Cholesterol Drugs Increase Risk of Diabetes; Diabetes Drugs Increase Risk of Heart Attacks

In the age of medical specialists,  we can find ourselves being treated as a collection of conditions.   Our whole health can get lost.   You may find yourselves taking a variety of medications,  perhaps one for cholesterol,  another for high blood pressure and yet another to regulate blood glucose levels. These medications each may be appropriate,  but they also may works against each other.
Two studies regarding cholesterol lowering medications and a diabetes drugs are cases in point.

Lipitor, Crestor and other statin medications taken to lower cholesterol also increase the risk of diabetes,  by about a 9 percent, according to a study that quantified a complication that doctors only recently discovered.

Meanwhile, hundreds of people taking Avandia, a diabetes medicine, needlessly suffer heart attacks and heart failure each month, according to confidential government reports that recommend the drug be removed from the market.

The statin study analyzed 13 studies undetaken after a 2008 trial from London-based AstraZeneca unexpectedly found patients given its drug Crestor had a 25 percent higher risk of diabetes. The new analysis involving more than 90,000 patients, published in the journal Lancet, shows the actual increase in diabetes is 9 percent, the risk is tied to the entire class of medications and the danger increases with age. As a class,  statins are the leading class of drugs sold in the world today,  with annual sales exceeding $35 billion.

Avandia, the diabetes medication,   was once one of the biggest-selling drugs in the world. Driven in part by a multimillion-dollar advertising campaign, sales were $3.2 billion in 2006. But a 2007 study by a Cleveland Clinic cardiologist suggesting that the drug harmed the heart prompted the F.D.A. to issue a warning, and sales plunged. A committee of independent experts found in 2007 that Avandia might increase the risk of heart attack but recommended that it remain on the market, and an F.D.A. oversight board voted 8 to 7 to accept that advice.

Yes, medications may be approrpriate based on overall risk factors,  but they also are powerful chemicals that can negatively effect on our whole health.  A solution optimizing the power of nutrition to significantly improve whole health and prevent heart disease can be used in many cases --- either to avoid the intake of medications or significantly reduce the dosages required to achieve target health result. kardea nutrition - heart healthy and inspired - defining statin alternatives. kardea gourmet - great science, fantastic foods and cardiovascular health.

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.

Major Study Looks to Nutritional Supplements & Heart Health

Boston researchers are launching a large, national trial of vitamin D and fish oil to see whether the dietary supplements reduce the risk of developing cancer or cardiovascular disease. They are also testing the idea that lower levels of vitamin D might explain higher rates of these diseases among African-Americans.

Boston researchers are launching a large, national trial of vitamin D and fish oil to see whether the dietary supplements reduce the risk of developing cancer or cardiovascular disease. They are also testing the idea that lower levels of vitamin D might explain higher rates of these diseases among African-Americans.

Dr. JoAnn Manson and Dr. Julie Buring, both of Harvard Medical School and Brigham and Women’s Hospital, hope to enroll 20,000 healthy older people in the $20 million study funded by the National Institutes of Health.

One quarter of the participants will be black. The researchers believe higher rates of cancer, heart disease, and stroke among blacks, compared with whites, might be related to dark skin’s lower ability to make vitamin D from absorbing sunlight, and they want to establish whether taking vitamin D supplements could reduce or eliminate these disparities.

“African-Americans have a higher risk of vitamin D deficiency and a greater frequency of certain types of cancer and diabetes and hypertension, so I think that it will be of great importance to look at whether something as simple as taking a vitamin D supplement can narrow these health gaps,’’ said Manson, who believes the study is one of the first large-scale randomized trials to target a specific group at higher risk for a deficiency of nutrients. “It would be wonderful if something as simple as a vitamin D pill could narrow that health gap.’’

Women over 65 and men over 60 with no history of cancer or cardiovascular disease will be randomly assigned into four groups.

Some will take daily pills with about 2,000 international units of vitamin D and about 1 gram of fish oil. Others will take pills containing no active ingredients. In the two other groups, participants will get one of the supplements and one placebo. “I think it’s important to be cautiously optimistic and not jump on the bandwagon to take megadoses of supplements before a clinical trial helps to clarify their role.’’

Treatment will last five years. Participants will not need to travel to Boston because study forms and pills will be mailed, according to www.vitalstudy.org, the website for the study.

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Selected nutrients already have been found to promote cardiovascular health, notably plant sterol, soluble fibers from oatmeal, barley, psyllium and beans, and mono and polyunsatured fats in place of saturated fats. For more information on nutritional approaches to cardiovascular health, go to Kardea Nutrition. For heart health cooking recipes incorporating these key nutrients, go to Kardea Gourmet

Plant Sterols & Omega-3s Combine To Boost Heart Health

A combination of fish oil and plant sterols demonstrated over a 22% reduction in overall cardiovascular risk. In the September 2008 publication in Atherosclerosis, the researchers reported that they failed to demonstrate similar result for individuals taking fish oil alone.

The study's authors', Michelle A Micallef, University of Newcastle, and Manohar L, Garg, Hunter Medical Research Institute, write, "to date, this is the first study to investigate the combined cardioprotective effects of these two functional foods" in individuals with high cholesterol but without history of heart disease. The authors' conclude that the combine use of fish oil and plant sterol therapy is "an ideal alternative or adjunct to pharmacological treatments, for maximum cardioprotection ih high risk individuals."

Kardea Nutrition delivers a system of products that enable combination therapy, offering delicious foods and quality supplement. The Kardea system extends beyond fish oils and plant sterols to include cholesterol-lowering fiber and monounsaturated-rich extra-virgin olive oil.

Strategies to Increase Good HDL Cholesterol

When it comes to cholesterol, most people think lower is better. But when we're talking about the cholesterol in our blood, it's a bit more complicated.

Low-density lipoprotein, or LDL, is known as the "bad" cholesterol and high-density lipoprotein, or HDL, is known as the "good" cholesterol. LDL optimally should be less than 100 mg/dL (milligrams per deciliter)---above this level, some amount of arterial plaque (the stuff that causes blocks in the arteries that can lead to heart attacks and stroke) is likely to develop. You and your doctor may or may not seek to lower your cholesterol levels if they are higher. This depends on a variety of risk factors. To assess your maximum LDL targets, click to the Kardea LDL Cholesterol Calculator based on the recommendations of the National Cholesterol Education Program. And if you are at high risk of heart disease, you and your doctor may seek to drive your cholesterol below 70mg/dL.

HDL cholesterol removes excess cholesterol from the blood, which slows the build-up in the arteries and ultimately lowers heart disease risk. Since estrogen increases HDL, women tend to have higher levels than men. Women should strive for an HDL above 50 mg/dL and men above 40 mg/dL. While genetics plays a role in your HDL level, there are some things you can do to modestly boost a sagging HDL:

• Lose weight if you're overweight. Exercising and cutting a few calories can give HDL a little boost, especially if you carry most of your excess weight in your abdomen.
• Quit smoking. Smoking, as well as secondhand smoke, can lower HDL.
• Recognize that different types of fats affect your HDL levels. Healthy fat choices such as omega-3s found in fish and monounsaturated fats found in olive oil and canola oil, nuts, seeds and avocados should be used---replacing the satured and trans fats found in processed foods, certain meats and dairy products.
  • Alcohol can raise HDL. If you can safely fit alcohol into your eating plan, keep it moderate -- no more than one drink a day for women and two drinks for men.

Also, you can consider the use of niacin as nicotinic acid. Available as both a supplement and a prescription medication, this form of niacin can significantly raise your HDLs. For an overview on niacin, read Kardea's discussion paper. And remember, in developing a program that optimizes your heart health and cholesterol profiles, it is best to collaborate with your health care professionals.

Looking Beyond Lowering LDL Cholesterol

The risk of developing cardiovascular diseases is typically assessed based on a standard cholesterol test measuring LDL (low-density lipoprotein) and HDL (high-density lipoprotein) levels and then factoring advanced age, gender, family history of heart disease, high blood pressure, diabetes, and smoking. Taking these factors into account, LDL lowering targets can then be established, and a program of therapeutic changes in lifestyle and nutrition can be established. If these changes are unable to bring cholesterol levels in line, medications are routinely provided.

However, studies indicate that these risk factors can account for only a portion, perhaps 50%, of the incidence of coronary artery disease. The scientific community has continued its investigations, and is finding that a number of other risk factors can be identified through blood test. On its website, Berkeley Health Lab, a leading medical lab with an integrated program for cardiovascular treatment, identifies many of these important factors including:

Size of LDL Particles: Some LDLs Are Worse Than Others

• Small LDL particles can cause plaque build up to progress much faster because they can enter the artery wall easier than large LDL particles
• Too many small LDL particles can increase your risk for a heart attack beyond any other risk factors you may have, such as smoking, high blood pressure, diabetes, etc.
• Certain medications, proper nutrition, and regular exercise can help your body produce fewer small LDL particles

Size of HDL Particles: Some HDLS Are Better Than Others

• HDL helps to protect against progression of plaque build-up in the artery wall
• HDL2b is the workhorse of all of the HDL particle types. It has the ability to pick up and remove cholesterol
• Certain medications, improved nutrition, loss of body fat, stopping tobacco use, and increased physical activity are some ways that HDL-C and HDL2b can be improved

Apolipoprotein B: Accurate LDL Particle Number

• ApoB is a direct measurement of the amount of LDL ("bad" cholesterol) particles
• A high apoB number indicates increased risk for heart disease
• Improved eating habits, increased physical activity, and loss of body fat are some lifestyle changes that improve apoB
• Your physician uses apoB to determine if certain medications are needed and to monitor their effectiveness

C-Reactive Protein-hs (CRP)

• High levels of CRP indicate inflammation within the body due to infection or tissue injury; it can also predict heart disease risk levels
  Certain medications may help reduce this risk
  Certain foods have anti-inflammatory benefits

ApoE Genotype

• ApoE is a genetic test that plays a role in helping to identify how people respond to different amounts of dietary fat. Your body's response to dietary fat impacts the formation of small or large LDL particles
• There are 3 types of apoE genotypes: apoE2, apoE3 and apoE4
• People with an apoE4 have a greater risk for heart disease
• ApoE can be used to help guide the right nutrition plan for you

Other risk factors measurable through blood tests also are discussed on this site.

Overall, most of us typically receive the standard test for cholesterol, with these more thorough tests reserved for those individuals at high risk. Yet, for those of us interested in the information needed to optimize our long term health, this more complete assessment can be very useful. Check with you healthcare provider about obtaining these more extensive blood test to better direct your unique course for optimizing your health.

Cardiovascular Disease Prevention: Between Healthy Habits and Prescription Medications

With cardiovascular disease the largest cause of death and disability in the United States, the scientific community continues intense investigations into approaches for prevention. In the New England Journal of Medicine, Doctor Mark Hlatky of Stamford University School of Medicine, writes, "The aphorism 'prevention is better than cure' makes perfect sense when applied to healthy habits such as following a sensible diet, maintaining an ideal body weight, exercising regularly, and not smoking. But increasingly, prevention of cardiovascular disease includes drug therapy, particularly statins to lower cholesterol levels."

In this editorial, Dr. Hlatky is reponding to the growing interest in prescribing cholesterol-lowering medications to a much larger segment of the American population---including those with cholesterol levels well below the risk standards established by the National Cholesterol Education Program of the National Institutes of Health. These medications already are the single largest class of drugs sold in the U.S. today, exceeding $30 billion/year.

There is mounting evidence that lowering LDL cholesterol below the NCEP risk-adjusted standards is reducing the incidence of cardiovascular events such as heart attack and strokes. Further, recent studies, notably the JUPITER study published in the New England Journal of Medicine, reinforces the evidence that statin medications not only favorably alters cholesterol levels but also reduce the level of inflammation in the arteries. In addressing inflammation, the medication may reduce a root cause of arterial plaque development.

Yet, what remains lost in the discussions between healthy habits and drug treatment is the positive, therapeutic power of nutrition. Nutritional solutions extends beyond the restriction of saturated fats, trans fats and cholesterol to nutrients that actively improve cholesterol levels and reduce inflammation. For many, these nutritional tools can allow the individual to achieve target cholesterol levels and serve as an effective statin alternative. For others, the nutritional approach offers an opportunity for reductions in the dosages and number of medications required to achieve heart healthy targets.

The tragedy: compared with the funding for pharmaceutical studies, an incredible small amount of money is being spent to advance the nutritional science. With few major studies reporting on the benefits of nutritional cholesterol management, the news media reports on the pharmaceutical studies. The extensive and widely reviewed understanding of the nutritional solution is then overshadowed.

Here at Kardea, we are working to provide you with both the knowledge and the natural products that advance heart health. We are only one source. For others, discuss with your medical providers. Also, check out our the resource page on the Kardea Nutrition website or for great recipes for cholesterol management, click over to Kardea Gourmet .

Another good source of information: http://cholesterol.about.com/od/treatments/u/Treatments.htm

Kardea Nutrition, Heart Healthy & Inspired.

Cholesterol Education Month A Good Time to Consider Statin Alternatives

September is National Cholesterol Education Month.

The stakes are high. Cardiovascular disease remains the leading cause of death and morbidity in the U.S. Cholesterol management is a leading focus for disease prevention. Sales of related medications now exceed $30 billion in annual sales.

With a passion for natural health, we know well that therapeutic nutrition---based on balanced diets incorporating good fats, viscous soluble fiber, plant sterols and selected other nutrients---can achieve significant improvements in blood lipid profiles. We can lower LDL (bad) cholesterol and triglycerides. We can raise HDL (good) cholesterol. We can reduce the inflammation that trigger arterial plaque development.

The science is more than solid. It is endorsed by the National Institutes of Health, the American College of Cardiology and the American Heart Association. The FDA endorses health claims associated with these nutritents. Overall, therapeutic nutrition can deliver results comparable to many cholesterol-lowering medications.

Yet, the new Lipitor ad campaign eclipses any public education promoting the natural alternatives.

We certainly are not opposed to the medical solution, but as a matter of public policy, our society would be far better served by an extensive therapeutic nutrition campaign than by the Pharma consumer campaigns.

Perhaps we should insist on equal time---for every dollar Big Pharma spends to promote a cholesterol-lowering medication, it should be required to spend an equivalent amount on a separate therapeutic nutrition campaign. In the meantime, raising consumer awareness remains an important function of the natural and health food retailers, and the nutritional health professionals.

Kardea Nutrition--hearty health and inspired---enabling natural cholesterol management.

Cholesterol Management: Beyond Disease Prevention

The guidelines of the National Cholesterol Education Program define LDL cholesterol below 100mg/dl as optimal for otherwise healthy people. Yet, as a matter of disease prevention, these same guidelines suggest that substantially higher levels of LDL cholesterol may be acceptable. These standards are used as a baseline for determining the appropriateness of cholesterol-lowering medications.


Many doctors also are well aware that the non-optimal LDL standards are only a baseline. These doctors are apt to prescribe a cholesterol-lowering medication to achieve the more optimal level.

Here at Kardea, we look to natural cholesterol management to achieve the more optimal levels. Yes, medications may be needed by some, but a nutritional approach has proven as potent as many pharmaceutical therapies. And we recognize that cholesterol management extends well beyond simply lowering LDLs. Our prior blog posts and the numerous links and articles found on our resources page explore this more comprehensive approach.

The important point: cholesterol management is consistent with good health, not simply disease prevention. Whatever your currents levels ---- even if you believe that your cholesterol is not at risky levels ---- consider the benefits of pursuing a more integrated and comprehensive approach.

Turning 50 with a Focus on Vitality Not Disease Prevention

I turned 50 this past June. I am told that 50 is not old. I am told that 50 is the new 40, or perhaps 35. I am a believer. I do not think like I am old. I remain eager to learn anew.

Yet, I have acquired a gnawing sense that time is bracketed, not limitless. The weekly mailings from the AARP provide the reminder. The challenges faced by my 85 year old parents sharpen the feelings. Neither is ravaged by a particular disease. Time, slowly but with increasing speed, erodes their vitality.

With an eye not only looking to disease prevention, but also towards extending my years of vitality, I approach a health consciousness. Overall, I believe that maintaining a healthy cardiovascular system is a key to extending vitality.

I exercise, but perhaps not with the intensity to optimize my cardiovascular health. The hip pains and lower back aches serve as a bit of an obstacle.

I watch my weight, but it still falls somewhere above the ideal range, although I am not defined as overweight.

I am perhaps most successful with assuring that I eat the right foods---balanced, high in fruits, vegetables, good fats (monounsaturated fats) and good carbs (whole grains and fibers), and enhanced with certain cholesterol-managing nutrients, notably plant sterols, viscous fibers, omega-3s and selected types of niacin. No doubt, my success here lies with the pleasure I derive from food shopping, gourmet cooking and social eating.

Natural Cholesterol Management: Looking Beyond Heart Disease Prevention

The guidelines of the National Cholesterol Education Program define LDL cholesterol below 100mg/dl as optimal for otherwise healthy people. Yet, as a matter of disease prevention, these same guidelines suggest that substantially higher levels of LDL cholesterol may be acceptable. These standards are used as a baseline for determining the appropriateness of cholesterol-lowering medications.

Many doctors also are well aware that the non-optimal LDL standards are only a baseline. These doctors are apt to prescribe a cholesterol-lowering medication to achieve the more optimal level.

Here at Kardea, we look to natural cholesterol management to achieve the more optimal levels. Yes, medications may be needed by some, but a nutritional approach has proven as potent as many pharmaceutical therapies. And we recognize that cholesterol management extends well beyond simply lowering LDLs. Our prior blog posts and the numerous links and articles found on our resources page explore this more comprehensive approach.

The important point: cholesterol management is consistent with good health, not simply disease prevention. Whatever your currents levels ---- even if you believe that your cholesterol is not at risky levels ---- consider the benefits of pursuing a more integrated and comprehensive approach.

Intermediate Dose Niacin and Natural Cholesterol Management

Niacin, also known as Vitamin B3, is vital for good health. Niacin helps convert food into energy, build red blood cell counts, and synthesize hormones.

For basic good health, a relatively small amount of niacin, about 20mg/day, is needed. Americans typically obtain this level from a balanced, healthy diet. Our bodies also can manufacture niacin.

At substantially higher levels—1000-2500mg/day--- a specific type of niacin significantly improves cholesterol levels. Niacin as nicotinic acid can lower LDL cholesterol by up to 25%, raise HDL cholesterol by as much as 35%, and lower triglyceride levels by 20% to 50%.[i] The medical community[ii] generally defines these high dosages as a drug that should be taken under a physician’s care. The primary concerns relate to potential liver complications. A doctor will monitor liver function as part of a routine blood test. As a practical matter, the very real and sometimes intense flushing side-effects associated with nicotinic acid at these levels may make a “buffered” prescription nicotinic acid the only viable option.

Nonetheless, nicotinic acid supplements are approved for sale by the Food and Drug Administration. Further, the intake of niacin at intermediate dosage levels --- 100-1000mg/day---has been shown to significantly improve the levels of both HDLs and triglycerides. Coupled with other elements of natural cholesterol management, intermediate dosage of niacin in the form of supplements may provide a meaningful contribution in long term cardiovascular health.

Cholesterols Management: Beyond LDL Reduction

LDL cholesterol reduction has been the primary focus of the medical and pharmaceutical community. This focus is supported by the significant and extensive research confirming the positive health effects of lowered LDL, including reduced heart attacks, strokes and other cardiovascular diseases.

Increasingly, medical science recognizes that LDL reduction alone is only part of cholesterol management and cardiovascular health and wellness.

Researchers are assessing the composition of cholesterol and triglycerides in our blood. For instance, the NIHs’ National Cholesterol Education Program (NCEP) reports that “strong epidemiological evidence links low levels of serum HDL cholesterol to increased CHD (coronary heart disease). High HDL-cholesterol conversely conveys reduced risk.”[iii] The NCEP identifies having HDLs less than 40mg/dl as a risk factor for heart disease. Levels above 60mg/dl are associated with a reduced risk of heart disease.

Statins, the leading medication for LDL reduction, have been associated with some HDL increases. Yet, under the NCEP guidelines, statins are typically recommended only when LDL levels are elevated.

Low HDL levels without elevated LDL levels are nonetheless fairly common. Up to 50% of patients not typically candidates for LDL-lowering medications have low levels of HDLs. In patients with premature coronary artery disease, low HDL levels are the most common abnormality in blood lipids.[iv]

A number of recent studies indicate that small increases in HDLs can significantly reduce the incidence of cardiovascular-related death. A 1mg/dl increase in HDL has been associated with a 2%-3% reduction in coronary artery disease.[v] Another extensive study concluded that increasing HDLs by 6% in patients with low HDL cholesterol decreased heart-related deaths and non-fatal heart attacks by 22%.[vi]

Intermediate Daily Dosages of Niacin as Nicotinic Acid

Between the 20mg recommended for basic health and the 100x greater levels used to manage at-risk patients lies a potential role for niacin for promoting cardiovascular health. In one study, patients took 50mg of niacin as nicotinic acid twice per day for 3 months. The patients on the niacin experienced an average 5% increase in HDLs, or an average of 2.1mg/dl.[vii] In another study, 500mg/day of niacin as nicotinic acid raised HDLs by 10% (close to 5mg/dl) and lowered LDLs by 5% and Triglycerides by 5%.[viii] At 1000mg/day, improvements were 15%, 7% and 11% for HDL, LDL and triglycerides respectively.

The medical community has refrained from endorsing the use of nicotinic acid supplements at these dosage levels as part of a more natural, statin-free solution to blood lipid management. The medical community’s reticence flows, in part, from doctors’ distrust of nutritional supplements. Supplements are subject to fewer regulations than pharmaceuticals, but the industry also is not without regulatory requirements, and many high quality and reliable supplement manufacturers and retailers exist.

Another issue surrounding niacin relates to the potential for consumer confusion. There are three types of niacin available---nicotinic acid, niacinamide, inositol hexanicotinate. Only nicotinic acid has been shown to be effective for cholesterol management.

Further, there are three forms of nicotinic acid—immediate release, sustained release and extended release.

Immediate release nicotinic acid often causes a very uncomfortable flushing of the skin accompanied by an intense feeling of heat, tingling and itching---even at relatively low levels of niacin. The flushing can start a few minutes or a few hours after taking niacin. Flushing typically subsides within 30 minutes, often much sooner.

At the intermediate dosage levels, flushing can be managed by gradually increasing the levels of nicotinic acid. You can start by trying 50mg with lunch and dinner. As your body grows accustomed to these levels, you can try raising your niacin intake with these meals. You might also try taking nicotinic acid before bed.

For individuals who cannot overcome the flush or for those looking to move to higher a dosage level, nicotinic acid is sold as a supplement in a sustained release version. The sustained releases version reduces the intensity of flushing, but at higher levels, it has been associated with liver damage.

The third form of nicotinic acid, extended release niacin, is available as a prescription. This form has typically been used at high level and only to treat harmful cholesterol levels that cannot be remedied through nutrition, certain lifestyle changes and statins.

Integrating Niacin into Natural Cholesterol Management

Intermediate doses of niacin as nicotinic acid may be meaningful for raising HDL cholesterol for cardiovascular health promotion, since the corresponding 5-10% increase in HDLs can significantly lower the risk of heart attack. The impact at these dosage levels alone may fall short of achieving more optimal cholesterol and triglyceride levels. When coupled with other nutrients, however, these niacin dosages may enable an individual to achieve optimal targets. Substantial LDL reductions can be further achieved through the restricted intakes of saturated and trans fats, higher intakes of monounsaturated fats, and therapeutic levels of plant sterols and selected types of fibers (including soluble fiber from oats, barley, psyllium, beans and certain fruits) .[ix] While Omega-3s have not been proven to lower LDL cholesterol, they lower triglycerides and may positively alter other factors leading to the build-up of arterial plaque. Modest weight loss and increased physical activity can further raise HDLs.

With many Americans suffering from the side-effects of statins and others preferring to minimize a lifetime of prescription drugs, it seems appropriate for the medical community to take a greater interest in the role of intermediate dosages of niacin, particularly as a component of broader therapeutic nutrition efforts.
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[i] Anne Goldberg, M.D. et al, Multiple-Dose Efficacy and Safety of an Extended-Release Form of Niacin in the Management of Hyperlipidemia. The American Journal of Cardiology, Vol. 85, pp 1100-1105 May 1, 2000.

[ii] Detection, Evaluation & Treatment of High Blood Cholesterol in Adults, Third Report of the National Cholesterol Education Program Expert Panel National Institute of Heart, Lung and Blood Institute, National Institutes of Health, September 2002. www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf

[iii] Ibid ”II Rational for Intervention”.

[iv] Ibid.

[v] DJ Gordon et al., High Density Lipoprotein Cholesterol and Disease: Four Prospective American Studies, Circulation 1989

[vi] HB Robins et al., Gemfibrozil for the Prevention of Coronary Heart Disease in Men with Low Levels of High-Density Lipoprotein Cholesterol, The New England Journal of Medicine 1999.

[vii] Jennifer Wink, MD et al., Effect of Very-Low-dose Niacin on High-Density Lipoprotein in Patients Undergoing Long-Term Statin Therapy, American Heart Journal, Volume 143, Number 3, March 2002.

[viii] Goldberg Op Cite, p1102

[ix] Ibid

Statins for Our Kids?

The American Academy of Pediatrics is recommending wider cholesterol screening for children. Underpinning these recommendations is the understanding that elevated LDL (bad) cholesterol in kids can lead to an onset of cardiovascular disease earlier in adulthood. It recognizes that the plaque in an adult's arteries may have begun developing very early in life.

The recommendations call for cholesterol screening of children and adolescents, starting as early as the age of 2 and no later than the age of 10, if they come from families with a history of high cholesterol or heart attacks before 55 for men and 65for women.

Screening is also recommended for children when family history is unknown, or if they have other risk factors, like being at or above the 85th percentile for weight, or have diabetes. If the child’s cholesterol level is normal, retesting is suggested in three to five years.

The report also suggests that for a selected group of children, prescribing a statin medication might be appropriate. Drug treatment, according to these recommendations, should be considered for children 8 and older who have very elevated LDLs, or when family history or weight indicate multiple risk factors for developing heart disease.

Not surprisingly, these recommendations raised an outcry.

“When you have a kid whose cholesterol looks like an overweight 65-year-old, what do you do?” asks Dr. David Ludwig, director of the childhood obesity program at Children’s Hospital in Boston and quoted in The New York Times. In developing the recommendations, we "had to balance the risks of treating children with powerful drugs, about which there is limited long-term data, with the risks of not treating children with unprecedented cardiovascular disease risk factors.”

Dr Ludwig also is reflective about these recommendations. Quoted in the Times, he comments “my concern is what this is saying about society when we are so quick to prescribe drugs for these conditions before having systematically attacked the problem from the public health perspective”.

For many, the systematic solution focuses on addressing childhood obesity. No doubt, an extraordinarily important challenge in its own right. Yet, cholesterol management in children go beyond issues associated with obesity. Elevated cholesterol can be found in otherwise fit and thin adults and children alike.

Between weight loss and medication lies therapeutic nutrition as outlined by the National Cholesterol Education Program (NCEP) of the National Institutes of Health. Eating a balanced diet that replaces saturated fats and trans fats with monounsaturated fats (e.g. fats in olive oil, nut butters), adds high levels of soluble fiber from oats, beans, high-pectin fruits, and psyllium) and adds plant sterols can significantly improve cholesterol and blood lipid profiles. Other nutrients, including Omega-3s from fish oils, also have been found useful.

The NCEP asserts that therapeutic lifestyle changes with a particular emphasis on what we eat (not simply how much we eat) can deliver results comparable to many cholesterol-lowering medications. For links to the NCEP reports, clinical research and other educational materials advancing natural cholesterol management: Kardea Nutrition http://www.kardeanutrition.com/. For recipes: http://www.kardeagourmet.com/

Red Yeast Rice: Statin Alternative or Natural Statin

A study recently published in the Mayo Clinic Proceeding has confirmed the power of natural alternatives for cholesterol management. The study, authored by group of doctors and researchers associated with University of Pennsylvania, found that a combination of the Therapeutic Lifestyle Changes (TLC) recommended by the National Cholesterol Education Program (NCEP) of the National Institutes of Health coupled with red yeast rice and fish oil supplements led to a more substantial reduction in LDL (bad) cholesterol than did simvastatin, a statin medication sold by Merck Drug under the brand name Zocor.


The authors wrote “our study was designed to test a comprehensive and holistic approach to lipid lowering…. These results are intriguing and show a potential benefit of an alternative, or naturopathic, approach to a common medical condition, hyperlipidemia”

Statin Alternative or Natural Statin

The media reported the study as an “alternative to statins.” In reality, the choice is between a prescription, controlled statin and a natural source of statins. The active ingredient in red yeast rice supplements is a naturally occurring statin. It is chemically similar to the prescription lovastatin sold by Merck under the brand name of Mevacor. In short, red yeast rice does not represent a statin alternative, but rather a natural source of statins.

For those of us with a predisposition to natural products, this may seem like an intriguing option, but red yeast rice supplements face some important challenges. The authors of this study outlined the issues:
• In 2001, the US Food and Drug Administration determined that red yeast rice with a controlled level of the lovastatin was a drug, not a dietary supplement.
• As a result, the supplement manufacturer cannot control or test for the active compounds in red yeast rice supplement. While the chemical composition of the red yeast rice supplement used in the study was known and controlled, the composition of various products and the batch consistency between lots from the same source make recommending red yest rice supplements difficult.
• Taking red yeast rice without a physician’s supervision could also have unknown risks. The lovastatin component can cause the same side effects as any statin, and a potentially dangerous metabolite, citrinin, can form in poorly manufactured preparations.

Statin Alternative Do Exist

The American Heart Association, the American College of Cardiology, the American College of Preventive Medicine and many other health and medical organization participated in developing the NCEP recommendations. The recommendations emphasize that “many people will be able to lower their LDL enough” with lifestyle and nutritional changes alone. The NCEP reports that “if your LDL needs more lowering, you may have to take a cholesterol-lowering drug” in addition to the lifestyle changes . “However, by staying on the TLC Program, you’ll be keeping that drug at the lowest possible dose. “

The Kardea website provides an extensive amount of information about TLC. It also addresses some of the nutrients not specifically recommended by the NCEP, but widely reviewed by the medical community. The important point: before taking a statin----from a prescription or an herbal supplement---consider your alternatives.

Foods with Plant Sterols

In nature, small quantities of plant sterols can be found in a range of foods, particularly vegetable oils. In the American diet, the average plant sterol intake is about 250 milligrams. Vegetarians consume in a range of 400 to 750 milligrams. Plant sterol intake in traditional diets has been estimated to be about 1g (1000mg). Medical studies have concluded that 2-3g (2000-3000mg) effectively lower cholesterol. Fortified foods or supplements are typically required to obtain these levels.


At our sister site, Kardea Gourmet, you can find a listing of a variety of foods with plant sterols --- naturally-occurring and fortified. You also can find (and contribute) great recipes for foods that actively work to improve cholesterol levels.

Father's Day Gourmet & Cholesterol Management

The science is clear and convincing. Therapeutic nutrition---that incorporates 2g of plant sterols, over 10g of soluble fiber, monounsaturated fats replacing saturated and trans fats, and reduced animal sources of protein-- can achieve cholesterol reductions comparable to many of the widely prescribed medications.

With my daughter, we have created a delicious, natural, cholesterol-lowering Father’s Day menu.

We recommend recipes for lunch, a snack and dinner. With a single serving of each dish, you will enjoy:

• 2g of natural plant sterols from foods and taken through the course of the day.
• 30g of total fiber
• 7 grams of heart healthy soluble fiber.
• 1g Omega-3 fatty acids (EPA/DHA)
• Only 150mg of dietary cholesterol (from the chicken and salmon)
• Saturated fat is below 7 percent of total calories.
• Monounsaturated fats equal about 23% of total calories.

Overall, we are nearly in-line with the recommendations of the National Cholesterol Education Program, but we fall a bit short on the heart healthy soluble fiber.

So look to breakfast to finish your therapy. Here are some simple guidelines. A good morning start would be an oat cereal and fruit. If you are looking for something a bit more interesting, there are a number of oat pancake recipes that can be found online. Stay away from the ones with butter and lots of eggs in the ingredients. Either way, you should get you to the 10g minimum recommendations for soluble fiber.

In my life, I actually shoot for the higher, 20-25g recommendation. The only way I have been able to achieve this goal is with psyllium husk or concentrated oat bran. I dissolve a tablespoon of one of these fibers into my morning juice. A heaping tablespoon of the psyllium husk, for instance, delivers 9g of heart health soluble fiber. Most people can tolerate such a dosage, but it is probably something you need to work up to.

The Menu

Luncheon
Mediterranean Salmon Salad
Chick Peas with Oregano
Roasted Asparagus
Whole Grain Bread or Whole Wheat Roll

Snack
Kardea Gourmet Nutrition Bar with 1g plant sterols, 7g fiber, and 7g protein.

Dinner
1st Course
Gazpacho: Quick, Bold & Delicious

2nd Course
Chicken Balsamic Reduction
Steamed Broccoli
Barley Pilaf

Dessert
Sorbet of Your Choosing
Fresh Berries or Sliced Ripe Peaches.

WebMD Addresses Natural Cholesterol Management

WebMD has recently released an online video addressing natural cholesterol management. View Video.

In the accompanying artcle, WebMD reports, "To lower your cholesterol, ...a handful of some "functional foods" have been shown to make a big impact on your cholesterol levels."

"These foods may not be magic, but they're close to it," says Ruth Frechman, RD, a spokeswoman for the American Dietetic Association quoted in the WebMD article.

The article continues that "studies have shown that a diet combining these "superfoods" may work as well as some cholesterol-lowering medicines to reduce your "bad" LDL cholesterol levels." This is great news for the 105 million adults in the U.S. with high cholesterol, particularly for the many people that can't handle the side effects from cholesterol drugs.

The Kardea website provides an excellent overview of how these key nutritions fit into a heart health diet. And for recipes enabling therapeutic nutrition for cholesterol management, click to Kardea Gourmet.

Plant Sterols: What Are They? How Do They Work?

Plants produce plant sterols. Animals produce cholesterol. Structurally similar, both bind to sites in our intestines where the cholesterol produced in our livers and consumed in our foods are absorbed into our blood.

Yet, our bodies have evolved the ability to distinguish between these types of sterols. On average, we absorb about 55% of cholesterol and less than 1% of the plant sterols. Plant sterols work to lower cholesterol by filling the "absorption gateways," thus blocking the cholesterol from entering the blood stream. Blocked cholesterol is execreted along with most of the plant sterols.

In nature, small quantities of plant sterols can be found in a range of foods, particularly vegetable oils (sources of plant sterols). The average plant sterol intake in the U.S. is about 250 milligrams. Vegetarians consume in a range of 400 to 750 milligrams. Plant sterol intake in traditional diets has been estimated to be about 1g (1000mg). Medical studies have concluded that 2-3g (2000-3000mg) effectively lower cholesterol. Fortified foods are typically required to obtain these levels.

The effectiveness of plant sterols will vary from person-to-person. Many people absorb cholesterol more effectively than others. For these individuals, the impact of plant sterols may be more significant.

Overall, plant sterols are an important component of a nutritional system designed to promote healthier cholesterol and blood lipid levels. Achieving maximum benefits from natural cholesterol management may require other nutrients---including the soluble fibers found in oats, beans, fruit and psyllium, certain types of niacin, Omega-3s, monounsaturated fats in place of saturated fats----all in the context of balanced nutrition, calorie-mindfulness and physcial activity.

Protein & Cholesterol Management: NCEP Discussion

In our recent posts, we have provided you with the summary evidence and recommendations from the National Cholesterol Education Program as it relates to the consumption of fats--both good and bad, carbohydrates and certain key nutrients like plant sterols and soluble fiber. In regard to proteins, the National Cholesterol Education Program provides somewhat weaker recommendations. The NCEP recent report states:

"Dietary protein in general has little effect on serum LDL cholesterol level or other lipoprotein fractions. However, substituting soy protein for animal protein has been reported to lower LDL cholesterol. Plant sources of protein are predominantly legumes, dry beans, nuts, and, to a lesser extent, grann products and vegetables, which are lower in saturated fats and cholesterol. Animal sources of protein that are lower in saturated fat and cholesterol include fat-free and low-fat dairy products, egg whites, fish, skinless poultry, and lean meats."

The report continues noting that "Since there are inconsistent findings regarding both the dose and potential benefit of soy protein, soy protein's major role in LDL-lowering may be to help reduce the intake of animal food products with the higher content of saturated fatty acids."

NCEP Evidence Statement: High intakes of soy protein can cause small sreductions in LDL cholesterol levels, especially when it replaces animal food products (Stength of Evidence: A2, B2).

NCEP Recommendation: Food sources containing soy protein are acceptable replacements for animal food products containing animal fats.

Carbs, Proteins & Fats: The NCEP Balance

Carbohydrate: 50-60% of Total Calories* **

Dietary Fiber: 20-30 grams per day (10-25grams from Soluble Fiber)

Protein: 15% of Total Calories
Total Fat: 25-35% of Total Calories*
Monunsaturated Fat: Up to 20% of Total Calories
Polyunsaturated Fat: Up to 10% of Total Calories
Saturated Fat: Less than 7% of Total Calories
Dietary Cholesterol: Less than 200mg/day.

*Allows an increase of total fat to 35% of total calories and reduction in carbohydrate to 50% for persons with the metabolic syndrome. Any increase in fat intake should be in the form of either polyunsaturated or monounsaturated fat. **Carbohydrate should derive perdominantly from foods rich in complex carbohydrates including grains--especially whole grains---fruits, and vegetables.

Carbohydrates & Cholesterol: Recommendations from the National Cholesterol Education Program

NCEP Evidence Statement: When carbohydrate is substituted for saturated fatty acids, LDL cholesterol levels fall (Strength of Evidence: A2, B2). However, very high intakes of carbohydrates (greater than 60 percent of total calories) are accompanied by a reduction in HDL cholesterol and a rise in triglyceride (B1, C1). The latter responses are sometimes reduced when carbohydrate is consumed with viscous fiber (C2); however, it has not been demonstrated convincingly that viscous fiber can fully negate the triglyceride-raising or HDL-lowering actions of very high intakes of carbohydrates.

NCEP Recommendations: Carbohydrate intakes should be limited to 60 percent of total calories. Lower intakes (e.g. 50% of calories) should be considered for persons with the metabolic syndrome who have elevated triglyceride or low HDL cholesterol. Regardless of intakes, most of the carbohydrate intake should come from grain products, especially whole grains, vegetables, fruits, and fat-free or low-fat dairy products.

Macronutrient NCEP Dietary Recommendations

Carbohydrate: 50-60% of Total Calories* **

Protein: 15% of Total Calories

Total Fat: 25-35% of Total Calories*

Monunsaturated Fat: Up to 20% of Total Calories

Polyunsaturated Fat: Up to 10% of Total Calories

Saturated Fat: Less than 7% of Total Calories

Dietary Cholesterol: Less than 200mg/day.

*Allows an increase of total fat to 35% of total calories and reduction in carbohydrate to 50% for persons with the metabolic syndrome. Any increase in fat intake should be in the form of either polyunsaturated or monounsaturated fat.
**Carbohydrate should derive perdominantly from foods rich in complex carbohydrates including grains--especially whole grains---fruits, and vegetables.

Trans Fatty Acids: Recommendations of the National Cholesterol Education Program

NCEP Evidence Statement: Trans fatty acids raise serum LDL cholesterol levels (Strength of Evidence: A2). Through this mechanism, higher intakes of trans fatty acids should increase risk for CHD (coronary heart diseases). Prospective studies support an association between higher intakes of trans fatty acids and CHD incidence (C2). However, trans fatty acids are not classified as saturated fatty acids, nor are they included in the quantititative recommendation for saturated fatty acid intake of less than 7 percent of calories in the TLC (therapeutic lifestyle changes) Diet.

NCEP Recommendation: Intakes of trans fatty acids should be kept low. The use of liquid vegetable oil, soft margarine, and trans fatty acid-free margarine are encouraged instead of butter, stick margarine and shortening.

NCEP Discussion: Substantial evidence from randomized clinical trials indicates that trans fatty acids raise LDL cholesterol levels, compared with unsaturated fatty acids. These stuides also show that when trans fatty acids are substituted for saturated fatty acids, HDL (good) cholesterol levels are lower.

Click recommendations on unsaturated fats, both monounsaturated and polyunsatured.

Polyunsaturated Fatty Acids: Recommendations from the National Cholesterol Education Program

NCEP Evidence: Linoleic acid*, a polyunsaturated fatty acid, reduces LDL cholesterol levels when substituted for saturated fatty acids in diets (Strength of Evidence: A1,B1). Polyunsaturated fatty acids can also cause a small reduction in HDL cholesterol when compared with monounsaturated fatty acids (B2). Controlled clinical trials indicate that substitution of polyunsatuarated fatty acids for saturated fatty acids reduces risk for CHD (coronary heart diseases) (A2,B2).

NCEP Recommendations: Polyunsaturated fatty acids are one form of unsaturated fatty acids that can replace saturated fat. Most polyunsaturated fatty acids should be derived from liquid vegetable oils, semi-liquid margarines, and other margarines low in trans fatty acids. Intakes of polyunsaturated fat can range up to 10 percent of total calories. (Note: recommendation for monounsaturated fatty acid is a higher at up to 20 percent of total calories).

*Linoleic acid is a colorless to straw-colored, polyunsaturated fatty acid that is liquid at room temperature and of the omega-6 series. Good sources of linoleic acid from vegetarian sources are sunflower oil, and safflower oil.

Viscous Soluble Fiber: Recommendations from the National Cholesterol Education Program

NCEP Discussion (excerpt): Because of the favorable effects of viscous fiber (soluble fiber from oats, fruit pectins, guar, beans and psyllium) on LDL cholesterol levels, the NCEP recommends that the therapeutic diet be enriched by foods that provide at least 5-10 grams of viscous fiber daily (Source of Soluble Fiber Chart). Even higher intakes of 10-25 grams per day can be beneficial.

NCEP Evidence Statement: 5-10 grams of viscous fiber per day reduces LDL cholesterol levels by approximately 5 percent (Strength of Evidence: A2, B1).

NCEP Recommendation: The use of dietary sources of viscous fiber (soluble fiber from certain sources) is a therapeutic option to enhance LDL lowering.

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.

Zetia/Vytorin Study: A Perspective

You may have heard the considerable debate regarding the cholesterol-lowering medication, Zetia. Unlike statins which affect your cholesterol production, this drug blocks the absorption of both dietary and biliary (liver-produced) cholesterol into the blood stream. The drug is intended to provide individuals who cannot reduce LDL cholesterol using diet and exercise with an alternative to high dosages of statin medications. It also was developed for those who simply cannot tolerate statins.

In a recent controversial study reported in the New England Journal of Medicine, the effects of taking Zetia and the statin, Zocor, combined (together known as the drug Vytorin) was compared to the effects of taking Zocor only.

Here are results:

The group taking the two drugs experienced an LDL cholesterol decline that was 27% greater than the Zocor-only group.

Despite the increased lowering of LDL cholesterol in the group that received both medications, both groups saw arterial plaque build at rate that was similar (although those on the combination drug saw a somewhat larger, but not statistically significant, increase).

This finding is at odds with our traditional understanding of the favorable relationship between lower LDL cholesterol and atherosclerosis.

The trial, however, did not directly address whether lowering of LDL cholesterol with the combination drug reduces heart attacks, strokes and other cardiovascular “events.” The combination drug may or may not provide an additional benefit.

So how is the medical community responding?

An editorial in the New England Journal of Medicine observes that “it seems prudent to encourage patients whose LDL cholesterol levels remain elevated despite treatment with an optimal dose of a statin to redouble their efforts at dietary control and regular exercise,” leaving Zetia for special situations. Yet, well trained, qualified doctors continue to prescribe the combination drug more broadly, believing that a single study does not unseat established wisdom.

The human body is profoundly complex, and we simply do not know with certainty how any particular approach will affect our long term health and longevity. We can only play the odds as we know them today. This requires that each of us take an educated approach to our health. Kardea aims to enable the members of its community to make more informed decisions about cholesterol management and natural nutrition.

Lowering Cholesterol: A Piece of the Heart Health Puzzle

The relationship between LDL cholesterol and cardiovascular diseases has been well-documented and summarized by the NIH's National Cholesterol Education Program.

Epidemiologic studies (i.e. research that associates the lifestyles of different populations or groups to a disease), laboratory studies (i.e. research into the effects of certain nutrients or medication on cells outside the body) and clinical studies (research on the effects of certain nutrients or medications on a living person) all show that cholesterol is a critical factor in the development of atherosclerosis.

Atherosclerosis occurs when plaque builds up on the walls of your arteries. This plaque leads to a narrowing and ultimate closing of an artery. Plaque also can break free of the arterial wall. It then can lodge further down your artery, causing a blockage that can lead to a stroke, heart attack, or a blood clot in your arms, legs or other parts of your body.

National Cholesterol Education Program Summary of Research

• Studies across different populations reveal that those with higher cholesterol levels have more arterial plaque and heart disease than those with lower levels. People who migrate from regions where average serum cholesterol in the general population is low to areas with high cholesterol levels show increases in their cholesterol levels as they acculturate. These higher levels in turn are accompanied by higher levels of heart disease.
• Atherosclerosis often can be identified in adolescence or early adulthood. The cholesterol level in young adulthood predicts development of heart disease later in life. In three prospective studies with long-term follow-up, detection of elevated serum cholesterol in early adulthood predicted an increased incidence of heart disease in middle-age.
• The power of elevated LDL to cause heart disease has been shown most clearly in persons with genetic forms of very high cholesterol. In these persons, advanced coronary atherosclerosis and premature heart disease occur commonly even in the complete absence of other risk factors. These disorders provide stronge evidence that LDL is a powerful cause.
• Since LDL-cholesterol levels of less than 100 mg/dL throughout life are associated with a very low risk for heart disease in populations, they can be called optimal. Even when LDL-cholesterol concentrations are near optimal (100–129 mg/dL), plaque formation occurs; hence, such levels must also be called above optimal. At levels that are borderline high (130–159 mg/dL), plaque formation proceeds at a significant rate, whereas at levels that are high (160–189 mg/dL) and very high (above 189 mg/dL) it accelerates further.
• A large number of clinical trials on cholesterol-lowering therapy have been carried out over the past four decades. The initial encouraging findings of earlier trials have recently been reinforced by the robust findings of a large number of studies.
  

The Research in Context: Only A Piece of the Puzzle

Lowering LDL cholesterol is not a guarantee of cardiovascular health. Many people on cholesterol-lowering medications still suffer heart attacks, strokes and other cardiovascular challenges. Similarly, LDL cholesterol levels above the "optimal" levels should not necessarily require an individual to proceed to a lifetime of cholesterol-lowering medications. Each of us should discuss this carefully with our medical providers.

In these conversations, however, you should recognize that cholesterol-lowering is only one piece of the puzzle. Some things to consider:

• Once built-up in your arteries, plaque is difficult to remove. Cholesterol-lowering therapies may only serve to reduce further development, but not fully remedy arterial health.
• The medical community also is investigating the role that different types of LDLs might play in the development of both plaque itself and the ability for plaque to remain “stable” and not break free from the arterial wall. This may be a factor even if LDL levels are low.
• Low levels (below 40mg/dl) of HDL cholesterol have been shown to be a risk factor for heart diseases and high levels (above 60mg/dl) have been associated with reducing the risk of heart disease and plaque development.

Beyond cholesterol management, cardiovascular health flows from different hereditary, environmental and lifestyle factors. It is a complex equation.

The important point: cholesterol management should be thought of as a lifetime approach, starting in your teens, to maintain cardiovascular health. Like weight-management and physical fitness, cholesterol management and its nutritional tools can promote long term health.

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.

Natural Cholesterol Management-Study Reaffirms Efficacy

A new study reaffirmed the recommendations of the medical community related to the power of nutrition to lower cholesterol independent of cholesterol-lowering medications.

"In the context of a low-saturated fat diet and in combination with other cholesterol-lowering dietary components, plant sterols appear to exert a very significant effect on LDL-C reduction of the order of 10 per cent for two grams per day of plant sterols," wrote lead author David Jenkins from St Michael's Hospital, Toronto."This figure is similar to studies where plant sterols have been given as the only cholesterol-lowering agent. "Numerous clinical trials in controlled settings have reported that daily consumption of 1.5 to 3 grams of phytosterols/stanols can reduce total cholesterol levels by eight to 17 per cent, representing a significant reduction in the risk of cardiovascular disease.

Participants in the new study adhered to the guidelines set out by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). According to these guidelines, "therapeutic lifestyle changes" can achieve results similar to some cholesterol lowering medications. The study sought to assess the effectiveness of "each functional food component to the overall cholesterol reduction observed and whether all ingredients have to be present," explained the researchers. Jenkins and co-workers prescribed the 42 subjects (average age 63) to a diet containing viscous fibres (10 g/1,000 kcal), soy protein (22.5 g/1,000 kcal), and almonds (23 g/1,000 kcal) for 80 weeks. In addition, plant sterols were taken (one gram per 1,000 kcal), except during weeks 52 to 62.

"Increased plant sterol intakes are likely to have been a part of the ancestral human diet at about one gram per day and are part of a more plant-based diet as currently recommended for CHD risk reduction, including green leafy vegetables, raw or dry roasted nuts, and non-hydrogenated vegetable oils," wrote the authors. "Their reintroduction into the Western diet to prevent CHD may be seen as similar to the desire to reintroduce fibre into the diet to reduce the risk of a number of chronic diseases....Plant sterols therefore appear a good fit with other cholesterol-lowering components in a dietary portfolio to reduce CHD risk," they concluded.


D Jenkins et al. Effect of plant sterols in combination with other cholesterol-lowering foods.
Metabolism, Volume 57, Issue 1, Pages 130-139

Vegans & High Cholesterol

Free of all animal products, a strict vegan diet contains no cholesterol. Yet, a vegan may face elevated levels of cholesterol. A paradox? Not really. We all are highly effective at producing and recycling cholesterol. Each cell wall requires cholesterol. Cholesterol serves as a building block for important hormones. Cholesterol plays a role in the digestion of dietary fats. We can manufacture cholesterol at a cellular level. We produce cholesterol in our livers. For many Americans, their own body produces 70%-80% of the cholesterol found in the blood stream. Only the residual comes from foods.

Within the context of our modern lifestyles and extended life spans, our well developed ability to manufacture cholesterol can adversely affect our heart and vascular health. This is true for vegans, vegetarians and omnivores alike.

If you are a vegan, how should you think about your cholesterol levels? Start with the facts. Get a blood test that provides information on your total cholesterol and its components—LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides. Then factor in your own family history to frame your understanding of these numbers. Then consider that a health circulatory system can play an important role in your long term health and wellness.

Other Benefits of a Vegan Diet

In terms of cholesterol management, vegans often enjoy benefits other than restricted intake of dietary cholesterol. The diet may be lower in saturated fats. Research shows that these fats, particularly those from animal and dairy products, elevate cholesterol levels. Interestingly, certain saturated fats from plants have been shown to be cholesterol neutral.

Vegans and vegetarians also consume a higher level of plant sterols. Plant sterols are the plant kingdom’s equivalent of cholesterol. At 2 grams per day, these sterols have been shown to lower LDL blood cholesterol levels by 15% or more. Omnivores typically consume 250mg (.25g) per day, while vegetarians consume between 400mg and 750mg.

Other Nutritional Measures for Cholesterol Management

If you are a vegan and still face issues related to your cholesterol levels, you can consider other measures consistent with your philosophy and commitment. Utilize high monounsaturated oil, like extra –virgin olive oil, in place of other oils and fats, search out plant sterol fortified foods, and increase your intake of cholesterol-lowering soluble fiber from oats, barley, beans, psyllium and fruit. For additional resources on Natural Cholesterol Management , click on to the Kardea Nutrition website.

Is Your Doctor Doubtful? Developing a Partnership with Your Health Providers

O.K. you have done your homework, and you are convinced that natural cholesterol management can and should be a meaningful part of your personal approach to long term health and longevity.

But you want to engage your doctor in setting up a system to monitor your progress. You know you need to monitor what is working and what is not. This will require periodic blood tests prescribed by your doctor and hopefully paid for by your health insurance.

But you are concerned that your doctor will be dismissive of your desired course of action.

No doubt, some physicians are more knowledgeable than others about natural nutritional approaches to cholesterol management. But most physicians, when presented with the evidence, are willing to explore the options.

So, if you meet resistence, suggest that your doctor read the recommendation of the NIH's National Cholesterol Education Program most recent report of the effecteness of "therapeutic lifestyle changes." In the NCEP recommendations, it is noted that this approach can achieve results similar to that attained by cholesterol lowering medication.

The NCEP reports, plus a listing of related research and studies, can be found on the Kardea Nutrition website.

Your doctor's views about natural cholesterol management also may hinge on concerns about compliance. Many doctors routinely recommended the therapeutic lifestyle changes, but patents often have difficulty changing their habits. It is on this point that you need to be honest with yourself. Can you maintain --- on a daily basis--the steps necessary to be effective with natural cholesterol management.

Sometime this is not easy. I know. I have been working on it. I designed the Kardea Nutrition products to make it easier for me to maintain the program and achieve measurable and signficant improvements in my blood lipid levels.

Give us a holler and let know how you are developing your relationships with your health care provider. Others will find your experience and advice really helpful!