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The American Heart Association (AHA) has done a great job discovering what cholesterol does and how it affects our health. We know that high cholesterol can cause heart disease and stroke, and by lowering our cholesterol we reduce our risk and keep our bodies health. Also, with diet, weight loss and exercise we can improve our cholesterol levels as well.

Not all cholesterol is bad for you. There are both good and bad forms of cholesterol, keeping these in balance is critical for proper heart health. In the past, the primary focus was to reduce the total or 'bad' cholesterol and doctors overlooked the HDL good cholesterol. Recent research suggests that raising the HDL levels may provide even more protection against heart disease. Raising the HDL by 1% can reduce your risk of cardiovascular disease by 2% in men and 3% in women. For example, if your HDL is 36mg/dl and it increased by 3.6mg/dl that's 10%, can make you 20-30% less likely to have heart disease. Several studies have proven that low HDL is a risk factor in heart disease. (17)

Prescription drugs are available to lower cholesterol and have been proven very effective. Millions of Americans can attest to the cholesterol lowing properties of prescription drugs and they can attest to the side effects as well. Prescription drugs (statins) can cause elevated liver enzymes which are an early indication of possible liver damage. These statins' have also been associated with muscle inflammation and muscle degeneration, causing muscle pain in many patients. Statin drugs also reduce the CoQ10 levels in the body; this can lead to heart disease if left go long enough. Statins do very little for boosting good cholesterol levels and as we recall boosting good cholesterol can reduce risk of heart disease.

Thankfully there are other effective solutions for lowering cholesterol levels naturally and without side effects. There are vitamin and herbal combinations that can effectively reduce cholesterol as much as 23%. (1) First let's review how cholesterol is linked to heart disease.

Cholesterol is a fatty like substance found in every living cell in the body. Cholesterol helps digest fats, strengthen cell membranes and make hormones. The majority of our cholesterol is manufactured in the liver, but cholesterol is also produced in the small intestines and by individual cells in the body. Even though the body makes all the cholesterol we need, approximately 1000 milligrams a day, we get additional cholesterol in our diet. (2,3) Foods highest in cholesterol are egg yolks and organ meat such as liver and kidney. No plant based food sources have cholesterol even avocado and peanut butter, they are only high in fat content. Animal sources and dairy all contain cholesterol.

Even though cholesterol is needed for many of the body's functions, too much in the blood is bad. Excess amounts of cholesterol in the blood lead to arterial cholesterol build up and increase your risk of blood clots, heart attack and stroke. (4) All your cells live off a constant flow of blood which supplies oxygen and nutrients. When cholesterol builds up on the arteries, the blood flow is reduced through the heart. If a blood clot hits a narrow artery and blocks blood flow a heart attack happens. If the arteries narrow and not enough blood flows to the heart one will experience heart pain and given time a heart attack as well.

Cholesterol can not dissolve into the blood so the cholesterol has to be transported through the blood by a special carrier called lipoproteins. Two well known lipoproteins are low density lipoprotein (LDL) and high density lipoproteins (HDL). LDL is associated with bad cholesterol and HDL is considered good cholesterol. LDL distributes cholesterol through out the entire body and is the cause of arterial fat build up. HDL carries cholesterol away from the arteries and back to the liver to be processed and eliminated. HDL reduces arterial fat build up and reduces the risk or heart disease. In fact studies have shown that by raising the HDL, good cholesterol, can reduce your risk of heart disease more than lowering the LDL. As a result the National Cholesterol Education Program (NCEP) has established these guidelines for a health heart: (5)

1.HDL level of 60 is optimal but 40 for men and 50 for women on average.
2.LDL levels in the range of 100 ' 159 are best.
3.Total cholesterol both HDL and LDL under 200.

Your doctor has probably been throwing around the work triglycerides. Triglycerides are the fats our body uses as fuel, the metabolisms energy source. Your triglyceride level changes with every meal through out the day. If the levels rise too much it's a sign your meals have to many carbohydrates and sugars. Triglycerides are another risk factor in heart disease. High amounts causes the blood to be sluggish and it reduces the amount of oxygen the blood can transport especially in the small blood vessels. There are medications available for triglycerides, but keep in mind there are side effects to taking statins. Consider a diet with reduced carbohydrate and sugar to lower those triglycerides along with a good vitamin and supplement regiment.

For a healthy heart consider the following vitamins, minerals and herbs: vitamin C, E, B-6, B-12, niacin, folic acid, magnesium, selenium and amino acids, also antioxidants coenzyme Q10, alpha lipoic acid, N-acetyl cysteine (NAC), policosanol, red yeast rice, and herbs hawthorn berry, garlic, grape seed, pine bark, soy isoflavones have all shown to have beneficial affects for a better cardiovascular system and healthier heart.

Vitamin C ' An antioxidant shown to reduce arterial stiffness and inhibit platelet aggregation ' two factors known to promote atherosclerosis. (6)

Vitamin E ' An antioxidant protects against atherosclerotic plaques and shown to reduce total cholesterol levels. (7)

Niacin ' lowers total cholesterol, LDL cholesterol and triglyceride levels, while raising the HDL cholesterol. (8)

Vitamin B12 ' shown to reduce Homocysteine levels. (8)

Coenzyme Q10 ' A fat soluble nutrient found in the mitochondria of virtually all cells and an essential factor in the Krebs cycle (cellular energy production). (9) A strong antioxidant shown to help prevent LDL oxidation and strengthen the inner lining of arteries.

Policosanol ' A substance derived from sugar cane shown to reduce LDL cholesterol by 23% and increase HDL by 13% in an 8 week period.

Hawthorn Berry Extract ' Supports the muscle strength of the heart, helping to maintain healthy heart rhythm. (10) Also known to control high blood pressure and relieve mild angina (chest pain).

Garlic Bulb ' An antioxidant that has a wide range of cardiovascular health benefits. Traditionally used to lower blood pressure and cholesterol this herb has been shown to raise HDL and inhibit LDL oxidation and platelet aggregation. (1)

N-Acetyl-L-Cysteine (NAC) ' A derivative of the amino acid, cysteine. NAC helps boost glutathione levels, one of the body's best cellular antioxidants and even helps boost good cholesterol levels.

Alpha Lipoic Acid ' An antioxidant and vital nutrient for the production of energy. Alpha Lipoic Acid helps recycle other antioxidants including vitamin C, vitamin E, Coenzyme Q10, and glutathione. Also, helps control cholesterol, lower high blood pressure, and help to manage blood sugar levels.

Soy Isoflavones ' Soy protein enriched diet has been shown to decrease LDL and triglyceride levels and significantly increase HDL levels. (12,13)

The Scripps Memorial Hospital in 2002 conducted a study of these supplements on 50 patients. These patients had varied health histories and they were evaluated before the test and at 3 months and 6 months. After three months HDL levels had improved in all cases and at 6 months total good cholesterol increased 23% and triglycerides dropped 40%. Reduction in Homocysteine and amino acids levels found in the blood was also observed.

These supplement combinations are safe, after a 6 month pilot study, 50 patients with varying cardiovascular histories did not experience any serious adverse effects and these supplements were safe to use with statins. (1)

Pantethine is also known as pantothenic acid or vitamin B5 found in small amounts in the foods we eat. Pantethine lowers cholesterol by blocking its production in the liver. The production of cholesterol in the body is extremely complex. It involves many biochemical processes and requires several enzymatic steps. Pantethine safely blocks several enzymes needed to produce cholesterol. One enzyme in particular, HMG-CoA, when blocked can reduce your cholesterol production by 50%. When cholesterol production is blocked, the liver will pull LDL out of the bloodstream further reducing the bad cholesterol in the body. On average Pantethine can lower total cholesterol by 16%, LDL cholesterol by 14% and triglycerides by 38% and raise HDL by 10%. (13-16)

If you currently do not have heart disease or atherosclerosis, you shouldn't need to worry about the amount of cholesterol you consume. Most doctors won't prescribe statins to healthy patients as a preventative due to the potential side effects of the drugs. If you find you are consuming a lot of cholesterol in your diet, I would recommend a diet change and supplementation of the vitamins listed above to maintain a healthy heart. With the help of our doctors and the vast amount of information that is out there, we will be able to prevent heart disease and live longer healthier lives.

References:
1. Dennish GW III, Goodman DA, Frankel P, Gawrych-Whitman R. ACTIVE study ( Addition of Cardioprotective Nutriceuticals to Diet and Exercise to Improve Markers of Cardiovascular Disease. Scripps Memorial Hospital IRB. Submitted to AHA 46th Annual Conference on Cardiovascular Disease March 2006
2. Pleuss J. Fat. In: Porth CM. Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998:1249.
3. Guyton AC, Hall JE.Lipid metabolism. In: Textbook of Medical Physiology. 10th Ed. Philadelphia, Pa: W.B. Saunders Company;2000:781-790.
4. Grodner M, Anderson SL, DeYoung S. Food cholesterol versus blood cholesterol. In: Foundations and Clinical Applications of Nutrition: A Nursing Approach. St. Louis, Mo: Mosby; 2000: 132-134.
5. Pasternak RC. 2001 National cholesterol education program (NCEP) guidelines on the detection, evaluation and treatment of elevated cholesterol in adults: adult treatment panel III (ATP III). ACC Current Journal Review. 2002 Jul-Aug:37-42.
6. Hallfrisch J, Singh VN, Muller DC, Baldwin H, Bannon ME, Andres R. High plasma vitamin C associated with high plasma HDL- and HDL2 cholesterol. Am J Clin Nutr. 1994 Jul;60(1):100-5.
7. Wilkinson IB, Megson IL, MacCullum H, Sogo N, Cockcroft JR, Webb DJ. Oral vitamin C reduces arterial stiffness and platelet aggregation in humans. J Acrdiovasc Pharmacol. 1999 Nov;34(5):690-3.
8. Marieb E. Vitamins. In: Human Anatomy and Physiology. San Francisco, CA: Pearson Benjamin Cummings; 2004:946-950.
9. Fleming T., ed. Coenzyme Q10 (CoQ10) In: PDR' for Nutritional Supplements. Montvale, NJ: Medical Economics Company; 2001: 103-6.
10. Nemecz G. Hawthorn: This herb dilates coronary vessels, lowers blood pressure and reduces lipid levels. U.S.Phamacist. 1999 Feb.
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12. Sirtori CR, Zucchi-Dentone C, Sirtori M, Gatti E, Descovich GC, Gaddi A, Cattin L, Da Col PG, Senin U, Mannarino E, et al. Cholesterol-lowering and HDL-raising properties of lecithinated soy proteins in type II hyperlipidemic patients. Ann Nutr Metab. 1985;29(6):348-57.
13. Hermansen K, Dinesen B, Hoie LH, Morgenstern E, Gruenwald J. Effects of soy and other natural products on LDL:HDL ratio and other lipid parameters: a literature review. Adv Ther. 2003 Jan-Feb;20(1):50-78.
14. Gaddi A, Descovich GC, Noseda G. Controlled evaluation of pantethine, anatural hypolipidemic compound, in patients with different forms of hyperlipoproteinemia. Atherosclerosis. 1984;50:73-83.
15. Tonutti L, Taboga C, Noacco C. [Comparison of the efficacy of pantethine, acipimox, and bezafibrate on plasma lipids and index of cardiovascular risk in diabetics with dyslipidemia]. Minerva Med. 1991;82:657-663.
16. Hiramatsu K, Nozaki H, Arimori S. Influence of pantethine on platelet volume, microviscosity, lipid composition and functions in diabetes mellitus with hyperlipedemia. Tokai J Exp Clin Med. 1981;6: 49-57.
17. Morgan J, Carey C, Lincoff A, et al. High-density lipoprotein subfractions and risk of coronary artery disease. Curr Atheroscler Rep. 2004;6(5):359-65.