Food Pharmacy to Fight Cholesterol

By William W. Li, M.D. President and Medical Director, The Angiogenesis Foundation

Hardening of the arteries is associated with genetics, diet and lifestyle as underlying causes, and clogging of the arteries by something called “plaque” can lead to a fatal heart attack or stroke. The plaque is made up of cholesterol, calcium, and other materials found in the blood. High blood cholesterol, which affects 1 in 6 adults, is one of the major risk factors for plaque build-up.

While you can’t change your genetics, and your doctor can prescribe medications that can control cholesterol, you can also take a proactive and preventive approach by aligning your diet to support better cardiovascular health. The following are some of the foods that can help lower your cholesterol.

Mustard Greens (Φύλλα Σιναπιού)

By its name, you might guess that mustard greens might be used to produce the condiment mustard – and you would be right! The seeds of the plant are used to make mustard. The leaves, however, are a delicious leafy green you can find in the produce section of the grocery store. They are rich in natural substances called sulforaphanes that, when eaten, help the body get rid of bile acid in our gut. Bile acids are used by the body to make cholesterol – so the less bile acid results in less cholesterol. Some cholesterol-lowering medicines help get rid of bile, too – but this is a natural way to do it using food.

Preparation Tips: What’s the best way to eat mustard greens? They are tasty raw in a salad, but researchers have actually shown that steaming mustard greens makes them even more potent in their ability to lower cholesterol! Raw or cooked, try adding mustard greens to your diet.

Dark Chicken Meat

Everyone knows that chicken is one of the healthier meats, but most people think the white meat, such as the breast, is the best cut. The dark meat found in thighs and legs is actually healthier for your heart. Dark meat contains a special vitamin called menaquinone (vitamin K2) that’s also found in some hard cheeses. Vitamin K2 interferes with the body’s ability to make cholesterol in the blood, and researchers have shown that vitamin K2 prevents hardening of the arteries, as well. When the levels of K2 were measured in the blood, people who ate more K2-containing foods had more than a 50% reduction in the chance of dying of heart disease.

Preparation Tips: Chicken thighs are often the preferred part of the bird in Asian cooking, and the legs are tasty roasted or stewed. Just make sure you trim away the skin and any fat before you cook them. And here’s the best part: dark meat is cheaper than chicken breast. A healthy serving to eat is 4 oz. per day, which measures out to be a portion a little bit bigger than a deck of playing cards. 

Persimmon (Λωτός)

Persimmons are a delicious orange fruit that grows in California, Asia and in the Mediterranean, where they are called “kaki.” Their season is late fall and winter, so they are a cool-weather treat.  Persimmons look a lot like tomatoes, and like tomatoes, they contain a natural substance called beta-cryptoxanthin that is related to vitamin A.  Researchers have shown beta-cryptoxanthin can protect the good form of cholesterol in our blood called HDL, or high-density lipoprotein, and it can also prevent hardening of the arteries. Want to know another benefit? It fights belly fat, as well!

Tips: When you eat a persimmon, just make sure you don’t eat the skin.  Cut it away, or eat around it like you would an orange slice. The reason is that some varieties of persimmon have skins that are astringent. That means it makes your mouth pucker. Just enjoy the tender sweet flesh. A persimmon a day is heart-healthy.

Pistachios

Pistachio are a cholesterol-lowering superfood. It contains a natural antioxidant called lutein that can raise the good cholesterol (HDL) and lower the bad form, called LDL (low density lipoprotein).

Tips: How much is heart-healthy? About 1/3 of a cup each day. That’s about 50 kernels of shelled pistachios. They’re also a great source of fiber in your diet.

Some Heart-Healthy Foods are Also Cancer fighters

Here’s the best news of all: the same natural substances I just mentioned that lower cholesterol – sulforaphanes, vitamin K2, beta-cryptoxanthin and lutein – also protect against cancer!  So, the next time you go to the grocery store, think about stocking your fridge and your pantry with some of these delicious foods that are good and good for you in more ways than one.

At the non-profit Angiogenesis Foundation, we are working to bring this type of practical, lifesaving information to the public through our Eat to Defeat Cancer campaign. To get recipes and more information on foods containing the heart-healthy substances that can also fight cancer, click here.

Grapefruit Lowers Cholesterol

Grapefruit contains pectin, a form of soluble fiber that has been shown in animal studies to slow down the progression of atherosclerosis. In one study, animals fed a high-cholesterol diet plus grapefruit pectin had 24% narrowing of their arteries, while animals fed the high-cholesterol diet without grapefruit pectin had 45% narrowing.Both blond and red grapefruit can reduce blood levels of LDL ("bad") cholesterol, and red grapefruit lowers triglycerides as well, shows a study published in the Journal of Agricultural and Food Chemistry.Israeli researchers from the Hebrew University in Jerusalem first tested the antioxidant potential of blond and red grapefruits and then their cholesterol-lowering potential in humans. The test tube research showed that red grapefruit contains more bioactive compounds and total polyphenols than blond, but both grapefruits are comparable in their content of fiber, phenolic and ascorbic acids, and the flavonoid, naringinen, although red grapefruit contains slightly more flavonoids and anthocyanins.In this recent study, participants added either red grapefruit, blond grapefruit or no grapefruit to their daily diet. The results indicated that both types of grapefruit appeared to lower LDL cholesterol in just 30 days: total cholesterol by 15.5% in those eating red grapefruit and 7.6% in those eating blond grapefruit; LDL cholesterol by 20.3% and 10.7% respectively; and triglycerides by 17.2% and 5.6% respectively. No changes were seen in the control group (those that didn't eat any grapefruit).Both red and blond grapefruits both positively influenced cholesterol levels, but red grapefruit was more than twice as effective, especially in lowering triglycerides. In addition, both grapefruits significantly improved blood levels of protective antioxidants. Red grapefruit's better performance may be due to an as yet unknown antioxidant compound or the synergistic effects of its phytonutrients, including lycopene.In response to this rapid and very positive outcome, the researchers concluded that adding fresh red grapefruit to the diet could be beneficial for persons with high cholesterol, especially those who also have high triglycerides.One caveat, however: Compounds in grapefruit are known to increase circulating levels of several prescription drugs including statins. For this reason, the risk of muscle toxicity associated with statins may increase when grapefruit is consumed. (See our Individual Concerns section for more information.)

Precautions: Research indicates that individuals taking statin drugs should avoid grapefruit. Grapefruit increases the amount of statin drug that reaches the general circulation in two ways. First, grapefruit contains a compound called naringenin, which inactivates an enzyme (cytochrome P450 3A4) in the small intestine that metabolizes statin drugs. Secondly, grapefruit also inhibits P-glycoprotein, a carrier molecule produced in the intestinal wall that would normally transport the statin drug back to the gut. The end result of these two mechanisms is that much more of the statin drug enters the systemic circulation than would normally be the case, leading to a build up in statin levels that can be quite dangerous, and may trigger a rare but serious statin-associated disease called rhabdomyolysis. Rhaddomyolysis affects muscle tissue, usually causing temporary paralysis or weakness, unless the muscle is severely injured.

Danger of Grapefruit: if you take Zocor (simvastatin), Lipitor (atorvastatin) and Pravachol (pravastatin) you should not eat grapefruit or drink grapefruit juice

Supplement​s against statins side effects

Most of the negative side effects caused by statins are due to the way these drugs deplete the body of the potent antioxidant CoQ10.

You see, statins work in the liver by blocking an enzyme pathway that leads to the creation of cholesterol. Unfortunately, that same enzyme pathway is the one your body uses to create CoQ10. So statin takers need to be especially aware of the fact that they’re not producing CoQ10 at the levels they would be if they were taking no medication. When your body lacks CoQ10, energy production will lag and cell function will suffer.

Here’s a list of nutrients I recommend to all statin users. Because of the CoQ10 connection, it’s at the top of the list. But because CoQ10 is so intimately involved in cellular energy production, I also recommend including complementary nutrients in your daily regimen. You’ll find many of these nutrients in a quality multivitamin and mineral formula. Others, like CoQ10, ribose, and broad spectrum carnitine, must be purchased separately and can be found in health food stores and most grocery stores.

· CoQ10, 100–200 mg (hydrosoluble softgel) daily. CoQ10 serves as a raw material for the production of adenosine triphosphate (ATP), the primary source of cellular energy. Also a potent antioxidant, CoQ10 helps to neutralize the free radicals generated during the ATP production cycle.

· Broad spectrum carnitine, 1–2 g daily. This nutrient shuttles the fatty acids necessary for ATP production into the cells and transports waste material out.

· Ribose, 5 g twice a day. Ribose allows used ATP molecules to be recycled more quickly. A simple sugar made in every cell, ribose is depleted by heart disease. When taken as a supplement, it rapidly re-energizes heart patients.

· Magnesium, 400–800 mg daily. In the body, magnesium helps activate and regulate more than 350 enzymatic reactions. It is also required to stabilize and store ATP.

· Vitamin E (100–200 IU of mixed tocopherols daily),

· Vitamin C (200 mg daily), and

· Alpha lipoic acid (50–100 mg daily).

These three major antioxidants protect your cells from free-radical damage and are able to penetrate the inner mitochondrial membrane.

· Copper (500 mcg to 1 mg daily),

· Zinc (15–30 mg daily),

· Molybdenum (75–150 mcg daily), and

· Manganese (2–4 mg daily).

All four are vital minerals for ATP production and cellular health and repair.

Read more: http://www.drsinatra.com/cholesterol-meds-statin-nutrient-depletion#ixzz2fAQQRlL0

Cholesterol medications: Consider the options

By Mayo Clinic staff
A healthy lifestyle is the first defense against high cholesterol. But sometimes diet and exercise aren't enough, and you may need to take cholesterol medications. Cholesterol medications may help:

• Decrease your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol that increases the risk of heart disease
• Decrease your triglycerides, a type of fat in the blood that also increases the risk of heart disease
• Increase your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol that offers protection from heart disease

Your doctor may suggest a single drug or a combination of cholesterol medications. Here's an overview of benefits, cautions and possible side effects for common classes of cholesterol medications.

Drug class and drug names	Benefits	Possible side effects and cautions
Statins Altoprev (lovastatin) Crestor (rosuvastatin) Lescol (fluvastatin) Lipitor (atorvastatin) Mevacor (lovastatin) Pravachol (pravastatin) Zocor (simvastatin)	Decrease LDL and triglycerides; slightly increase HDL	Constipation, nausea, diarrhea, stomach pain, cramps, muscle soreness, pain and weakness; possible interaction with grapefruit juice
Bile acid binding resins Colestid (colestipol) Questran (cholestyramine/ sucrose) Welchol (colesevelam)	Decrease LDL	Constipation, bloating, nausea, gas; may increase triglycerides
Cholesterol absorption inhibitor Zetia (ezetimibe)	Decreases LDL; slightly decrease triglycerides; slightly increase HDL	Stomach pain, fatigue, muscle soreness
Combination cholesterol absorption inhibitor and statin Vytorin (ezetimibe-simvastatin)	Decreases LDL and triglycerides; increases HDL	Stomach pain, fatigue, gas, constipation, abdominal pain, cramps, muscle soreness, pain and weakness; possible interaction with grapefruit juice
Fibrates Lofibra (fenofibrate) Lopid (gemfibrozil) TriCor (fenofibrate)	Decrease triglycerides; increase HDL	Nausea, stomach pain, gallstones
Niacin Niaspan (prescription niacin)	Decreases LDL and triglycerides; increases HDL	Facial and neck flushing, nausea, vomiting, diarrhea, gout, high blood sugar, peptic ulcers
Combination statin and niacin Advicor (niacin-lovastatin)	Decreases LDL and triglycerides; increases HDL	Facial and neck flushing, dizziness, heart palpitations, shortness of breath, sweating, chills; possible interaction with grapefruit juice
Omega-3 fatty acids Lovaza (prescription omega-3 fatty acid supplement) Vascepa (Icosapent ethyl)	Decrease triglycerides	Belching, fishy taste, increased infection risk

Most cholesterol medications lower cholesterol with few side effects, but effectiveness varies from person to person. If you decide to take cholesterol medication, your doctor may recommend periodic liver function tests to monitor the medication's effect on your liver. Also remember the importance of healthy lifestyle choices. Medication can help control your cholesterol — but lifestyle matters, too.

Flaxseed against cholesterol

Flax seed oil is a rich source of essential fatty acids, most notably omega-3 fatty acids. Also known as polyunsaturated fatty acids, these compounds are necessary for healthy growth and development. According to the University of Maryland Medical Center, they are also critical for proper brain function and cardiovascular health.

Various flaxseed preparations - including ground flaxseed, partially defatted flaxseed, and flaxseed bread and muffins - seem to significantly reduce total cholesterol and the “bad cholesterol,” low-density lipoprotein (LDL) cholesterol, in people with normal cholesterol levels and in men and pre-menopausal women with high cholesterol. But flaxseed doesn’t have much effect on “good cholesterol,” high-density lipoprotein (HDL) cholesterol. Most flaxseed preparations don’t affect triglyceride levels either, but unfortunately partially defatted flaxseed (flaxseed without as much alpha-linolenic acid content) can increase triglycerides by approximately 10%.

 

Flaxseed might slow blood clotting. Taking flaxseed along with medications that also slow clotting might increase the chances of bruising and bleeding.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others.

 

Red Rice Yeast Instead of Statins?

Cardiologists David Becker, M.D., and Ram Gordon, M.D., Chestnut Hill Cardiology, studied 62 patients with high cholesterol in the first randomized, double-blinded placebo-controlled trial to evaluate red yeast rice in patients with a history of statin-associated myalgias (side effects that include muscle pain and weakness). Thirty-one of the patients took three 600-mg capsules of red yeast rice twice per day over the course of six months, and the other half received identical placebo tablets. The red yeast rice patients also participated in weekly meetings for the first three months, where they were taught about heart disease and how to incorporate heart-healthy nutrition, exercise and stress management into their lives.

At the conclusion of the study, the research found:

- Low-density lipoprotein cholesterol (also known as "bad cholesterol") levels decreased more in the patients receiving the red yeast rice (average decrease, 35 mg/dL) than in patients receiving the placebo (average decrease, 15 mg/dL).

- Total cholesterol levels improved more in the red yeast rice group than in the placebo group.

- Muscle pain scores, weight loss, HDL cholesterol (high-density lipoprotein or "good cholesterol") and liver or muscle enzyme levels did not differ between the two groups.

Red Yeast Rice, a staple of Chinese medicine for more than a thousand years, is derived from a fungus that grows on rice. A series of compounds within the red yeast rice have been found to slow the production of cholesterol in the liver. The medical community, however, has been slow to consider its potential use as an alternative treatment therapy for patients with statin-associated myalgias because the supplement is not regulated by the Food and Drug Administration.


Question to Andrew Weil M.D.:
Now that a scientific study has found that red rice yeast supplements work as well as statin drugs for cholesterol control I'm wondering if I should switch from the statin I now take. What's your recommendation?

Answer (Published 6/30/2009)

You're referring to a study published in the June 16, 2009 issue of the Annals of Internal Medicine showing that a red rice yeast supplement worked as well to lower LDL ("bad") cholesterol as prescription statin drugs. The study included 62 patients, all of whom quit taking statins because of muscle pain, the most common side effect of these drugs. Half the 62 patients in the study received a red rice yeast supplement; the other half were given a placebo. After three months, average LDL levels among those taking the red rice yeast had dropped an average of 27 percent compared with six percent among the placebo group. All the participants were taught how to eat well, exercise and otherwise maintain a healthy lifestyle. Only seven percent of the patients taking the supplement developed muscle pain; among statin users, at least twenty percent experience muscle pain initially but many improve once their bodies get used to the drug.

Red rice yeast (Monascus purpureus) is a natural source of statins, but unlike pharmaceutical products, it provides a mix of these compounds rather than a single one. The complex mixture interacts with the body more smoothly and is less likely to cause toxicity.

One active ingredient in red rice yeast extract, monacolin K, is the active component of the FDA approved statin Mevacor. The lead researcher of the new study, David Becker, M.D., of Chestnut Hill Cardiology in Pennsylvania, said that because the dose of monacolin K in the red rice yeast supplement used in the study was five times smaller than the amount in a typical Mevacor prescription, "something else is having a powerful lipid-lowering effect." Healthy lifestyle changes among the study participants probably didn't account for the difference.

This is a valuable study, but I wouldn't recommend switching from a statin to red rice yeast without your physician's approval and supervision. Because supplements are unregulated and the demand for quality ingredients is growing, some products will not actually contain any red rice yeast extract and, as a result, won't be effective.

I have put many patients on red rice yeast products with excellent results and have seen only two patients who could not tolerate them because of side effects. Note that anyone taking statins, either as red rice yeast or prescription drugs, should be on daily supplements of coenzyme Q10 (CoQ10). Statins inhibit the body's production of this coenzyme along with lowering cholesterol. CoQ10 is necessary for optimum function of muscles, including heart muscle.

Andrew Weil, M.D.

Berberine against Cholesterol

Berberine is a quaternary ammonium salt from the protoberberine group of isoquinoline alkaloids.

It is found in such plants as Berberis [e.g. Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), Berberis aristata (tree turmeric)], Hydrastis canadensis (goldenseal), Xanthorhiza simplicissima (yellowroot), Phellodendron amurense^[2] (Amur cork tree), Coptis chinensis (Chinese goldthread), Tinospora cordifolia, Argemone mexicana (prickly poppy), and Eschscholzia californica (Californian poppy). Berberine is usually found in the roots, rhizomes, stems, and bark

During the last few decades, many studies have shown berberine has various beneficial effects on the cardiovascular system and significant anti-inflammatory activities.^[18] A Canadian report suggested berberine can effectively reduce intracellular superoxide levels in LPS-stimulated macrophages. Such a restoration of cellular redox by berberine is mediated by its selective inhibition of gp91phox expression and enhancement of SOD activity.^[19]

Berberine exerts up-regulating activity on both the low-density-lipoprotein receptor (LDLR) and the insulin receptor (InsR). This one-drug-multiple-target characteristic might be suitable for the treatment of metabolic syndrome.^[20][21]

Berberine lowers elevated blood total cholesterol, LDL cholesterol, triglycerides and atherogenic apolipoproteins (apo B) (Apo B),^[41] but the mechanism of action is distinct from statins.^[42][43][44] Berberine reduces LDL cholesterol by upregulating LDLR mRNA expression posttranscriptionally while downregulating the transcription of proprotein convertase subtilisin/kexin type 9 (PCSK9), a natural inhibitor of LDL receptor (LDLR),^[45] and increasing in the liver the expression of LDL receptors through extracellular signal-regulated kinase (ERK) signaling pathway,^[46] while statins inhibit cholesterol synthesis in the liver by blocking HMG-CoA-reductase. This explains why berberine does not cause side effects typical to statins. Berberine and plant stanols synergistically inhibit cholesterol absorption in hamsters.^[47]

Berberine seems to improve the arterial endothelial function in humans.^[26][48] Berberine activates AMP-activated protein kinase (AMPK),^[49] specifically extracellular signal-regulated kinases (ERK),^[50] which plays a central role in glucose and lipid metabolism,^[51][52] suppresses proinflammatory cytokines,^[53] and reduces MMP-9 and EMMPRIN expression,^[54] which are all beneficial changes for heart health.