Heart Health: Lowering High Cholesterol
Sample Chapter from Natural Medicine, Optimal Wellness
by Jonathan V. Wright, M.D. and Alan R. Gaby, M.D.

Dr. Wright's Case Study

The doctor I saw for my check-up wants me to take a cholesterol-lowering drug . . ." David MacElroy began.

"And his wife won't let him!" Wendy MacElroy finished. "He finally took a step to check on and protect his health, and I won't let him take that - poison - as a result."

"C'mon, Wendy, it's not poison, it's a medicine," David said.

"I've read the complete drug description in the PDR - the Physicians' Desk Reference - and it certainly is," Wendy replied. "It might lower your risk of dying from cholesterol-related illness, but it raises your risk of dying of something else. It's the same for all those 'cholesterol' drugs. And I know that changing what you eat and taking the right vitamins can control your cholesterol and help you be healthier and probably live longer, too!"

"Don't get excited, that's why I'm here." He turned toward me. "I admit that I've been a 'junk fooder' all my life. Wendy's tried to raise our kids right on really good food, and I haven't been much of a help or a very good example. But I turned 40 this year, and I made up my mind it's time to reform. I haven't told you yet that my father died of a heart attack at 56, and his father died the same way at 61. I figure I can only push it so far."

"Likely you're right. How high was your choolesterol?"

"It was 322."

"And your HDL-cholesterol - the 'good' cholesterol?"

"Thiry-four," Wendy said. "Definitely high risk. I have to give Dave some credit - even before he had his cholesterol checked; I guess it was right after his 40th birthday - I noticed he was cutting back on the hamburgers and grease when we're out."

"Even I know that 'low fat' is the way to go to lower cholesterol, isn't it?"

"Most of the time, but not always. Is there any diabetes in your family?"

"I don't think so. Neither of my parents, or any of my grandparents, as far as I know. Wendy?"

"Don't know why it's always us women who're supposed to know these things," she smiled. "But we do. No one in David's family can think of anyone who's had diabetes." She paused. "Why does that make any difference?"

"Individuals with diabetes in their families frequently have their cholesterol levels - and triiglycerides as well - raised mostly by sugar, refined carbohydrate, and carbohydrate in general in the diet, and less by dietary fat."

"Really? Maybe that's why my friend Molly has been so frustrated with her cholesterol. It just won't come to normal, and she's been the strictest low-fat person I know for several years. But her mom has 'maturiry' diabetes ... but back to Dave. He should be on low-fat, right?"

"Sounds like that's right for him."

"OK, so I'll ease back on beef and pork, eliminate the eggs and butter, use margarine and lowwfat milk, Cut way back on ice cream, eat more chicken and turkey--'is that the general idea?"

"We'd better review 'good' fats and 'bad' fats and a few related topics. Generally speaking, the 'bad' fats - the ones we want to reduce - are the saturated fats, and the 'good' fats are the unsatuurated fats. You're right about beef and pork - their fat content is all 'saturated', so cutting these foods back is wise. Actually, the fats in chicken and turkey are mostly saturated, too, there's just less of it. But there's one 'animal protein' that contains almost entirely 'good', unsaturated fats ..."

"That's fish, isn't it?" Wendy asked.

"Yes"

"Well, Dave likes salmon and halibut ... "

"And marlin and swordfish and mahi and nearly any fish but cod," David said. "It's just hard to find those in a 'fast-food' format - but I like' em, and I'll do it, as long as I can have some chicken and turkey, too."

"No problem. Now, about margarine, butter, milk, and other dairy, and eggs. First, margarine is worse for us than butter. It does contain unsatturated fats, but some of them are trans-fatty acids, which are probably worse than eating satuurated fat itself. If you must use one or the other, butter's better, but mostly avoid it. For home use, you could make 'better butter', a mixture of buttter, beneficial oils, and lecithin, first suggested by Adelle Davis ..."

"My mother has all her books, I'll look it up!" Wendy exclaimed.

"There's not much to say about milk, except that it belongs in little cows and not in little people - or big ones for that matter. There's even good reason to suspect that homogenized milk is a cause of atherosclerosis, independent of its fat content. Stop milk - just say no!"

Dave looked bothered. "What about cheese and ice cream?"

"Dave really likes ice cream," Wendy said. "That part's easy. There are terrific alternative products. We've put Rice Dream, Ice Bean, and similar products to the 'children's party' test, and they always disappear completely."

"That's the best test there is," Wendy agreed. "Where do we get them? And what about cheeses?"

"Natural-food stores. And once Dave's cholesterol is under control, a little cheese occasionally will likely be tolerable. Now, about those eggs - eat 'em!"

David looked puzzled. "Why's that? I thought eggs were full of saturated fat and cholesterol."

"The 'average' egg has approximately 300 millligrams of cholesterol, but more importantly, the 'average' egg contains approximately 1,500 millligrams of phospholipids. It's a bit technical, but those phospholipids more than offset any possible adverse effects of egg cholesterol. Even more importantly, phospholipids have a unique function in keeping brain-cell membranes healthy. Eggs and soy are the only dietary sources of phospholipids. Since most of us still don't eat soy products - although for you it actually would be a good idea, since soy protein has been shown to lower serum cholesterol - if we eliminate eggs, we're eliminating the only dietary source of nutrients crucial to brain cells."

"I need all the brain protection I can get," David said.

"Me too! I never recommend eliminating eggs except as a 'last resort.'"

Wendy reviewed her notes. "Let's see - much more fish, chicken, turkey, less beef and pork, add some soy protein, no milk or dairy except maybe a little cheese later on, eat those eggs ... and you didn't mention it yet, but on the 'posiitive' side, lots of vegetables, fruits, and whole grains - and eliminate sugar, white flour, and food chemicals."

"Excellent summary, and you're right, I should have emphasized the vegetables, fruits, and whole grains first. I also should mention other foods which lower cholesterol. In addition to soy prootein, garlic, onions, oat bran, carrots, and alfalfa sprouts are all beneficial."

"Now, what about supplements?" "There are so many vitamins, minerals, and botanicals known to lower serum cholesterol that drugs are virtually never a necessity. Let's see, there's inositol hexanicotinate, lecithin, pantethine, L-carnitine, beta-sitosterol, calcium, and chromium. Then, to raise HDL cholesterol, the 'good' cholesterol, there's magnesium, vitamin C, chromium, lecithin (or phosphatidyllcholine), and vitamin E. Then there are botaniicals, including gugulipid, garlic oil, ginger, pectin, fenugreek powder, reishi mushroom, silymarin, turmeric, Garcinia camboga, artichoke ... "

"Whoa," David exclaimed. "If you or Wendy think I'm going to take all that stuff ... "

"No, of course not. Just illustrating why drugs are hardly ever necessary. We'll keep it a lot simpler. Besides, if you're serious about reforming your diet ..."

"I am, I am. I've passed the big 4-0. I'm not a kid anymore."

"Then supplementation will be less necessary.

So: please start with vitamin E - the 'mixed toocopherol' type - 400 IU daily. There are several studies show that vitamin E lowers heart-attack risk by a very significant percent."

"Next, inositol hexanicotinate, 600 milliigrams, twice daily. It's helpful for lowering serum cholesterol, and a much safer form of niacin when higher quantities are necessary."

"Third, vitamin C. For now, please use 2 grams twice daily. Also, please get a high-potency multiple vitamin/mineral with at least 200 microograms of chromium and 300 to 400 milligrams of magnesium. You may need to get a separate multiple mineral if you can't find those in a vitamin-mineral combination. Lastly, lecithin. Remember those phospholipids for brain cells?

Besides eggs, soy lecithin is the only other diet source. Might as well protect those brain cells and increase your HDL cholesterol with the same item. Please obtain the 19-grain capsules, and for now, take 2 twice daily."

"That's it?" Wendy asked.

''Along with real diet change, that should do the job. If not ... "

"I know, there are 50 million more suppleements I could take," Dave said.

After 6 months, Dave's total cholesterol was down to 237 mg/ dl, and his HDL cholesterol had risen to 41 mg/ dl. At the end of a year, his numbers were 188 and 46, respectively, and his risk of following his father and grandfather to an early cardiac death was substantially reduced.

Dr. Gaby's Commentary

While lowering elevated serum choolesterol seems like a good idea, the outcome (in terms of heart disease and mortality) depends on how you do it. In one study, men with heart disease were assigned to receive either no dietary advice (control group) or a low-fat diet supplemented with unsaturated fat (corn oil). Although treatment with corn oil reduced serum cholesterol, it also nearly doubled the incidence of heart attacks, compared with the control group. This adverse effect of corn oil may have resulted from a depletion of vitamin E (unsaturated fats increase vitamin E requirements). Another possibility is that ingesting large amounts of corn oil (about 4 tablespoons per day in this study) upset the ballance between omega-3 and omega-6 fatty acids. These two types of essential fatty acids, which are classified according to their chemical structure, are each important for cardiovascular health. Howwever, the typical Western diet already appears to contain too many omega-6 fatty acids (found in corn oil, sunflower oil, and safflower oil) relative to the amount of omega-3 fatty acids (found in fish oil, flaxseed oil and, to a lesser extent, soybean oil). Creating a further imbalance by taking a corn-oil supplement might cause a relative deficiency of omega-3 fatty acids, which could adversely affect the heart.

Studies using cholesterol-lowering drugs have also produced conflicting results. For example, long-term treatment with clofibrate did not improve coronary mortality and actually increased the death rate from other causes. Administering cholestyramine (Quesrran) did reduce heart-disease deaths, but did not significantly reduce total mortality, because deaths from other causes were increased. The newer "statin" drugs (such as pravastatin and simvastatin) have produced more enncouraging results - reducing both coronary and total mortality. However, the long-term safety of these drugs has not been demonstrated, and there is concern that they may cause cancer.

While the evidence indicates that most of us should aim for a serum cholesterol level near the lower end of the normal range (such as 150 to 180 mg/dl), we should seek to attain these levels in ways that do not cause adverse effects. Fortunately, there are a number of safe, natural ways to lower total and LDL cholesterol and/or raise HDL cholesterol, through both diet and natural treatments.

Dietary Considerations

Foods to Eat, Foods to Avoid

A cholesterol-lowering diet should be low in total fat and refined sugar (refined sugar lowers HDL cholesterol in some individuals). Specific foods that have been shown to reduce serum choolesterol include soy products, carrots, oat bran, yogurt, walnuts, garlic, and onions. High-fiber foods (such as whole grains, legumes, fruits, and vegetables) may also help lower cholesterol levels. In one study, the cholesterol-lowering effect of a diet high in fruits, vegetables, and nuts was 34 to 49% greater than what would have been predicted from the fat content of the diet. Boiled (unfilltered) coffee contains at least two compounds that raise serum cholesterol, whereas filtered coffee has little or no effect on cholesterol levels. Ingesting one or two alcoholic beverages per day may inncrease HDL cholesterol; however, there is still no firm proof that drinking alcohol prevents heart disease. Although eggs contain a large amount of cholesterol, eating eggs does not seem to raise serum cholesterol levels in most people.

Role of Food Allergies

Food allergy may also be a cause of elevated serum cholesterol. In one study, 7 patients with multiple food allergies followed a diet in which most of the calories came from beef fat. The patients were also given various nutritional supplements. Although such a diet would normally have been expected to increase serum cholesterol, the average level actually fell from 263 to 189 mg/ dl. Evidently, eliminating the biochemical stresses associated with repeated allergic reactions helped lower serum cholesterol, although the nutritional supplements may have had an effect, as well.

Nutritional Supplements

Pantethine

A naturally occurring derivative of the B-vitamin pantothenic acid, pantethine plays a role in the metabolism of fat and cholesterol. Several studies have shown that pantethine can reduce serum cholesterol levels by about 10 to 20%, while increasing HDL cholesterol by 10% to as much as 38%. These results are similar to those seen with many cholesterol-lowering drugs. Pantethine has not been reported to cause any significant side effects, even with long-term use. Unlike panteethine, pantothenic acid does not affect serum choolesterol levels.

Niacin (nicotinic acid) is recognized in conventional medicine as an effective cholesterol lowering vitamin. Large doses (such as 3 grams per day) can substantially reduce cholesterol levels and may increase HDL cholesterol; however, at those doses, niacin sometimes puts stress on the liver or causes other side effects. Smaller amounts (such as 1,300 mg per day) have been shown to reduce serum cholesterol by an average of 11 %. Even lower doses of niacin can reduce serum cholesterol if chromium is taken at the same time. In one report, a daily dose of 100 mg of niacin and 200 mcg of chromium reduced serum cholesterol from 399 to 280 mg/dl in one patient and from 337 to 260 mg/ dl in another. This combination treatment probably works by promoting the production of glucose-tolerance factor, a molecule that enhances the action of insulin. Unlike niacin, niacinamide does not decrease serum cholesterol.

Inositol hexanicotinate, a compound that connsists of niacin plus the B-vitamin inositol, can be used as an alternative to niacin. Inositol hexaniicotinate does not typically cause the "niacin skin flush" (an uncomfortable skin reaction that often occurs after taking niacin and lasts about 20 to 30 minutes) and has not been associated with liver toxicity. However, this compound does not appear to be as effective as niacin at lowering serum cholesterol levels. In addition, there is not enough published research to know whether inositol hexanicotinate is completely safe for the liver.

In a double-blind study, 56 patients with high serum cholesterol were randomly assigned to receive calcium (as calcium carbonate), 400 mg, 3 times per day, or a placebo for 6 weeks, and the alternate treatment for an additional 6 weeks. Commpared with the placebo, calcium reduced LDL cholesterol by 4.4% and increased HDL cholesterol by 4.1 %. The ratio of LDL to HDL cholesterol deecreased significantly with calcium treatment (suggesting a reduction in cardiac risk). The mechanism by which calcium affects cholesterol levels is not fully understood, although it may bind cholesterol and fats in the intestinal tract, thereby preventing their absorption.

Other Nutrients

Vitamin E has been shown to increase HDL cholesterol levels, but only in relatively young individuals (around age 30) who have abnormally low HDL choiesterol. Vitamin C at a dose of 1 gram per day increased HDL-cholesterol levels in elderly men and women with heart disease and in elderly men (but not women) without heart dissease. In another study, 16 patients with elevated LDL- and low HDL-cholesterol levels received approximately 400 mg of magnesium per day fot 4 months. Total cholesterol decreased significantly from an average of 297 to 257 mg/dl, while HDL cholesterol increased significantly from 35.2 to 46.7 mg/dl. Other nutrients that may lower serum cholesterol and/or raise HDL cholesterol include copper, lecithin, and essential fatty acids. L-carnitine has been shown to have a beneficial effect on both total- and HDL-cholesterol levels; however, in some cases L-carnitine causes a paradoxical worsening of cholesterol levels. An herb known as gugulipid (Commiphora mukul) has been shown to reduce serum cholesterol by more than 20%, without producing any significant adverse effects. Beta-sitosterol, a steroid found in many plant foods, has also been reported to lower serum cholesterol. In selected cases, thyroid hormone is an extremely effective cholesterol-lowering agent.

Conclusion

The potential benefits of any cholesterol-lowering regimen (particularly drug therapy) should be weighed against its risks. A number of dietary modifications and nutritional supplements can reduce serum-cholesterol and/or increase HDL-cholesterol levels. Many of the nutrients discussed in this chapter also have been shown to prevent heart disease in ways that are unrelated to their effect on serum cholesterol. Antioxidants are espeecially important, as they may prevent cholesterol from being converted to dangerous cholesterol oxides.

Summary of Recommendations for Improving Cholesterol Levels

• Diet: Avoid refined sugar, refined flour, foods high in saturated fat and cholesterol (with the possible exception of eggs), margarine and partially hydrogenated vegetable oil, and unfilltered coffee. Emphasize fruits, vegetables, whole grains, nuts, seeds, legumes (particularly soy), and fish. Work with food allergies in selected

• Pantethine, 300 mg, 2 to 4 times per day.

• Inositol hexanicotinate, 500 to 600 mg, twice daily, plus chromium, 200 to 500 mcg per day. An alternative to this regimen is 100 mg of niacin per day, plus 200 to 500 mcg of chromium per day. Larger doses of niacin are more effective, but should be monitored by a doctor.

• Calcium, 600 to 1,200 mg per day, plus magnesium, 300 to 500 mg per day.

• Other nutrients or herbs that may reduce total cholesterol levels include L-carnitine (results are unpredictable), beta-sitosterol, gugulipid (Commiphora mukul), and essential fatty acids (results with fish oil are unpredictable).

• Other nutrients that may increase HDL cholesterollevels include vitamin C, vitamin E, L-carnitine (results are unpredictable), chroomium, and lecithin.

• Antioxidants such as vitamin C, vitamin E, seleenium, and carotenoids might help minimize the adverse effects of elevated serum cholesterol.

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