Report to Doctors: Dietary Interventions for Cholesterol Lowering Effective but Underutilized

Dietary intervention to lower serum LDL-cholesterol (LDL-C) is effective, yet underutilzsed in general family practice, reports a June 2009 article published in the Australian Family Physicians journal.

A year long trial showed an average LDL cholesterol lowering of 13%, with about one-third of subjects achieving a reduction greater than 20%. An important difference in the results related to the individual's adherence to dietary advice. The most effective dietary strategies are replacing saturated and trans fatty acids with poly- and monounsaturated fats and increasing intake of plant sterols. Losing weight and increasing soluble fibre and soy protein intake can also lower serum cholesterol and may be considered when recommending a nutritionally balanced, cholesterol lowering diet.

Kardea Gourmet Bars: What Dietitians Are Saying

Here at Kardea Nutrition, we are on a mission to enable cholesterol management through a nutritional, natural approach. For some, this approach allows the individual to avoid the need for prescription medications. For others, it allows for sharply lower doses of these medication to achieve targeted cholesterol levels. For all, it offers an opportunity to optimize our longer term health.

While we are here to provide the products that better enable this lifestyle, the dietitians and nutritionists are in the field working with individuals each day to change lifestyles and create healthful eating habits. We are reaching out to these health profressionals across the country. Here are some responses that we have received:

"Thanks so much for sending the samples of the Kardea bars. The bars are great and the breakdown is just perfect - especially since I've been trying to find more products we can carry here with sterol esters."—Susan, MS, RD, LDN, Urbana, IL.

"They are fantastic! Love the fiber content and that you are using psyllium. … Many thanks." Stacey RD, CPT, Santa Monica, CA

"I love the bars. Thanks."---Jennifer MS, MPH, RD, Massachusetts (Corporate Wellness Manager)

"I received your samples, and tried one myself. It was very good. Will recommend to my patients. Thank you."---Vickie , MS, RD, CDE, Maryland

"I spoke with you earlier about your great product. I work for in the Employee Wellness Department at a major insurance company and we are actively seeking better for you products for our cafeteria. Additionally, we offer cholesterol screenings, health fairs, diabetes classes, etc. I am sure you will find great opportunities for both you and our company." ---Judith RD, LDN, CDE, Texas

"We are selling your bars like hot cakes."--Sarah, RD, LD, Iowa, In-store dietitian.

"Hi-I am a registered dietitian working for a company whose mission is to personalize the treatment of patients threatened with cardiovascular disease. A colleague of mine in NY mentioned she had sampled your product and was recommending it to her patients. I wondered if you might supply me with a sample as well. Thank you."--Stacey, RD, LD, Alabama

"Even as I write this I am preparing a presentation on the ‘role of foods and a sensible diet to manage cholesterol and heart health’ for an elite group of ADA spokespersons. I intend to showcase Kardea bar and oil in my presentation."---Kantha, PhD, Illinois.

Plant Sterols: Recommendations from the National Cholesterol Education Program

NCEP Evidence Statement: Daily intakes of 2-3 grams per day of plant stanol/sterol esters will reduce cholesterol by 6-15 percent Strength of Evidence (A2, B1)

NCEP Recommendation: Plant stanol/sterol esters (2g/day) are a therapeutic option to enhance LDL cholesterol lowering.

NBC News Reports: Plant Sterols-A Natural, Safe & Easy Way to Lower Cholesterol

Wednesday, April 8, 2008
Reported by: Joe Vignolo, Denise Nakano, NBC News

A natural, safe and easy way to lower cholesterol. It's been around forever, but chances are, it's one alternative medicine you have never heard of.

"Nowadays, it is no longer good enough to know your total cholesterol level. You really need to know your breakdown - the breakdown between the good and the bad," said cardiologist Dr. Daniel Rader. This is the bad stuff: too much LDL, or bad cholesterol, circulating in the blood. It builds up in the arteries, slowly narrowing them or forming clots. And that can lead to heart attack or stroke.

Medicine can help, "but, there are an awful lot of people who have cholesterol levels that are higher than they should be, but not so high that they really need medication," said Dr. Rader.

Diet and exercise work. And, Dr. Rader says, so can eating phyto or plant sterols, naturally found in fruits, vegetables, nuts and seeds, added to other foods like spreads and snack bars, or taken as a supplement.

"There's no question that phytosterols, or plant sterols, are one of the best proven - if you will - 'alternative' methods of lowering cholesterol, short of drug therapy," said Dr. Rader.

Dr. Rader is a specialist in preventive cardiac medicine. He is a strong believer in plant sterols for people with high cholesterol who don't yet show signs of heart disease. He says they have almost no side effects and are safe for children and teens.

Research finds they can reduce bad cholesterol by 10 to 15 percent. And you can use them in combination with cholesterol-lowering prescription drugs. "I've never had really serious cholesterol trouble, but each time I went to the doctor, she was warning me that it was inching up," said David Hollenberg, who tried plant sterols. Hollenberg says he has never been shy about alternative medicine and decided to give a plant sterols supplement a try. He doesn't know yet what impact they have had on his cholesterol, but he thinks it is worth a try.

"Plant sterols are one of the rare things in the alternative medicine world that actually have been studied, have been proven to work, and are actually endorsed by people like me: card-carrying, regular doctors who actually think that this really makes sense to do," said Dr. Rader.
If you decide to try plant sterols to lower your cholesterol, dose really matters. To be effective, you must take it every day and be sure you're getting enough. For example, one or two tablespoons of sterol-containing spread a day has what you need.

Kardea Nutrition foods with plant sterols.

Plant Sterols or Plant Sterol Esters: Count Correctly!

Here at Kardea, we use natural plant sterol esters that combine the free plant sterol found in soy bean with a safflower oil. Sterol esters are considerably more expensive than the plant sterols, but much of the research in regard to the efficacy of sterols to consistently lower total and LDL cholesterol without adversely lowering HDL (good) cholesterol was based on the sterol ester.

The FDA first approved the sterol heart health claim only for the plant sterol ester. In this claim, the FDA defines that individuals should consume 1.3 grams/day of plant sterol esters to have a meaningful effect on heart health. To make this claim, food manufacturers are required to incorporate at least .65 grams of plant sterol esters into each serving as listed on the nutritional statement. Generally, sterol esters contain about 60% free sterols.

Since then, the FDA has allowed the claims for the free plant sterol. Under this claim, the FDA targets .8 grams of plant sterols per day with each serving containing .4 grams.

Looking beyond the FDA health claims, the National Cholesterol Education Program of the NIH, along with the American Heart Association and the American College of Cardiology, recommends daily consumption of 2 grams/day of plant sterols.

For those of us utilizing a natural and nutritional approach for cholesterol management, we must make certain that we are counting our sterol intake correctly. Kardea seeks to make this as clear as possible. We provide you with the numbers for the free sterol content in our products. For example, our bars contain 1 gram of plant sterols, and we utilize a significantly greater amount of plant sterol esters to reach this level. So, you need two bars per day to reach the NCEP recommendation.

Alternatively, a bar and two tablespoons of our sterol-fortified olive oil will achieve the same results. For recipes using Kardea olive oil with other heart healthy foods, visit www.kardeagourmet.com.

Other products might fit into your lifestyle. If you are a chip snacker, you might try the natural products at Corazonas Foods. One serving contains .4 grams of the sterols. For products containing non-natural ingredients, try Proactiv Supershots and their margerine-like spreads. Lots of other products are available.

There also are plant sterol supplements on the market. Different brands deliver different levels of sterols. Count correctly!

Red Yeast Rice Supplements-Can They Still Be Effective?

FDA Consistent in Restricting Sale of Lovastatin-Natural or Synthetic

Summary: Certain types of red yeast rice naturally contain lovastatin, the same active ingredient in Merck’s prescription statin medication Mevacor. Whether natural or synthetic, the FDA has consistently maintained that lovastatin has serious potential side effects and should remain a controlled (prescription) medication. As such, the FDA denied Merck’s multiple petitions to sell low-dose Mevacor on an over-the-counter basis. The FDA also has placed restrictions on red yeast rice supplements with verified levels of the naturally-occurring statin. For those interested in natural alternatives, certain nutrients, notably plant sterols, soluble fiber from oats, barley, beans, psyllium and fruit, Omega-3’s from marine sources, niacin, and monounsaturated fats replacing saturated fats, should be considered as an effective alternative approach.

Red Yeast Rice: A Particular Type is a Natural Statin

Red yeast rice is the product of yeast grown on rice. As a food, red yeast rice can be found as a paste, whole dried grains, or as a ground powder. In these forms, it has been a common food in certain Asian diets. In its traditional forms, red yeast rice contains no more than trace amounts of the active cholesterol-lowering agent. In fact, some types of red yeast rice contain no actives.

As a supplement, a particular type of enhanced red yeast rice was shown to significantly lower total cholesterol and LDL (bad) cholesterol. The active ingredient has been identified as lovastatin, the same as found in the popular statin drug, Mevacor and its generic equivalents.

Lovastatin, in turn, is a controlled prescription medication.

Can red yeast rice supplements offer benefit in comparison with prescribed statin medications?

For those preferring naturally-derived solutions, red yeast rice sources of statins could be preferred. This conceptually would be equivalent to a naturally-derived vitamin E as opposed to a synthetic. As we have further come to understand, the active agents in a natural product may be more bioavailable or more effective due to other compounds that accompany whole food. Yet, the FDA consistently views statins--natural or synthetic-- as powerful medication with potential side-effects and potential drug interactions. As such the FDA restricts the sale lovastatin, regardless of its source.

Most recently, the FDA rejected the petition of pharmaceutical giant Merck to offer Mevacor without a prescription. Merck has made three tries to have this statin sold over the counter. In rejecting Merck’s latest petition, the FDA indicated that too many of the wrong people would use the drug if it no longer required a prescription.

Last summer, the FDA issued warnings to consumers not to buy or eat certain red yeast rice products. FDA testing revealed the products contained lovastatin.

The FDA stated that “these red yeast rice products are a threat to health because lovastatin can cause severe muscle problems leading to kidney impairment. This risk is greater in patients who take higher doses of lovastatin or who take lovastatin and other medicines that increase the risk of muscle adverse reactions. These medicines include the antidepressant nefazodone, certain antibiotics, drugs used to treat fungal infections and HIV infections, and other cholesterol-lowering medications.”


What’s in Red Yeast Rice Supplements Today?

Back in 1999, when the clinical studies on the efficacy of red yeast rice were first released, supplements with identified and controlled levels of the active compounds could be purchased. Today, however, such supplements cannot be produced. In fact, red yeast rice supplements may be made from the varieties of red yeast rice that does not the cholesterol-lowering compound. We simply do not know.

Natural Cholesterol Management Alternatives

The coupling of target levels of plant sterols (2-3g/day) and soluble fiber (10-25g/day) with a calorie-mindful diet replacing saturated and trans fats with monounsaturated fats can achieve results similar to many cholesterol-lowering medications. Niacin and omega-3s from fish oil also can play a role. Check with your health care professional about a complete program. Click Here to Learn More.

Kardea Gourmet Nutrition Bars---Now Available!

Just returned from the first full production run of our gourmet nutrition bars for cholesterol management. A great experience! As many of your know, we took great care in the formulation of these bars. The criteria was to create great taste, use only all-natural ingredient, deliver effective levels of key cholesterol-managing ingredients (plant sterols, soluble fiber, soy protein), maintan a low fat, particularly low saturated fat, standards, and create a lower glycemic profile. Thanks to everyone who has been involved in this process. As we all agree, we have created a breakthrough product.

The bars will be available through our online store starting on February 25, and a limited supply of variety packs also are available (first come, first served). Single-flavor 15 counts are available in banana walnut, lemon ginger, chai spice and cranberry almond.


Thanks to all who made this start-up a huge success. I have spent a career in food manufacturing, and you folks delivered as one of the best cross-functional teams in the business.

Kardea Nutrition-enabling natural cholesterol management, heart healthy and inspired.

And our collective best wishes for Rod's grand daughter's recovery and health.