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Talking To Your Patients About Cholesterol

James Meschino, DC, MS, ROHP

Cardiovascular disease remains the number one killer in our society, claiming the lives of one in every two men and one in every three women. High cholesterol is a cardinal risk for heart attack, stroke and other vascular diseases and patients typically have a number of questions about cholesterol. The following is the hand-out material that I provide to all my patients in regards to providing them with a brief, user-friendly understanding about the influence of nutrition on cholesterol. The intent is to motivate them to make lifestyle changes to keep their cholesterol in the ideal range or help them reduce it into the ideal range. Feel free to reproduce the following information on your own stationary if you feel it would benefit your own patients.

What is cholesterol?
Cholesterol is a fatty-waxy material that is found in high fat meat and dairy products, as well as egg yolks, organ meats and shellfish. Our bodies make additional cholesterol in the liver when we eat foods that contain a lot of saturated fat such as beef, pork, lamb, high fat dairy products, chocolate (made with cocoa butter), and possibly coconut and palm oil. Eating trans fats (hydrogenated fats) found in many fried foods, cookies, pastries, muffins, shortenings etc, also increase the body’s cholesterol production.

How does the liver handle cholesterol?
Most of the cholesterol you eat is absorbed and transported to the liver. Once in the liver, cholesterol, as well as the additional cholesterol your liver makes when you eat foods high in saturated fat and/or trans fats, are transported out of the liver in a carrier vehicle known as the VLDL.

The VLDL looks a bit like an egg. Its outer shell is made out of protein and on the inside of the shell you see cholesterol where the white of the egg would normally reside. In this model the yolk represents triglycerides (the saturated and trans fats you consume form triglycerides – a storage form of fat, within the liver). As the VLDL circulates through the bloodstream the triglycerides are taken up by your fat cells (and your fat cells in turn get larger) and by your muscles. Fat is the primary fuel that muscles burn when you are at rest and during light to moderate activity. Thus, the more muscle mass you have, the faster you burn fat, even when sitting in a chair.

Once the triglycerides are removed from the VLDL the remnant particle is known as the LDL-cholesterol, which is the bad cholesterol that promotes heart attack and stroke.

How does LDL-cholesterol promote heart attack and stroke?
Although various body tissues remove LDL-cholesterol from the bloodstream and use the cholesterol to make their cell membrane, bile acids, vitamin D and various hormones (e.g. estrogen, progesterone, cortisone, testosterone), once the tissues have acquired all the cholesterol they need, they stop extracting LDL-cholesterol from the bloodstream. And any extra LDL-cholesterol continues to circulate in your arteries.

This is where the trouble begins, as LDL-cholesterol tends to stick to the walls of the artery causing progressive narrowing of these important blood vessels. It’s a bit more complex than this, but the bottom line is that excess LDL-cholesterol causes narrowing of your arteries. Once 85% of the artery is blocked with LDL-cholesterol plaque symptoms start to occur, such as angina and transient ischemic attacks (resembling mini-strokes).

In up to 40% of cases the first symptom is a sudden death heart attack. So, waiting for symptoms to occur is not a good idea. A good idea is to keep your LDL-cholesterol level within the safe and desirable zone, which is under 2.5 mmol/L (96 mg/dL).  If you already had a heart attack, stroke, heart operation, or have diabetes, or kidney disease (including kidney transplant), then you should aim for an LDL-cholesterol level at or below 2.0 mmol/L (77 mg/dL).

What is the difference between Total Cholesterol, LDL-Cholesterol and HDL-cholesterol?
Your doctor wants to know several things about your cholesterol level, which indicate your risk level for heart attack and stroke.

The total cholesterol comprises the total amount of cholesterol in your bloodstream when you total the amount found in the VLDL, the LDL and the HDL. This number should be below 3.9 mmol//L (150 mg/dL) or at worst 4.7 mmol/L (180 mg/dL).

The LDL-cholesterol was covered in the section above.

The HDL-cholesterol is the good cholesterol in that it is a carrier vessel that vacuums up the cholesterol in the artery wall and brings it back to the liver. Thus, a high HDL-cholesterol helps to protect you against heart disease. Being fit and at your ideal weight helps to raise the HDL-cholesterol.

How can you lower your total and LDL-cholesterol and/or triglyceride levels naturally?

  1. Eat less saturated fat and trans fats – To lower your cholesterol, it is best to refrain from eating foods that are high in saturated fat and trans fats, as explained above. This means relying on chicken breast, turkey breast and fish as your main protein staples if you are not a vegetarian. It also means not eating any milk or yogurt that is above 1% milk fat or any cheese that is above 3% milk fat. It means eliminating butter, ice cream, whipped cream and all other high fat dairy products, and avoiding fried food, foods containing a lot of trans fats as well food containing palm or coconut oil.
  2. Eat cholesterol-lowering fiber – You should also eat foods that drag cholesterol out of the body and have been shown to lower blood cholesterol by up to 25%. These foods include beans and peas (especially red kidney beans, chick peas and lentils), oat bran and oat meal, psyllium husk fiber (2-3 teaspoons per day), ground flaxseed (2 tablespoons per day) and fruits containing pectin fiber (apples, peaches, pears, plums).
  3. Consider supplementing with natural agents proven to lower cholesterol – certain natural supplements aimed at lowering cholesterol contain Gum Guggul and Artichoke Leaf Extract. Both of these natural agents have been used in human clinical trials to lower the bad cholesterol by up to 27% and triglycerides by up to 30%.

In Short:

Gum Guggul or Gugulipid is derived from the mukul myrrh tree, which contains guggulsterones – the active constituent that account for its cholesterol- and triglyceride-lowering effects.  Gugulipid was granted approval in India for marketing as a cholesterol- and trigylceride-lowering drug in June 1986, due to its impressive efficacy and safety. Gugulipid has been shown to help the body clear excess cholesterol and triglycerides from the bloodstream.

Artichoke Leaf Extract contains active constituents that help flush cholesterol from the body via the fecal route. It increases the flow of cholesterol (and bile, which is a building block of cholesterol) from the liver to the intestinal tract. Human studies indicate that Artichoke Leaf Extract alone can reduce LDL-cholesterol (the bad cholesterol) by 23%.

Dosage: Take two capsules, two or three times per day with meals, of a supplement that contains 500 mg Gum Guggul (standardized to 2.5% guggulsterones) and 200 mg Artichoke Leaf Extract (standardized to 13-18% caffeoylquinic acids) per capsule. Speak to your health practitioner for more information about supplementation.

In some cases prescription drugs may also be required to get cholesterol into the safe range. However, studies suggest that 90% of individuals with high cholesterol can reduce it into the ideal range using the nutrition, lifestyle and supplementation practices outlined above.

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