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High Cholesterol (Hypercholesterolemia)

Introduction

Elevated serum cholesterol is associated with a high risk of heart disease. Most medical doctors suggest cholesterol levels should stay under 200 mg/dl. Cholesterol levels lower than 200 are not without risk; many people with levels below 200 have heart attacks. But as a guideline, as levels fall below 200, heart disease risk declines. Many nutritionally oriented doctors consider cholesterol levels of no more than 180 to be optimal.

Medical labs also break down total cholesterol measurement into LDL cholesterol (which is directly linked to heart disease) and HDL cholesterol (the so-called "good" cholesterol). The relative amount of LDL to HDL is more important than total cholesterol. It is possible for someone with high HDL to be at low risk for heart disease even with total cholesterol above 200. Check with your doctor for details.

Dietary and Lifestyle Changes

Dietary changes that may be helpful: There are many dietary interventions that may help lower serum cholesterol levels. For example, eating saturated fat from animal foods is linked to high serum cholesterol and heart disease. Avoiding dairy fat and meat reduces cholesterol and may reverse heart disease. Skimmed milk and nonfat yogurt and cheese are essentially fat-free. "Low-fat" dairy is not: 25% of calories from 2% milk come from fat. Americans eat a little saturated fat from plant foods like coconut and palm oil. Palm oil may elevate cholesterol.

Yogurt and other fermented milk products lower cholesterol. Eating fish may increase HDL cholesterol and is linked to a reduced risk of heart disease in most but not all studies. Fish contains little saturated fat, and fish oil contains EPA and DHA, omega-3 oils that protects against heart disease.

Vegetarians have low cholesterol and less heart disease, in part because they avoid animal fat. Vegans (no meat, dairy, or eggs) have the lowest cholesterol levels, and going on such a diet can reverse heart disease.

Dietary cholesterol: Most dietary cholesterol comes from egg yolks. Therefore, eating eggs increases serum cholesterol in most studies. Yet, eating eggs does not increase serum cholesterol as much as eating saturated fat, and eating eggs may not increase serum cholesterol at all if the overall diet is low in fat. Consequently, some doctors of natural medicine do not discourage egg consumption.

Eggs are not innocent, however. When cholesterol from eggs is cooked or exposed to air, it oxidizes. Eating oxidized cholesterol may increase heart disease. Eating eggs also makes serum cholesterol susceptible to damage, which is linked to heart disease. Egg eaters are more likely to die from heart disease even when serum cholesterol levels are not elevated.

Fiber: Fiber from beans, oats, psyllium seed, and fruit pectin lowers cholesterol levels in most studies Doctors of natural medicine often recommend that people with elevated cholesterol eat more of these high-fiber foods. However, even grain fiber (which does not lower cholesterol) protects against heart disease. It makes sense to eat more of all types of fiber.

Soy: Tofu, tempeh, miso, and some protein powders in health food stores are derived from soybeans.  Soy protein reduces cholesterol. Isoflavones from soy beans may also have this effect.

Sugar: Eating sugar reduces HDL. It also increases other risk factors linked to heart disease. Although the exact relationship between sugar and heart disease is unclear, many nutritionally oriented doctors recommend that people with high cholesterol reduce their sugar intake.

Coffee: Drinking boiled or French press coffee increases cholesterol levels. Modern paper coffee filters trap the offending chemicals and keep them from entering the cup. Therefore, paper filtered coffee does not increase cholesterol levels in most studies. However, paper-filtered coffee does appear to significantly increase homocysteine—a risk factor for heart disease. The effects of decaffeinated coffee remain in debate.

Alcohol: Moderate drinking (one to two drinks per day) increases HDL. This effect happens equally for wine and other drinks. Alcohol also "thins" blood. However, alcohol causes liver disease, cancer, high blood pressure, alcoholism, and, at high intake, even increased risk of heart disease. As a result, many doctors of natural medicine do not recommend alcohol, even for people with high cholesterol. Nonetheless, those who have one to two drinks per day appear to live longer and are less likely to have heart disease. People with high cholesterol should consult a nutritionally oriented doctor before deciding whether light drinking might do more good than harm.

Olive oil: Olive oil lowers LDL, especially when it replaces saturated fat in the diet. People from countries that use olive oil appear to be at low risk for heart disease.

Trans Fatty Acids: Trans fatty acids are found in processed foods containing hydrogenated oils. The highest levels occur in margarine. Margarine consumption is linked to increased risk of heart disease. Eating trans-fatty acids increases the LDL-to-HDL ratio. Margarine and other foods containing partially hydrogenated oils should be avoided.

Garlic: Garlic is available as a whole food, in powder as a spice, and as a supplement. Eating garlic helps lower cholesterol. Garlic also acts as a blood thinner and may reduce other risk factors for heart disease. Doctors of natural medicine typically recommend eating garlic, taking 900 mg of garlic powder from capsules or a tincture of 2-4 ml three times daily.

Number and size of meals: The practice of eating many small meals rather than three large ones is called "grazing." When people eat more small meals, serum cholesterol levels fall. It is probably best to avoid large meals and to eat more frequent but smaller meals.

Lifestyle changes that may be helpful: Exercise increases HDL, an effect that occurs even from walking. Exercisers have a low risk of heart disease. People over forty years of age or who have heart disease should talk with their doctor before starting an exercise program; overdoing it can actually trigger heart attacks. Obesity increases the risk of heart disease, in part because weight gain lowers HDL. Weight loss increases HDL and reduces triglycerides, another risk factor for heart disease. Smoking is linked to a lowered level of HDL. It also causes heart disease. Quitting reduces the risk of having a heart attack. The combination of feelings of hostility, stress, and time urgency is called type A behavior. Men (but not women) with these traits are at high risk for heart disease in most, but not all, studies. Stress or type A behavior may elevate cholesterol in men. Reducing stress and feelings of hostility reduces the risk of heart disease.

High Cholesterol: Nutrients and Herbs

Nutritional supplements that may be helpful: High levels (several grams per day) of Vitamin B3 in the form of niacin lowers cholesterol.1 The other form of B3—niacinamide—does not. Some cardiologists and doctors of natural medicine recommend large amounts of niacin for people who have high cholesterol levels.

Because of toxicity, high levels of niacin should only be taken under the supervision of a nutritionally oriented doctor or a cardiologist. To avoid the side effects of niacin, doctors of natural medicine increasingly use inositol hexaniacinate, recommending 500-1,000 mg taken three times per day rather than niacin. This form of niacin lowers serum cholesterol but unlike niacin appears safe.

In some, but not all, studies Vitamin E increases HDL cholesterol. Vitamin E also protects LDL cholesterol from becoming damaged. Most cardiologist believe that only damaged LDL increases the risk of heart disease. People who take several hundred IU of vitamin E per day have a much lower risk of heart disease. Double-blind research indicates that vitamin E significantly reduces the risk of heart disease. Doctors of natural medicine generally recommend that everyone supplement at least 400 IU of vitamin E per day to lessen the risk of having a heart attack.

Like vitamin E, Vitamin C protects LDL from damage. In some studies, cholesterol levels fall when people with elevated cholesterol levels supplement with vitamin C. The decrease is due to a drop in LDL. An amount sometimes recommended by nutritionally oriented doctors is 1 gram per day.

Pantethine is a special form of vitamin B5 (pantothenic acid). Pantethine may help reduce the amount of cholesterol made in the body. Several studies have found that pantethine (300 mg taken two to four times per day) significantly lowers serum cholesterol levels and increases HDL. Common pantothenic acid does not appear to have this effect.

Vitamins B6, B12, and folic acid, lower homocysteine —a substance linked to heart disease risk. Homocysteine may increase the rate at which LDL is damaged. Therefore, limiting homocysteine levels should help protect against heart disease, an idea supported by preliminary research.

Quercetin is a bioflavinoid that protects LDL from damage. Several studies have found that people who eat foods high in quercetin have a much lower risk of heart disease. though the research is not consistent. Quercetin is found in apples, onions, and black tea and as a supplement. Dietary amounts linked to protection from heart disease are as low as 35 mg per day.

Supplementation with the mineral chromium has increased HDL levels in people. Chromium supplementation has reduced LDL and increased HDL in humans.

Brewer’s yeast containing chromium lowers serum cholesterol. People with higher blood levels of chromium are at lower risk of heart disease. A reasonable and safe amount is 200 mcg per day.

Several studies show that supplementing with calcium reduces cholesterol levels. Possibly the calcium is binding fat and preventing its absorption. Reasonable supplemental levels are 800-1,000 mg per day.

Magnesium is needed by the heart in order to beat. Although the mechanism is unclear, magnesium supplements (432 mg per day) lowered cholesterol in a South American study. Intravenous magnesium reduces death following a heart attack in most but not all studies. Disturbing research reports that magnesium supplements given to people with heart disease increases the number of heart attacks. The benefits of taking magnesium supplements for people at risk for heart disease remains unclear despite the relative success of post-heart attack intravenous magnesium.

Carnitine is needed by the heart muscle to utilize fat for energy. Some studies report that carnitine reduces serum cholesterol, although other studies do not support such findings. HDL cholesterol may increase with carnitine supplementation. People who do suffer a heart attack appear to have a reduced risk of dying if they supplement with carnitine. Most studies use 1-4 grams of carnitine per day.

Soy protein appears to lower cholesterol in people. The saponins in soy bind to cholesterol to limit its absorption in the intestine and soy’s phytosterols also block the absorption of cholesterol.

Another nutrient that may be helpful in lowering high cholesterol levels is Chondroitin sulfate. Preliminary research suggests that chondroitin sulfate may lower blood cholesterol levels.

Beta-sitosterol, alone and in combination with similar plant sterols, reduces blood levels of cholesterol. This appears to be because beta-sitosterol blocks absorption of cholesterol.

Octacosanol has been reported to lower LDL cholesterol levels while raising HDL cholesterol levels. Octacosanol appears to work primarily by inhibiting the liver’s production of cholesterol.

Royal Jelly has been shown in animal studies to help prevent the cholesterol-elevating effect of nicotine and to lower blood cholesterol levels. Human studies have confirmed that royal jelly can lower cholesterol levels.

Are there any side effects or interactions? Soy contains a compound called phytic acid, which can interfere with mineral absorption. In the amounts often used to affect cholesterol levels, niacin can be toxic. Therefore, no one should take large amounts without the supervision of a cardiologist or nutritionally oriented doctor. Although the inositol hexaniacinate form of niacin has not been linked with side effects, the amount of research remains quite limited. Therefore, it makes sense for people taking this supplement in large amounts (500 mg three times per day) to be followed by a nutritionally oriented doctor.

Vitamin B6, in large amounts, can damage sensory nerves, leading to numbness in the hands and feet. Folic acid is remarkably safe; however, folic acid supplements can mask the symptoms of vitamin B12 deficiency, which could lead to permanent neurological damage. Although this problem is rare, folic acid and vitamin B12 should always be taken together.

Vitamin E toxicity is very rare, and supplements are widely considered to be safe. Some individuals may develop diarrhea after as little as a few thousand milligrams of vitamin C per day, while others are not bothered by ten times this amount. However, high levels of vitamin C deplete the body of copper. No clear toxicity from quercetin has been identified.

Supplemental intake (typically 50-300 mcg per day) of chromium has not been linked consistently with any toxicity in humans. Side effects other than allergic reactions have not been reported from the use of brewer’s yeast. Individuals with sarcoidosis, hyperparathyroidism, or with chronic kidney disease should not supplement with calcium. In addition, individuals with a history of kidney stones should use calcium supplements cautiously. For other adults, 1,200-1,500 mg per day is safe. Magnesium at high intakes can produce diarrhea in some people.

Carnitine has not been consistently linked with any toxicity symptoms. At intakes of chondroitin sulfate greater than 10 grams per day, nausea may occur. No other adverse effects have been reported. Care should be taken if using a form of chondroitin sulfate that contains sodium, as this may worsen high blood pressure.

No significant side effects or interactions have yet been reported in studies on beta-sitosterol.

Long-term human studies using doses up to twice the typical therapeutic dose of octacosanol (that is, 20 mg each day) have not shown any negative effects.

Occasionally, royal jelly can provoke an allergic reaction in a susceptible individual.

Herbs that may be helpful: More than thirty-two human studies have demonstrated Garlic’s ability to lower serum cholesterol levels. Common garlic intakes in these studies ranged from 600-900 mg for a duration of four to sixteen weeks. Reports that have analyzed the results of all studies performed to date on the cholesterol-lowering effect indicate that over a one-to-four month period, the administration of garlic powder tablets reduces total serum cholesterol by 9-12%.

Persons with no aversion to the odor can chew one whole clove of raw garlic daily. Otherwise, odor-controlled, enteric-coated tablets standardized for allicin content can be taken in the amount of 900-mg daily (providing 5,000 mcg of allicin), divided into two daily doses. For health maintenance, half of the therapeutic regimen is adequate.

Guggul, the mixture of ketonic steroids from the gum oleoresin of Commiphora mukul, is an approved treatment of hyperlipidemia in India and has been a mainstay of Ayurvedic herbal approaches to preventing atherosclerosis. Clinical studies indicate that guggul is effective in the treatment of high cholesterol. One study found total serum cholesterol to drop by 17.5%. Another study compared guggul to the drug clofibrate. With guggul, the average fall in serum cholesterol was 11%. With clofibrate, the reduction averaged 10%. HDL rose in 60% of patients responding to guggul, while clofibrate had no effect.

Daily intakes of guggul are typically based on the amount of guggulsterones in the extract. The recommended amount of guggulsterones is 25 mg three times per day. Most extracts contain 5-10% guggulsterones, and nutritionally oriented doctors usually recommend taking it for twelve to twenty-four weeks.

Fo-ti root has been shown to lower cholesterol levels, according to animal and human research, as well as to decrease hardening of the arteries. A tea can be made from processed roots by boiling 3-5 grams in 250 ml (1 cup) of water for ten to fifteen minutes. Three or more cups are drunk each day. Fo-ti tablets, each in the amount of 500 mg, are also available. Many people take five tablets three times per day.

Wild yam has been shown to raise HDL. Wild yam can be taken as 2-3 ml of tincture three to four times per day or one or two capsules or tablets of the dried root three times per day,

Alfalfa leaves contain substances called saponins, which block absorption of cholesterol and prevent the formation of atherosclerotic plaques.

Other herbal supplements that may help lower serum cholesterol include psyllium, fenugreek, green tea and maitake.

Are there any side effects or interactions? (Refer to the individual herb for complete information.) Most people enjoy garlic; however, some individuals who are sensitive to it may experience heartburn and flatulence. Because of garlic’s anti-clotting properties, persons taking anticoagulant drugs should check with their doctor before taking garlic. Those scheduled for surgery should inform their surgeon if they are taking garlic supplements. There are no known contraindications to the use of garlic during pregnancy and lactation.

Early studies with the crude oleoresin of Commiphora mukul reported numerous side effects including diarrhea, anorexia, abdominal pain, and skin rash. Modern extracts are more purified and far fewer side effects (e.g., mild abdominal discomfort) have been reported with long-term use. Guggul should be used with caution by persons with liver disease and in cases of inflammatory bowel disease and diarrhea. A physician should be consulted for any case of elevated cholesterol and triglycerides.

The unprocessed fo-ti roots may cause mild diarrhea. Some people who are sensitive to fo-ti may develop a skin rash. Very high doses may cause numbness in the arms or legs.

Some people may experience nausea when taking large amounts of wild yam. Alfalfa is usually safe; however, there have been isolated reports of persons allergic to alfalfa. Persons with lupus or a history of lupus should avoid the use of alfalfa products.

Using psyllium in the suggested amounts is generally safe. Side effects, such as allergic skin and respiratory reactions to psyllium dust, have largely been limited to people working in plants manufacturing psyllium products.

Use of more than 100 grams of fenugreek seeds daily can cause intestinal upset and nausea; otherwise, it is extremely safe. Green tea is extremely safe. The most common adverse effect reported from consuming a large amount of green tea is insomnia, anxiety, and other symptoms caused by the caffeine content in the herb. Used as suggested, there have been no reports of any side effects with maitake.

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