Beyond Diet and Exercise: Alternative Approaches to Lowering Cholesterol

For some people, diet and exercise just won’t be enough to lower their cholesterol. But there’s one more step before moving on to prescription medication. There’s a lot of scientific evidence that certain alternative approaches can successfully improve cholesterol.

Niacin

Niacin is actually a B vitamin that has been shown to not only lower LDL and triglycerides, but also to raise HDL. When taken in doses in the area of 1,500 to 3,000 mg per day, LDL levels are usually reduced by about 5% -15%, and up to 25% in some patients.

Also called nicotinic acid or vitamin B3, it decreases production of particles in the liver that are necessary for carrying cholesterol and fat in the bloodstream. Although it is a B vitamin, the high dosages required to affect cholesterol should be taken only under a physician’s supervision.

Such high doses are considered “pharmacologic” and must be prescribed by a qualified healthcare practitioner. The practitioner will instruct you on how to increase the amount of niacin slowly, over the course of 4 to 6 weeks, and to take the medicine with meals to avoid stomach irritation.

Phytosterols

Phytosterols  are naturally occurring plant compounds that block the body from absorbing cholesterol. Their chemical make-up is similar to cholesterol, so that they fool the body and block the absorption of cholesterol.      Phytosterols are benign and not absorbed by the body.

Plant Stanols and Sterols

Plant stanols and sterols occur naturally in small amounts in many plants. Those used in certain food products are taken from soybean and tall pine tree oils. Plant stanols and sterols help block the absorption of cholesterol from the digestive tract, which therefore helps to lower LDL. Studies show that a daily intake of about 2 grams of either stanols or sterols reduces LDL cholesterol by about 5% – 15% often within weeks.

Stanol and sterol esters can be found branded margarines. The product, Benecol contains stanol ester while Take Control contains sterol ester. Both Benecol and Take Control are low in saturated fat and trans fat and are considered healthy margarines.

Turmeric

Turmeric, the spicy yellow ingredient found in Indian food, contains the active ingredient, curcumin. Recent research suggests that curcumin may reduce cholesterol by interfering with intestinal cholesterol uptake, increasing the conversion of cholesterol into bile acids, and increasing the excretion of bile acids. Curcumin has powerful antioxidant and anti-inflammatory properties and may help prevent the oxidation of LDL cholesterol to a more dangerous form that is more likely to end up in your arteries.

Medical authors such as Dr. Andrew Weil and Dr. Nicolas Perricone advise copious amounts of turmeric in your diet for a host of health reasons, not to mention the flavor – Bon Appetit.

Red Rice Yeast Extract

Originating in Asia, red rice yeast extract derives from the activities of red yeast on rice and the byproduct has been proven to lower cholesterol. It contains the same ingredient found in prescription statin drugs, and statin drugs have a physiological effect on the liver. Consequently, the use of red rice yeast extract should be considered risky and not taken without consulting your physician.

The Indian Guggul

Guggulipid is extracted from guggul and also contains plant sterols. Guggul is a yellowish resin produced by the mukul mirth tree, a small, thorny plant that grows throughout northern India. Several studies suggest guggul and guggulipid lower cholesterol levels. However, the jury is still out on this one and more evidence may be needed.

When All Else Fails: The Use of Statin Drugs

If all diet, exercise and alternative measures fail, then a prescription route may need to be followed. Again, remember all those sorcerer’s brooms building up cholesterol in your arteries year after year, you don’t want to let this go.

The advent of powerful cholesterol-lowering drugs known as statins (with brand names such as Crestor, Lipitor, Zocor, and the like) has made it possible for virtually anyone to safely slash total and LDL cholesterol. Discuss this option with your family doctor.

Unfortunately, statins are costly and have side effects. And worst of all, once started you’re on them for life. According to the NIH, “Statins stop an enzyme that controls the rate at which the body produces cholesterol. They lower LDL levels more than other types of drugs-about 20% -55% -and also moderately lower triglycerides and raise HDL.

Conclusion

Heart Disease is the number one killer in the U.S. Science to date attributes the depositing of plaque on artery walls via excess cholesterol as a major contributor. Control this substance now and you can mitigate the risk of heart disease later in life. Extreme cases will require prescription medication and close monitoring by a physician.

As always, prevention is best. However, the simple, but permanent, lifestyle changes outlined in this piece can cut it off at the pass.

The Natural Route: Try Diet and Exercise First

Should you discover that you have elevated LDL cholesterol and a low HDL factor, your doctor will most likely insist that you immediately go on a statin drug. Forgive her. It’s not her fault, that’s the training doctors get in Western medicine — a system that only reimburses for drugs and surgery and not diet and lifestyle changes.

But we also live in an era of the educated patient, and you have the right to collaborate with your doctor to try alternative means before going on statin drugs for the rest of your life. So discuss the natural route first to see if you can get your numbers in the healthy range.

But also realize that your doctor probably has received no training in nutrition or exercise to help prescribe a program to you. She will most likely tell you to eliminate red meat and dairy products and walk or exercise more. For some, this may be enough, but for many it will not and bigger changes in diet and exercise will need to be implemented to affect improvement.

The Value of Aerobic Exercise

Exercise is a proven way to improve cholesterol. It sets off a series of enzymatic reactions in the body that increase HDL and lower triglycerides.

Probably the person most credited for launching the aerobics craze of the eighties, was Dr. Kenneth Cooper in his landmark book, Aerobics.

According to Dr. Kenneth Cooper, regular aerobic exercise will contribute to increasing HDL and lowering triglycerides.

He’s also written sequel books on exercising for better health, including improving one’s cholesterol. In his book Controlling Cholesterol The Natural Way, Cooper advises:

“We’ve known for a long time that exercise – especially aerobic exercise done over a sustained period of 20 to 30 minutes or so at least 3 days per week – can raise the level of “good’ HDL cholesterol by 5-10%… another fact that we have known for a while is that exercise can lower levels of blood triglycerides… [this] involves the release during exercise of an enzyme known as lipoprotein lipase, or LPL, which breaks down the triglycerides for use as body fuel.”

Therefore regular aerobic exercise, walking, jogging, biking, say 3 times per week for 30 minutes even at only 50% of aerobic maximum will burn up triglycerides while stimulating more HDL…not to mention how good it will make you feel.

Stress Management Through Yoga, Pilates or Tai Chi

Daily stress raises your cholesterol levels. Therefore any form of stress-management technique may help lower it. All forms of exercise will relieve stress and keep you in the “present moment.” In particular, mind-body exercise that emphasizes concentration on breath, such as yoga, Pilates and tai chi, are exceptional forms of stress management.

Specific Dietary Changes to Lower LDL

One could write books on all the various foods that affect some component of cholesterol. One basic concept to understand is that cholesterol comes from two sources, the food you eat and your own body. The cholesterol in your system from diet is only about 20%. That means 80% is manufactured by your liver.

There is much inconclusive discussion on whether eliminating dietary cholesterol has any affect on health at all. But again, based on current science, it is recommended that the intake of dietary cholesterol be minimized. This underscores the importance of reading those food labels.

The elimination of high cholesterol items such as milk products and egg yolks is healthier anyway. Milk products are high in saturated fats and egg yolks are high in arachidonic acid, and their reduced intake is good for overall health.

Limiting Dietary Cholesterol

The National Heart Lung and Blood Institute advise that you limit dietary cholesterol to 300 milligrams per day. Certain foods with high concentrations of dietary cholesterol should be limited. Beef, pork and bacon have anywhere from 80 to 90 mg. of cholesterol per 3 ½ once serving. Lamb has 122 mg. and veal 128 mg. Fried chicken with the skin on is an unhealthy 167 mg., while roasting it with the skin off is a healthier 85 mg., the same as turkey. Boiled shrimp tops the list with 195 mg. per serving.

Limit Daily Intake of Saturated Fats

Saturated fat raises your blood cholesterol more than anything else in your diet. Americans eat an average of 11% of their total calories as saturated fat. Your liver uses saturated fat to make LDL cholesterol.

Saturated fat is identifiable as a solid at room and refrigerator temperatures. It is found in the greatest amount in foods from animals, such as fatty cuts of meat, poultry with the skin on, whole-milk dairy products and lard, as well as in some vegetable oils, including tropical oils like coconut and palm oils.

Eliminate All Trans Fats

Trans fats are bad for a number of reasons, only one being that it increases cholesterol. Although the package for margarine may say 0% cholesterol, the bad news is that it stimulates the liver’s production of cholesterol.

Trans fatty acids are formed when liquid vegetable oils go through a chemical process called hydrogenation. Common in a range of food products – biscuits, chips, doughnuts, crackers – the hydrogenated vegetable fat is used by food processors because it is solid at room temperature and has a longer shelf life.

So, as you read those food labels, eliminate all foods that contain the phrase hydrogenated or partially hydrogenated.

Eat Fewer High Glycemic Foods

High glycemic foods turn to glucose very quickly in the bloodstream and are generally bad for health for a number of reasons . You should eat fewer simple carbohydrates such as sugar, white flour, white rice, and high-fructose corn syrup, which can markedly increase your triglycerides. These should be offset with lower glycemic foods like unrefined, complex carbohydrates such as fruits, vegetables, whole grains, legumes and soy products.

Foods That Improve Cholesterol

O.K., now that have a list of items to either eliminate or reduce in your diet, there are others that you should try to increase in your diet to improve your cholesterol make-up.

Soluble Fiber Inhibits the Absorption of Cholesterol

In addition to reducing the intake of dietary cholesterol, another remedy is to block your absorption of cholesterol in the first place and that’s where soluble fiber does the trick nicely.

Soluble fiber dissolves into a gel-like substance in the intestines. The substance helps to block cholesterol and fats from being absorbed through the wall of the intestines into the blood stream. Research shows that people who increased their soluble fiber intake by 5 – 10 grams each day had about a 5% drop in their LDL cholesterol. The NIH recommends that you get at least 5 – 10 grams of soluble fiber a day-and, preferably, 10-25 grams a day, which will lower your LDL even more.

Brussels sprouts, pinto beans, navy beans, lima beans, kidney beans, black beans, pears (with skin), whole citrus fruits (not juice), and psyllium are high sources of soluble fiber.

The Value of Oats

Oats should be part of your daily diet to control cholesterol. Oats contain Beta-glucan, which has also been shown to lower LDL. Scientists from the U.S. Department of Agriculture’s Agricultural Research Service have developed a new oat variety containing higher levels of beta-glucan. This variety may soon allow food manufacturers to offer smaller portions of whole oat products that will pack the same health benefits as ordinary oats. Also on the horizon is “HiFi”, which is not a stereo system but a new strain of oat that lowers LDL even further.

Red Grapefruit

According to Dr. Shela Gorinstein of Hebrew University, one red grapefruit a day will keep the cholesterol away and help prevent heart disease. Her team’s study published in the March 2006 issue of Journal of Agricultural and Food Chemistry found that red grapefruit (more so than white grapefruit) was effective in lowering cholesterol, although it is not yet clear as to why.

To be continued in next post…

Aging and Rising Cholesterol Levels

Cholesterol levels tend to rise as we age, but when should one reach for a statin drug for presumably the rest of their life?

The matter should not be take lightly, it is a forerunner to heart disease — the No. 1 killer in the US, responsible for 37% of all deaths.

According to Louisiana State University AgCenter nutritionist, Beth Reames, one out of every two men and one out of every three women will develop heart disease sometime in their lives. That’s a big percentage and the philosophy of wellness is to proactively address health risks before they become medical conditions.

As with all health issues, we can only respond to the science that is available at the moment. There are conflicting theories. Some suggest that rising LDL is not a threat, per se, but is a player in a biological conspiracy. Alternate theories label inflammation as the chief culprit. But until links between heart disease, C-Reactive Protein and Homocysteine (measures of inflammation) are more readily used, we must stick with the cholesterol yardstick, know our numbers and take proactive measures.

The Sorcerer’s Apprentice – Cholesterol Keeps Rising Over Time

Remember the Disney story of the Sorcerer’s Apprentice? The brooms kept carrying buckets of water and, over time, an unmanageable ocean was formed.

The same phenomenon happens with cholesterol deposits; they keep building year by year and cause a narrowing of our artery walls. In some cases this leads to a coronary block and either angina or a cardiac arrest.

As children we start out with a low total cholesterol reading somewhere in the 30-70 mg/dL range. (The yardstick for measuring cholesterol and all its subcomponent parts is milligrams per deciliter). As maturing adults that number trends upward for most of us and breaks into the 200s by middle age.

If you haven’t had your cholesterol measured in a while, it’s high time, because it’s probably gone up. Aging boomers are having an impact on total population numbers. A recent report in the Journal of General Internal Medicine revealed that an estimated 63 million U.S. adults have high LDL cholesterol levels, and as a consequence, 38 million are at increased risk for heart disease.

Regardless of your age, you should begin to make lifestyle and dietary changes now that will keep this beast in its cage. Even the young should make adjustments, because they can more easily adopt lifelong dietary and lifestyle changes that will stave off a cholesterol problem later. First of all, it’s not all bad. Cholesterol is an odorless, white, waxy, powdery substance that is found in every cell of our bodies. We actually need a certain amount of it to sustain life. It is an important building block for cell membranes, hormones and vitamin D. It also aids in the digestion of fat into caloric energy.

Cholesterol consists of lipoproteins. A lipoprotein is a combination of fat (lipid) and protein that wraps around the individual fat molecules in our bodies, transporting them throughout our bodies and aiding in the digestion of fat.

But too much of a good thing turns into a bad thing. Many factors in modern society cause cholesterol to elevate as we age. Evolution never addressed the problem of too much cholesterol in our bodies because we never used to live this long. Therefore we have to take control, get smarter and take preventive measures. According to the National Institute of Health, the recommended cholesterol test is called a ‘lipoprotein profile.’ It measures the levels of total cholesterol, LDL, HDL, and triglycerides in the blood. The lipoprotein profile is calculated from a small sample of blood after a 9 to 12-hour fast.

Know Your Numbers

The 3 numbers that are most closely monitored are HDL, LDL and triglycerides — the good, the bad and the ugly. LDL is singled out as the real bad guy and triglycerides are his general accomplice.

Think of HDL as Clint Eastwood. It actually sops up the harmful LDL which needs to be removed from the system. So, you want more HDL and less of LDL. Actually LDL is not in itself bad, it’s excess LDL that is bad. In fact without some LDL you could not survive. Aristotle’s “everything in moderation” rules.

Triglycerides are fats that, as the name implies, consist of three fatty acids attached to a molecule of glycerol. The role triglycerides play in heart disease is conflicting. But generally speaking, it is a good idea to have low triglyceride levels. O.K., so we want to keep our LDL number nice and low, but what’s the acceptable range? And when should we be concerned? According to the American Heart Association, adults age 20 or older should have their cholesterol levels checked minimally every five years. Unfortunately many people ignore this and walk around with elevated cholesterol levels without knowing it.

Here Are The Ranges For The Various Components:

Sources: American Heart Association and Dr. Kenneth Cooper’s book: Controlling Cholesterol the Natural Way.

In the old days there was a simple decision process, doctors only monitored the total cholesterol count and when that got above 200, they would write a prescription for a statin medication to bring it down. Recent scientific advances now look at the interplay between the component parts

A New View on Cholesterol

New thought on cholesterol does not focus on the “total cholesterol count” but gives strong consideration to the ratio of its subcomponent parts — particularly the relationship between HDL and total cholesterol. Recall that HDL is the good stuff that actually removes LDL from our blood vessels.

Think of LDL and HDL as transport vehicles. LDL transports cholesterol to your arteries and deposits it there. HDL retrieves cholesterol from your arteries and expels it through the liver. So, if your HDL and LDL are in balance, if you are retrieving as much as you are depositing, theoretically you’re at less risk even though you may have a high total cholesterol count.

As an analogy, imagine that you have a crew of workmen dumping 100 wheelbarrow loads of dirt per hour into a pit, and another crew of workman removing dirt from that very same pit at the same rate of 100 wheelbarrow loads per hour. Dirt will never accumulate in that pit. Similarly, the same holds true for cholesterol. For example, let’s say you’re male with a total cholesterol of 200. According to our chart above, you would be categorized as borderline. But let’s say your HDL level is 60. Then the HDL ratio is calculated as follows:

HDL Factor = Total cholesterol / HDL

HDL Factor = 200/60=3.3

When we refer to the chart above, the 3.3 number is in the healthy zone for men. This is significant because there are many natural ways to elevate your HDL number.

Unfortunately, many schooled MD’s are still only looking at the total cholesterol number when they advise treatment, especially the prescription of statin drugs. You should discuss the HDL factor with your doctor and see if she agrees that your risk is lower and therefore you don’t need medications.

To be continued in our next post…