High Total Cholesterol

High Total Cholesterol: Overview

A thorough evaluation of your heart attack risk requires much more than cholesterol level checks.  Early detection of heart disease risk is critical if you want to prevent a heart attack.

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Three main types of lipoproteins exist:

  1. HDLhigh-density lipoprotein
  2. LDLlow-density lipoprotein
  3. VLDL – very low density lipoprotein

All three types of lipoproteins come in different sizes.  HDL carries the so-called "good" cholesterol.  We now know that HDL can be grouped into large and small sizes.  Large HDL removes cholesterol from the arteries while small HDL does not participate in this activity.  As such it could be important to know if you have large HDL, acting to protect your heart, or small HDL, not adding any protection.  When measuring HDL cholesterol there is no way to know the size of HDL.

LDL carries the so-called "bad" cholesterol.  Unlike HDL with one good size and one bad size, all LDL is bad.  LDL comes in three sizes and the smallest size is thought to be the most dangerous type.  Small LDLs penetrate the artery wall easier than large LDLs and they are also more easily trapped in the artery wall where their cholesterol can be released to cause plaque build-up.

VLDLs mainly carry particles called triglycerides.  The VLDLs are the group most influenced by when you last ate.  Large VLDL particles are the most dangerous.  A combination of high numbers of both large VLDL particles and small HDL particles may place an individual at substantial increased risk for heart disease.

Causes and Development

Elevated cholesterol levels have been seen in patients with atherosclerosis, diabetes, hypothyroidism and pregnancy.

Complications

Although an elevated total cholesterol (hypercholesterolemia) is associated with an increased heart attack risk, newer tests are more predictive.  A simple and inexpensive blood test for high sensitivity C-reactive protein (hs-CRP) has proved to be more accurate than cholesterol screening in predicting a person's risk for a heart attack according to researchers at the Brigham and Women's Hospital in Boston.  [NEJM, 3/23/2000]

Here are some statistics about total cholesterol:

  • Among middle-aged men, 9-12% of those men with cholesterol at 240mg/dL or greater will develop symptomatic Congestive Heart Disease (CHD) over the next 7-9 years.  Amongst men who do develop CHD, the majority also have one or more other risk factors that predispose them to developing CHD.
  • Mortality is greatest in men over the age of 45 and specifically in those who smoke or have elevated blood pressure along with elevated total cholesterol.
  • Highest mortality occurs in men who have total cholesterols greater than 300mg/dL.
  • Women generally have about one-half the CHD risk as men for the same cholesterol levels.
  • One study found that, for both men and women, CHD risk correlated greatly with level of elevation of LDL-Cholesterol and reduction of HDL-Cholesterol.
  • HDL-Cholesterol is generally a better predictor of CHD.  When elevated there is a lower risk of CHD, when low there is a higher risk of CHD.

Conditions that suggest High Total Cholesterol:

Circulation

Musculo-Skeletal

Gout / Hyperuricemia

Increased risk of gout is strongly associated with obesity, hypertension, high cholesterol and diabetes.

Reproductive

Erectile Dysfunction (ED, Impotence)

There are several causes of erectile dysfunction, and a high cholesterol level is one.  Cholesterol builds up inside of all of one's arteries.  In the heart it can cause a heart attack.  In the brain it can cause a stroke.  And clogs in the penile artery can cause ED.

Risk factors for High Total Cholesterol:

Diet

Environment / Toxicity

Mercury Toxicity (Amalgam Illness)

Elevated total cholesterol greater than 270mg may be associated with mercury toxicity.

Habits

Hormones

Hypothyroidism

High cholesterol is one of the consequences of untreated hypothyroidism.

Lab Values - Chemistries

Laboratory Test Needed

Metabolic

Nutrients

Manganese Requirement

See the link between Low HDL/LDL Cholesterol Ratio and Manganese Need.

Organ Health

Supplements and Medications

Symptoms - Food - Intake

Counter-indicators
High/moderate legume consumption

A study of 9,600 Americans found that those who ate plenty of legumes had lower total cholesterol.  Legumes are rich in soluble fiber, which has been shown to help lower total cholesterol and LDL (''bad'') cholesterol levels, the study authors note.  [Archives of Internal Medicine 2001;161: pp.2573-8].

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High Total Cholesterol suggests the following may be present:

Metabolic

Nutrients

Manganese Requirement

See the link between Low HDL/LDL Cholesterol Ratio and Manganese Need.

Vitamin CoQ10 Need

The statin drugs used to treat elevated blood cholesterol levels by blocking cholesterol synthesis also block CoQ10 synthesis.  Supplemental CoQ10 should be considered in anyone on statin drugs.

Organ Health

High Total Cholesterol can lead to:

Aging

Alzheimer's Disease

It is thought that the connection between high cholesterol and Alzheimer's disease exists in a protein called beta-amyloid, a sticky substance that builds up in the brains of Alzheimer's patients leading to nerve cell damage and loss of cognitive function.  Accumulation of the protein is believed to be related to higher cholesterol levels.

Musculo-Skeletal

Gout / Hyperuricemia

Increased risk of gout is strongly associated with obesity, hypertension, high cholesterol and diabetes.

Recommendations for High Total Cholesterol:

Amino Acid / Protein

L-Taurine

Taurine lowers serum cholesterol levels by combining with cholesterol to form bile.

Cysteine / N-Acetylcysteine (NAC)

Cysteine is sometimes used to improve cholesterol ratios.

Botanical

Garlic

Several studies have shown a mild lowering effect on total cholesterol and LDL cholesterol.  Garlic oil does not produce this cholesterol-lowering benefit like raw, cooked or powdered garlic does.  Large doses are required (6,000 to 8,000mg per day) to produce this effect, which causes gastrointestinal discomfort for some people.  Furthermore, this benefit does not become evident until after 3 months of continuous use.

Artichoke Extract

Choleretics typically lower cholesterol levels because they increase the excretion of cholesterol and decrease the synthesis of cholesterol in the liver.  Consistent with its choleretic effect, cynara extract from artichoke leaf has been shown to lower blood cholesterol (13%) and triglyceride levels (5%) in both human and animal studies.

Grape Seed Extract

One month of treatment reduced total and LDL-cholesterol levels, but had no effect on HDL-cholesterol levels, in a study of 40 patients with diagnosed chronic venous insufficiency.  [Phytother Res 2002;16(2): pp.1-5]

Diet

Plant-Based Nutrition

Cholesterol levels are much lower in vegetarians.[1-4] Vegetarian diets reduce serum cholesterol levels to a much greater degree than is achieved with the National Cholesterol Education Program Step Two diet.[5-8] In one study published in The Lancet [7] total cholesterol in those following a vegetarian diet for 12 months decreased by 24.3%.

  1. West RO, Hayes OB.  Diet and serum cholesterol levels: a comparison between vegetarians and nonvegetarians in a Seventh-day Adventist group.  Am J Clin Nutr 1968;21:853-62
  2. Sacks FM, Ornish D, Rosner B, McLanahan S, Castelli WP, Kass EH.  Plasma lipoprotein levels in vegetarians: the effect of ingestion of fats from dairy products.  JAMA 1985;254:1337-41
  3. Fisher M, Levine PH, Weiner B, et al.  The effect of vegetarian diets on plasma lipid and platelet levels.  Arch Inter Med 1986;146:1193-7
  4. Burslem J, Schonfeld G, Howald M, Weidman SW, Miller JP.  Plasma apoprotein and lipoprotein lipid levels in vegetarians.  Metabolism 1978;27:711-9
  5. Cooper RS, Goldberg RB, Trevisan M, et al.  The selective lowering effect of vegetarianism on low density lipoproteins in a cross-over experiment.  Atherosclerosis 1982;44:293-305
  6. Kestin M, Rouse IL, Correll RA, Nestel PJ.  Cardiovascular disease risk factors in free-living men: Comparison of two prudent diets, one based on lacto-ovo-vegetarianism and the other allowing lean meat.  Am J Clin Nutr 1989;50:280-7
  7. Ornish D, Brown SE, Scherwitz LW, et al.  Can lifestyle changes reverse coronary heart disease? Lancet 1990;336:129-133
  8. Hunninghake DB, Stein EA, Dujovne CA, et al.  The efficacy of intensive dietary therapy alone or combined with lovastatin in out patients with hypercholesterolemia.  New Engl J Med 1993;328:1213-9

The ratio of HDL- to total-cholesterol has been shown to be significantly lower in vegans as compared to lacto-ovo-vegetarians.

Animal/Saturated Fats Avoidance

It should be noted that there is not necessarily a strict relationship between cholesterol intake and blood cholesterol level.  A properly functioning liver regulates the blood cholesterol level by storing, producing, releasing and excreting cholesterol as appropriate – primarily as bile.  Even vegans, whose dietary intake of cholesterol is by definition essentially zero, have cholesterol in their blood (usually at very healthy levels) because their bodies manufacture it.

Increased Legume Consumption

A study of 9,600 Americans found that those who ate plenty of legumes had lower total cholesterol.  Legumes are rich in soluble fiber, which has been shown to help lower total cholesterol and LDL (''bad'') cholesterol levels, the study authors note.  [Archives of Internal Medicine 2001;161: pp.2573-8].

Grain-free Diet

It is important to realize that diet is the key to lowering cholesterol levels.  Restriction of processed grains, sugars and dairy, and replacing all fluids with water are key.  Many doctors are finding large and relatively quick drops (as much as 100 points in several weeks) in people who follow these recommendations.

Minor cholesterol (LDL) reductions can be achieved by adding whole grains (especially oats) to the diet.  This may seem confusing! Although moderate grain consumption (due to its fiber content) can lower cholesterol somewhat in some individuals, radical grain restriction may substantially lower cholesterol levels in others.  If large reductions are needed or other cholesterol-lowering methods are ineffective, grain and sugar restriction may be the answer.

Increased Fruit/Vegetable Consumption

Soluble fiber from fruit pectin has lowered cholesterol levels in most trials.  Doctors often recommend that people with elevated cholesterol eat more foods high in soluble fiber.

Smaller, More Frequent Meals

Controlling cholesterol levels may be a case of not only what is eaten but how often.  Men and women who eat six or more times a day have cholesterol levels that are about 5% lower than those of less frequent eaters.  The researchers found lower levels of cholesterol in the frequent eaters regardless of their body mass, physical activity or whether they smoked.  From other studies we know that a 5% lowering of cholesterol may be associated with a 10% reduction in coronary heart disease risk.  [British Medical Journal, Dec 1, 2001]

Nut and Seed Consumption

So-called "good fats" that come from raw nuts and seeds are an important part of protecting the cardiovascular system.  Pecans, for example, will lower total cholesterol, triglycerides, apolipoprotein B and lipoprotein(a).  [A Monounsaturated Fatty Acid Rich Pecan Enriched Diet Favorably Alters the Serum Lipid Profile of HealthyMen and Women, Jnu 2001;131: pp.2275-2279]

Whole almonds or almond oil (replacing half of the habitual fat intake) reduced plasma triglyceride, total and LDL-cholesterol concentrations, and increased HDL-cholesterol levels in a trial of 22 men and women with normal lipid levels.  [J Nutr 2002;132(4): pp.703-707]

High/Increased Fiber Diet

The fiber supplements of choice for hypercholesterolemia are psyllium, pectin or guar gum.  The amount of pectin in approximately two servings of fruit rich in pectin such as pears, apples, grapefruit, and oranges is 15gm.  Psyllium or guar gum are obtained by supplement.  The RDA for total fiber is 20-30gm.  The fiber from whole grains – especially oats – does have a cholesterol-lowering effect, especially in someone on a previously low fiber diet.

Three months of supplementation with ground flax seed at 40gm per day reduced serum total cholesterol in a study of postmenopausal women.  [J Clin Endocrinol Metab 2002;87(4): pp.1527-32]

Soy Isoflavones

Soybean isoflavone fraction, which contains primarily genistein, daidzein and glycetein, has been shown to have a hypocholesterolemic effect.

A soy protein isolate reduced total and LDL-cholesterol concentrations in a study of 60 patients with high cholesterol levels.  [Eur J Clin Nutr 2002;56(4): pp. 352-35]

Olive Oil

Monounsaturated fatty acids – as contained in olive oil – reduce total and LDL cholesterol concentrations without reducing the levels of HDL cholesterol, thus leading to favorable changes in the serum lipid profile and possibly to changes in the physicochemical properties of lipoproteins.  In this way olive oil, with its high monounsaturated fatty acid content, may contribute to the prevention and management of hypercholesterolemia, a dominant risk factor for the development of atherosclerosis, and to the prevention of CHD.

Drug

GHB (Gamma-Hydroxybutyrate)

In a study of 100 patients at the Warsaw Institute of Hematology, GHB was shown to lower cholesterol levels.

Extract

Habits

Hormone

Melatonin

Melatonin helps to decrease total cholesterol and "bad" LDL cholesterol levels.

Mineral

Selenium

A selenium deficiency is associated with hypercholesterolemia.

Potassium

In experiments, potassium-supplemented individuals not only had their high blood pressure reduced but reduced their cholesterol measurements as well, confirming that a deficiency of potassium is associated with hypercholesterolemia.

Zinc

Zinc deficiency is associated with hypercholesterolemia.

Chromium

Chromium recently has been shown to lower blood cholesterol while mildly raising HDL (high-density lipoprotein), the good portion of cholesterol.  This lowers the risk ratio for coronary artery disease.

Chromium picolinate supplementation at 1,000mcg per day over a 13-week period combined with exercise decreased total cholesterol, LDL cholesterol and insulin levels in a recent small study of both males and females.  [J Nutr Biochem, 1998;9: pp.471-475]

Henry Schroeder, MD, who has done numerous studies with chromium, has shown that 2mg of inorganic chromium given daily reduced cholesterol levels by about 15%.

Nutrient

Inositol

A deficiency of inositol is associated with hypercholesterolemia (increased blood-fat levels).

Oxygen / Oxidative Therapies

Vitamins

Vitamin B3 (Niacin)

Probably the best form of vitamin B3 to use for the purpose of cholesterol reduction is inositol hexaniacinate (flush-free niacin).  It is often given at 500mg tid for two weeks, then increased to 1,000mg tid.  If using regular niacin, start out with 100mg tid working up to 1,000mg tid with meals.

Niacinamide is not effective for lowering cholesterol.  Niacin may also be helpful by transforming small unprotective HDL particles into larger ones which do offer a protective effect to the cardiovascular system.

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