Cholesterol is an essential component of many vital organic molecules within the body, such as cellular membranes, steroid hormones (estrogen and testosterone), and bile acids. Cholesterol is a fatty substance made in the liver and is synthesized according to the body’s needs and specific requirements.
However, abnormally high levels of blood cholesterol (hypercholesterolemia), can be caused by dietary, lifestyle, and genetic factors. High blood cholesterol can build-up cholesterol-filled plaque in the arteries. This process is linked to coronary heart disease (CHD), heart attack, and strokes. Other risk factors for high blood cholesterol include low thyroid function (hypothryroidism), physical inactivity, obesity, and smoking.
Cholesterol is transported to and from the cells by special lipoprotein carriers; low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
- LDL is called the “bad” form of cholesterol, because it’s the main source of cholesterol accumulation in the blood vessels to the heart and brain. The higher the LDL blood cholesterol (greater than 160 mg/dL), the greater the risk of CHD. Patients with heart disease need to maintain an LDL cholesterol level of less than 100 mg/dL (milligrams per deciliter).
- HDL is called the “good” form of cholesterol, because it doesn’t form cholesterol-filled plaque in the arteries. Instead, HDL picks up cholesterol from the arteries and carries it back to the liver for disposal from the body. A high HDL blood cholesterol may protect against heart disease. Patients with a low HDL level (less than 35 mg/dL) have a higher risk of both heart attack and stroke.
Since there are often no overt symptoms in the early stages of high cholesterol, it’s important to have cholesterol levels measured at five year intervals after the age of 20, especially if you are at risk for the development of coronary heart disease. The risk factors for CHD include:
- Family history of heart disease
- Men 45 years or older
- Women 55 years or older (or premature menopause without estrogen replacement therapy)
- High LDL “bad” cholesterol
- Low HDL “good” cholesterol
- Cigarette smoking
- Diabetes mellitus
- Pysical inactivity
According to the National Center for Health Statistics (NCHS) (1):
- 18 percent of adults age 20 years and over have high serum cholesterol
- The mean serum cholesterol level for adults age 20 years and over, is 203 mg/dL.
- Cholesterol screenings should be ordered at 5.2 percent of doctor’s visits.
The National Cholesterol Education Program (NCEP) recommends that all healthy adults be screened for both total cholesterol and HDL cholesterol levels (2). Treatment depends on the results of this cholesterol screening, and one’s assessment of coronary heart disease risk factors. Cholesterol management may include dietary and lifestyle modifications, nutritional supplements, and prescription drug therapy. The dietary and lifestyle guidelines to lower cholesterol include:
- Reducing or eliminating the amount of animal products in the diet (contains saturated fat and cholesterol)
- Eliminating partially hydrogenated fats and oils (trans fats)
- Eating small portions of lean meat, fish and poultry, and fat-free and low-fat dairy products
- Eating fiber-rich plant foods (fruits, vegetables, grains, soy, and legumes).
- Maintaining a healthy weight
- Exercising regularly
- Don’t Smoke
“Statins” drugs, such as atorvastatin (Lipitor), are commonly prescribed to reduce total and LDL cholesterol, as well as triglycerides. Other medications that reduce cholesterol include gemfibrozil and clofibrate. These drugs have, however, been associated with toxic side effects.
Niacin (Vitamin B3)
Supplementation with niacin has been known to lower cholesterol levels for decades. Studies have shown that niacin lowers LDL cholesterol, while raising HDL cholesterol (3). Other studies comparing niacin to lipid-lowering drugs (lovastatin and gemfibrozil) have reported that although lipid-lowering drugs produced a greater reduction in LDL cholesterol, niacin produces a greater increase in HDL cholesterol (4, 5). Due to niacin’s side effects at high doses (including skin flushing, gastric irritation, nausea, and liver damage), the safest form of niacin is flush-free niacin (inositol hexanicotinate) (6).
Pantethine (Vitamin B5)
Pantethine, the active form of vitamin B5, reduces cholesterol synthesis in the liver.
Studies have found that pantethine supplementation lowers LDL cholesterol, while raising HDL cholesterol (7-9).
Studies have demonstrated that Vitamin C supplementation increases HDL cholesterol and lowers total cholesterol (10-14). The antioxidant activity of vitamin C also may help to prevent LDL oxidation by free radicals, there in turn lowering the risks for developing atherosclerosis (15).
Vitamin E helps to lower LDL cholesterol levels and prevents LDL oxidation by free radicals. Vitamin E also lowers specific risk factors for developing atherosclerosis (16).
Essential Fatty Acids (Fish Oil)
Supplementation with essential fatty acids such as fish oil have been reported to reduce plasma cholesterol levels, with the most significant decrease being in triglycerides (17, 18).
Soy has been shown to lower cholesterol and to reduce the risk of coronary heart disease (19). One study reports that a soy based diet decreased LDL and total cholesterol, while slightly increasing HDL cholesterol (20).
Numerous studies have found that garlic lowers LDL and total cholesterol, raises HDL cholesterol, and reduces the risk of coronary heart disease (21-24). The most effective garlic supplements are those standardized for its beneficial components, alliin and allicin.
Policosanol, a natural supplement derived from sugar cane wax, has been shown to decrease blood cholesterol levels (25). Studies have found that policosanol lowers LDL and total cholesterol, while raising HDL cholesterol (25, 26). Another study comparing policosanol to lipid-lowering statins drugs reported that policosanol produced a slightly lower reduction in LDL cholesterol and a greater increase in HDL cholesterol than the other drug treatment groups, without side effects (27).
Guggulipid (Commiphora mukul)
Guggulipid, an extract of the mukul myrrh tree (Commiphora mukul) of India, has been used for centuries to treat various ailments including obesity and infections. Supplementation with guggulipid effectively lowers blood cholesterol levels (28).
High soluble fiber intake can lower blood cholesterol levels (29, 30). Studies have reported that the dietary supplementation with psyllium fiber effectively lowers blood cholesterol levels (31-34).
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