New Lows Advised for Cholesterol

By Mark Stengler, ND

Do you know your cholesterol levels? Updated cholesterol level guidelines made headlines recently, calling for individuals in specific risk categories to reduce LDL cholesterol levels (low-density lipoprotein, the so-called “bad cholesterol”) to new lows. The guidelines, issued by the National Cholesterol Education Program, may mean millions more Americans will be advised to enter cholesterol-lowering drug therapy through the use of statins, a class of lipid-lowering drugs that work in the liver to reduce the production of LDL cholesterol by inhibiting the activity of a liver enzyme, known as HMG CoA reductase.

The guidelines for cholesterol-lowering intervention are based on the degree of risk for coronary heart disease (CHD) events. Individuals with existing CHD, diabetes, or atherosclerotic disease are at the highest risk and are recommended to attain the lowest level of LDL. For people who do not have existing CHD or elevated LDL, the classification and treatment recommendations are based on whether they have other risk factors (such as high blood pressure, smoking, low HDL cholesterol, and family history of CHD). Anyone with two or more risk factors is advised to keep LDL levels below 130mg/dL. People with no risk factors or only one should keep their LDL levels below 160 mg/dL.

Understanding Cholesterol
Cholesterol is an essential component of every cell in the body and is needed to manufacture hormones and other life-giving substances. Although cholesterol is obtained through high-fat, high-cholesterol foods, the body also manufactures its own cholesterol —primarily in the liver, and to a lesser degree the small intestine.

There are two types of cholesterol. Low-density lipoprotein (LDL), 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 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.

Lowering Cholesterol
So if you do have high cholesterol levels, what exactly are your options? At what point do you consider medication as a solution?

Most nutrition-oriented doctors recommend diet and lifestyle changes, as well as nutritional supplements, as the frontline treatment for elevated cholesterol levels and other cardiovascular risk factors. This involves addressing stress, environmental toxins, diet, and exercise. Nutritional supplements are used to prevent cholesterol oxidation and to optimize cholesterol levels and other cardiovascular risk markers.

Some individuals have very high cholesterol levels due to genetic factors. For example, someone with a total cholesterol level above 300 mg/dL or LDL above 240 mg/dL may very well require statin drug therapy, especially in light of a strong family history of heart disease or genetically high cholesterol levels. In addition, studies are demonstrating that statin drug therapy should be strongly considered for immediate use after a heart attack to reduce the risk of further coronary events. Doctors also may advise drug therapy for people who are unwilling to change hazardous diet and lifestyle behaviors, or for individuals for whom nutritional treatment and lifestyle changes are not effective.

Statin drugs are a group of cholesterol-lowering drugs used for the prevention of cardiovascular disease. Common examples include lovastatin (Altacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), and atorvastatin (Lipitor).

Statins’ Side Effects
A critical part of making the decision to begin drug therapy for high cholesterol levels involves being fully informed. Statin drugs often are effective at lowering cholesterol, but they come with the potential of several side effects, including elevated liver enzymes or liver damage, kidney damage, and myopathy—a group of neuromuscular disorders in which the primary symptom is muscle weakness due to dysfunction of muscle fiber. Other symptoms of myopathy can include muscle cramps, stiffness, and >> spasm. The risk of myopathy increases when statin drugs are used with drugs such as cyclosporine, fibric acid derivatives, erythromycin, niacin, or antifungals. In rare cases, the drugs may cause rhabdomyolysis—a potentially fatal disease that destroys muscle.

Another disadvantage of statin medications is that they deplete the energy-producing nutrient coenzyme Q10 (CoQ10). A 1993 study in the Journal of Clinical Pharmacology found that the use of certain statin drugs reduced CoQ10 levels by an average of 40 percent after three months of use. Several other studies have also found that CoQ10 levels are lowered by the use of cholesterol-lowering drugs. In one study, 100 mg per day of supplemental CoQ10 reversed this effect. Coenzyme Q10 is important for energy production within all of our cells, including the cells of the heart. Therefore, it is important to maintain healthy CoQ10 levels for optimal energy production and cardiovascular function.

Controlling Cholesterol Naturally
Diet: Following a healthy diet can help improve cholesterol levels and reduce the major risk factors for heart disease: high cholesterol, high blood pressure, and unhealthy weight. Your diet should focus on whole foods (fruits, vegetables, whole grains, nuts, and seeds) that are rich in fiber and nutrients that promote cardiovascular health. Reduce your intake of packaged and processed foods. Foods known to aid in lowering high cholesterol levels include cold-water fish such as salmon, mackerel, and halibut. Foods such as oatmeal, lentils, legumes, walnuts, soy, and garlic have also been shown to improve cholesterol levels. In addition, for overall heart health, choose lean protein sources such as soy products and skinless turkey and chicken, while limiting your intake of read meat.

Exercise: Experts agree that regular exercise is important for improving cholesterol levels. Exercise doesn’t need to be complicated to reap heart-healthy benefits. Simply walking briskly for 20 minutes, three times a week will make a difference in your cardiovascular health. If you have not been exercising on a regular basis, consult your doctor before starting any exercise routine.

Super Supplements: Various studies have shown the efficacy of several nutritional supplements in reducing total and LDL cholesterol, while increasing the heart-friendly HDL cholesterol.

A review of placebo-controlled studies in the American Heart Journal found that policosanol lowered total cholesterol by 17 percent to 21 percent and LDL cholesterol by 21 percent to 29 percent. It also raised the good HDL cholesterol by 8 percent to 15 percent. The report found that a daily dose of 10 mg of policosanol was as effective in lowering total or LDL cholesterol as the statin drugs simvastatin (Zocor) or pravastatin (Pravachol). The recommended dose is 10-20 mg daily.

Red yeast rice (Monascus purpureus) is a powerful supplement shown to significantly lower total cholesterol levels. In one study, men and women took 1.2 grams of red yeast rice extract daily for two months. Researchers found a significant de-crease in total and LDL cholesterol. In addition, HDL levels were significantly increased and elevated triglycerides were lowered. Also, a double-blind trial at UCLA School of Medicine found that supplementing with 2.4 grams per day of red yeast rice extract for 12 weeks >> significantly lowered total and LDL cholesterol in a group of people who had elevated cholesterol.

Niacin has been the focus of many studies on elevated cholesterol and triglyceride levels. It has been shown to increase the good HDL and lower LDL cholesterol, as well as improve other cardiovascular risk markers.

Guggul (Commiphora mukul) extract has been shown to reduce total cholesterol, LDL, and triglyceride levels. As an added bonus, it can increase HDL cholesterol. Most studies on guggul have used a standardized extract of guggulsterones, commonly referred to as gugulipid.

A 12-week study demonstrated that 1,500 mg of gugulipid reduced total cholesterol by an average of 22 percent and triglycerides by 25 percent. Another study of 205 people with elevated cholesterol or triglyceride levels showed that gugulipid worked better than the cholesterol-lowering drug clofibrate (Atromid-S). HDL cholesterol was increased in 60 percent of participants who responded to gugu-lipid therapy, while clofibrate had no effect on HDL cholesterol. The recommended dose for reducing cholesterol and triglyceride levels is 1,500 mg of a 5 percent guggul standardized extract.

Navigating the Cholesterol Maze
In the confusing world of elevated cholesterol levels, it is strongly recommended that you consult with a nutrition-oriented doctor on diet, lifestyle, and nutritional supplements. For those who require drug intervention, it is important that preventative measures such as nutritional supplementation and lifestyle modifications be implemented to prevent serious side effects.

Enter a comment related to this article

---