also reduce the risk of elevated insulin levels, which lead to an increased production of cholesterol by the liver.
9. Exercise regularly. Thirty minutes of exercise, three to five times a week, has been shown to be effective for elevated cholesterol. Even walking has been shown to benefit cholesterol levels. Exercise decreases total and LDL cholesterol and increases the good HDL cholesterol.
10. Lose weight and body fat, and you’ll also reduce cholesterol levels. You also improve insulin resistance, which is related to elevated cholesterol levels.
11. Stop smoking. Habitual smokers have lower levels of HDL cholesterol and increased risk of heart attacks.
12. Adopt stress reduction techniques. (Stress has been shown to elevate cholesterol in some individuals.)
Dr. Stengler’s Solutions
Dr. Stengler utilizes diet, exercise, and supplements as a first line therapy to balance cardiovascular risk markers such as elevated cholesterol. Supplements he commonly uses includes red yeast rice extract, niacin, fish oil, plant sterols, garlic, and others.
Study on Effect of Red Yeast Rice Extract on Heart Disease
A study published in the Journal of the American Geriatric Society examined the effect of red yeast rice extract on the risk of heart disease in Chinese people with a history of cardiovascular disease. The trial involved 1,445 Chinese people ages 65 to 75. About half of them were given 600 mg of xuezhikang two times per day and the other half was given a placebo two times per day for four years. The treatment group had a reduced rate of new coronary events including nonfatal heart attacks, sudden death from cardiac causes, and other heart-related deaths by almost 37%. Those taking red yeast rice extract were also 48% less likely to die from other causes such as cancer and stroke than were people in the placebo group. (J Am Geriatr Soc 2007;55:1015–22.)