Related Items: Dyslipidemia, Dyslipidemic Diet,
Hypercholesterolemia, Hypercholesterolemic Diet, Hyperlipoproteinemia
High Cholesterol Information
Although it is by no means the only major risk factor, elevated serum (blood) cholesterol
is clearly associated with a high risk of heart
disease.
Most doctors suggest cholesterol levels should stay under 200 mg/dl. As levels fall below
200, the risk of heart disease continues to decline. Many doctors consider cholesterol levels
of no more than 180 to be optimal. A low cholesterol level, however, is not a guarantee of
good heart health, as some people with low levels do suffer heart attacks.
Medical laboratories now subdivide total cholesterol measurement into several components,
including LDL (“bad”) cholesterol, which is directly linked to heart disease, and
HDL (“good”) cholesterol, which is protective. The relative amount of HDL to LDL
is more important than total cholesterol. For example, it is possible for someone with very
high HDL to be at relatively low risk for heart disease even with total cholesterol above 200.
Evaluation of changes in cholesterol requires consultation with a healthcare professional and
should include measurement of total serum cholesterol, as well as HDL and LDL cholesterol.
The following discussion is limited to information about lowering serum cholesterol levels
or increasing HDL cholesterol using natural approaches. Because high cholesterol is linked to
atherosclerosis and heart disease, people concerned about heart disease should also learn more
about atherosclerosis.
What are the symptoms of high cholesterol?
This condition does not produce symptoms. Therefore, it is prudent to visit a health
professional on a regular basis to have cholesterol levels measured.
Dietary changes that may be helpful for high cholesterol
Eating animal foods containing saturated
fat is linked to high cholesterol levels1 and heart disease.2 Significant amounts of
animal-based saturated fat are found in beef,
pork, veal,
poultry (particularly in poultry skins and dark meat), cheese,
butter, ice cream, and all other forms of
dairy products not labeled “fat
free.” Avoiding consumption of these foods reduces cholesterol and has been reported to
reverse even existing heart disease.3
Unlike other dairy foods, skimmed milk,
nonfat yogurt, and nonfat cheese are essentially fat-free. Dairy products
labeled “low fat” are not particularly low in fat. A full 25% of calories in 2% milk come from fat.
(The “2%” refers to the fraction of volume filled by fat, not the more important
percentage of calories coming from fat.)
In addition to large amounts of saturated fat from animal-based foods, Americans eat small
amounts of saturated fat from coconut and palm oils. Palm oil has been reported to elevate
cholesterol.4 5 Research regarding coconut oil is mixed, with some trials finding no link
to heart disease,6 while other
research reports that coconut oil elevates cholesterol levels.7 8
Despite the links between saturated fat intake and serum cholesterol levels, not every
person responds to appropriate dietary changes with a drop in cholesterol. A subgroup of
people with elevated cholesterol who have what researchers call “large LDL
particles” has been reported to have no response even to dramatic reductions in dietary
fat.9 (LDL is the “bad” cholesterol most associated with an increased
risk of heart disease.) This phenomenon is not understood. People who significantly reduce
intake of animal fats for several months but do not see significant a reduction in cholesterol
levels should discuss other approaches to lowering cholesterol with a doctor.
Yogurt, acidophilus milk, and kefir are fermented milk products that have been
reported to lower cholesterol in most,10 11 12 13
14 15 16 but not all, double-blind and other controlled
research.17 18 19 Until more is known, it makes sense for
people with elevated cholesterol who consume these foods, to select nonfat varieties.
Eating fish has been reported to increase
HDL cholesterol20 and is linked to a reduced risk of heart disease in
most,21 but not all, studies.22 Fish contains very little saturated fat, and fish oil contains EPA and DHA, omega-3 fatty acids that a
Lifestyle changes that may be helpful for high cholesterol
Exercise increases protective HDL cholesterol,135 an effect that occurs even
from walking.136 Total and LDL cholesterol are typically lowered by exercise,
especially when weight-loss also occurs.137 Exercisers have a relatively low risk
of heart disease.138 However,
people over 40 years of age, or who have heart disease, should talk with their doctor before
starting an exercise program; overdoing it may actually trigger heart attacks.139
Obesity increases the risk of heart
disease,140 in part because weight gain lowers HDL cholesterol.141 Weight loss reduces the body’s ability to
make cholesterol, increases HDL levels, and reduces triglycerides (another risk factor for heart
disease).142 143 Weight loss also leads to a decrease in blood
pressure.
Smoking is linked to a lowered level of HDL cholesterol144 and is also known to
cause heart disease.145 Quitting
smoking reduces the risk of having a heart attack.146
The combination of feelings of hostility, stress, and time urgency is called type A
behavior. Men,147 148 but not women,149 with these traits are
at high risk for heart disease in most, but not all, studies.150
Stress151 or type A behavior152 may elevate cholesterol in men. Reducing
stress and feelings of hostility has reduced the risk of heart disease.153
Nutritional supplements that may be helpful for high cholesterol
Glucomannan is a water-soluble dietary fiber that is derived from konjac root.
Controlled154 155 and double-blind156 157 trials
have shown that supplementation with glucomannan significantly reduced total blood
cholesterol, LDL cholesterol, and
triglycerides, and in some cases raised HDL cholesterol. Effective amounts of glucomannan
for lowering blood cholesterol have been 4 to 13 grams per day.
Test tube and animal studies indicate that
policosanol is capable of inhibiting cholesterol production by the liver.158
159
Extensive preliminary and double-blind research in Cuba and other countries in Latin
America has demonstrated that taking 10 to 20 mg per day of policosanol extracted from sugar
cane results in significant changes in blood cholesterol levels, including total cholesterol
(17 to 21% lower on average), LDL cholesterol (21 to 29% lower), and HDL cholesterol (7 to 29%
higher).160 161 162 163 164
165 166 167 168 169 170
The combined results of nine double-blind trials indicate that supplementation with beta-hydroxy-beta-methylbutyrate (HMB)
effectively lowers total and LDL cholesterol.171 All trials used 3 grams per day,
taken for three to eight weeks.
Vitamin C appears to protect LDL
cholesterol from damage.172 In some clinical trials, cholesterol levels have fallen
when people with elevated cholesterol supplement with vitamin C.173 Some studies
report that decreases in total cholesterol occur specifically in LDL
cholesterol.174 Doctors sometimes recommend 1 gram per day of vitamin C. A review
of the disparate research concerning vitamin C and heart disease, however, has suggested that most
protection against heart disease from vitamin C, is likely to occur with as little as 100 mg
per day.175
Pantethine, a byproduct of vitamin B5 (pantothenic acid), may help reduce the
amount of cholesterol made by the body. Several preliminary176 177
178 179 180 and two controlled181 182 trials
have found that pantethine (300 mg taken two to four times per day) significantly lowers serum
cholesterol levels and may also increase HDL. However, one double-blind trial in people whose
high blood cholesterol did not change with diet and drug therapy, found that pantethine was
also not effective.183 Common pantothenic acid has not been reported to have any
effect on high blood cholesterol.
Chromium supplementation has reduced total
cholesterol,184 185 LDL cholesterol186 187 and
increased HDL cholesterol188 189 in double-blind and other controlled
trials, although other trials have not found these effects.190 191 One
double-blind trial found that high amounts of chromium (500 mcg per day) in combination with
daily exercise was highly effective, producing nearly a 20% decrease in total cholesterol
levels in just 13 weeks.192
Brewer’s yeast, whi
Herbs that may be helpful for high cholesterol
Researchers have determined that one of the ingredients in red yeast rice, called monacolin K, inhibits the
production of cholesterol by stopping the action of the key enzyme in the liver (i.e., HMG-CoA reductase) that is
responsible for manufacturing cholesterol.288 The drug lovastatin (Mevacor®) acts in a fashion similar
to this red-yeast-rice ingredient. However, the amount per volume of monacolin K in red yeast
rice is small (0.2% per 5 mg) when compared to the 20 to 40 mg of lovastatin available as a
prescription drug.289
The red yeast rice used in various studies was a proprietary product called
Cholestin®, which contains ten different monacolins. The sale of Cholestin has been
banned in the United States, as a result of a lawsuit alleging patent infringement. Other red
yeast rice products currently on the market differ from Cholestin in their chemical makeup.
None contain the full complement of 10 monacolin compounds that are present in Cholestin, and
some contain a potentially toxic fermentation product called citrinin. 290 Until
further information is available, red yeast rice products other than Cholestin cannot be
recommended.
Use of psyllium has been extensively
studied as a way to reduce cholesterol levels. An analysis of all double-blind trials in 1997
concluded that a daily amount of 10 grams psyllium lowered cholesterol levels by 5% and LDL
cholesterol by 9%.291 Since then, a large controlled trial found that use of 5.1
grams of psyllium two times per day significantly reduced serum cholesterol as well as
LDL-cholesterol.292 Generally, 5 to 10 grams of psyllium are added to the diet per
day to lower cholesterol levels. The combination of psyllium and oat bran may also be effective at lowering LDL
cholesterol.293
Guggul, a mixture of substances taken from
a plant, is an approved treatment for elevated cholesterol in India and has been a mainstay of
the Ayurvedic approach to preventing atherosclerosis. One double-blind trial studying the
effects of guggul reported that serum cholesterol dropped by 17.5%.294 In another
double-blind trial comparing guggul to the drug
clofibrate, the average fall in serum cholesterol was slightly greater in the guggul
group; moreover, HDL cholesterol rose in 60% of people responding to guggul, while clofibrate
did not elevate HDL.295 A third double-blind trial found significant changes in
total and LDL cholesterol levels, but not in HDL.296 However, in another
double-blind trial, supplementation with guggul for eight weeks had no effect on total serum
cholesterol, but significantly increased LDL-cholesterol levels, compared with a
placebo.297 Daily intakes of guggul are based on the amount of guggulsterones in
the extract. The recommended amount of guggulsterones is 25 mg taken three times per day. Most
extracts contain 5 to 10% guggulsterones, and doctors familiar with their use usually
recommend taking guggul for at least 12 weeks before evaluating its effect.
In a double-blind trial, people with moderately high cholesterol took a tincture of
Achillea wilhelmsii, an herb used in traditional Persian medicine.298
Participants in the trial used 15 to 20 drops of the tincture twice daily for six mon
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The information presented in Healthnotes is for informational
purposes only. It is based on scientific studies (human, animal, or in
vitro), clinical experience, or traditional usage as cited in each article.
The results reported may not necessarily occur in all individuals. For many of
the conditions discussed, treatment with prescription or over the counter
medication is also available. Consult your doctor, practitioner, and/or
pharmacist for any health problem and before using any supplements or before
making any changes in prescribed medications.
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