With the American Heart Association reporting that more than 100 million Americans suffer from borderline-high cholesterol, it is safe to say that this health condition has reached epidemic proportions.
What exactly is cholesterol? It?s simply a fat found in the blood. ?Cholesterol is one of the body?s defense mechanisms. It?s found in every cell in the body and helps cells maintain their integrity—their shape and size,? says Dr. Fred Pescatore, founder of the Centers for Integrative and Complementary Medicine in New York. It is only when cholesterol levels get high that they become dangerous. ?The straight medical model says that high cholesterol levels cause plaque, which causes hardening of the arteries, [which] leads to high blood pressure and to coronary disease and ultimately stroke,? he says. Pescatore believes the body produces too much cholesterol in response to inflammation, which can arise from myriad triggers, such as a poor diet and stress.
High cholesterol has no symptoms, so having a blood test for cholesterol levels is important. ?You should start worrying about it when you are a teen-ager,? Pescatore says. ?No joke, a third of our kids are overweight and they have a higher likelihood of high cholesterol.? Individuals with normal cholesterol should have it checked every decade and those with high cholesterol every six months.
Although men tend to have higher cholesterol levels than women, females catch up once they reach menopause. ?Estrogen is cardio-protective, and at menopause estrogen levels drop,? Pescatore says.
Experts agree that the real key to lowering cholesterol is diet. Individuals with high cholesterol should avoid sugars, refined carbohydrates and saturated fats. In addition to the diet, there are supplements available that are proven to substantially reduce cholesterol numbers. Following are supplements that retailers may want to include in a cholesterol section.
Red rice yeast
This product is made by fermenting red rice to grow the yeast Monascus purpureus, which has been found in studies to be as effective at lowering cholesterol as statin drugs. ?It?s one of the best products for cholesterol,? Pescatore says. The remarkable aspect of red rice yeast is that it not only lowers levels of low-density lipoprotein cholesterol and triglycerides (unhealthy fats), but it raises levels of high-density lipoprotein (good) cholesterol. Researchers believe it works by the same mechanism as statin drugs—it restricts the liver?s cholesterol production.
Although the U.S. Food and Drug Administration has been threatening to pull red rice yeast products off store shelves because their active ingredient levels are too close to those of prescription statin drugs, the agency has not yet done so. FDA?s actions have resulted in a manufacturer suit, and currently the National Nutritional Foods Association is intervening to keep the products on the market.
Because red rice yeast acts the same as statin drugs in the body, the two should not be taken at the same time. Also, like statin drugs, red rice yeast can produce side effects such as stomach upset. The levels of active ingredients in the supplement can vary greatly, so retailers should ensure that the products they order contain effective levels.
The gums and pectins in soluble fibers form a gel when combined with water in the digestive tract. As it goes through the digestive system, soluble fiber binds with cholesterol, removing it as waste. ?Think of it as a glacier moving through the intestines,? says Robert Kowalski, medical journalist and author of the best-selling The 8 Week Cholesterol Cure (HarperTorch, 1999). ?When [cholesterol] is removed by the fiber, the body has to make more, so the liver has to draw cholesterol out of the bloodstream and so cholesterol levels fall,? he says.
The science supporting the effectiveness of soluble fiber in lowering cholesterol was so solid that in 1995 the FDA approved a health claim for oats (which are high in soluble fiber) stating that the grain helps reduce the risk of heart disease. The degree of cholesterol reduction depends on how often and how much soluble fiber a person eats. Studies show that 3 grams a day are needed to lower cholesterol. Fiber supplements are a good way for consumers to obtain enough of it in their diets.
Plant sterols are cell membranes present in fruits, vegetables, seeds and nuts. These membranes resemble the structure of cholesterol, which is itself a sterol, but an animal sterol. ?Sterols are so similar to cholesterol that the body can?t tell the difference when they enter the digestive tract,? Kowalski says. Specialized cells in the first third of the digestive tract pick up cholesterol and transport it to the bloodstream. ?These specialized cells will pick up sterols just as readily as cholesterol,? he says. So if sterols are taken before a meal, they saturate these specialized cells with sterols instead of the cholesterol from the meal.
Many foods such as margarine and salad dressing now contain sterols, but sterols can also be obtained with supplements. If supplements are used, they should be taken 15 minutes to 20 minutes prior to meals.
Daily supplementation with folic acid may help the body remove homocysteine, and in turn lower cholesterol. Homocysteine is an acid in the blood that can damage the inner lining of arteries and produce blood clots. Several studies have shown that patients with heart disease and stroke had low levels of folic acid and that subjects with high levels of B vitamins had lower homocysteine levels. In a 2002 Journal of the American Medical Association review, researchers found that high blood levels of homocysteine were indeed associated with cardiovascular disease, including high cholesterol levels, and that folic acid was confirmed to lower homocysteine levels. When subjects combined B6 and B12 supplementation, homocysteine levels decreased even further.
?We?re still not sure if homocysteine is a marker in people who have had cardiac events or whether it?s an indicator for coronary events, but most physicians are treating it as an indicator,? Pescatore says. He recommends that anyone with elevated homocysteine levels take a folic acid, B6 and B12 supplement.
Niacin, or B3, is another member of the B vitamin family that is proven to lower cholesterol. ?Taken in large doses [niacin] not only reduces LDL or bad cholesterol, but also triglycerides. I am a major advocate,? Kowalski says. One study, published in the Annals of Internal Medicine in 2000, found that when subjects took a beginning dose of 375 mg of niacin (which was increased during the study) the supplement raised HDL levels more than 25 percent and lowered triglyceride levels by 30 percent. When statin users added extended-release niacin to their treatment, it slowed disease progression 68 percent more than a statin alone, reported the American Heart Association journal Circulation in November 2004.
Niacin appears to work by stimulating the liver to produce less of a protein that carries triglycerides and LDL cholesterol, thereby reducing blood levels of these two compounds.
Although retailers should advise consumers with high cholesterol to overhaul their diets first and foremost, they can recommend supplements with confidence for an adjunct treatment. Consumers may need to try out several to see which works the best for them. ?People don?t need to take them all,? Pescatore says. ?I recommend two to three at a time.?
Anna Soref is a Lafayette, Colo.-based freelance writer.
Natural Foods Merchandiser volume XXVI/number 3/p. 86, 90