High Cholesterol _Hypercholesterolemia_.pdf

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					              High Cholesterol



Herbal Supplements

                      DEFINITION                    produced in our own
Yoga/Tai Chi/Qigong   Cholesterol is one of         liver. The liver produces
                      many lipids found through-    approximately 3000 mg
MindBody              out the body. Lipids are      of cholesterol in a 24
                      fat-like substances, but      hour period which is
Pet Therapy           cholesterol should not be     more than enough for
                      confused with dietary fat.    the average person.
Naturopathy           For instance, avocados        What we consume is
                      contain fat, but no choles-   simply “extra.”
Homeopathy            terol. Only foods derived
                      from animal sources, such     Once produced within
Ayurveda              as meats, provide dietary     the liver, cholesterol cir-
                      cholesterol. Cholesterol is   culates within the blood
                      an important building         stream and combines
                      block in the formation and    with proteins to form
                      repair of cell walls, func-   lipoproteins. High-densi-
                      tion of nerve tissue, and     ty lipoprotein (HDL), also
                      the production of hor-        known as the “good cho-
                      mones such as testos-         lesterol,” acts by carrying
                      terone, estrogen, and the     cholesterol back from
                      stress hormone, cortisol.     the cells to the liver
                      The majority of cholesterol   where it can be eliminat-
                      identified in our blood-      ed. A high HDL is bene-
                      stream is not from our        ficial while a low HDL (<
                      diet, but instead             40) is associated with
plaque formation within the                              In adults without CHD
heart arteries and related           Total Cholesterol
events such as heart attacks
                                           Desirable                     < 200 mg/dl
and cardiovascular death.
                                           Borderline High               200-239 mg/dl
A second lipoprotein is low-               High                          > 240 mg/dl
density lipoprotein, or LDL,
which is also known as “bad          HDL Cholesterol

cholesterol.” An elevated                  Desirable                     > 40 mg/dl
LDL is associated with
                                  more common conditions             reduction 26%, triglyceride
plaque formation, heart
                                  which contribute to elevated       reduction 12%, and HDL
attack and cardiac death.
                                  triglycerides.                     rise 5% using the common
The detrimental effects of
                                  Diabetes may elevate triglyc-      statin medication, pravas-
LDL occur only after it has
                                  eride levels, particularly if      tatin (Pravachol) (3).
been combined with oxygen.
                                  blood sugars are poorly con-       Along with the significant
This process known as oxida-
                                  trolled. Excessive alcohol         reduction in cholesterol
tion, perhaps may be pre-
                                  intake may also elevate triglyc-   came a 31% reduction in
vented, or at least limited, by
                                  eride levels. Low thyroid hor-     heart attack and heart
a variety of vitamin and nutri-
                                  mone levels and kidney failure     related deaths. The need
tional supplements such as
                                  may also contribute, although      for angioplasty or heart
vitamin B6, vitamin B12, folic
                                  infrequently, to elevated          surgery was also reduced
acid, and vitamin E as well as
                                  triglyceride levels.               37%. It is important to
                                                                     know, and understand,
                                  Primary prevention is the          what the level of choles-
Triglycerides are lipids, but
                                  reduction of adverse event         terol means.
not lipoproteins. They too cir-
                                  rates, such as heart attack and
culate in the bloodstream.
                                  cardiac death, in persons who      Secondary prevention is
Triglycerides are the main
                                  are at risk, but who do not yet    an attempt to decrease
source of fat storage within
                                  have evidence of coronary          future cardiac events in
the body. Elevated triglyc-
                                  heart disease (CHD). There         individuals who already
erides (>200) are associated
                                  have been over 50 trials that      have known CHD. Most
with plaque formation within
                                  have demonstrated the ability      have already suffered a
the heart arteries, albeit to a
                                  to reduce cholesterol through a    heart attack, undergone
lesser degree than elevated
                                  wide variety of means. In a        angioplasty or had coro-
LDL cholesterol (1). While
                                  combined analysis of 28 such       nary artery bypass sur-
some rare genetic disorders
                                  trials, each 10% reduction in      gery. Many studies have
may lead to elevated triglyc-
                                  total cholesterol yielded a 22%    shown tremendous benefit
erides, there are several
                                  reduction in coronary heart dis-   to lowering cholesterol
 Can lipid values be lowered      ease at 2.1 to 5 years (2). In     with dramatic declines in
 and if so, does it make any      one such trial, West of            death, heart attack and
                                  Scotland Coronary Prevention       the need for additional
                                  Study (WOSCOPS), at 4.9            cardiac procedures. The
 Yes to both                      years the average total choles-    Scandinavian Simvastatin
                                  terol reduction was 20%, LDL       Survival Study (4S)
 Does cardiovascular             dramatically reduce unto-        modified in the latest
 prevention in people who        ward heart-related events.       guidelines and is now <40
 already have coronary                                            mg/dl, rather than 35. A
 heart disease (CHD) have        In order to provide uniform      low HDL cholesterol is
 an impact?                      standards, the National          considered a risk factor in
                                 Cholesterol Education            determining an individual's
 Yes it does.                    Program (NCEP) was               goal LDL cholesterol.
                                 formed to develop treatment      However, ATP III stops
involved 4444 people with        guidelines for elevated cho-     short of recommending a
cardiac chest pain or a pre-     lesterol in adults (Adult        goal for LDL raising.
vious heart attack along with    Treatment Panel III, or ATP
elevated cholesterol levels      III) (6). In these new guide-    Given all of the evidence,
(4). Those involved were all     lines, LDL cholesterol           there is little doubt that
placed on a cholesterol low-     remains the "primary target"     lowering cholesterol saves
ering diet and then random-      of cholesterol-lowering thera-   lives and reduces heart
ized to either simvastatin       py.                              attacks in individuals at
(Zocor) or placebo. Over                                          risk for heart disease or
5.4 years, simvastatin led to    All adults age 20 years or       with established CHD.
a 25% reduction in total cho-    older should have a fasting      The effectiveness of phar-
lesterol and 35% reduction       lipoprotein profile performed    macologic therapies is well
in LDL cholesterol. These        including total cholesterol,     established. Therefore, a
dramatic reductions were         HDL cholesterol, LDL cho-        holistic approach to cho-
associated with a 42%            lesterol and triglycerides       lesterol lowering should
reduction in heart-related       obtained once every five         never be substituted for
deaths and a 37% reduction       years. An individual's ideal     proven therapies without
in the need for further car-     LDL cholesterol is then          the consent of your med-
diac procedures such as          determined based upon            ical provider. Instead,
angioplasty or bypass sur-       other cardiovascular risk fac-   holistic therapies should
gery. These results held         tors. For those individuals      be viewed as complement-
true for the elderly and         with none or one risk factor,    ing the traditional
women as well. In fact in a      other than diabetes, their       approach for lipid lowering
separate trial, Cholesterol      goal LDL cholesterol is <160     including diet, exercise,
and Recurrent Events             mg/dl. For individuals with 2    and medications. Due to a
(CARE), women benefited          or more risk factors, exclud-    lack of funding, it is not
substantially more than men      ing diabetes, their goal         surprising that there are
with a 46% reduction in          should be an LDL choles-         fewer studies examining
major heart-related events       terol <130 mg/dl. Finally, for   the potential role of holistic
for women and a 20%              individuals with known coro-     therapies in lipid lowering.
reduction for men (5). The       nary heart disease, or dia-      Regardless, the effective-
results of these trials have     betes, their goal LDL choles-    ness of pharmacologic
served as powerful testa-        terol is <100 mg/dl.             therapies is well estab-
ments to the ability of tradi-                                    lished and a holistic
tional medications to lower      A definition of a low HDL        approach to cholesterol
cholesterol and in so doing,     cholesterol has been             lowering should never be
substituted without the con-      The NCEP has outlined two        to cardiovascular health
sent of your medical              diet plans for the reduction     has been shown to reduce
provider. Instead, holistic       of cholesterol. The Step I       the incidence of heart dis-
therapies should be viewed        diet is a low fat diet with no   ease (8). Developed in
as potentially complementing      more than 30% of total calo-     the 1950's by Nathan
the traditional pharmacologic     ries coming from fat.            Pritikin, the Pritikin diet
approach to lipid lowering. It    Saturated fat such as animal     severely restricts fat to 5
is also not surprising that       fat can be no more than 8 to     to 10% of total calories in
fewer studies, involving          10% of calories and dietary      favor of vegetables, fruits
fewer patients, have actually     cholesterol is recommended       and grains (9). While not
examined the success of           at less than 300 mg. If after    for everyone, these diets
non-pharmacologic treat-          3 to 6 months the target cho-    are effective in lowering
ments in lowering choles-         lesterol is not achieved, the    cholesterol and may allow
terol and preventing unto-        Step II diet should be tried.    you to avoid costly med-
ward cardiovascular events.       In this more stringent plan,     ications without the poten-
Regardless, while less well       saturated fat is kept to 7% of   tial cost and side effects.
studied, many of the holistic     total calories, and dietary      It is also worth noting that
approaches to cholesterol         cholesterol is held at 200       triglyceride levels frequent-
lowering promote a healthier      mg. Other cholesterol lower-     ly increase in response to
lifestyle through better eating   ing diets worth considering      a low fat diet, however this
and exercise.                     are the Ornish diet and the      increase can be offset by
                                  Pritikin diet. Both are highly   maintaining high fiber
DIET                              restrictive of fat intake.       intake and through weight
Much can be said about the        Popularized in the late          loss.
benefits of diet therapy and      1970's, the Ornish diet
lowering cholesterol. For         restricts fat intake to less     Very low fat diets (15-20%
additional information about      than 10% of total calories       of total calories) can
diet and cholesterol lower-       and includes other holistic      reduce your total choles-
ing, visit our Holistic Heart     therapies such as medita-        terol and LDL cholesterol
Library.                          tion. The Ornish approach        by 10-20% (10).
                                                                   Obviously, less stringent
         A Healthy Diet Plan                                       diets are less effective.
                                                                   Community-based studies
                                                                   examining people with
  Include all food groups                                          high cholesterol who have
  Emphasize a variety in food choices                              received standard instruc-
                                                                   tions for cholesterol lower-
  Include personal food preferences                                ing generally see only a
                                                                   2% reduction in total cho-
  Develop for life long use, not a “quick fix”                     lesterol. Therefore, despite
  Not reliant on supplements or special foods                      individual exceptions, most
                                                                   people will fail to attain
  Minimum intake of 1200 kcals per day                             “desirable” cholesterol lev-
                                                                   els with diet alone (11).
                                                                    oat foods leads to a 2-19%
Individuals who should not consume a very low                       decline in total cholesterol
fat diet: (9)                                                       in individuals with elevated
                                                                    cholesterol (12). Increasing
Insulin dependent diabetics
                                                                    your fiber intake is a natu-
People with hypertriglyceridemia                                    ral way to promote a lower
Persons with eating disorders                                       cholesterol and a healthier
Carbohydrate malabsorption illnesses                                Try pectins. While there are
                                                                    many health benefits to
Pregnant women                                                      eating more fruits, the
                                                                    pectins particularly preva-
                                                                    lent in apples have been
Another dietary approach          recommends 25-30 grams of         identified to actually lower
to lowering your cholesterol      fiber from foods per day.         cholesterol (13). Other
is by increasing your fiber       Unfortunately, the average        good sources of pectins
intake. Dietary fiber is clas-    American intake is 15 grams       include pears, oranges,
sified by its solubility in       per day. Fiber, in the form       grapefruit and carrots.
water. Insoluble fiber such       of oatmeal, was the first food    Foods rich in soy protein
as bran cereals, popcorn,         approved by the FDA to have       are becoming increasingly
brown rice, whole grain           a specific health claim.          recognized as heart
breads, vegetables (beets,        “Soluble fiber from oatmeal,      healthy. Several mecha-
carrots, kale, okra, peas,        as part of a low saturated fat,   nisms, including cholesterol
spinach) and fruits (apples,      low cholesterol diet, may         reduction, have been tout-
pears, berries), serve to         reduce the risk of heart dis-     ed for the role of soy in
speed transit through the         ease.” Regular ingestion of
intestines. While insoluble
fiber has many desirable                      Soyfood                        Grams Soy
qualities, it has little impact
on cholesterol levels.
                                                                            Protein (15)
Soluble fiber on the other,
such as fruits (apricots,              1 soy protein bar                          14
mangoes, oranges, peach-
es, plums, rhubarb), dried             1/4 cup dry textured soy flour              8
beans and peas, oat prod-
ucts, psyllium, and vegeta-            1/4 cup dry textured soy
bles (broccoli, cabbage,
                                       protein concentrate                        12
white potatoes) act as a
cement within the intestine
binding cholesterol and car-           1/2 cup black soybeans                      9
bohydrates and preventing
their absorption. The                  1/2 cup green soybeans                      7
American Heart Association
decreasing the risk of coro-       calories each and 5 grams of
                                   fat. A “light” version is also
nary heart disease. Soy low-
                                   available which contains 3
                                                                      Fish highest in
ers cholesterol by (14):
• decreasing its absorption        grams of fat. It is recommend-

                                                                      fatty acids
• increasing LDL receptor          ed by the manufacturer to
activity and thus increasing       consume 2 servings per day
its uptake from the blood-         of Take Control which each          include
                                   contains 50 calories, and 6
                                   grams of fat. Of course, nei-
• increasing bile acid excre-
tion leading to elimination of     ther product contains choles-        herring,
cholesterol into the gut           terol.                                     sardines,
• stimulating thyroid hor-                                            salmon,
                                   Fish contain polyunsaturated
mone production and a
                                   fatty acids, particularly the         and trout.
resultant fall in cholesterol
                                   omega-3 form, which is
The FDA has now approved           important in building healthy
                                                                      increase HDL 14% when
the following health claim for     muscle cell membranes, as
                                                                      taken at 2 grams/day and
soy protein: “Diets low in         well as brain, nerve and eye
                                                                      lower triglycerides 43% and
saturated fat and cholesterol      tissue. Their deficiency in the
                                                                      increase HDL 18% when
that include 25 grams of soy       diet can actually contribute to
                                                                      consumed at 4 grams/day
protein may reduce the risk        obesity, adult onset diabetes,
                                                                      (18,19). In addition, a
of heart disease. One serv-        hypertension and coronary
                                                                      recent study examining the
ing of [name of food] pro-         heart disease (17). Diets low
                                                                      health benefits of increased
vides ____grams of soy pro-        in omega-3 fatty acids may
                                                                      fish intake found a 44%
tein.” (15)                        actually lead to a reduced
                                                                      reduction in cardiac events
                                   HDL cholesterol and high
                                                                      such as heart attack and
Is it margarine, butter or bet-    triglycerides. In individuals
                                                                      heart related chest pain in
ter? Both Take Control and         with normal lipid values, sup-
                                                                      the individuals who con-
Benecol are spreadable             plementation with fish oils
                                                                      sumed the largest quantity
products, which are utilized       have been demonstrated to
                                                                      of fish in their diet (20). In
in the diet similar to butter or   lead to a 25% lower triglyc-
                                                                      this study, there was a sig-
margarine. They can be             eride level with no significant
                                                                      nificant rise in their HDL
purchased in the dairy sec-        effect on HDL or LDL (18,19).
                                                                      cholesterol as well.
tion of the grocery store.         In indivduals with elevated
Both contain canola oil, plant     levels of lipids, fish oils have
                                                                      Current dietary recommen-
stanol esters, and soybean         been demonstrated to
                                                                      dations are to consume
oil as well as other con-          decrease triglyceride levels
                                                                      0.65 grams per day of
stituents. Both actually           28% with a slight increase in
                                                                      omega-3 fatty acids, which
lower total cholesterol and        LDL, but also an increase in
                                                                      corresponds to 20-62
LDL cholesterol with no            HDL. Finally, in people with
                                                                      grams of fatty fish (21).
effect on HDL cholesterol. It      severe elevations in triglyc-
                                                                      While these cold-water fish
is recommended that you            erides, fish oils have been
                                                                      may be high in fat, they are
consume 3 servings per day         demonstrated to decrease
                                                                      packed with omega-3 fatty
of Benecol, containing 45          triglycerides 25% and
                                                                      acids. Individuals not
consuming 3 ounces of fish       oxidation, however it general-    order to stabilize them.
3-4 times per week may con-      ly can be stored for up to 30     These foods may actually
sider supplemental gel caps      days in the refrigerator. Flax    elevate cholesterol and pro-
containing omega-3 fatty         seed oil can also be taken as     vide no benefit. Other
acids. Most supplements          a supplement (1 tbsp 1-3          foods high in trans fat
also contain high amounts of     times per day) or 1000 mg of      include all restaurant fried
vitamin A and D as well.         ALA daily, however this only      foods and almost all com-
                                 provides the omega-3 benefit      mercial cakes, cookies,
    Omega-3 Fatty Acid           without the fiber. The oil sup-   snack foods and chips.
        Content (21)             plement may actually be pre-
    Fish     (% by weight)       ferred if avoiding the extra    Derived from the words
Mackerel         1.8-5.3         fiber.                          Canadian and oil, canola oil
Herring          1.2-3.1                                         was developed in Canada
Salmon           1.0-1.4         Nuts obtain about 80% of        from a genetic variation of
Tuna             0.5-1.6         their total energy from fat,    rapeseed. Canola contains
Trout            0.5-1.6         largely monounsaturated fat. the lowest levels of saturat-
Halibut          0.4-0.9         In some nuts, such as wal-      ed fatty acids of any veg-
                                 nuts, this may mean a signifi- etable oil and is high in
Flax seed is rich in both
                                 cant amount of heart healthy monounsaturated fatty
omega-3 and omega-6 fatty
                                 omega-3 fatty acids.            acids˜a winning combina-
acids. A heart healthy
                                 Research has actually           tion. Like all vegetable oils,
omega-3 fatty acid, alpha-
                                 demonstrated that eating        its cholesterol free.
linolenic acid (ALA), is found
                                 nuts can lower total choles-
in particularly high concen-
                                 terol, LDL and triglycerides    Having wine with dinner
tration in flax seed. Flax
                                 (22,23). Nuts are also a        may be of benefit in raising
seed is also an excellent
                                 good source of dietary fiber,   HDL. Researchers have
source of dietary fiber.
                                 copper, magnesium, and          known for many years that
These properties make it an
                                 potassium. Nuts are an          the French appear to have
excellent dietary supplement
                                 excellent natural source of     less heart disease than
for maintaining a healthy
                                 vitamin E, as well as rich in   Americans (24). The rea-
cholesterol. In order to
                                 the amino acid arginine.        son for this occurrence is
obtain all of the potential
                                 Keep in mind that eating nuts felt to be a rise in HDL
benefits of flax seed, pur-
                                 does contribute fat calories to afforded to those who con-
chase the milled flax seed or
                                 a diet. Those extra calories    sume red wine on a regular
grind it yourself at home.
                                 should be taken into account basis (25). While recent
The seeds must be broken in
                                 when calculating daily nutri-   studies have demonstrated
order to reap the benefits.
                                 tional needs and calorie        this to be directly correlated
Due to the high fiber content,
                                 intake.                         with the amount consumed
start by consuming a low
                                                                 (26), excessive alcohol
amount such as 1 tsp 2-3
                                 Avoid both margarine and        intake can have many neg-
times per day and work up to
                                 peanut butter, which contain    ative effects on the heart as
2 1/2 tsp with meals (10
                                 trans fat. Most come from       well as other organs and
grams/day). It's worth noting
                                 partially hydrogenated oils     thus must be consumed in
that flax seed can become
                                 and are added to foods in       moderation. Therefore, if
rancid due to its high rate of
choosing to drink red wine,     HERBAL SUPPLEMENTS                arteries. Numerous stud-
consume no more than two        Be cautious of red yeast and      ies have supported the
4-ounce glasses per day.        Cholestin. Cholestin is actu-     benefits of garlic in reduc-
Also keep in mind that a 4-     ally a marketed supplement        ing cholesterol levels,
ounce glass of wine con-        made from red yeast, which        while others have suggest-
tains approximately 80 calo-    is fermented from rice. Either    ed no effect. Two meta-
ries and thus even modest       Cholestin or red yeast can be     analyses reported that gar-
daily use can lead to grad-     obtained as a supplement          lic can lower total choles-
ual weight gain.                without a prescription. Their     terol by 12% and 9%
                                active ingredient is similar to   respectively (32,33).
Keep in mind that failure to    the prescription statin-type      However, these results
maintain a healthy diet plan    drug lovastatin (Mevacor).        have been refuted in sev-
with resultant weight gain      While effective in lowering       eral more recent trials,
may adversely affect your       cholesterol approximately         which found garlic to be no
lipid profile. Over 50% of      15%, it is not as effective as    better than placebo (34-
Americans are overweight        lovastatin and is comparable      36). Perhaps as addition-
and it's getting worse. In      in cost to 5 mg of lovastatin     al, larger studies are per-
1980, 25% of Americans          ($30 to $37/month) (29,30).       formed assessing the
were overweight, while in       There is also data to suggest     potential role of garlic in
1999 the incidence has          that Cholestin and red yeast      lowering cholesterol, its
risen to 55%. Increased         have similar side effects to      role will be better under-
abdominal fat is particularly   other prescription statin-type    stood in cardiovascular
associated with an              medications, including liver      disease. It is also worth
increased risk of adult onset   damage (31). If cholesterol       noting that garlic works
diabetes, which can lead to     levels warrant treatment,         synergistically with fish oils
a marked elevation in           stick to the traditional pre-     to promote a healthy cho-
triglycerides and LDL cho-      scribed medications and           lesterol. If choosing to
lesterol as well as a reduc-    have their effectiveness and      take garlic, remember it is
tion in HDL cholesterol. You    safety followed as recom-         the ability of the supple-
can assess your ideal           mended by a physician.            ment to yield allicin, which
weight body proportions by                                        confers benefit. When
calculating your body mass    Garlic is one of the most           selecting a garlic prepara-
index (BMI) and waist-to-hip  commonly ingested herbal            tion, also make sure that it
ratio.                        supplements with a wide             is stomach coated in order
                              range of reported health ben-       to avoid being broken
Beyond your diet, smoking     efits. Its role in cardiovascu-     down by stomach acid.
may also adversely affect     lar disease has not yet been        Lastly, some “odor free”
your lipid profile. Compared proven, but has mainly               garlic preparations may
with nonsmokers, smokers      focused on reducing choles-         have no active ingredients
of at least 25 cigarettes per terol levels. It has also been      at all (34). The typical
day have lower levels of      suggested that garlic may           dosage is 900 mg daily,
HDL cholesterol and higher play a role in lowering blood          given in three divided
levels of LDL cholesterol     pressure and preventing             doses or 4 grams of fresh
and triglycerides (27,28).    plaque build-up in the body's       garlic.
Niacin is also known as vita-     closely followed by your med-      While it is touted as actual-
min B3 or niacinamide.            ical provider (42). There are      ly reducing the production
Presently, niacin is FDA          many potential drug interac-       of cholesterol (43), there is
approved for the treatment        tions to also be aware of.         insufficient evidence to
of elevated cholesterol and       Fortunately, there is a newer      support this claim.
has been recommended by           prescription formulations of
the National Cholesterol          niacin (Niaspan) which is bet-     EXERCISE
Education Program (NCEP)          ter tolerated and may be the       Make regular aerobic exer-
for the treatment of elevated     preferred formulation of the       cise a part of life. Studies
cholesterol not responding to     active B vitamin.                  which have examined the
diet therapy alone, or as a                                          relationship between exer-
second-line agent when diet       There is no doubt that vitamin     cise and cholesterol levels
therapy and a single drug         C is an anti-oxidant and           and have identified a
has been inadequate (38).         essential nutrient. It is          reduction in total choles-
Niacin lowers LDL choles-         involved in a wide variety of      terol and LDL cholesterol,
terol and triglycerides and       metabolic processes through-       combined with an increase
raises HDL cholesterol.           out the body including lipid       in HDL cholesterol in those
When used at recommended          synthesis. As a result, it has     who exercise on a regular
dosages, it has similar effec-    been supported as a valuable       basis (45). For the sake of
tiveness to statin-type lipid     supplement to raise your HDL       comparison, running at
lowering drugs and bile acid      (43). Unfortunately, while it is   least 12 miles per week
sequestrants, but unfortu-        true that vitamin C is involved    has been shown to raise
nately has a much higher          in such synthesis, there is        HDL cholesterol more than
incidence of side effects (39-    insufficient evidence to sug-      alcohol intake (46).
41). Flushing is the most         gest ingesting additional vita-    However, you don't have
common side effect and may        min C will actually lead to a      to be a long distance run-
be accompanied by                 higher HDL. The best advice        ner to achieve the benefits
headache, pruritus and other      is to eat a balanced diet con-     of exercise. In fact, in the
skin sensations. Generally        taining fresh fruits and veg-      Framingham Offspring
these dissipate over the first    etables rich in vitamin C.         Study, even one hour of
two weeks of use and can                                             exercise per week con-
many times be reduced by          Pantothenic acid remains           ferred an improved cardiac
pre-treating with aspirin 325     unproven. Also known as            risk profile when HDL cho-
mg or by taking it with meals     vitamin B5 or as one of its        lesterol, heart rate, body
or at bedtime. Dosages of         metabolites, pantethine, pan-      mass index, and tobacco
1.5 to 3.0 grams per day are      tethenic acid is essential in      use were analyzed (45).
generally required for maxi-      the metabolism of carbohy-         Not surprisingly, there is
mum benefit, however due          drates, proteins, and lipids       an inverse relationship
to side effects, most people      (43). It also plays a role in      between HDL cholesterol
start at much lower doses         the breakdown of carbohy-          and obesity - those who
initially. At doses exceeding     drates, production of sugars       exercise raise their HDL
3 grams, niacin may lead to       within the body, and the man-      cholesterol and maintain a
liver toxicity and therefore it   ufacturing of cholesterol pre-     healthy weight.
is important to have its use      cursors within the liver.
Just about everyone should       there is no data to suggest       In addition, relaxation
participate in an exercise       that any of these actually        through pet companion-
program. However, those          reduce cholesterol levels, all    ship promotes a healthy
over 40 years-old or with        involve relaxation techniques     lifestyle and happier out-
any medical conditions,          combined with gentle stretch-     look. In a study at the
such as cardiovascular dis-      ing - good habits to get into.    University of Pennsylvania
ease, should consult a med-      Perhaps by reducing stress        School of Veterinary
ical provider first. He or she   and feeling good, it may be       Medicine, pet owners had
may wish to perform a            easier to eat right and engage    significantly lower blood
treadmill exercise test prior    in other heart healthy habits.    pressure when they were
to beginning a regular exer-                                       greeting their pet than
cise routine. Generally, it is   MIND/BODY                         when they were reading
recommended to perform           Whether or not mind/body          neutral text (50). A
aerobic exercise such as         techniques can actually lower     healthier lifestyle equals
walking, jogging, swimming,      cholesterol has not been          more exercise, better
or biking at least 3 times per   established and most likely       nutrition, and weight con-
week to at least 70% of your     has no direct effect.             trol which are all key com-
maximum predicted heart          However, mind/body therapy        ponents to lowering cho-
rate (220-age in years).         incorporates relaxation tech-     lesterol and maintaining it
However, recent research         niques which may be valuable      over time.
has suggested that it is the     in calming the stress of life
amount of energy expended        and thus promoting a healthi-     NATUROPATHY
per week exercising and not      er lifestyle, better nutrition,   Naturopathy focuses on
necessarily the duration         and exercise, all valuable to     the body's own ability to
which matters most (48,49).      achieving a lower cholesterol     heal itself. Practitioners
Therefore, it appears short      and reduced risk of coronary      of naturopathy rely on a
bursts of exercise (10 min-      heart disease.                    variety of techniques
utes 3 times per day) may                                          founded in ancient Indian,
be equivalent in benefit to  PET THERAPY                           Chinese and Greek medi-
longer durations once per    Pet therapy could easily have         cine. These include relax-
day. This is good news to    been included in mind/body            ation therapy, counseling
those who have limited       medicine or even exercise             and psychotherapy, herbal
blocks of time, or physical  sections of this article              medicine, nutrition coun-
limitations to prolonged     because the positive stimuli          seling, physical therapy,
exercise.                    received from either owning           and homeopathy. While
                             or visiting with a pet                the constituent parts of
YOGA/TAI CHI/QI GONG         crossover to so many facets           naturopathy have been
Relaxation and exercise      of holistic health. Not surpris-      studied for their beneficial
make for a healthy combina- ingly, there is no research to         effects in the treatment of
tion. For those who are      suggest that owning a pet             cardiovascular diseases,
unable to perform vigorous   lowers cholesterol directly, but      there is little research on
aerobic exercise, yoga, tai  just think how many people            naturopathy as a whole in
chi, or qi gong may be an    attain regular exercise simply        treating these conditions.
excellent alternative. While because they do own a pet!
HOMEOPATHY                       power of ayurvedic medicine  1995;333:1301-1307
Homeopathy is relatively                                      4. Scandinavian
                                 for cardiovascular disease, or
new compared to many of          specifically elevated choles-Simvastatin Survival Study
the holistic approaches dis-                                  Group. Randomised trial of
                                 terol. Ayurvedic practitioners
cussed already. Founded in       have touted guggul, also     cholesterol lowering in
1790 by Dr. Samuel               known as gugulipid, for the  4444 patients with coronary
Hahnemann, homeopathy is         treatment of cardiovascular  heart disease: the
based upon the belief that       disease and a means to       Scandinavian Simvastatin
“like cures like.”               lower blood cholesterol lev- Survival Study (4S). Lancet
Homeopathic therapies            els. Select studies have sug-1994;344:1383-1389
involve administering very       gested that gugulipid can    5. Sacks FM, Pfeffer MA,
dilute solutions of herbal       reduce total and LDL choles- Moye LA, et al. for the
substances felt to stimulate     terol, however the effects onCholesterol and Recurrent
the body's own “vital force.”    HDL cholesterol are less     Events Trial Investigators.
By so doing, a person is         clear (51,52). The doses of  The effect of pravastatin on
able to heal himself or her-     gugulipid utilized in this   coronary events after
self rather than relying on      research has been 100-500    myocardial infarction in
pharmaceutical agents. To        mg of gugulipid per day      patients with average cho-
date, there is little research   (51,52). The studies to date lesterol levels. N Engl J
on homeopathic medicine          are inconclusive and its bestMed 1996;335:1001-1009
for the treatment of cardio-     to await further research on 6. Executive summary of
vascular disease and per-        gugulipid.                   the third report of the
haps none directed specifi-                                   national cholesterol educa-
cally at elevated cholesterol  REFERENCES                     tion program (NCEP)
levels. Therefore, its use for 1. Ginsberg HN. Is hyper-      expert panel on detection,
these conditions remains to    triglyceridemia a risk factor  evaluation, and treatment
be established.                for atherosclerotic cardiovas- of high blood cholesterol in
                               cular disease? A simple        adults (Adult Treatment
AYURVEDA                       question with a complicated    Panel III). JAMA
Ayurvedic medicine was         answer. Ann Intern Med         2001;285(19):2486-2497
founded in ancient India       1997;126:912-914               7. Schirmer G. The Healthy
around 3500 B.C. It is         2. Law MR, Wald NJ,            Heart: Cardiovascular
known in Hindu texts as the Thompson SG. By how much Nutrition and Fitness.
Vedas, meaning “science of and how quickly does reduc- MED2000, Inc. 2000;3
life.” In ayurvedic medicine, tion in serum cholesterol con- 8. Ornish D, Brown SE,
practitioners prescribe treat- centration lower risk of       Scherwitz LW, Billings JH,
ment and preventative ther- ischaemic heart disease?          et al. Can lifestyle changes
apy consisting of diet, herbal BMJ 1994;308:367-373           reverse coronary heart dis-
supplements, exercise and      3. Shepherd J, Cobbe SM,       ease? The Lifestyle Heart
yoga, as well as other treat- Ford I, Isles CG, et al.        Trial. Lancet 1990;336:129-
ments in order to maintain a Prevention of coronary heart 133
person's balance in life.      disease with pravastatin in    9. Pritikin N. The Pritikin
Little research is available   men with hypercholes-          program for diet and exer-
with regard to the healing     terolemia. N Engl J Med        cise. Bantam Books. New
York, NY. 1979                   Focus on fish oils. Clin           alcohol intake, increased
10. Lichtenstein AH,             Cardiol 1999;22(Suppl 6);II-       levels of high-density
VanHorn L. Very low fat          40-43                              lipoprotein and its subfrac-
diets. Circulation               19. Hornstra G, Barth CA,          tions, and decreased risk of
1998;98:935-939                  Galli C, et al. Functional food    myocardial infarction. N
11. Ballantyne CM, West          science and the cardiovascu-       Engl J Med 1993;329:1829-
MS, Jaax SM, et al. Should       lar system. Br J Nutr              1834
lipid-lowering drugs be part     1998;80(Suppl II):S113-S146        26. De Oliveira e Silva ER,
of initial therapy in the sec-   20. Rissanen T, Voutilainen        Foster D, McGee Harper M,
ondary prevention of CHD?        S, Nyyssonen K et al. Fish         et al. Alcohol consumption
J Am Coll Cardiol                oil-derived fatty acids,           raises HDL cholesterol lev-
1996;27(suppl A):134A            docosahexaenoic acid and           els by increasing the trans-
12. Bell S, Goldman VM,          docosapentaenoic acid, and         port rate of apolipoproteins
Bistrian BR, et al. Effect of    the risk of acute coronary         A-I and A-II. Circulation
B-glucan from oats and           events: The Kuopio                 2000;102:2347-2352
yeast on serum lipids. Crit      ischaemic heart disease risk       27. Migas OD. The lipid
Rev Food Sci Nutr                factor study. Circulation          effects of smoking. Am
1999;39(2):189-202               2000;102:2677-2679                 Heart J 1988;115:272
13. Lampe HW. Health             21. Kris-Etherton PM, Shaffer      28. Tiwari AK, Gode JD,
effects of vegetables and        Taylor D, Yu-Poth S, et al.        Dubey GP. Effect of ciga-
fruit: assessing mechanisms      Polyunsaturated fatty acids in     rette smoking on serum
of action in human experi-       the food chain in the United       total cholesterol and HDL in
mental studies. Am J Clin        States. Am J Clin Nutr             normal subjects and coro-
Nutr 1999;70(Suppl:475S-         2000;71(Suppl);179S-188S           nary heart disease patients.
490S)                            22. Lowes BD, Simon MA,            Indian Heart J 1989;41:92
14. Lichtenstein AH. Soy         Tsvetkova TO, Bristow MR.          29. Busch F. The New
protein, isoflavones and car-    Inotropes in the beta-blocker      Nutrition: From antioxidants
diovascular disease risk. J      era. Clin Cardiol                  to Zucchini. John Wiley &
Nutr 1998;128:1589-1592          2000;22(Suppl III):III-11 ˆ III-   Sons. New York, NY. 2000
15. Hasler C. Public health      15                                 30. Heber D, et al.
implications of the soy pro-     23. Morgan WA, Clayshulte          “Cholesterol-lowering
tein health claim. The Soy       BJ. Pecans lower low-density       effects of a proprietary
Connection 1999-2000;8(1)        lipoprotein cholesterol in peo-    Chinese red-yeast-rice
16. 2000 Soyfoods Guide.         ple with normal lipid levels. J    dietary supplement.” Am J         Am Diet Assoc                      Clin Nutri 1999;69:231-236
April 16, 2001)                  2000;100:312-318                   31. Robbers JE, Tyler VE.
17. Simopoulos AP.               24. Rimm EB, Giovannucci           Tyler's Herbs of Choice.
Essential fatty acids in         EL, Willett WC, et al.             Binghamton, NY: Haworth
health and chronic disease.      Prospective study of alcohol       Herbal Press, 1999
Am J Clin Nutr                   consumption and risk of coro-      32. Silagy C, Neil A. Garlic
1999;70(Suppl):5605-5695         nary disease in men. Lancet        as a lipid lowering agent - a
18. Harris WS.                   1991;338:464-468                   meta-analysis. J R Coll
Nonpharmacologic treatment       25. Gaziano JM, Buring JE,         Physicians Lond
of hypertriglyceridemia:         Breslow JL, et al. Moderate        1994;28:39-45
33. Warshafsky S, Kamer           lovastatin and niacin in pri-     Disease: A textbook of car-
RS, Sivak SL. Effect of garlic    mary hypercholesterolemia. A      diovascular medicine.
on total serum cholesterol. A     prospective trial. Arch Intern    Braunwald E (ed.)
meta-analysis. Ann Intern         Med 1994;154:1586-1595            Philadelphia, PA. W. B.
Med 1993;119:599-605              40. Vega GL, Grundy SM.           Saunders Co, 1992
34. Isaacsohn JL, et al.          Lipoprotein responses to          47. Daneberg AL, Keller JB,
Garlic powder and plasma          treatment with lovastatin,        Wilson PW, Castelli WP.
lipids and lipoproteins, a        gemfibrozil, and nicotinic acid   Leisure time physical activity
multicenter, randomized,          in normolipidemic patients        in the Framingham Offspring
placebo-controlled trial. Arch    with hypoalphalipoproteine-       Study. Description, seasonal
Intern Med 1998;158:1189-         mia. Arch Intern Med 1994         variation, and risk factor cor-
1194                              Jan 10;154(1):73-82               relates. Am J Epidemiol
35. Berthold HK, Sudhop T,        41. Guyton JR, Goldberg AC,       1989;129;76
von Bergmann K. Effect of a       Kreisberg RA, et al.              48. I-Min L, Sesso HD,
garlic oil preparation on         Effectiveness of once-nightly     Paffenbarger RS. Physical
serum lipoproteins and cho-       dosing of extended-release        activity and coronary heart
lesterol metabolism. JAMA         niacin alone and in combina-      disease risk in men. Does
1998;279(23):1900-2               tion for hypercholesterolemia.    the duration of exercise
36. Superko HR, Krauss RM.        Am J Cardiol 1998;82:737-         episodes predict risk?
Garlic powder, effect on          743                               Circulation 2000;102:981-986
plasma lipids, postprandial       42. American Society of           49. Sesso HD, Paffenbarger
lipemia, low-density lipopro-     Health-System Pharmacists.        RS, I-Min L,. Physical activity
tein particle size, high-densi-   ASHP Therapeutic Position         and coronary heart disease
ty lipoprotein subclass distri-   Statement on the safe use of      risk in men. The Harvard
bution and lipoprotein(a). J      niacin in the management of       alumni health study.
Am Coll Cardiol                   dyslipidemias. Am J Health        Circulation 2000;102:975-980
2000;35:321-6                     Syst Pharm 1997;54:2815-          50. Katcher AH, Friedmann
37. Imai J, Ide N, Nagae S,       2819                              E. Potential health value of
et al. Antioxidant and radical    43. McKevoy GK, ed. AHFS          pet ownership. Continuing
scavenging effects of aged        Drug Information. Bethesda,       Education 1980;2(2):117-121
garlic extract and its con-       MD: American Society of           51. Nityanand S, Srivastava
stituents. Planta Med             Health-System Pharmacists,        JS, Asthana OP. Clinical tri-
1994;60:417-420                   1998                              als with gugulipid. A new
38. National Cholesterol          44. Castleman M. Blended          hypolipidaemic agent. J
Education Program.                Medicine. St. Martin's Press.     Assoc Physicians India
Cholesterol Lowering in the       2000                              1989;37(5):323-328
Patient with Coronary Heart       45. Sellier P, Corona P,          52. Singh RB, Niaz MA,
Disease.                          Audoin P, et al. Influence of     Ghosh S. Hypolipidemic and
Website:http://www.nhlbi.nih.     training on blood lipids and      antioxidant effects of
gov/health/prof/heart/chol/ch     coagulation. Eur Heart J          Commiphora mukul as an
ol_low.pdf                        1988;9:32                         adjunct to dietary therapy in
39. Illingworth DR, Stein EA,     46. Farmer JA, Gotto AM.          patients with hypercholes-
Mitchel YB, et al.                Risk factors for coronary         terolemia. Cardiovasc Drugs
Comparative effects of            artery disease. In Heart          Ther 1994;8:659-664
                Caution! Grapefruit juice may interfere with
                     an increasing list of medications.
Grapefruit juice is certainly     unknown and it appears to be as several. However, daily
one of the most popular, and      specific to grapefruit and       ingestion of grapefruit and
perhaps healthiest, break-        does not occur with other        its juice over a few weeks
fast drinks in America. Yet       fruits and fruit juices.         may lessen its effects, and
for almost 10 years now we                                         individuals who regularly
have known that consuming         The common blood pressure drink grapefruit juice without
this popular drink or eating      medications amlodipine           difficulty may never develop
the fruit may alter the effec-    (Norvasc) and nifedipine         a problem with these med-
tiveness of several heart-        (Procardia;Adalat) have          ications. So far there have
related medications, as well      shown 20-30% increased           been no major problems
as several others. First dis-     drug levels in the blood when reported despite the many
covered when researchers          consumed with grapefruit         drugs that appear to be
used grapefruit juice to          juice, while the antidepres-     effected by grapefruit.
mask the taste of alcohol,        sant buspirone(Buspar) has       Regardless, it is still best to
grapefruit juice appeared to      shown several fold increases consult a doctor if planning
increase the effects of           in the breakdown products of to eat grapefruit or drink the
felodipine (Plendil), a com-      the drug in the urine.           juice and while taking any of
mon blood pressure lower-         Common "statin" cholesterol- the medications listed
ing medication.                   lowering drugs remain a con- below.
                                  cern as well. The most
Why grapefruit juice and no       recent data suggests that
other fruit juices? It appears    consuming one glass of
that a chemical specific to       grapefruit juice daily along       The best
grapefruit juice inhibits a       with the common statin lovas-
common enzyme in the              tatin(Mevacor) raises the con-     advice is to be
intestine. This enzyme typi-      centration of the active ingre-
cally breaks down medica-         dient by 36%. It appears pru-      aware of the
tions and therefore decreas-
es the amount of drug avail-
                                  dent to avoid consuming any
                                  statin with grapefruit juice,
able in the body to exert its     particularly if taken in high      interaction and
effects. With this enzyme         doses or when first initiating a
inhibited, a drug can exhibit     statin medication.                 avoid
a greater effect on the
organ's system(s) that it is      Can you still drink grapefruit
                                                                     grapefruit juice
designed to treat such as         juice and avoid the potential      if an
the liver, heart, vascular sys-   interaction? Well maybe.
tem, or brain. Despite            Thirty percent of enzyme inhi-     interaction is
extensive research in this        bition is still present 24 hours
area, the exact chemical in       after drinking the juice and       at all possible.
grapefruit that causes this       one glass of juice appears to
enzyme inhibition remains         have the same effect
Below is a list of medications that have been identified as interacting with grapefruit juice.

Drug-Grapefruit juice interactions*
Calcium channel blockers                  Antihistamines
      Felodipine (Plendil)                      Ebastine
      Nimodipine (Nimotop)                      Terfenadine (Seldane))
      Nisoldipine (Sular)                 Psychiatric medications
      Nitrendipine                              Buspirone (Buspar)
      Pranidipine                               Carbamazepine (Tegretol)
Immunosuppressants                              Diazepam (Valium)
      Cyclosporine (Sandimmune)                 Midazolam (Versed)
      Tacrolimus (Prograf)                      Triazolam (Halcion)
HMG-CoA reductase inhibitors              Prokinetics
      Atorvastatin (Lipitor)                     Cisapride (Propulsid)
      Lovastatin (Mevacor)                      Others
      Simvastatin (Zocor)                       Methadone
                                                Sildenafil (Viagra)
* generic name (trade name); some may have multiple trade names not listed

Title: Drug-Grapefruit Juice Interactions
Authors: Garvan C. Kane, MD and James J. Lipsky, MD
Source: Mayo Clinic Proceedings 2000;75:933-942

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