Cholesterol: The Good, The Bad, And The Triglycerides


For high-density lipoprotein (HDL or good) cholesterol, higher levels are better. In the average man, HDL cholesterol levels range from 40 to 50 mg/dL. In the average woman, they range from 50 to 60 mg/c1L. An HDL cholesterol of 60 mg/dL or higher gives some protection against heart disease.

For low-density lipoprotein cholesterol (LDL or bad) cholesterol, an optimal range is 100 to 129 mg/c1L. As to triglyceride levels: normal is less than 150 mg/dL.

But, according to the association, more than 105 million American adults have total blood cholesterol values of 200 mg/dL and higher, and 36.6 million American adults have levels of 240 or above. Other than cholesterol levels, researchers today are exploring potentially more elucidative cardiovascular disease risk markers: C-reactive protein, fibrinogen, lipoprotein(a), LDL-C particle size and density, lipoprotein-associated phospholipase A2, calcium scoring, carotid artery intimal-medial thickness and brachial artery reactivity. But cholesterol is still an important part of the equation that needs to be addressed when talking about risk of heart disease.

Charlene Lee, marketing director for Cyvex Nutrition (Irvine, CA) noted in an interview last year that: "Elevated blood cholesterol and triglyceride levels have long been considered risk fact At Cyvex Nutrition, we believe that primary prevention of coronary heart disease (CHD) offers the greatest opportunity for reducing the burden of cardiovascular related deaths in the US Recent clinical trials demonstrate that LDL-lowering therapy reduces total mortality, coronary mortality, major coronary events, coronary artery procedures and stroke in people with established CHD. Therefore, controlling cholesterol safely is a priority, and Biocosan OITIA (95 percent policosanol) is a sound solution; and, only one 20 mg tablet or capsule per day is suggested for benefit!"

With the aging American population and surging obesity rates, the term "bad cholesterol" is painfully relevant, said Paul Dijikstra, executive vice president for InterHealth Nutraceuticals in Benicia, CA.

"Maintaining a healthy total cholesterol level to reduce cardiovascular disease (CVD) risk has remained top-ofmind for health professionals and their patients," he said. "And this priority is well-placed, he said, referring to the AHA statistics on the100 million Americans with either borderline or high cholesterol counts.

"Unlike some other indicators of CVD risk, cholesterol is a household term. The general public is well aware of the connection between unhealthy cholesterol levels and the risk of CVD. One tangible evidence of consumer interest is the increase in functional foods products that tout their healthy cholesterol benefits." The company's contribution in the fight against elevated cholesterol levels, ChromeMate is a patented niacin-bound chromium complex.

Sunil Kohli, vice president of Health Plus Inc. (Chino, CA) noted two key ingredients in the company's Heart Cleanse formula that in large part addresses healthy cholesterol levels. Guggulipid/guggul is a purified extract from the Indian medicinal plant Commiophora mukul. Studies have shown that guggul can help significantly lower blood cholesterol and triglycerides. Guggul works in the liver by increasing the arteries by promoting healthy fat and cholesterol levels in the blood. L-carnitine has been used for the treatment of various forms of cardiovascular disease.

Cholesterol And Circulation

"Cholesterol has an intimate relationship with circulation – after all, when fatty buildups/plaque occur healthy circulation is drastically impeded, leading to potential heart attacks/adverse cardiovascular events," said Eileen Sheets, managing director, Bioforce USA (Ghent, NY).

The company distributes a popular circulatory health supplement, Heart & Circulatory Health Capsules, Sheets noted. One to two capsules a day over a period of six months promotes lower blood cholesterol levels, and reduces platelet aggregation. It is also a vasodilator and an antioxidant.

It contains garlic which has been shown to have a significant action in lowering cholesterol and triglycerides in the blood. At the same time, it reduces the level of low-density lipoproteins (LDL) while increasing the levels of high-density lipoproteins (HDL). It also contains a vegetable oil that is a natural source of vitamin E, which supports the action of the garlic, and keeps the artery wall supple.

It has Hawthorne (Crataegus oxyacantha) that contains procyanidins that have been shown to increase blood flow to the heart and strengthen and stabilize blood vessels, helping prevent destructive changes. Finally Passiflora has a calming effect on the nervous system, which of course, is very beneficial to the heart and circulation.

Functional Options

Pam Stauffer, global marketing programs and communications manager with Cargill (Minneapolis, MN) said manufacturers want to reduce bad and not affecting the good cholesterol at all with end products that include ingredients that naturally lower cholesterol.

Cargill's CoroWise plant sterol product has been added to retailer Kroger's milk and has been used in Minute Maid orange juice and a number of other products. "It doesn't affect taste and texture of food," Stauffer said. The CoroWise ingredient is now also offered in the Centrum Cardin multivitamin.

According to Cargill's website, because plant sterols are structurally similar to cholesterol, they compete with the cholesterol we ingest for absorption through the small intestine. To a point, the more plant sterol present in the intestine following a meal, the less cholesterol absorption will occur.

Further the plant sterols we consume are not absorbed themselves to any appreciable extent. So, when you consume phyosterols, you not only inhibit the uptake of cholesterol by the body, but you "flush" most of the plant sterols through the system without absorbing them as well. The overall effect is an average decline in LDL cholesterol of eight to 15 percent, with no observed adverse effects.

EFAs

"Omega-3 fatty acids from marine sources containing EPA and DHA have some effect of lowering the total cholesterol, but their main effect is to reduce the amount of 'bad' cholesterol at the same time as increasing the 'good' cholesterol," said Baldur Hjaltason sales manager with EPAX AS (Lysaker, Akershus, Norway), North America, Japan and China."Much clinical work has been done in this area. It is also important to mention that marine omega-3 fatty acids also reduce the total blood fat (triglyceride levels), which is also a high risk factor for CVD [cardiovascular disease]. This gives the omega-3 fatty acids a certain advantage to attack the problem in two different ways."

The category is growing, Stauffer said, as evidenced by Centrum launching their cardio multi and the CoroWise infused Oroweat wholegrain bread sold east of the Mississippi by Bimbo Bakery. These functional products are geared to men and women although women are the primary shopper sand are buying it for their husband, family members and themselves.

However, she noted, there is still an awareness gap. “If you ask someone walking down the street about plant sterols, they won't know they are. But Centrum is huge," she said, "and has a broad reach within the market."

"Adding plant sterols to foods and multivitamins is more exciting to consumers. It offers a variety in a user friendly way," Stauffer said. "Cognis works closely with their branding partners by holding programs to reach consumers and health care professionals, by public relations by and maintaining a relationship with the American Dietician Association. That's so our partners don't have to make a separate investment on their own."

Another heart-friendly ingredient in development for Cargill is Barliv betaglucan (barley betafiber), a concentrated soluble fiber derived from barley. The clinical data show that it has cholesterol-lowering properties similar to oats, Stauffer said.

In a double-blind study conducted at the University of Minnesota, 155 generally healthy adults with LDL cholesterol levels between 130 and 190 mg/dL, and half of whom met the criteria for metabolic syndrome, followed a low saturated fat, low cholesterol diet for four weeks. Then they consumed ready-to-eat cereal and a juice drink containing barley beta-glucan twice daily for six weeks, while they continued on the diet.

The test subjects' daily intake of barley betaglucan was either 3 grams or 5 grams. Blood tests confirmed those subjects' blood levels of glucose and free fatty acids improved after meals among individuals with the metabolic syndrome. The findings indicate that adding barley betaglucan to the diet can significantly improve multiple CVD risk markers, and after-meal metabolism among individuals with the metabolic syndrome.

Statins And Omega-3s

"One of the major drugs to treat high cholesterol content in the blood is statins. They are very effective in lowering the total cholesterol content but do not change the ratio between HDL and LDL as the marine-based oils do," Hjaltason said. "Clinical trials have shown that when combining statins with omega-3 marine oils you will get synergic effects due to the fact that the statins and the omega-3 fatty acids have different mechanisms of how they effect the cholesterol level and ratio.

"It is important to note that health care professions can advise their patient to first try marine oil concentrates to lower their bad cholesterol before prescribing statins. Also, the uses of statins can most likely be reduced by adding omega-3 concentrated supplements to the diet."

Another important factor is the role of EPA from marine omega-3 fatty acids on inflammation, Hjaltason pointed out. "We know that many of the CVD start when you get inflammation in your cardiovascular system. There are no symptoms so the patient is not aware until the disease is at relatively high stage. Small inflammation over time can lead to the veins clogging with cholesterol and blood fat that can be avoided by regular intake of marine-based EPA.

"The pharmaceutical companies are very much aware of the synergic effects of omega-3 fatty acids from marine sources and the statins. Several clinical trials are on the way where statins have been blended with omega-3 marine oils. This will most likely be the next generation of statins. But until then, patients will get similar clinical effect by taking their omega-3 supplements with the statins."

Inherited High Cholesterol

A major trend is the huge competition between certain drug manufacturers for their pharmaceuticals, such as Vytorin that address inherited cholesterol and dietary cholesterol, said Sheets. "This has been a relatively new discovery, the idea that a person can have genetically higher LDL cholesterol levels. The relative amounts of HDL to LDL can determine whether the liver breaks down cholesterol properly.

So it becomes increasingly important to address the proper functioning of the liver to aid heart health. At Bioforce USA, we believe this spells out opportunity for the industry to continue to get the message across that eating a healthy diet, using supplements and adopting a healthier lifestyle in general is the key to good health and lowering risk of heart surgery!"

Get The LDL Out

The AHA's advice to keep cholesterol under control:

• schedule a screening

• eat foods low in cholesterol and saturated fat

• maintain a healthy weight

• exercise regularly

As for the latter, the AHA along with American College of Sports Medicine (AGSM) updated its physical activity guidelines for heart health this year. All healthy adults ages 18 to 65 years need moderate-intensity aerobic physical activity for at least 30 minutes on five days each week or vigorous-intensity aerobic physical activity for at least 20 minutes on three days each week. Further, adults will benefit from performing activities that maintain or increase muscular strength and endurance for at least two days each week.

Bringing It All Together

In Dr. Shari Lieberman's book, The Real Vitamin & Mineral Book; A definitive Guide to Designing Your Personal Supplement Program (Avery, 2003), she states: "The balance between good and bad fats is determined by several factors, including diet (nutrition), exercise and heredity. Fortunately, we can manipulate two out of three of these factors to create a more desirable balance."

For example, Lieberman continued, "Cholesterol can be lowered by the consumption of certain supplements. These supplements, which include niacin, vitamins C and E, chromium, EPA (eicosapentaenoic acid) and coenzyme Q10 FO may also lower LDL and raise HDL cholesterol. Moreover, antioxidants such as vitamin E, beta carotene, garlic and coenzyme Q10 have been shown to protect LDLs from oxidizing and causing havoc in our arteries. Aerobic exercise and very low-fat, high-fiber diet have also proven effective in this regard.

Be aware that simply reducing the amount of cholesterol in your diet is a rather ineffective way of changing your blood cholesterol levels. The most effective plan for lowering blood cholesterol includes all of these measures. And unlike the drugs commonly used to lower cholesterol, this plan is safe."