High Cholesterol

Elevated Serum Cholesterol

Although it is by no means the only major risk factor, elevated serum cholesterol is clearly associated with a high risk of heart disease. Most doctors suggest cholesterol levels should stay under 200 mg/dl. Cholesterol levels lower than 200 are not without risk, however, as many people with levels below 200 have heart attacks. As levels fall below 200, heart disease risk continues to decline. Many doctors consider cholesterol levels of no more than 180 to be optimal.

Diet, lifestyle consideration, exercise and taking specific supplements can all play a major role in managing high cholesterol.

• See nutritional recommendations
• See dietary and lifestyle recommendations
• See detailed discussion of nutrients and research

LDL & HDL

Medical laboratories now subdivide total cholesterol measurement into several components, including LDL cholesterol (which is directly linked to heart disease) and HDL cholesterol (the so-called "good" cholesterol). The relative amount of HDL to LDL is more important than total cholesterol. For example, it is possible for someone with very high HDL to be at relatively low risk for heart disease even with total cholesterol above 200. Evaluation of changes in cholesterol requires consultation with a healthcare professional and includes measurements of blood levels of total cholesterol as well as HDL and LDL cholesterol.

Few Symptoms

High cholesterol rarely causes symptoms. It is usually detected during a routine blood test that measures cholesterol levels (see the Exams and Tests section). You may first discover it when you are diagnosed with a condition that is caused in part by high cholesterol, such as coronary artery disease, stroke, or peripheral vascular disease.

Distinct Symptoms

Some people with lipid disorders, such as familial hypercholesterolemia, may have other distinct symptoms such as deposits of excess cholesterol that collect in the skin or eye tissue. These cholesterol deposits can also cause nodules in tendons in the hands or feet or, rarely, yellow streaks in the hands.

These are the most important supplements and recommendations.

Causes

Conventional Treatment

Self Help

Lifestyle changes that may be helpful

• Exercise: Exercise increases protective HDL cholesterol, an effect that occurs even from walking. Exercisers have a relatively low risk of heart disease. People over 40 years of age or who have heart disease should talk with their doctor before starting an exercise program; overdoing it can trigger heart attacks.
• Weight loss: Obesity increases the risk of heart disease, in part because weight gain lowers HDL cholesterol. Weight loss reduces the body's ability to make cholesterol, increases HDL levels, and reduces triglycerides (another risk factor for heart disease).
• Quit smoking: Smoking is linked to a lowered level of HDL cholesterol and is also known to cause heart disease. Quitting smoking reduces the risk of having a heart attack.
• Stress reduction: The combination of feelings of hostility, stress, and time urgency is called type A behavior. Men with these traits were found to be at high risk for heart disease in most, but not all, studies. Stress or type A behavior may elevate cholesterol levels in men. Reducing stress and feelings of hostility has reduced the risk of heart disease.

Diet Pluses

• Number and size of meals When people eat more small meals, serum cholesterol levels fall compared with the effect of eating the same food in three big meals. People with elevated cholesterol levels should probably avoid very large meals and eat more frequent but smaller meals.
• Eat soy: (30 grams per day of soy protein) Tofu, tempeh, miso, and some protein powders in health food stores are derived from soybeans. Isoflavones from soybeans reduce both total and LDL cholesterol.
• Low-fat foods: Unlike other dairy foods, skimmed milk, nonfat yogurt, and nonfat cheese are essentially fat-free. However, so-called "low-fat" dairy products are not particularly low in fat. A full 25% of calories from 2% milk come from fat. (The "2%" refers to the fraction of volume filled by fat, not the more important percent of calories coming from fat.)
• Eat fish: Eating fish has been reported to increase HDL cholesterol and is linked to a reduced risk of heart disease in most studies. Fish contains EPA and DHA, omega-3 fatty acids that appear to protect against heart disease.
• Eat vegetables: Vegetarians have lower cholesterol and less heart disease do than meat eaters, in part because they avoid animal fat. Vegans (people who eat no meat, dairy, or eggs) have the lowest cholesterol levels, and going on such a diet has reversed heart disease in some studies.
• Use olive oil: Olive oil is high in monounsaturated fatty acids, and lowers LDL cholesterol, especially when it replaces saturated fat in the diet. People from countries that use significant amounts of olive oil appear to be at low risk for heart disease. Although olive oil is safe for people with elevated cholesterol, it is very high in calories, and intake should be limited in overweight people.
• Fiber (20 grams per day for several months): Soluble fiber from beans, oats, psyllium seed, and fruit pectin has lowered cholesterol levels in most trials. Doctors often recommend that people with elevated cholesterol eat more of these high soluble fiber foods. However, even grain fiber (which contains insoluble fiber and does not lower cholesterol) has been linked to protection against heart disease.
• Glucomannan: Glucomannan is a water-soluble dietary fiber that is derived from konjac root. Trials have shown that supplementation with glucomannan significantly reduced total blood cholesterol, LDL cholesterol, and triglycerides, and in some cases raised HDL cholesterol. Effective amounts of glucomannan for lowering blood cholesterol have been 4 to 13 grams per day.
• Flaxseed: Like other good sources of soluble fiber, flaxseed been reported to lower cholesterol. The cholesterol-lowering component in flaxseed is likely to be the fiber and not the oil. Thus, it makes sense to use partially defatted flaxseed instead of whole flaxseed or flaxseed oil to lower cholesterol.
• Moderate Alcohol: Moderate drinking (one to two drinks per day) increases protective HDL cholesterol. This effect happens equally with different kinds of alcohol-containing beverages. Alcohol also acts as a blood thinner, an effect that might lower heart disease. However, alcohol consumption can cause liver disease, cancer, high blood pressure, alcoholism, and, at high intake, an increased risk of heart disease. In deciding whether light drinking might do more good than harm, people with high cholesterol should consult a healthcare professional.
• Eat garlic: Eating garlic helped lower cholesterol in some but not all research. Garlic is known to act as a blood thinner and may reduce other risk factors for heart disease. For these reasons, doctors typically recommend eating garlic as food, taking 900 mg of garlic powder from capsules (providing 5,000-6,000 mcg of allicin), or using a tincture of 2-4 ml taken three times daily. Individuals taking warfarin should consult a healthcare practitioner before taking garlic supplements.
• Green tea (Camellia sinensis): about three cups per day (providing 240-320 mg of polyphenols).
• Eat nuts: Research consistently shows that people who frequently eat nuts have a dramatically reduced risk of heart disease, probably because nut consumption lowers cholesterol levels. Of nuts commonly consumed, almonds and walnuts may be the most effective at lowering cholesterol and macadamia nuts may be least beneficial. Hazelnuts and pistachio nuts may also help lower cholesterol.

Diet Avoidances

• Avoid large meals
• Avoid sugar: Eating sugar has been reported to reduce protective HDL cholesterol and slightly increase (worsen) other risk factors linked to heart disease.
• Dietary Fats Reduce saturated fats: Eating animal foods containing saturated fat is linked to high serum cholesterol and heart disease. Significant amounts of animal-based saturated fat are found in beef, pork, veal, poultry (particularly in poultry skins and dark meat), coconut oil, palm oil, cheese, butter, ice cream, and all other forms of dairy products not labeled "fat free."
• Avoid trans fatty acids: Trans fatty acids (TFAs) are found in many processed foods containing hydrogenated oils. The highest levels of TFAs occur in margarine. Margarine consumption is linked to increased risk of heart disease. Eating TFAs increases the ratio of LDL to HDL. Margarine and other processed foods containing partially hydrogenated oils should be avoided.
• Reduce egg consumption: Although eating eggs may not increase cholesterol if the overall diet is low in fat, it increased serum cholesterol in most studies. Moreover, when cholesterol from eggs is cooked or exposed to air, it oxidizes. Oxidized cholesterol is linked to increased risk of heart disease.
• Avoid coffee: Drinking boiled or French press coffee increases cholesterol levels although drinking paper filtered coffee generally does not increase cholesterol levels. However, paper-filtered coffee does appear to significantly increase homocysteine - another risk factor for heart disease. The effects of decaffeinated coffee on cholesterol levels remain in debate.

Key nutritional supplements

• Vitamin B3 (niacin): High amounts (several grams per day) of niacin, a form of vitamin B3, lower cholesterol. The other common form of B3 - niacinamide - does not. Some cardiologists prescribe 3 grams of niacin per day or even higher amounts for people with high cholesterol levels. At such intakes, acute (flushing, headache, stomachache) and chronic (liver damage, diabetes, gastritis, eye damage, and possibly gout) toxicity may occur. Many people are not able to continue taking these levels of niacin due to discomfort or danger to their health. Therefore, high intakes of niacin must only be taken under the supervision of a qualified healthcare professional.
• Pantethine (300 mg taken two to four times per day): Pantethine, a special form of vitamin B5 (pantothenic acid), has been shown to significantly lower serum cholesterol levels and increase HDL. Common pantothenic acid has not been reported to have this effect.
• Vitamin C (100 mg to 1 gram per day): Vitamin C protects LDL cholesterol from oxidative damage and may help lower elevated LDL cholesterol. Most protection against heart disease from vitamin C is likely to occur with as little as 100 mg per day.
• Beta-glucan: Beta-glucan is a type of soluble fiber molecule derived from the cell wall of baker's yeast, oats and barley, and many medicinal mushrooms, such as maitake. Beta-glucan is the key factor for the cholesterol-lowering effect of oat bran.For lowering cholesterol levels, the amount of beta-glucan used has ranged from 2,900 to 15,000 mg per day.
• Beta-hydroxy-beta-methylbutyrate (HMB): The combined results of nine double-blind trials indicate that supplementation with beta-hydroxy-beta-methylbutyrate (HMB) effectively lowers total and LDL cholesterol. All trials used 3 grams per day, taken for three to eight weeks.
• Chromium/brewer's yeast (200 mcg per day of chromium; true brewer's yeast contains up to 60 mcg of chromium per tablespoon, and a reasonable intake is two tablespoons per day): Chromium supplementation has reduced LDL cholesterol and increased HDL cholesterol in human trials. Brewer's yeast, which contains readily absorbable chromium, has also lowered serum cholesterol. People wishing to use brewer's yeast as a source of chromium should look for products specifically labeled "from the brewing process" or "brewer's yeast," because most yeast found in health food stores is not brewer's yeast and does not contain chromium.

Other nutritional supplements that may be helpful

• Beta-sitosterol: 1.6 grams per day.
• Calcium: 800-1,000 mg per day.
• Copper: 3-4 mg per day for eight weeks.
• Flaxseed: (raw, defatted) 15 grams per day.
• Inositol hexaniacinate (500-1,000 mg three times per day instead of niacin): People should not take niacin, including inositol hexaniacinate, without the supervision of a healthcare provider.
• Royal jelly: Royal jelly has prevented the cholesterol-elevating effect of nicotine and has lowered serum cholesterol in animal studies. Preliminary human trials have also found that royal jelly may lower cholesterol levels. An analysis of cholesterol-lowering trials shows that 50 to 100 mg per day is the typical amount used in such research.
• Tocotrienols: 200 mg per day.

Key herbs

• Fenugreek (Trigonella foenum-graecum) powder: 10-30 grams three times per day with meals.
• Guggul (Commiphora mukul) (providing 25 mg of guggulsterones three times per day for at least 12 weeks): Guggul is a mixture of substances taken from the plant Commiphora mukul. Guggul extract has been shown to lower total cholesterol and raise HDL cholesterol. Daily intakes of guggul are based on the amount of guggulsterones in the extract. Most extracts contain 5-10% guggulsterones.
• Psyllium (Plantago ovata, Plantago ispaghula) (5-10 grams added to the diet per day to lower cholesterol levels): Use of psyllium has been extensively studied as a way to reduce cholesterol levels.An analysis of all double-blind studies concluded that psyllium lowered cholesterol levels by 5% and LDL cholesterol by 9%.
• Red yeast rice (Monascus purpureus) (1.2-2.4 grams [5-10 mg monacolins] per day in divided amounts for at least 12 weeks): A proprietary red yeast product (Cholestin®) contains ten different compounds called monacolins that inhibit cholesterol synthesis. One of these compounds is lovastatin (Mevacor®), a prescription drug used to reduce cholesterol levels. Although lovastatin occurs naturally in red yeast rice, the sale of Cholestin has been banned in the United States, as a result of a lawsuit alleging patent infringement. Other red yeast rice products currently on the market differ from Cholestin in their chemical makeup and some contain a potentially toxic compound called citrinin. Until further information is available, red yeast rice products other than Cholestin cannot be recommended.

Other herbs that may be helpful

• Achillea wilhelmsii: In a double-blind trial, people with moderately high cholesterol took a tincture of Achillea wilhelmsii, an herb used in traditional Persian medicine. Participants in the trial used 15-20 drops of the tincture twice daily for six months. At the end of the trial, participants experienced significant reductions in total cholesterol, LDL cholesterol and triglycerides, as well as an increase in HDL cholesterol, compared to those who took placebo. No adverse effects were reported.
• Artichoke (Cynara scolymus) (320 mg of standardized leaf extract two to three times per day for at least six weeks): Artichoke has moderately lowered cholesterol and triglycerides in some, but not all, reports.

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Research on high cholesterol and alternative treatment options.