Cholesterol and Heart Disease
How to Protect Your Heart
Robert G Carlson, M.D., FACS
I would like to talk to you about your cholesterol and your body’s cholesterol metabolism and its effect on your risk in developing cardiovascular disease. The incidence of elevated cholesterol in the US is staggering. Over 105 million American adults have a total cholesterol over 200 mg/dl, and 37 million have levels greater than 240 mg/dl. What this means is that one out of every two Americans have high cholesterol and are at a risk of developing coronary artery disease. Are they really at higher risk for heart disease or does that what the pharmaceutical companies and their experts want us to believe?
Is the reason why suddenly in our 40’s and 50’s we develop dangerously spiraling cholesterol levels because we eat worse then we did when we were in our twenties? I doubt that, but then why?
I would like to explain how we can control the low density lipoproteins, increase your high density lipoproteins, and improve your coronary artery disease risks. I would also like to explain why I believe that the avoidance of statin agents, and their associated risks is important, and that there are safer natural alternatives to lowering cholesterol.
I see patients on a day to day basis who absolutely refuse to use statin agents because they make them feel lousy, they give them muscle aches, make their memory foggy, but despite these symptoms they are told that they must take their statin agent to reduce their cholesterol which will prevent them from having a heart attack. It certainly is a double edge sword with one side feeling bad, but the other side knowing that you do not want to get heart disease and have a heart attack. There must be some alternative?
There is an alternative, and that the natural supplements have been proven to dramatically reduce cholesterol and triglycerides with minimal side-effects. It would seem that this natural approach should be a first-line therapy, but unfortunately for the patient it is not.
So now, I would like to take you on a journey and explain to you how cholesterol affects coronary artery disease. I would like to show you how using these natural cholesterol lowering supplements, can safely reduce your LDL’s, increase your HDL’s, lower your triglycerides, and decrease the critically important inflammatory reactions that occur within your blood vessels. Inflammatory reactions cause the development of coronary artery disease, not cholesterol. Elevated cholesterol levels do impact this inflammatory reaction, but the goal of driving cholesterol levels so low that the treatment results in more injurious side-effects, which outweigh any benefit to the patient. Of course the benefit to the pharmaceutical company encouraging its use is to the tune of 15 billion dollars a year. Pretty nice benefit.
There has been numerous cholesterol lowering supplements that have been studied in the nutritional literature, in the cardiovascular literature, and the pharmacologic literature.
These components have been shown to be truly beneficial in lowering cholesterol and they also avoid the side-effects that are inherent in statin use. One of the agents, red yeast rice, has been around for over 2000 years, a natural substance used by the Chinese for promoting circulation. Merck obtained a patent on this natural product and has no forced the FDA to substantially reduce the natural amount of .red yeast rice in the over-the-counter preparations. This may have been a blessing, because the lower dose is very effective in reducing inflammation and cholesterol, but has none of the nasty side-effects of the pharmaceutical cholesterol –lowering agents. I believe that every woman after the age of 50 should be on fish oil. Maybe even everyone. The Omega-3 fish oils are incredibly beneficial to our health by extinguish the flame of inflammation, reducing cholesterol and triglycerides, and improving your bodies ability to protect itself from the ravages of free-radicals. Omega -3’s have been shown to reduce the cardiovascular disease risk, stabilize our hearts electrical irritability and thus reduce sudden death and arrhythmias.
Heart Disease, in its basics is associated with coronary artery disease, or the blockage of the coronary arteries on the surface of the heart. This narrowing results in reduced blood flow to the heart muscle. Symptoms initially may be very subtle, including increased fatigue, and may advance to having angina, or chest pain. In the beginning this pain may initially be caused by increased activity, but may progress to chest pain with minimal activity. Up to 20 % of the patients, especially diabetics may experience absolutely no chest pain or warning signs. A heart attack pursues when the blood vessel becomes completely blocked resulting in the sudden deprivation of blood flow and oxygen to heart muscle. This will result in permanent, unrecoverable damage to the heart muscle that may progress to heart failure. Obviously prompt attention before the blood vessel closes down is critical, and will result in a happy healthy heart. Coronary artery disease is the most common form of heart disease, but it is also the most preventable.
I would like to explain to you about some of the physiology that occurs within a coronary artery, and the relationship of cholesterol, as well as why this process occurs. The coronary artery plays a very vital role in providing the heart with nutrients and oxygen enriched blood. The heart muscle depends on these arteries to provide it with blood so that it can maintain its rigorous exercise schedule of pumping blood throughout your body. In the operating room you can actually see that the heart doesn’t just push blood out into the body, but that the heart muscle actually twists and forces blood out of the heart like wringing a wet towel.
The heart muscle has to work properly for this to occur, and if there is damage from a heart attack to the muscle than the heart doesn’t force the blood out as well and becomes less efficient. With severe damage this can progress to congestive heart failure.
You should think of the arteries on the surface of the heart like arteries on a tree. Each main artery divides into smaller and smaller branches. They carry blood to different regions of the heart muscle. Now any of these individual arteries can become narrowed by a build-up of this fatty atherosclerotic plaque, and these deposits can restrict blood flow resulting in lack of oxygen and nutrition to the heart muscle. The heart muscle will die when this occurs unless the blockage can be quickly opened such as with surgery or angioplasty.
Two major factors associated with the development of coronary artery disease are hypertension or high blood pressure, and hypercholesterolemia or elevated cholesterol. About 65 million people in the U.S. have high blood pressure, and more than 7 million have had a heart attack. Nearly 5 million people have congestive heart failure from a damaged heart. And more than 5 million have had a stroke. Every minute some dies from a heart attack or a coronary event. The development of these blockages, not only in the coronary arteries, but in the carotid arteries and in the peripheral vasculature system is associated with the development of atherosclerotic plaque. This is a very complex process, and it isn’t solely the result of the build-up of fatty plaque or cholesterol in the arteries, or the resultant development of blood clots within the arteries. These processes involve inflammation within the arteries and the associated of elevated cholesterol levels.
Though in women, elevated triglycerides may be more important in the development of coronary artery disease. Blocking these processes is critical because it not only lowers cholesterol, but reduces the inflammation within the blood vessels. Often combinations of a number of high quality natural ingredients are carefully blended to protect your heart, and its critical live sustaining blood supply.
The process that leads to coronary artery disease and a heart attack involve a complex cascading of events. First there has to be some kind of abnormality in your cholesterol metabolism resulting in elevated serum cholesterol levels or more specifically the LDL’s. Of course cholesterol may be elevated because your body needs cholesterol to be the building block for critical hormones, such as testosterone, estrogen, and the stress hormone cortisol.
Cholesterol belongs to a class of chemicals in your body known as lipids. Cholesterol performs a number of extremely vital functions within your body. It helps maintain cell membrane, it’s the backbone for the bile acids used in digestion, and an important precursor for vitamin D metabolism. Cholesterol is the precursor, or beginning ingredient in making all sex hormones, including estrogen, progesterone, and testosterone. So with dramatic lowering of cholesterol, the resultant dramatic fall in testosterone results in increased incidence of depression and fatigue.
Another common side effect associated with statin agents when used to dramatically reduce cholesterol levels are the neurodegenerative type diseases, almost like Lou Gehrig’s disease or Multiple sclerosis, and this is because there is damage to the cellular membranes that make up the insulation around the nerves. It is like electrical wiring in an old house where the insulation around the wire has broken down leaving exposed wiring. It just doesn’t work as well, and inadequate electrical supply and short circuiting becomes more common. These poorly functioning nerves and membranes result in muscle aches/pains as well as decrease strength and decreased nerve function. Memory and thought process may also be severely affected.
It seems that a lot of these problems begin when cholesterol levels become elevated and a plan to implement the aggressive reduction of cholesterol with the use of statin agents.
Therefore elevated cholesterol levels have been described as the initiating phase in the development of atherosclerosis.
Cholesterol is packaged in a special molecule called lipoprotein, which allows the cholesterol molecule to move around the body. There are numerous lipoproteins and there subtypes, but I would like to talk about the LDL’s or low density lipoproteins. Th e LDL’s are the lousy or bad cholesterols, and the HDL’s, high density lipoproteins and those are the good guys. The LDL cholesterols are packaged within the liver like wrapping a gift up in paper. The cholesterol molecule wrapped in a nice package is then carried transported from the liver and delivered anywhere in the body that it is needed. Inside of the blood vessel, the LDL packages are then unwrapped as they find their way inside the wall of the blood vessel. And it is there that they make one nasty mess. The HDL’s or good cholesterol are designed to pick-up the mess caused by the oxidized LDL’s by beating them up with a baseball bat.(see cartoon). The HDL’s through them over their shoulders and carry them back to the liver where they are either recycled or eliminated.
Problems occur when there are not enough HDL’s to carry cholesterol back to the liver, and the LDL-cholesterol accumulates in your body, creating an environment where your body is vulnerable to plaque-depositing oxidation. This is the process that leads to vascular disease. These excess LDL particles migrate through the wall of the blood vessel and settle in the middle layers. The particles become oxidized, like a cut apple set on a kitchen counter. After a short period of time this crisp white apple becomes brown with oxidation and exposure to free radicals. Just like the apple, this oxidation process causes injury to the inside of the blood vessel. Some natural blends with coenzyme Q-10, are effective in controlling cholesterol , but when mixed with Omega 3 fish oils, selenium, and Policosanol is so effective is because it reduces this oxidative reaction inside of blood vessels and thus the development of arterial disease. Normally the blood vessel has a very slippery lining called the endothelium. It’s very smooth, almost like sliding down a water slide at a water park. There is very little resistance to the blood flowing through blood vessels, unless the surface is damaged or blockages develop inside of the blood vessel. The inciting event involves an injury to the wall, which creates a microscopic nick. High blood pressure, stress, smoking, diabetes and abnormally high cholesterol can create this localized damage. It is through this microscopic crack that LDL’s find there way through the surface of the blood vessel and migrate into the middle layers. They lodge into the middle layer of the blood vessel called the media, and it is there where these cholesterol packed cells begin the inflammatory process. It is like a blowfish that expands and irritates the inside of the vessel. Your body tries to fight this reaction and these process results in the development of essentially scar tissue, which narrows the blood vessel ultimately reducing the ability of the blood vessel to carry blood to the critical areas that need it. In addition the surface were the crack occurs can set off a reaction where blood clots develop inside of the blood vessel, resulting in the sudden and complete blockage of all blood flow to the heart or vital organs.
Ideally we would like to reduce these bad LDL cholesterol molecules that burrow deep into the wall of the blood vessel creating a war zone, and also increase the number of scavenging HDL’s so that any excess bad cholesterol can be whisked away from the blood vessel before it causes a problem. Natural blends of products including, Red Yeast Rice, Omega 3- fish oils in addition to Policosanol, Coenzyme Q-10, Selenium and Guggliolipid act like fireman fight a raging fire and decrease the inflammatory reaction with the walls of the blood vessel by extinguishing the flames of the inflammatory reactions. Quenching these damaging fires allows the blood vessel to heal without the resultant narrowing.
The prevailing theory is if we reduce the amount of LDL’s circulating around in your blood stream, we will reduce the chance of these accumulating in your blood vessels causing coronary artery disease. By increasing your HDL’s or the good guys we allow your body to scavenge up excess LDL’s and to reduce the risks of LDL’s causing damage to your blood vessels.
Natural, effective and safe….Now that’s a good choice
I would like to go through each of the different natural options of controlling heart disease both by reducing elevated cholesterol without significant side-effects, but even more important by reducing the inflammatory response which results in the development of heart disease.
Let’s first talk about the phytosterols or plant sterols. These plant sterols have there origin from plants, and although they are structurally similar to cholesterol, they are poorly metabolized by humans and poorly absorbed. In fact that works to our benefit. Plant sterols actually block cholesterol absorption by competing with receptors inside of the intestine that are supposed to absorb the cholesterol. So these plant sterols basically block the doorway where cholesterol from the food we eat, is suppose to enter our body. So when you eat that cheeseburger the cholesterol that normally would enter your body, will now be blocked by the plant sterols. That doesn’t mean you should eat more cheeseburgers, but certainly this is one of the many ways to naturally reduce your cholesterol. Therefore when cholesterol absorption is reduced, the levels of cholesterol and LDL’s decrease in the blood stream. A second reason why plant sterols work so well and that there is a mechanism in your intestines that actually pumps excess cholesterol out of your blood stream and into the intestines for elimination. By lowering the total cholesterol, and the LDL’s, plant sterols may reduce your risk of heart disease.
Studies vary but a reduction of total cholesterol and the bad cholesterol, LDL’s was a consistent pattern. So by itself it is effective, but it is in conjunction with other available natural cholesterol lowering ingredients such as combinations present in Heart Savior through New Health Corp, these proprietary blends are clinically proven to raise the good cholesterol, and lower the bad cholesterol(LDL) and the ugly cholesterol( VLDL). And extremely important to women is that it dramatically lowers the triglycerides and total cholesterol.
Next I would like to talk about the effective cholesterol lowering properties of Red Yeast Rice. Red Yeast rice a naturally occurring HMG-CoA Reductase inhibitors, uses the same mechanism that is employed by statin agents to lower cholesterol. However what has occurred in creating the statin agents is that the naturally occurring compound of Red Yeast Rice had to be chemically modified. This had to be done because Red Yeast Rice has been around for over two thousand years and is no longer in patent. Therefore this modification allows a new patent to be formed and therefore the associated tremendous financial ramifications of the multi-billion dollar earnings of a cholesterol lowering product. Unfortunately this chemical modification results in liver toxicities as well as other common side-effect like muscle aches and pains, which interestingly are absent in the unmodified natural substance of Red Yeast rice. Red Yeast Rice has been used in China for centuries to promote circulation, soothe an upset stomach and invigorate the spleen, though I’m not sure what the invigoration part really means. Red Yeast rice forms naturally occurring HMG-CoA Reductase inhibitors known as monacolins. There are over 9 different monacolins in red yeast rice, all of which possess the HMG-CoA reductase inhibitor activity present in the statin agents and will dramatically reduce cholesterol.
Other active ingredients in red yeast rice include isoflavones, sterols, and monounsaturated fatty acids, all critical in controlling the inflammatory reaction that resultsin the progression of coronary artery disease, and even cancer.
There was a 1999 American Journal of Clinical Nutrition study that was performed at UCLA over a 12 week period which demonstrated the impressive reduction of total cholesterol, LDL cholesterol, and total triglyceride levels. This double-blinded, randomized, placebo controlled prospective study, a perfectly designed study to avoid criticism of the results, was impressive. The red yeast rice significantly reduced cholesterol concentrations, beyond diet alone, and without, and I emphasize without significant adverse effects.
Another study involved 324 patients studied over an 8 week period, and these patients with previously elevated cholesterol demonstrated impressive reductions in total cholesterol, the bad LDL cholesterol, and triglycerides. In addition, the good guys, HDL’s increased by 20%. The pattern is clear, the reduction of total cholesterol, the reduction of the bad LDL cholesterol, the reduction of triglycerides, and the increase in the good HDL cholesterols. This is classic for Red Yeast Rice with the consistent improvement in patients with dangerous heart disease producing lipid profiles. I again emphasize that data that suggests in women that elevated triglycerides are more indicative of the risk of heart disease in women than the total cholesterol, and therefore a reduction in triglycerides by over a third in only three months is incredible. Red Yeast Rice alone is great in fighting high cholesterol levels, but could you imagine adding 5 other extensively researched ingredients to enhance the efficacy of the Red Yeast Rice. It sounds too good to be true, and coupled with an extremely low side-effect profile, it even sounds better. These products are available and will provide excellent preventative properties for achieving optimal heart health. So why risk the quality of your lifestyle with the pharmaceutically created cholesterol lowering agents that beat up your liver and muscles?
Next I would like to talk about inisotol, or non-flushing niacin. Niacin plays an important role in energy producing cycles in the body, metabolism of carbohydrates and fats, as well as in optimizing the nervous and digestive systems. Now people, who have taken Niacin before, clearly recall the red faced flushing effects of the medicine. They feel like heat is rushing up through them and blowing out through the top of there head. Because of this, and despite niacin’s incredible cholesterol lowering benefits, patients refuse to take it. It’s absolutely miserable and I don’t blame them for not taking it, I wouldn’t take it either. Researchers developed a non-flushing version of niacin called inositol hexanicotinate that allows your own bodies enzymes to gradually release the niacin, and thus avoid the flushing symptoms.
Don’t let its scientific name, inositol hexanicotinate concern you. It’s just Niacin, a B-vitamin that has been modified for a slower release than niacin alone. It has been used regularly in Europe for many years, and it is know for its ability to significantly increase the good HDL cholesterol, while lowering the LDL’s and the triglycerides. Niacin is more effective than the statin agents in protecting against the ravages of heart disease, and it does this particularly well in people with low HDL’s and high triglycerides. Niacin is also very effective in reducing the small particle fractions of the LDL’s. The small fractions can squeeze inside of blood vessels and feed the fire of inflammation inside of the blood vessels which will result in arterial disease. So the smaller the particles the worse damage they will do to your blood vessels. It was reported in the November 1998 American Journal of Cardiology, that in cardiology research Niacin has been shown to decrease triglycerides, increase HDL cholesterol the good guys, lower the LDL cholesterols and decrease lipoprotein A. It was also shown to decrease fibrinogen, all of which demonstrate a significant benefit by reducing the inflammatory response inside of the injured blood vessel. Because of Niacin’s unique ability to improve the lipid profiles it has been identified by Cardiologists as an effective and safe way to reduce the relative risk of cardiovascular disease in patients.
I want you to think back to my discussion about the intense inflammatory reaction that occurs inside of injured blood vessels exposed to high cholesterol levels. Lipoprotein A and fibrinogen feed this raging fire inside of the blood vessels, promoting the development of coronary artery disease. This inflammatory reaction attracts the body’s attention and it tries to heal the blood vessel. This process results in smooth muscle proliferation and the narrowing of blood vessels. Interestingly, Niacin blocks these inflammatory reactions, and therefore reduces the risk of the associated cardiovascular diseases. It all makes sense. Numerous other studies have shown the tremendous benefit of Non-flushing niacin with doses ranging from 1.5 grams to 6 grams per day and have been shown to decrease LDL cholesterol by 10-25%, triglyceride levels by 25-50%, HDL cholesterol levels by 15-35%, and all this by using the amazing inisotol. Niacin or the non-flushing formula of niacin called: hexaniaconate will promote healthy levels of cholesterol, and reduce Lp (A), which is a toxin that is associated with heart disease.
Policosanol is a mixture of alcohols derived from sugar cane wax. It is effective in patients who have hypercholesterolemia, or high cholesterol and hypertriglyceridemia, and specifically in patients with non-insulin dependent diabetes. So therefore diabetics with elevated cholesterol should use Policosanol to help reduce their cholesterol. A daily dose of Policosanol of20 mg/day was shown in a 2001 Pharmacology study to lower LDL’s by 27%, total cholesterol by 15%, and it lowered triglycerides by 13%.
Policosanol protects LDL’s from oxidation essentially neutralizing them, inhibits thromboxane, discourages blood clot formation by inhibiting platelet aggregation, all of which tremendously reducing the inflammatory reaction sparked by the explosion of LDL’s entering inside of the blood vessels. In clinical trials, Policosanol has demonstrated cholesterol lowering results similar to low dose statin agents by itself, but without the side-effects. It is beneficial in reducing atherosclerosis by reducing platelet aggregation and lipoprotein peroxidation. Policosanol not only reduces the number of bad cholesterol in the blood stream, but also stops them from getting inside of the blood vessel and inciting havoc.
Another less common compound Guggulipid, is a natural ingredient derived from gum resin of a tree, is effective in treating elevated total cholesterol, LDL, and triglycerides. The anti-oxidant activity of guggul can prevent the LDL oxidation which is associated with arterial plaque build-up. The mechanisms of its ability to lower cholesterol include: inhibition of cholesterol biosynthesis, enhancing the rate of disposing of cholesterol, and prompting rapid degradation of cholesterol. Guggul lowers total cholesterol by lowering the bad LDL’s, and increasing the beneficial HDL’s. It also has anti-inflammatory activity and will reduce the levels of C-reactive protein. C reactive protein is a marker for the intense inflammatory reaction associated with coronary artery disease. It also prevents platelet aggregation and can be preventative against heart disease and stroke.
Selenium is an essential trace element that is closely tied into heart function. It has excellent anti-oxidant properties and tied with methionine is known for being protective in the reduction of prostate, bladder, and breast and colon cancer. When selenium is added to Vitamin C its benefits are tremendous in the reduction of all cancers. Selenium is also a catalyst for the production of active thyroid hormone. One of the mechanisms of Selenium’s critical function involves its incorporation into an enzyme called glutathione peroxidase, and this vital enzyme protects red blood cells and cell membranes against the undesirable reactions associated with peroxides. If you ever taken peroxide and poured it onto an area of blood you immediately note the bubbling oxidation reaction. You can now imagine this irritating reaction occurring on the inside of a fragile blood vessel and the damage associated with its angry raging oxidative reaction. And once the blood vessel is damaged this cascade of inflammation is initiated with its associated deposition of atherosclerotic plaque and subsequent creation of dangerous blockages. In some cases this entire cascade can be halted by the use of selenium. The dependence of the enzyme glutathione peroxidase on selenium clarifies the anti-oxidant role of this essential micronutrient. Good selenium nutrition is a key importance for the antioxidant defense, as well as for efficient energy metabolism.
Coenzyme Q-10 is a nutrient that supports a healthy LDL environment by preventing the oxidation of excessive LDL’s. Now how does coenzyme q-10 work? It is required for cellular function, and has been shown to progressively decrease with age. In patients with chronic conditions such as heart disease, diabetes, renal disease, liver disease and extended illnesses will have lower coenzyme Q-10 levels.
Lipitor also blocks the important production of coenzyme q-10, which is necessary in maintain heart muscle health and energy. In women with low coenzyme q-10 levels the incidence of breast cancer is markedly increased. The importance of coenzyme Q-10 is derived from its ability to provide energy to the body. It helps process ATP, and transports it into the cell. Coenzyme q-10 is very beneficial in patients with cardiomyopathies from heart damage, because they are chronically starved for energy. By introducing coenzyme q-10, the energy producing ATP is express delivered into the energy starved heart muscle cells.
Co-enzyme Q-10 is a vitamin like substance and is found in all cells, and it is critical for the production of energy. In fact, 95 % of all energy made by our cells is produced with the assistance of Co-enzyme Q-10. Organs that need an incredible amount of energy to function, such as the heart, lungs, and liver will have the highest concentration of Q-10.
If you are still wondering why it is so important, let’s look at these facts. Studies have shown that the use of statin agents for cholesterol control will reduce the level of co-enzyme q-10 by up to 40%, and that by replacing the coenzyme, the muscle aches that are so prevalent with statin therapy disappear. It appears that these statin agents, by altering membrane function actually also impair energy transport to these muscles to keep them functioning properly. Co-enzyme q-10 has also been used in patients with congestive heart failure and this is related to providing energy through ATP to damaged, poorly functioning, energy starved cells. It has also been used in patients on the list for heart transplant, and allows them to safely wait until a heart is available without going into heart failure. Recent reports have also shown improvement in heart function and exercise tolerance. Other studies have been performed to evaluate the benefit of coenzyme Q-10 in patients undergoing heart surgery. It has been shown to improve cardiac function after coronary artery bypass or valve replacement. I like use Coenzyme Q-10 in conjunction with D-ribose on my off-pump coronary bypass patients. When operating on a heart that is still beating, one needs to cause localized ischemia or lack of blood flow to the area that you are operating on. This repeated ischemia causes the heart to not function as well after repeated bypasses, as it leaks all its ATP out of the muscle cells. Adding Co-Q10 and ribose stabilizes this loss and allows me to safely perform bypass without ever stopping the heart.