Cholesterol Reduction-B

Integrated and Alternative Medical Approaches

Some people with high cholesterol are able to reduce to safe levels by using combinations of dietary supplements that have been shown to lower serum cholesterol, protect against LDL cholesterol oxidation, and reduce the risk of an abnormal arterial blood clot formation.

Benefits of Policosanol
Policosanol is a natural supplement derived from sugar cane. The main ingredient is octacosanol. Octacosanol is an alcohol found in the waxy film that plants have over their leaves and fruit. The leaves and rinds of citrus fruits contain octacosanol, as does wheat germ oil.

Policosanol has been shown to normalize cholesterol as well or better than cholesterol-lowering drugs, without side effects such as liver dysfunction and muscle atrophy (Mas et al. 1999). Efficacy and safety have been proven in numerous clinical trials, and it has been used by millions of people in other countries. Policosanol lowers harmful LDL-cholesterol and raises protective HDL-cholesterol. HDL-cholesterol removes plaque from arterial walls.

Policosanol helps stop the formation of artery lesions (Noa et al. 1995), an effect similar to that of statin drugs. This was proven in studies on rabbits fed a diet designed to create high cholesterol. According to researchers “in most policosanol-treated animals, atherosclerotic lesions were not present, and in others, thickness of fatty streaks had less foam cell layers than in controls” (Arruzazabala et al. 2000).

Policosanol also inhibits the oxidation of dangerous LDL-cholesterol (Menendez et al. 1999), which promotes the destruction of blood vessels by creating a chronic inflammatory response. Oxidized LDL can also provoke metalloproteinase enzymes. (Xu et al. 1999). These enzymes promote blood vessel destruction, partly by interfering with HDL’s protective effect. Studies show that rats treated with policosanol have fewer foam cells, reflecting less inflammatory response and blood vessel destruction (Noa et al. 1996; Lindstedt et al. 1999).

Healthy arteries are lined with a smooth layer of cells so that blood can race through with no resistance. This layer becomes thick and overgrown with cells as a consequence of diseased arteries. As the artery narrows, blood flow slows down or is blocked completely. Policosanol can stop the proliferation of these cells in much the same way as lipid-lowering drugs (Noa et al. 1998; Negre-Aminou et al. 1996).

Policosanol also inhibits the formation of clots, and may work synergistically with aspirin in this respect. In a comparison of aspirin and policosanol, aspirin was better at reducing one type of platelet aggregation (clumping together of blood cells). But policosanol was better at inhibiting another type. Together, policosanol and aspirin worked better than either alone (Arruzazabala et al. 1997; Stusser et al. 1998).

Policosanol has also been shown to inhibit thromboxane, a blood vessel-constricting agent that contributes to abnormal platelet aggregation that can lead to heart attack or stroke. One study showed significant reductions in the level of thromboxane in humans after two weeks on policosanol (Carbajal et al. 1998).

Benefits of Fiber
High intake of soluble fiber is a very effective way of lowering serum cholesterol. Most people, however, find that high amounts of fiber produce gastrointestinal upset, and therefore do not consistently take enough fiber to lower cholesterol levels.

In populations with reported higher incidence of elevated cholesterol, fiber may be of benefit as found in a 1998 study conducted in Mexico City.

Psyllium and oat bran have been shown to lower plasma LDL cholesterol levels in different populations. Hypercholesterolemia is prevalent in the Northern part of Mexico and might be associated to dietary habits and sedentary lifestyle. These results indicate that psyllium and oat bran are efficacious in lowering plasma LDL cholesterol in both normal and hypercholesterolemic individuals from this population (Journal of the American College of Nutrition, Dec. 1998, 17(6):601-8).

Another study contradicts this as follows:

Various soluble fibers reduce total and LDL cholesterol by similar amounts. The effect is small within the practical range of intake. For example, 3 grams soluble fiber from oats (3 servings of oatmeal, 28 grams each) can decrease total and LDL cholesterol by approximately 0.13 mmol/L. Increasing soluble fiber can make only a small contribution to dietary therapy to lower cholesterol (Am. J. Clin. Nutr., (United States), Jan. 1999, 69(1):30-42).

Caution: DO NOT take psyllium if you are presently taking the prescription drugs digitalis or nitrofurantoin.

Chitosan is a fiber composed of chitin, which is a component of the shell of shellfish. Scientists in Norway have processed chitin to provide a magnetic binding affinity for fat and cholesterol in the digestive tract. Chitosan can absorb as much as seven to eight times its weight of fat and bile in the digestive tract. The fat and cholesterol are then excreted through the bowel, thereby improving bowel function and reducing cholesterol levels in the body.

One of the first studies to show a direct correlation between lowering of serum cholesterol with chitosan-suggesting that the agent could be used to inhibit the development of atherosclerosis in individuals with hypercholesterolemia-appeared in the June 1998 issue of the journal Atherosclerosis. Researchers at the Department of Medicine, University of Auckland, New Zealand, found that animals fed for 20 weeks on a diet containing 5% chitosan or on a control diet attained blood cholesterol levels significantly lower in the chitosan-fed animals throughout the study and at 20 weeks were 64% below that of control animals. That's right, 64%!

Additionally, when the area of aortic plaque in the two groups of animals were compared, a highly significant inhibition of plaque deposits was observed in the chitosan-fed animals-42% and 50%, compared to 42% in the control animals.

Earlier in the August-October 1994 issue of the journal ARM Medicina, Helsinki, clinical studies with chitosan demonstrated that in 5 weeks total cholesterol (LDL) was reduced by 32%, HDL increased by 7.5%, and triglycerides were lowered by 18%.

Another study done almost 20 years ago in the April 1980 American Journal of Clinical Nutrition reported a 25 to 30% reduction in cholesterol over a several-month period, initially documenting chitosan's potential cholesterol-lowering effectiveness.

Because of chitosan's ability to bind fat, chitosan is also an excellent aid in weight loss as well as normalization of cholesterol levels in the body.

Caution: Chitosan, like other fibers, can reduce absorption of trace minerals as well as dietary fat. For that reason, it is recommended that trace minerals be taken at a separate time than when the fiber is consumed.

Benefits of Niacin
Niacin (vitamin B3) improves cholesterol profiles when given in doses well above the vitamin requirement. Nicotinic acid lowers total cholesterol, LDL-cholesterol, and triglyceride levels, while raising HDL-cholesterol levels. Most people cannot use the doses (1000 to 3000 mg a day) of niacin required to suppress cholesterol levels. Niacin causes a flushing effect, resembling an acute allergic reaction that many people find intolerable. While niacin is considered relatively safe, like other cholesterol-lowering drugs, it can cause liver toxicity when taken in high doses. Monitoring liver enzymes every 6 months is important when taking more than 1000 mg of niacin a day. Those with hepatitis should avoid niacin.

Flush-free niacin may lower cholesterol while boosting the beneficial HDL fraction. In a report on the antiatherogenic role of HDL (high density lipoprotein) cholesterol, flush-free niacin (inositol hexanicotinate) "appears to have the greatest potential to increase HDL cholesterol [by] 30%." This study was made over a 5-year period and focused on the effect of high LDL numbers exhibited before a patient's first coronary event(s).

As reported in a November 1998 American Journal of Cardiology research study, "Nicotinic acid (niacin) has been shown to decrease triglyceride, increase HDL cholesterol, lower LDL cholesterol, and decrease lipoprotein (a); it also decreases fibrinogen," an additional benefit that reduces the risk of related cardiovascular disease.

To determine whether lower doses of nicotinic acid are as effective and better-tolerated than the typical regimen currently used, researchers at the University of Texas Southwestern Medical Center in Dallas, as reported and described in the Archives of Internal Medicine, 1996, conducted a trial using two different doses (1.5 g and 3.0 g) of nicotinic acid.

The results showed that the lower dose (1.5 g ) nicotinic acid treatment significantly lowered triglyceride levels, raised HDL concentrations by approximately 22%, and favorably altered the ratio of total cholesterol: HDL cholesterol in both normal patients and those with abnormal lipid levels at baseline. Further improvement in lipid levels was also observed in those patients who tolerated the higher dose of nicotinic acid.

In this study, significant improvement in blood lipids levels was observed among the 75% of patients who tolerated low-dose nicotinic acid therapy. The authors conclude that use of nicotinic acid in lower doses than traditionally prescribed is both well-tolerated and effective in altering blood lipid levels. In addition, they suggest that this vitamin may be particularly worthwhile when combined with other lipid-lowering medications.

Note: Nicotinamide, another form of the vitamin B3, does not lower cholesterol levels and should not be used in the place of niacin.

Benefits of Artichoke
The discovery that artichoke leaf extract reduces elevated cholesterol levels opens up exciting perspectives in the prevention and treatment of arteriosclerosis and coronary heart disease.

It was as early as the 1930s that scientists first discovered that artichoke extract had a favorable effect on atherosclerotic plaques in the arteries (Tixier, 1939). Later animal studies, in which rats were fed a high-fat diet, also showed that artichoke extract prevented a rise in serum cholesterol levels and the manifestation of atherosclerotic plaque (Samochowiec, 1959 and 1962).

In addition to findings in animal experiments (Samochowiec et al., 1971; Frohlich and Ziegler, 1973; Wojcicki 1976; Lietti 1977 and 1978), a study by Fintelmann in 1996 of 553 outpatients demonstrated a significant effect of the extract on fat (lipid) metabolism. The researchers found a significant decline in both the cholesterol and triglyceride levels in the blood, which confirmed a discovery made as early as the 1930s.

Recent research confirms these earlier findings. The study by Fintelmann demonstrated a significant reduction in cholesterol and triglyceride levels in spite of the relatively short duration of the study (6 weeks). On an average, there was an 11.5% reduction in serum cholesterol from 264 mg/dL initially to 234 mg/dL. Serum triglycerides were similarly reduced from 215 mg/dL initially to 188 mg/dL, corresponding to a decrease of 12.5%. Although this was an open study, its reliability is buttressed by the relatively large number of patients (302) and the very high level of statistical significance attained for the main results.

Very fascinating results came out of an excellent double-blind clinical trial conducted by Petrowicz in 1996. He studied the cholesterol-lowering effect of artichoke leaf extract on 44 healthy individuals under strictly controlled conditions over a 12-week period. There was a significant decrease of cholesterol levels in the volunteers who had high initial levels (greater than 220 mg/dL). In fact, the higher the initial cholesterol value, the more significant was the reduction in cholesterol levels. It was moreover observed that the protective HDL cholesterol levels showed a tendency to increase.

The restricting effect of artichoke leaf extract on cholesterol synthesis was demonstrated in some very interesting studies by Gebhardt (1995, 1996, and 1997) on rat hepatocytes (liver cells). A highly significant concentration-dependent inhibition of cholesterol synthesis was found. The 1997 study indicates that artichoke leaf extract reduces the formation of cholesterol in a physiologically favorable, long-lasting manner. This reduction of cholesterol synthesis persisted for hours following the period of exposure.

The study further indicates that artichoke extract may work through indirect inhibition of the enzyme HMGCoA-reductase, which might avoid problems known to occur with strong direct inhibitors of HMGCoA-reductase during long-term treatment. The indirect inhibition was supported by the fact that artichoke leaf extract effectively blocked insulin-dependent stimulation of HMGCoA-reductase without affecting insulin in general. HMGCoA-reductase is a key enzyme in cholesterol synthesis, and HMGCoA-reductase inhibitors generally reduce total cholesterol, LDL cholesterol and triglyceride levels

The International Antioxidant Research Centre, UMDS-Guy's Hospital, London, UK, published its research in September 1998 in Free-Radical Research, in which investigators stated, "Artichoke extract retarded LDL oxidation. . . and . . . overall, the results demonstrate the antioxidant activity of the artichoke extract."

Benefits of Garlic
A study published in the Journal Nutrition Research (1987, 7:139-49) showed that a liquid garlic extract made by Kyolic caused a 12 to 31% reduction in cholesterol levels in the majority of test subjects after 6 months. The study showed that 73% of the subjects given the Kyolic garlic experienced a greater than 10% reduction in cholesterol, compared with only 17% of the subjects in the placebo group showing the same improvement.

If you have high LDL cholesterol levels, garlic supplementation is especially important because LDL cholesterol oxidation causes atherosclerosis, and garlic specifically inhibits LDL oxidation. And garlic helps protect the arterial lining against oxidation. Most importantly, garlic prevents abnormal platelet aggregation (thrombosis) via several different mechanisms. The formation of arterial blood clots is the primary cause of most heart attacks and strokes.

Investigators reported in a study published in the American Journal of Clinical Nutrition (1996, 64:866-70) that the daily administration of 7.2 grams of Kyolic garlic powder for 6 months produced a modest reduction (of between 6.1 and 7%) in total cholesterol, compared with the placebo group. The more dangerous LDL cholesterol was reduced 4 to 4.6% in the Kyolic group.

The heart-healthy benefits of garlic include protecting the endothelial lining of the arterial system against oxidative damage. A study published in Atherosclerosis (1999, 144:237-49) shows an actual reduction in buildup of fatty plaque in arteries in garlic-supplement users. Fatty plaque is comprised of many substances, including cholesterol. When plaque accumulates in the coronary arteries, the condition can lead to heart attack. In a study of 280 adults, German researchers reported that participants who took 900 mg of garlic powder a day had up to 18% less plaque in their arteries than those who took a placebo, or "dummy," powder. Male study participants who took a placebo had a 5.5% increase in plaque volume, while those who took the garlic powder experienced just a 1.1% increase in plaque buildup during the 4-year study period. By comparison, women who took the garlic showed a 4.6% decrease in plaque volume, while those who took the placebo powder had a 5.3% increase. Garlic may affect plaque buildup by reducing blood platelet stickiness (aggregation) and specifically preventing the oxidation of LDL cholesterol onto the lining of the arteries. Platelet aggregation helps plaque cling to the arteries.

An April 1998 study reported on the effect of garlic on blood lipids, blood sugar fibrogen, and fibrinogenic activity of 30 patients who received 4 grams of garlic daily for 3 months. The patients were monitored at 1.5 and 3 months when it was determined that garlic had "significantly reduced total serum cholesterol and triglycerides, and significantly increased HDL cholesterol." With regard to fibrinogenic activity, it was determined that the garlic inhibited platelet aggregation (Prostagland. Leuk. Essent. Fatty Acids, April 1998, 58[4]:257-63).

An earlier study in June 1994, the University of Massachusetts Medical School published a report that found that those U.S. adults who consumed one-half to one clove of garlic each day showed cholesterol levels that were reduced by 9% (JAMA, June 1, 1994, 271[21]:1660-61). A survey of 7 out of 8 studies on garlic showed that dosages of between 600 to 900 mg of garlic powder (Allium sativum L.) produced a 5 to 20% reduction in cholesterol and triglycerides. (Fortschr. Med. (Germany) 1990, 108[36]:49-54). Other studies have shown that much higher doses of garlic were required for cholesterol reduction.

Human patients fed a daily dose of Kyolic ("Aged Garlic Extract") over a 10-month study showed that "adhesion to fibrinogen was reduced by 30%-compared to placebo . . . and that . . . the beneficial effect of garlic preparations on lipids and blood pressure extends also to platelet function" (Journal of Cardiovascular Pharmacology [United States], 1998, 31[6]:904-8).

Note: Overall studies seem to indicate that dosages of garlic may be a factor in its efficacy. The suggested dose of high allicin garlic extract should be between 6000 mg and 8000 mg daily taken with meals. Since large amounts of garlic may cause stomach upset, we recommend that garlic be taken with the largest meal of the day.

In summary, the mechanisms by which garlic have shown to protect against cardiovascular disease include the following: cholesterol reduction, preventing abnormal blood clot formation inside of blood vessels; protecting against LDL cholesterol oxidation; and protecting the endothelial lining of the arterial system against oxidation. A review of all the studies on garlic indicates that high doses are required for effective cholesterol reduction. If you were to use garlic alone to lower serum cholesterol, you should take 6000 to 8000 mg a day. When used in combination with other cholesterol-lowering nutrients, lower doses of garlic may be effective.