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THE FOLLOWING MEDICAL AND SCIENTIFIC MATERIAL IS FOR CONSUMER INFORMATIONAL AND EDUCATIONAL PURPOSES ONLY UNDER SECTION 5 OF DSHEA.

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Lowering Cholesterol & Triglycerides

Supporting cardiovascular health system is a very important goal for health-conscious people. Maintaining healthy levels of blood fats (lipids), including cholesterol and triglycerides, provides a significant way to decrease your cardiovascular risk.

  • Introduction

    Most cholesterol is produced by the liver. It is primarily found in animal foods that are high in saturated fat, including fatty meats, egg yolks, shellfish, and whole-milk dairy products. Cholesterol plays an essential role in the formation and functioning of cell membranes and is also used to produce certain important hormones that are collectively referred to as “steroid” hormones.

    Cholesterol is transported through the bloodstream by a proteins called lipoproteins. There are at least two kinds of lipoproteins that are particularly important: low-density lipoprotein (LDL) (often termed the "bad" cholesterol) and high-density lipoprotein (HDL) (often termed the "good" cholesterol).

    LDL transports cholesterol from the liver out to the rest of the body. Because higher levels of LDL have been tied to an increased risk of cardiovascular disease, lower LDL levels are considered healthier. HDL picks up excess cholesterol in the bloodstream and returns it to the liver where it can be eliminated from the body. Therefore, a higher HDL is considered beneficial. A simple blood test, performed after a 10-12 hour fast, can tell you what your cholesterol levels are, including HDL-C, LDL-C, and total cholesterol.

    In people with one or more risk factors for cardiovascular disease, there may be increased concern about cholesterol readings. Included among these risk factors are cigarette smoking, high blood pressure, diabetes, being significantly overweight, a personal history of heart disease, a family history of early heart disease (before the age of 70), or being age 45 or older for men or age 55 or older for women. Cholesterol blood tests should always be interpreted by your physician in the context of your complete medical history including current health, lifestyle, and age.

    General guidelines for interpreting cholesterol test results have been established by the National Cholesterol Education Program (NCEP):1

    Total cholesterol

    Desirable: less than 200 mg/dL

    Borderline high: 200-239 mg/dL

    High: 240 mg/dL or higher

    LDL-C:

    Optimal: less than 100 mg/dL

    Near optimal: 100-129 mg/dL

    Borderline high: 130-159 mg/dL

    High: 160-189 mg/dL

    Very high: 190 mg/dL or higher

    HDL-C:

    Low: less than 40 mg/dL

    Triglycerides are another type of fat that circulates in the blood. When food is eaten, excess calories not needed by the body are converted into triglycerides and stored for later use. When energy is needed, triglycerides are released to provide an energy source. A fasting blood test is used to determine the triglyceride level. The following guidelines2 are used to interpret the results:

    Normal: <150 milligrams per deciliter (mg/dL)

    Borderline high: 150 to 199 mg/dL

    High: 200 to 499 mg/dL

    Very high: 500 mg/dL or above

    Triglycerides can become elevated as a result of the following: uncontrolled diabetes (either type 1 or type 2), obesity, hypothyroidism (a low level of thyroid hormone), kidney disease, liver disease, genetic causes, excessive alcohol intake, pregnancy, and a high-carbohydrate diet (greater than 60% of calories from carbohydrates), especially when the carbohydrates are mostly from refined white-flour and white-sugar foods such as cakes, candy, cookies, snack foods, sodas, and so on. Many medications can also raise triglyceride levels as a side effect. These include oral contraceptives with a high estrogen content, oral estrogen replacement, thiazide diuretics, beta-blocking agents, glucocorticoids (prednisone), atypical antipsychotics, oral isotretinoin, tamoxifen, and certain antiretroviral drugs used to treat HIV infection.

  • Lifestyle Factors

    Eating a healthy diet and obtaining regular exercise are highly beneficial for maintaining good cardiovascular health, including achieving optimal levels of fats in the blood. There are many in-depth guides that discuss a healthy diet for anyone concerned about heart disease. The basics are pretty simple. Aim for a diet that includes an abundance of high-fiber, nutrient-rich fruits, vegetables, and whole grains, and has a moderate amount of healthy fats, especially monounsaturated fats like olive oil, along with good sources of protein, including low-fat meat, poultry, fish, nuts, seeds, and beans. In general, avoid high fat intake and in particular, avoid all "trans" fats, the partially hydrogenated fats found in many fast foods, baked goods, snack foods, processed foods, fried foods, margarines, and shortenings.

    Eliminating trans fats is extremely important for cardiovascular health. Trans fats have been proven to raise LDL cholesterol, lower HDL cholesterol, and contribute significantly to the development of heart disease.3 Research has shown that, ounce for ounce, trans fats are far worse than saturated fats when it comes to heart disease. The Nurses' Health Study found that replacing only 30 calories (7 grams) of carbohydrates every day with 30 calories (4 grams) of trans fats nearly doubled the risk for heart disease.4 Reducing trans fat intake can also help lower triglycerides.

    Reducing your intake of sugar and sugar-loaded foods can also help to lower triglycerides. In fact, people who consume a lot of foods made from white flour and white sugar - such as cakes, cookies, snack bars, candy, pies, and junk food - could lower their triglycerides substantially just by reducing their consumption of these foods while increasing dietary fiber. It is also important to eliminate the consumption of sodas and other drinks that contain sugar since these often contribute substantially to increased elevation of triglyceride levels. Reducing alcohol intake is also important since even small amounts of alcohol can raise triglycerides. A general rule for anyone who is concerned about their triglyceride level is to drink no more than one alcoholic drink per day, if any.

    Eating plentiful amounts of fruits and vegetables may be particularly important for cardiovascular protection. Several large studies have shown that a high intake of fruits and vegetables is tied to a decreased risk for coronary heart disease.5 and ischemic stroke.6,7 The researchers believe that fruits and vegetables provide multiple factors that are beneficial for cardiovascular protection, including antioxidant vitamins, fiber, and minerals such as potassium. In one very large study that followed 84,251 women (34 to 59 years of age) for 14 years and 42,148 men (40 to 75 years of age) for 8 years, it was found that those who consumed the highest amounts of fruit and vegetables had a substantially lower risk of heart disease, compared to those who consumed low amounts. In fact, every additional daily serving of fruit and vegetables was associated with a 4% lower risk for coronary heart disease, with intake of green leafy vegetables and vitamin C–rich fruits and vegetables providing the most value.8

    There has also been research suggesting that alpha-linolenic acid (found in seeds, nuts and whole grains) may help prevent secondary cardiovascular events. In one trial, there was a much lower incidence of second heart attacks and deaths in people who used an alpha-linolenic-rich Mediterranean diet for five years after their first heart attack.9 Over the five years, there was a trend toward lower total and LDL cholesterol, and increases in HDL cholesterol. The levels of antioxidants and other important micronutrients were also higher in those consuming the Mediterranean diet so it is not entirely clear which component of the diet yielded the improvements. However, this type of diet is known to be supportive overall for cardiovascular health.

    It is also important to consume a diet that helps maintain your optimal weight or helps with weight loss in those who are currently overweight. Excess weight contributes to elevated blood fats, including cholesterol and triglycerides, in both men and women.10,11,12,13,14 Even modest weight loss (as little as 5-10 pounds) has been shown to contribute to reductions of total cholesterol.15,16

    Lack of exercise is also contributes independently to an increased risk of heart disease. Just instituting a regular exercise program is one of the best things you can do to improve your cardiovascular health.17 Lack of regular physical activity is strongly associated with elevated blood fats,18,19 while increased physical activity has been shown to improve blood fats.20In particular, physical activity has been shown to lower LDL levels and triglyceride levels, while also improving insulin sensitivity, blood pressure, and cardiovascular function.21,22,23,24 Physical activity can also raise good HDL cholesterol.25,26 You should always discuss with your physician your current health status and fitness level before instituting an exercise program. After you're given the go-ahead, make regular exercise a part of your life and you'll gain countless benefits, including improved cardiovascular health.

  • Standard Medical Therapies

    There are a number of prescription drugs approved for the treatment of cholesterol, both for lowering elevated levels of LDL cholesterol, and for raising levels of HDL cholesterol. One of these drug classes, the fibrates, is also used to treat elevated triglycerides.

    Statins (also known as HMG CoA reductase inhibitors) are the drugs that are most commonly prescribed for improving high cholesterol levels. Included in this class are atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor). Statin drugs work by blocking an enzyme needed to make cholesterol, thus lowering the amount of cholesterol produced by the liver. These drugs result in significant (18-55%) reductions in LDL cholesterol, and modest (5-15%) increases in HDL cholesterol in many people. Although maximum doses of the strongest statins (Lipitor, Zocor, and Crestor) will also lower triglycerides, such doses are not considered appropriate unless the LDL cholesterol is at least 30% above the desired level. These drugs also have the potential to cause a number of serious side effects. The most common side effects associated with statins are muscle pain, constipation, weakness, upset stomach, abdominal pain, cramping, gas, and nausea. These side effects are often mild but their intensity may depend on the dosage prescribed. In some people, more serious side effects may develop, including serious muscle inflammation and liver toxicity. All statin drugs significantly deplete coenzyme Q-10, a nutrient that is crucial for cardiovascular health, so supplementation with 100 to 400 mg daily of this important cellular nutrient is advisable for anyone taking statins.

    Bile acid sequestrants are another class of drugs prescribed for the treatment of elevated cholesterol. Included in this class are cholestyramine (Prevalite, Questran), colesevelam (WelChol) and colestipol (Colestid). The liver uses cholesterol to make bile acids which are needed for the digestion of fats. These drugs lower cholesterol by binding to bile acids in the gut and preventing their re-absorption. This prompts the liver to use extra cholesterol to make more bile acids. The end result is a reduction in the level of cholesterol in the blood. These drugs result in moderate (15-30%) reductions in LDL cholesterol, and small (3-5%) increases in HDL cholesterol. Since these drugs can raise triglycerides levels, they are generally not used for people with that problem. The most common side effects associated with these drugs are abdominal pain, gas, constipation, and a decreased absorption of other drugs. Bile acid sequestrants can also lead to multiple fat-soluble nutrient deficiencies, including vitamins A, D, E, and K so supplementation with these nutrients is advisable for anyone taking these drugs.

    Fibrates (fibric acids) are drugs which are usually prescribed for the treatment of elevated triglycerides. Included in this class are fenofibrate (Lofibra, Tricor) and gemfibrozil (Lopid). These drugs result in moderate (5-20%) decreases in LDL cholesterol and moderate (10-20%) increases in HDL cholesterol, along with substantial reductions (40%) in triglycerides. Side effects from these drugs may include indigestion, muscle pain and gallstones. Some fibrates, including gemfibrozil, deplete both vitamin E and coenzyme Q-10 so supplementation with these nutrients is advisable for anyone using fibrates.

    Cholesterol absorption inhibitors are another type of drug prescribed to treat elevated cholesterol. The only drug currently available in this class is ezetimibe (Zetia). It works by limiting the absorption of dietary cholesterol in the small intestine. In studies it has resulted in moderate (18%) decreases in LDL cholesterol, and very small increases (1%) in HDL cholesterol. The most common side effects are diarrhea and headache. Less common side effects include stomach pain, fatigue, muscle aches, and liver toxicity.

  • Beneficial Nutrients

    There are a number of natural agents that have been studied in relationship to maintaining optimal blood fat levels. For people concerned about their cholesterol and triglyceride levels, utilizing one or a combination of these nutrient therapies may provide significant benefit, especially if they can help you safely avoid starting drug therapy.

    L-Carnitine is an amino acid derivative that is used by the body for energy metabolism and the proper use of fats. It is necessary for the transport of long-chain fatty acids into the mitochondria where they are burned to produce energy. L-Carnitine can help lower triglycerides and raise HDL cholesterol in some people. In people living with HIV, supplementation with L-Carnitine has been shown to lower triglycerides, whether the elevation is caused by the disease itself27 or by the antiretroviral medications used to treat it.28,29 In people with kidney disease who are on hemodialysis, L-Carnitine has been shown to dramatically reduce triglycerides while also increasing HDL cholesterol when given intravenously30 and orally.31 In healthy men with normal cholesterol and triglycerides but low HDL cholesterol, treatment with 1000 mg of L-Carnitine daily resulted in a substantial increase in HDL, as well as a decrease in serum triglycerides.32 The dosage level of Acetyl-L-Carnitine (its most bioavailable form) in 2 packets of K-PAX Immune Support Formula is 1000 mg.

    Fiber supplements may help reduce LDL and total cholesterol. Soluble fiber appears best at reducing the absorption of cholesterol in the intestines. Soluble fiber binds bile (which contains cholesterol) and cholesterol from foods so that the body excretes it. Combined with other heart-healthy lifestyle changes, such as weight reduction and improved diet and exercise, the National Cholesterol Education Program (NCEP) of the U.S. National Heart, Lung and Blood Institute encourages the use of soluble fiber (10-25 grams per day) as a dietary option to reduce LDL cholesterol.33 Five to 10 grams of soluble fiber supplementation daily can decrease LDL cholesterol by about 5 percent. Oat bran, found in oatmeal and whole oats, is a good source of soluble fiber. Regular consumption of up to 150 grams of whole oat products per day may beneficially reduce LDL cholesterol and total cholesterol. Eating oatmeal for breakfast on a regular basis is a simple way to consume amounts that may be useful. Psyllium seed products such as K-PAX Fiber Formula are potent sources of soluble fiber that may help reduce total and LDL cholesterol. One to two servings per day of a psyllium supplement consumed twice daily may contribute to improving cholesterol levels. Food sources of soluble fiber include kidney beans, Brussels sprouts, apples, pears, barley and prunes. Including these foods in your diet may contribute to maintaining healthy cholesterol levels. Fiber supplements and high-fiber foods may cause gas and bloating in some people. Gradually increasing the amount of these products may help prevent this.

    Fish oil supplements usually contain two heart-healthy omega-3 fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). The average American diet contains an over-abundance of omega-6 fatty acids, which are pro-inflammatory. Regular consumption of fish oils, rich in omega-3 fatty acids, can help maintain a healthy balance between these two types of fatty acids and support healthy cardiovascular function.

    In the 1970's, a study of Greenland Eskimos discovered that although they consumed a very high-fat diet, this population experienced a very low incidence of heart disease.34 It was identified that the Eskimo's diet contained a significant proportion of marine fats, specifically two omega-3 fatty acids (EPA and DHA). Since inflammation is a key factor in the development of heart disease, scientists believe that the benefits of plentiful fish oil intake are in part due to its natural anti-inflammatory qualities, as well as its favorable effects on heart rhythm, platelet aggregation, and triglyceride levels.

    Since the Greenland study results were published, a large body of additional research has validated its findings, confirming the efficacy of omega-3-rich fish oils for benefiting cardiovascular health. Despite the fact that high doses of fish oil can sometimes raise LDL cholesterol, its benefits seem to far outweigh any risks.35,36,37,38 Research has also clearly shown the usefulness of fish oil supplements for reducing triglycerides.39,40 The highest quality fish oil supplements are made from cold water, wild caught fish as opposed to products which may use fish oil produced from cheaper, farm-raised fish that are fed low quality feed and given antibiotics.

    Niacin (nicotinic acid) is a B vitamin that has been shown in many studies to be an effective natural therapy for lowering LDL cholesterol and triglycerides, as well as also raising HDL cholesterol. First researched over 40 years ago, niacin is currently considered a first-line agent for lowering LDL cholesterol by the National Cholesterol Education Program (NCEP) of the U.S. National Heart, Lung and Blood Institute.41 NCEP also recommends niacin for lowering triglycerides. Research has shown that niacin lowers total cholesterol and triglycerides42 and raises HDL cholesterol levels.43

    The use of niacin is sometimes limited by the bothersome side effect of "flushing", a burning and/or reddening of various parts of the body, including most commonly the face, neck, arms, and upper chest. This unpleasant sensation can continue for half an hour or longer in people taking high doses of instant-release niacin. Time-released forms of niacin can sometimes reduce the flushing effect. Higher doses of niacin are generally required for achieving the most significant improvements in blood fats. High doses of niacin may cause nausea, diarrhea, cramps, headache, irregular heartbeat, and liver toxicity in some people and should only be used under the supervision of a physician.

    Pantethine is the more biologically active form of pantothenic acid, and is composed of a combination of pantothenic acid and the aminothiol cysteamine. Research has shown significant reductions in blood fats in people treated with pantethine. In addition, pantethine supports normal platelet function and endothelial responsiveness, and has overall antioxidant benefits. Studies have shown that in doses of 600 to 1200 mg daily, pantethine can lower LDL cholesterol and triglycerides, and also raise HDL cholesterol. In one study, there were significant reductions of total cholesterol, LDL cholesterol, and the LDL/HDL ratio in 24 perimenopausal women with elevated cholesterol who were treated with 900 mg of pantethine daily for 16 weeks.44

    Another study assessed the effects of pantethine in 37 people with elevated cholesterol and/or elevated triglycerides, of whom 21 were also diabetic. Three months of treatment with 600 mg of pantethine per day yielded significant reductions in cholesterol, triglycerides, and LDL cholesterol, along with a significant increase in HDL cholesterol.45In a double-blinded trial with 29 patients with elevated blood fats, treatment with 900 mg of pantethine (300 mg three times daily) yielded highly significant reductions in total and LDL cholesterol (a decrease of 13.5% in both).46 Triglyceride levels were also reduced around 30%. HDL cholesterol levels increased about 10%. Switching from pantethine to placebo yielded a rapid return to baseline cholesterol levels.

    In another trial, pantethine (900-1200 mg daily for 3 to 6 months) was used to treat a cohort of 7 children and 65 adults suffering from elevated cholesterol alone or with elevated triglycerides.47 Pantethine treatment produced significant reductions in total cholesterol, LDL cholesterol, and triglycerides, along with a significant increase of HDL-cholesterol. In a one-year clinical trial in 24 people with elevated blood fats, pantethine treatment yielded significant reductions of total cholesterol and LDL cholesterol, with parallel increases of HDL cholesterol.48 The researchers who carried out these trials universally concluded that pantethine is a valid therapy for elevated blood fats. In none of these studies were there any significant side effects. The dosage level of pantethine contained in two packets of K-PAX Invince-A-Tor™ is 900 mg.

    Plant sterols are becoming a popular addition to the diets of people concerned about lowering total and LDL cholesterol levels. Studies have shown that as part of a diet low in saturated fat and cholesterol, foods containing at least 0.65 grams per serving of plant sterols, taken twice daily with meals for a daily total intake of at least 1.3 grams, may reduce the risk of heart disease.

    In conjunction with other heart-healthy lifestyle changes such as weight reduction and improved diet and exercise, the National Cholesterol Education Program (NCEP) of the U.S. National Heart, Lung and Blood Institute encourages the use of plant stanols and sterols (2 grams per day) along with soluble fiber (10-25 grams per day) as dietary options to enhance LDL cholesterol reduction. More than 20 studies have shown that plant sterols are both safe and effective in a wide group of individuals and they are now often included as one of the leading natural approaches to managing total and LDL cholesterol. Studies have shown that plant sterol in doses of 2-3 grams per day lower LDL cholesterol levels by 6-15%.49,50,51,52 The use of plant sterols has also been shown to reduce LDL cholesterol in people who have elevated cholesterol and type 2 diabetes.53 The dosage level of plant sterols contained in two packets of K-PAX Invince-A-Tor™ is 1.3 grams.

    Plant sterol supplements are generally well tolerated. However, in some people, high doses of plant sterols may cause gastrointestinal distress, including indigestion, gas, diarrhea, nausea, or constipation. Because regular daily consumption of plant sterol supplements may result in a 10 to 20 percent decrease in carotenoids in the blood, it is recommended that an additional serving of a carotenoid-rich fruit or vegetable be consumed daily by anyone supplementing with plant sterols; research has confirmed that this will maintain normal blood levels of carotenoids.

    Flaxseed is a grain that contains alpha-linolenic acid, an omega-3 fatty acid. For it to benefit the body a multi-step conversion process must take place which in some individuals can be inefficient.54 For this reason, it is generally thought that the use of fish oil, a more direct provider of omega-3 fatty acids, is more useful for supporting cardiovascular health.

    There have been several trials which showed positive changes in cholesterol levels when flaxseed was added to the diet. In one small trial with 15 people who had elevated cholesterol, those who ate 3 slices of bread containing flaxseed along with 15 grams of ground flaxseed daily for 3 months had significant reductions in both total cholesterol and LDL cholesterol.55 In a double-blind study, people who consumed 38 grams of flaxseed baked into muffins and bread daily had significant (14.7%) reductions in LDL cholesterol.56 In another study of healthy women, adding 50 grams of ground flaxseed to the diet daily yielded a 9% reduction in total cholesterol and an 18% reduction in LDL cholesterol.57

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