Cholesterol Introduction

:cholesterol-sm.gif 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.

Cholesterol Symptoms

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

Cholesterol Statistics

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.

Treatments to Lower Cholesterol

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.

Supplements helpful for Lowering Cholesterol

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).

Vitamin C

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

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 Isoflavones

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).

Psyllium Fiber

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).


1. National Center for Health Statistics (NCHS), “Fast Stats: Cholesterol”:

2. Kwiterovich PO Jr. The antiatherogenic role of high-density lipoprotein cholesterol. Am J Cardiol, Nov. 1998, 82:9A, 13Q-21Q

3. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 351-353.

4. Illingworth DR et al. Comparative effects of lovastatin and niacin in primary hypercholesterolemia. Arch Intern Med 1994 (154): 1586-95.

5. Vega GL et al. Lipoprotein responses to treatment with lovastatin, gemfibrozil, and nicotinic acid in normolipidemic patients with hypoalphalipopproteinemia. Arch Intern Med 1994 (154): 73-82.

6. Arsenio L et al. Effectiveness of long-term treatment with pantethine in patients with dyslipidemias. Clin Ther 1986 (8): 537-45.

7. Gaddi A et al. Controlled evaluation of pantethine, a natural hypolipidemic compound, in patients with diferent forms of hyperlipoproteinemia. Atheroscl 1984 (50): 73-83.

8. Bertolini S, et al. Lipoprotein changes induced by pantethine in hyperlipoproteinemic patients: adults and children. Int J Clin Pharmacol Ther Toxicol. 1986;24(11):630-7. 11.

9. Binaghi P, et al. Evaluation of the cholesterol-lowering effectiveness of pantethine in women in perimenopausal age. Minerva Med. Jun1990;81(6):475-479.

10. Simon JA. Vitamin C and cardiovascular disease: a review. J Am Coll Nutr 1992 (11): 107-25.

11. Howard PA et al. Effect of vitamin c on plasma lipids. Pharmacother 1995 (29): 1129-36.

12. Jacques PF et al. Ascorbic acid and plasma lipids. Epidemiology 1994 (5): 19-26.

13. Hallfrisch J et al. High plasma vitamin C associated with high plasma HDL and HDL2 cholesterol. Am J Clin Nutr 1994 (60): 100-5.

14. Simon JA, et al. Relation of Serum Ascorbic Acid to Serum Lipids and Lipoproteins in US Adults. J Am Coll Nutr. 1998;17(3):250-5.

15. Lynch SM, et al. Ascorbic acid and atherosclerotic cardiovascular disease. Subcell Biochem. 1996;25:331-67.

16. Chan AC. Vitamin E and atherosclerosis. J Nutr. 1998;128(10):1593-6.

17. Tsai PJ, Lu SC. Fish oil lowers plasma lipid concentrations and increases the susceptibility of low density lipoprotein to oxidative modification in healthy men. J Formos Med Assoc 1997 96(9): 718-26.

18. Morcos NC. Modulation of lipid profile by fish oil and garlic combination. J Natl Med Assoc 1997 89(10): 673078.

19. Kirk EA, Sutherland P, Wang SA, Chait A, LeBoeuf RC. Dietary isoflavones reduce plasma cholesterol and atherosclerosis in C57BL/6 mice but not LDL receptor-deficient mice. J Nutr 1998 128(6): 954-59

20. Anderson JW, Cook-Newell ME, Johnstone BM. Meta-Analysis of the Effects of Soy Protein Intake on Serum Lipids. N Eng J Med. Aug1995;333:5.

21. Steiner M, et al. A Double-blind Crossover Study in Moderately Hypercholesterolemic Men that Compared the Effect of Aged Garlic Extract and Placebo Administration on Blood Lipids. Am J Clin Nutr. 1996;64(6):866-70.

22. Agarwal KC. Therapeutic Actions of Garlic Constituents. Med Res Rev. 1996;16(1):111-24.

23. Warshafsky S et al. Effect of garlic on total serum cholesterol. A meta-analysis. Ann Intern Med 1993 (119): 599-605

24. Jain AK et al. Can Garlic reduce levels of serum lipids? A controlled clinical study. Am J Med 1993 (94): 632-5.

25. Canetti M, et al. A two-year study on the efficacy and tolerability of policosanol in patients with type II hyperlipoproteinaemia. Int J Clin Pharmacol Res. 1995;15(4):159-65.

26. Mas R, et al. Effects of policosanol in patients with type II hypercholesterolemia and additional coronary risk factors. Clin Pharmacol Ther. Apr1999;65(4):439-47.

27. Prat H, et al. Comparative effects of policosanol and two HMG-CoA reductase inhibitors on type II hypercholesterolemia. Rev Med Chil. Mar1999;127(3):286-94.

28. Nityanand S et al. Clinical trials with gugulipid, a new hypolipidaemic agent. J Assoc Physicians India 1989 (37): 321-8.

29. Haskell WL, et al. Role of water-soluble dietary fiber in the management of elevated plasma cholesterol in healthy subjects. Am J Cardiol. Feb1992;69(5):433-9.

30. Brown L, et al. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. Jan1999;69(1):30-42.

31. Davidson MH, et al. Long-term effects of consuming foods containing psyllium seed husk on serum lipids in subjects with hypercholesterolemia. Am J Clin Nutr. Mar1998;67(3):367-76.

32. Anderson JW, et al. Long-term cholesterol-lowering effects of psyllium as an adjunct

to diet therapy in the treatment of hypercholesterolemia. Am J Clin Nutr. Jun2000;71(6):1433-1438.

33. Trautwein EA, et al. Psyllium, not pectin or guar gum, alters lipoprotein and biliary bile acid composition and fecal sterol excretion in the hamster. Lipids. Jun1998;33(6):573-82.

34. Anderson JW, et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr. Feb2000;71(2):472-9.

35. Life Extension eds., Disease Prevention and Treatment, 4th ed. Florida: Life Extension Media, 2003.


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