Developing Your Program for Natural Cholesterol Management
Cholesterol Blockers | Good Fat/Bad Fat | Carbohydrates & Protein | HDLs & Low Level Niacin Supplements | Omega-3s
Strategies for Natural Cholesterol Management
You might be surprised to learn that only a small share of your blood cholesterol
comes from food. Your body produces up to 80% of the cholesterol in your blood,
with most manufactured by the liver. Cholesterol management thus looks
to affect:
- The production of cholesterol in the liver
- The absorption of both biliary (liver-produced) and dietary
cholesterol into the blood stream
- The composition of cholesterol in your blood
Different nutrients can affect one or more of these activities. Some
nutrients block the absorption of cholesterol. Others affect cholesterol
production. Still others affect the composition. Depending on each person’s own unique chemistry, different people will have different responses to these nutrients.
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The Cholesterol Blockers
Both biliary (liver-produced) and dietary cholesterol are absorbed through
the intestines. The liver uses cholesterol to produce bile, an agent
critical for the digestion of fat. This bile, along with extra free
cholesterol, flows from the liver into the digestive tract.
Once in the digestive tract, much of the bile is broken down, increasing the
amount of cholesterol available to be absorbed. This cholesterol
now blends with that from the meat and dairy products you’ve eaten.
These various sources of cholesterol can then be absorbed into the blood stream.
Once in your blood stream, a complex set of chemical interactions takes place
affecting the composition of cholesterols and its effects on your health.
Plant Sterols (phytosterols)-Up to 15% LDL Reduction
Structurally similar to cholesterol, plant sterols “fill the absorption
gateways” in the digestive tract that provide passage for both genetic
and dietary cholesterol into the blood. Blocked cholesterol then moves down the digestive
tract and is excreted.
In nature, small quantities of plant sterols can be found in a range
of foods, particularly vegetable oils. The average plant sterol intake
is about 250 milligrams. Vegetarians consume in a range of 400 to 750 milligrams.
Plant sterols, or phytosterols, have been used to lower cholesterol since the
1950s. The effectiveness of the early sterols proved to be highly variable,
and the dosages provided were massive by today’s standards
daily. Early attempts to improve sterol effectiveness focused on physically
grinding the sterol into very small particles. More recently, science
has made natural plant sterols more bio-available by attaching the “free
sterols” to a fatty acid. The results are plant sterol esters,
and it is in this form that the effectiveness of sterol has been most studied.
NCEP’s report recommends “2-3 grams per day of plant sterols from plant sterol esters to
reduce LDL cholesterol” by up to 15 percent. While other food
and supplement manufacturers utilize both the plant sterol and the plant sterol
esters in their formulations, Kardea utilizes only plant sterol esters.
Soluble Fiber-Up to 8% LDL Reduction
There are two types of fiber: soluble and insoluble. Only soluble
fiber plays a significant role in natural cholesterol management. Moreover,
only certain soluble fibers have been shown to be effective. These are viscous soluble
fibers found in such foods as oats, barley, beans, psyllium and high pectin
fruits such as apples. 10-25 grams of these fibers per day per day
are targets for natural cholesterol management.
As compared to plant sterols, viscous soluble fiber affects cholesterol absorption
differently. In your digestive tract, these fibers bind with the cholesterol-containing
bile produced by the liver. In turn, this cholesterol is not “freed” for
absorption into the blood stream. Instead, it is excreted.
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Good Fat/Bad Fat
Low-fat dieting has been ingrained into our belief system as a means to lose
weight and promote cardiovascular health.
Yet, these beliefs are now largely outdated. Detailed research shows that total dietary
fat, whether high or low, isn't linked with disease. What matters is
the type of fat in the diet.
The National Cholesterol Education Program now broadly recommends a diet composed
of 25-35% fats with strict limitations on the levels of saturated trans fats. It
further recommends 50-60% higher fiber, less processed carbohydrates
as well as 15% protein.
Good Fats/Bad Fats-Tier One-Up to 10% LDL Reduction
Trans fats, found in processed foods containing partially hydrogenated oils, are the worst. Trans fats raise the bad LDL cholesterol while lowering the good HDL cholesterol. Saturated fats drive up total cholesterol, increasing both LDL and HDL cholesterol. Saturated fats increase bad LDLs at levels far greater than the good HDLs.
The mechanisms through which saturated and trans fats raise cholesterol levels
are unclear. Nonetheless, the scientific consensus is that up to a 10%
reduction in LDL cholesterol can be achieved simply by holding saturated fat
intake to less than 7% of total calories.
When replacing saturated fats with polyunsaturated fats, total cholesterol
declines, with bad LDL cholesterol decreasing more than HDL cholesterol. This
is generally considered a positive result, but the decline in absolute level
of good HDL cholesterol diminishes a portion of the benefits.
When replacing saturated fats with monounsaturated fats,
LDL levels are reduced without affecting HDL levels. Overall, the effects
are a more significant improvement in your blood cholesterol profile.
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Carbohydrates & Protein
Carbohydrates
The NCEP notes that diets that are very high in carbohydrates (greater than
60% of daily calories) may cause a reduction in HDL cholesterol, although there
is no strong evidence to suggest that it affects LDL cholesterol. For
most individuals, NCEP thus recommends diets with 50-60% of calories
from less processed, higher fiber carbohydrates. If, however, you are diagnosed
with metabolic syndrome or diabetes, lower carbohydrate levels may be
appropriate.
Protein
Proteins are generally neutral, having little direct effect on LDL, HDL
or total cholesterol. The NCEP reports that replacing animal protein with vegetable protein, particularly soy protein, may result in lower LDLs. This relationship
is under evaluation. Substituting animal protein with soy protein may
simply represent a reduction in saturated fats and dietary cholesterol. Further,
many other sources of vegetable proteins, notably beans, also are a good source
of viscous soluble fiber.
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HDLs & Low Level Niacin Supplements
Niacin from Nicotinic Acid
Also known as Vitamin B3, niacin is required for most cellular processes and
contributes to numerous vital bodily processes. Among them, niacin helps convert
food into energy, helps build red blood cell count, and helps synthesizes hormones. To
prevent niacin deficiency, the U.S. government recommends a daily intake of
19mg of niacin for adult men and 13 mg for adult women.
At substantially higher levels, niacin from nicotinic acid favorably
affects cholesterol levels. This form of niacin can lower LDL cholesterol
by up to 25% and raise HDL cholesterol by as much as 35%. It is
not uncommon for a doctor to couple high levels---in amounts well above 1000mg---
of nicotinic acid with another cholesterol lowering medication. Intake of niacin
at these levels should take place with a close working relationship between
you and your doctors.
Yet, niacin supplements are approved for sale by the Food and Drug Administration. At
doses of 50mg twice per day (100mg/day)---about the levels you will find in
many Vitamin B Complex supplements---niacin from nicotinic acid has
been shown to raise good HDL cholesterol. At
500mg per day, this same form of niacin has been shown to increase
HDL cholesterol by 10%. At levels approaching 1000mg per day, niacin
has been shown to raise good HDL cholesterol by 15%.
Why then isn’t niacin considered a Tier One nutrient?
As noted in Achieving Results with Natural Cholesterol Management, the difference between a Tier One and Tier Two nutrient for natural cholesterol management lies with the level of consensus within the medical community. Both Tier One and Tier Two nutrients certainly are supported by extensive science. Niacin supplements can be very effective in raising HDLs, but it faces some challenges within the medical community, limiting its elevation to a Tier One Status.
Part of the challenge lies with the “flushing” side effect. Often
very uncomfortable, a flush can be accompanied by an intense feeling of heat,
tingling and itching. It can start a few minutes or a few hours after
taking niacin. Once flushing begins, it typically subsides within 30
minutes. This flush causes many individuals to abandon the use of niacin. For
some in the medical community, niacin thus may not be seen as a viable nutritional
recommendation.
Flushing can be managed by gradually increasing the levels of nicotinic acid. You
can try starting at 50mg with lunch and dinner. As your body grows accustomed
to these levels, you can try raising your niacin intake with these meals. You
also might take nicotinic acid before bed. Nicotinic acid also is sold in a sustained release version, which also reduces the intensity of flushing. While the FDA continues to allow the sale of this form of niacin, liver difficulties in a rare number of cases have been associated with this version. A third form of nicotinic acid called extended release niacin also is available as a prescription.
Another challenge relates to the potential confusion over the types of niacin. Niacin is available in 3 forms: nicotinic acid, niacinamide, and inositol hexanicotinate. Only niacin in the form of nicotinic acid has proven to affect cholesterol levels. Niacinamide has not proven particularly useful for natural cholesterol management, but serves to deliver levels of niacin needed in one’s everyday diet. Inositol hexanicotinate forms often are sold as a “no-flush” version of niacin. Research indicates that this form of niacin is not absorbed,and is thus not useful for cholesterol management.
Finally, the broad Tier One consensus in cholesterol management has been built
around LDL reduction, not HDL increases. Sterols lower LDL cholesterol.
Viscous soluble fiber lowers LDL cholesterol. Restrictions of saturated fats
and dietary cholesterol lower LDL cholesterol. Each has thus been incorporated
into the recommendations of the National Cholesterol Education Program. At
levels below 1000mg per day, niacin has not been shown to consistently lower LDLs. In this context, the effects of lower doses of
niacin on raising HDLs were presumably not considered in the development of
the NCEP recommendations.
In summary, immediate-release niacin from nicotinic acid at levels
below 1000mg per day can play an important role in your natural cholesterol
management program.
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Omega-3s
Omega-3s are polyunsaturated fat. Omega-3s occur as alpha-linolenic
acid (ALA), primarily from flax, soy, canola oil and walnuts, and
in fish oils as eicosapentanoic acid (EPA) and docosahexaenoic acid (DHA).
The American College of Cardiology Foundation recommends DHA/EPA supplementation
of 1 to 2 g per day if you get an insufficient amount of omega-3 intake from
fish. The NCEP is less aggressive in its approach. It
recommends higher dietary intakes of Omega 3s as an option for reducing risk
for coronary heart disease, but it does not recommend a specific level.
In looking at the broad goals of lowering LDL and raising HDL, Omega 3 fatty
acids might not be incorporated into a discussion of natural cholesterol management.
In fact, large doses have been shown to increase LDL cholesterol.
Yet, Omega-3s, particularly those from marine sources, have been shown to
have a significant positive relationship to cardiovascular health.
Omega-3s may play an important role in reducing arterial inflammation
that leads to plaque. Where inflammation occurs, LDL cholesterol
adheres to the inner lining of the blood vessel, eventually forming plaque. Simply
stated, LDLs are part of the materials that make up plaque. If arterial
inflammation is reduced, then less LDL cholesterol will be deposited.
While Omega-3s may not affect total levels of either LDLs or HDLs, researchers
are exploring the sub-types within the LDL and HDL categories. Improving
the make-up of these sub-types may represent another function of Omega-3s.
One thing for certain is that in doses ranging from 2-4 grams per day, Omega
3 fatty acid will lower triglycerides and very low-density lipoproteins (VLDL).
Beyond cardiovascular health, Omega-3s may provide other positive benefits
in the areas of eye health and brain function.
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