Cholesterol

Paul Reller, L.Ac.

Lowering cholesterol has long been a goal to reduce the risk of stroke, heart attack and atherosclerosis. Complementary and Integrative Medicine is useful to the patient to further reduce risk, to reduce or clear atherosclerotic plaque, and to improve the health of the systems that create and regulate the various cholesterols, lipoproteins and triglycerides in the body. The ultimate goal in cholesterol health is to normalize unhealthy cholesterol/lipoprotein and triglyceride levels and to promote higher levels of healthy cholesterol, and high density lipoproteins (HDL). As scientific study of this problems reveals the various aspects of the cholesterol metabolism more specifically, we find that we need more than just a single pill to achieve our goals, and in fact, there may be even more important predictors of cardiovascular problems that need to be addressed.

The first step in deciding on the need for complementary and integrative therapies is to understand the health problem and take a pro-active approach. Below is some useful information to get you on your way. If you choose to integrate Complementary Medicine into your therapy, such as herbal prescription, nutrient supplement and dietary advice, as well as acupuncture, you may also see progress in overall health and related problems, such as weight loss, diabetes, metabolic syndrome, cardiovascular health and improved hormonal health. Ultimately, you may be able to reduce your dependancy on drugs that control your cholesterols, triglycerides or lipoproteins.

Protecting yourself from cardiovascular risk and achieving a healthy lipid homeostasis is one of the most important health goals that you can set for yourself. Cardiovascular death is the number one cause of death behind iatrogenic cause in the United States, and cardiovascular accidents in the form of transient ischemic attacks (TIA) and heart attack, as well as peripheral artery disease (PID), thrombosis (circulating embolism), etc. are problems that most of us will face as we age. While many of us are now under the impression that reducing cholesterol with drugs will prevent these health problems, statistics show that this approach has not significantly reduced cardiovascular deaths or disease in the United States. High cholesterol in circulation is associated with a broader health problem, and addressing the underlying health problems is the actual way to decrease cardiovascular risk. In addition, there are a number of foods and herbs that will reduce excess circulating cholesterol in a healthy way without side effects. The statin drugs used by standard medicine were derived from a chemical found in a Chinese herb called Hong qu mi, or Red Yeast Rice, which is a medicinal yeast grown on rice and popularly used in herbal medicine and common food preparation and coloring in China for centuries. The goal of cholesterol reduction in Complementary Medicine, though, is not to have the patient take an herbal extract for the rest of their life, but to actually restore the normal lipid homeostasis and allow the body to maintain healthy lipid levels without treatment.

Understanding Cholesterol

Cholesterol is the most abundant steroid hormone in the human body. It is an abundant nutrient, especially in meat fat. Cholesterol circulates in the human body attached to various proteins in the blood, and is essential to build many hormones (e.g. estrogen and testosterone) which are made from cholesterols, to maintain cell membranes, to create bile to digest fats, to create activated Vitamin D to regulate calcium, and many other processes. The body naturally makes cholesterol in every cell to perform numerous functions. Much production of cholesterol hormone occurs in the liver, which is the main metabolic organ in our bodies, and both breaks down cholesterol and regulates storage and transportation as well. Cholesterol hormone itself is a healthy and essential molecule. Cholesterol is carried to and from the liver attached to lipoproteins, which are fat and protein molecules. Increases in high-density lipoproteins (HDL), which mainly carry cholesterols and triglycerides back to the liver from storage in fat cells, has been shown to reduce atherosclerotic plaque.

Cholesterol is produced in our livers, but also in peripheral tissues, where it is also stored and released into circulation. Statin drugs block production of cholesterol in the liver. Peripheral tissues produce and release cholesterol as needed as well, and this results in the increase in high density lipoprotein (HDL) a beneficial carrier of triglycerides from our fat cells back to the liver for processing to glucose as needed. Thus, circulating cholesterol levels are not an entirely clear problem. Even in patients with high circulating levels of cholesterol, the metabolic picture may not always indicate a need for blocking the production of cholesterol in the liver. There is a possiblity that in many patients that high circulating cholesterol is a healthy aspect of the lipid metabolism.

Carrier proteins in our blood are called lipoproteins, and it is these that are often mistakenly referred to as cholesterols when high cholesterol is discussed with patients, or in advertisements, because they transport cholesterols to and from the liver. Since cholesterol is produced in all human cells, dietary intake does not have a significant direct relationship on the amount of cholesterol in the body, although cholesterol may be taken in from the diet, primarily from meats and dairy products. Since the body depends on a steady supply of cholesterol to function well, the liver is very good at producing cholesterol and breaking it down, as well as producing the lipoproteins that carry it to and from the liver. Excess cholesterol in the diet may either be broken down efficiently by a healthy liver, or it may need to be stored in your body fat. Cholesterol levels in the body are different from cholesterol levels in circulation. It is impossible to measure cholesterol levels in the body, and the circulatory levels are the only measurement we have. Three things may cause high cholesterol in your blood circulation: (1) poor liver function, (2) excess unhealthy fat in the diet, or (3) increased need for cholesterols in your metabolism. High cholesterol in circulation in thus not a simple thing to analyze, and has little bearing on atherosclerotic plaque. As time has gone by, and further research into what constitutes unhealthy atherosclerotic plaque has been performed, we have learned that a number of other factors are much more important in reducing the unhealthy atherosclerotic plaques that lead to the emboli which cause strokes and heart attacks, and to the unhealthy areas on arteries that lead to aneurysms and arterial bleeding.

Cholesterol reduction in and of itself may present some health problems. Are there health problems with low cholesterol? Research has linked depression and suicide to low cholesterol levels, as well as anxiety and hormone deficiency. This does not mean that anyone with these problems has low cholesterol. Low cholesterol is seen in hyperthyroid disorders, liver diseases, intestinal diseases, manganese deficiency, and other nutritional deficiencies. An article in the July, 2007 Journal of the American College of Cardiology reported that a study at Tufts University School of Medicine found that patients lowering cholesterol to a very low level for 5 years increased their risk of cancer, with one more person per 1000 acquiring a cancer diagnosis in this group. Chemical reduction of cholesterol production has its long-term risks. Another question in recent years is the quality of cholesterols produced in the long-term when taking drugs that inhibit genetic expression of cholesterol and lipoproteins. Poorly formed cholesterols may have negative consequences to the health, since cholesterol is a hormonal building block for all steroid hormones and the Vitamin D3, or hormone D3 prohormone, cholecalciferol. In fact, statin drugs that inhibit cholesterol expression will also inhibit the cellular antioxidant CoQ10 (via inhibition of mevalonate), which is also referred to as Coenzyme Q10, and ubiquitone (because it is ubiquitous, or in all cells). Chronic use of these statin drugs eventually puts increased oxidative stress on our cells, which is highly associated with cardiovascular disease. This is the catch 22. There is speculation that chronic use of statin drugs may result in too many dysfunctional cholesterol hormone molecules, and that this could create increased demand in the body for cholesterol production. It is not unusual for a patient to experience a quick reduction in circulating cholesterol levels after starting the statin drugs, and then an eventual rise in circulating cholesterol levels with chronic use, prompting prescribing medical doctors to utilize a high-dose statin therapy. This practice and potential health threat is what prompted the study at Tufts University School of Medicine. And then we must consider that the circulating levels that are measured are not an accurate measurement of the active cholesterol in the body, since cholesterol is produced by a wide variety of cells in the body.

Cholesterol lowering statin drugs come with a variety of long-term risks and potential harmful effects. Besides inhibiting the pathways for the hormone Vitamin D3 and CoQ10, statins have created problems with protein catabolism that has resulted in accumulation of broken proteins in tissues, which creates muscle and joint pain, and in a severe situation creates a dangerous stress for the kidney in clearing protein fragments. When this situation is severe, rhabdomyolysis, or excess breakdown of protein fragments, occurs. One statin drug, Baycol (cerivastatin) was withdrawn from the market because of confirmation of about 100 rhabdomyolysis-related deaths. As of January 2006, over 6000 court cases of wrongful death were pending against Bayer for this injury, and 3082 had been settled, though without acknowledgment of liability (settlements exceeded $1.5 billion). The implications are that milder problems with protein fragment accumulation occur in many patients taking statin drugs, resulting in the eventual increase in muscle and joint pain, and potentially increased stress for the kidney. An increasing incidence of prescription of multiple drugs that may increase the risk of rhabdomyolysis, such as SSRI antidepressant and anti-anxiety drugs, antipsychotic medications, which are increasingly prescribed for off-label purposes, diuretics, and neuormuscular blocking agents prescribed for chronic pain, prescribed together and with statin drugs, increase the risk of protein fragment (peptide) accumulations considerably. Patients without acute severe symptoms are rarely evaluated and diagnosed.

In 2011, the FDA announced new restrictions, contraindications, and dose limitations for simvastatin (Zocor) to “reduce the risk of muscle injury“. These June 8, 2011 updates on the statin warnings include acknowledgement that a higher dosage of statin drugs come with considerable risk of muscle pain, tenderness, or weakness, as well as an elevation of a muscle enzyme in the blood circulation called creatine kinase (CK). A severe harm, in the form of rhabdomyolysis, where the accumulated peptides and metabolites from muscle dysfunction and breakdown overwhelm the kidneys occurs in 4.9 of every 100,000 patients taking simvastatin for one year, and 4.4 of every 100,000 patients taking atorvastatin (Lipitor) or pravastatin (Pravachol or Selektine). Milder forms of induced muscle injury and dysfunction occur in a relatively high percentage of patients, and a number of other concurrantly taken medications will increase the level of the statins in the body, including the antibiotics erythromycin, clarithromycin, telithromycin, cyclosporine, HIV inhibitors, danazol (Danocrine, to treat endometriosis and fibrocystic breast disease), nefazadone (Serzone, an antidepressant), gemfibrozil (Lopid or Gemcor, to treat high triglycerides), posaconazole (Noxafil, an antifungal and antiyeast infection drug), itraconazole (Sporanox, an antifungal), and ketoconazole (Feoris or Nizoral, an antifungal). The revised risks for muscle pathology and rhabdomyolysis for simvastatin were 5 per 1000 person-years, and 2 per 1000 person-years respectively. These figures represent diagnosed cases, and assuredly underestimate the percentage of patients affected with muscle pathology that is not diagnosed or attributed to statin use. In addition, the increase in CK, indicating more rapid muscle breakdown and dysfunction, is a prime marker for the autoimmune diagnoses of polymyositis and dermatomyositis, and may be associated with misdiagnosis of these pathologies. The data for these FDA revised warnings came from the SEARCH study, a 7 year, randomized, double-blinded clinical trial of simvastatin 80 mg in survivors of myocardial infarction, as well as the FDA adverse event reporting system (AERS) database. With the imminent loss of patent protection and the advent of generic status for statin drugs, with availability without prescription, the public should be aware of the acknowledgement of these risks, which reflect very conservative views on the statin drugs, dosages and interactions.

Of course, the belief in standard medicine is that these cholesterol lowering drugs provide such a remarkable benefit that even bringing up the subject of health risks is taboo, and many studies have been designed to discount any evidence of major health risks. As these drugs are now losing their patents and going generic, though, the reports of health risks are increasing in the medical journals. The patient population will soon face the probability that these statin drugs, once generic, will be marketed by the pharmaceuticals as over the counter drugs, available without prescription. This will inherently imply that there must be no safety concerns. The fact is that the FDA nearly refused to approve statin drugs when they were introduced in the mid 1980s for a reason, and the cavalier prescription and promotion of statins for a majority of the overall patient population is a matter of concern. The intelligent patient is beginning to understand that there are many other ways to decrease the risk of cardiovascular disease and death which may be much more effective, and certainly have less long-term risk, than taking statin drugs. The implication that one is safe as long as they take statin drugs to lower the cholesterol and hypertension medications is simply not true, and the promotion of this belief in the patient population is doing more harm than good.

Naturally occurring statins for the lowering of high cholesterol without side effects

A number of foods and herbs are now confirmed to effectively lower excess cholesterols. Red rice yeast is a nutritional aid long used in China that is proven effective. Oyster mushrooms contain a nutrient chemical also proven effective, which has been identified as a naturally occurring lovastatin. A number of wild mushrooms, or cultivated varieties, contain up to 2.8 percent lovastatin on a dry weight basis. Variance in the differing types of cultivated Red rice yeast and mushrooms produce a variance in the dosage of these naturally occurring statins, and use of these products should include monitoring of the cholesterol levels to assess dosage over time. Fluctuating levels of cholesterol impose no immediate risk. Naturally occurring statin molecules are also found to be modulating within the evolved array of chemicals in the these foods, helping the organism to maintain a homeostatic cholesterol level, unlike the effects of synthetic statin chemicals.

Other scientific studies have confirmed that aged garlic extract, guggulipid (an herbal resin from the mukul myrrh tree), and policosanol (from sugar cane - not found in processed sugar, though) also significantly lower excess cholesterols. As of 2010, there are also competing scientific studies that have called these initial studies into question, and this subject is being further studied by the NIH. Other herbal products have also demonstrated mild cholesterol reducing capabilties. Fenugreek seed, artichoke leaf extract, turmeric, and even rosemary extract are being investigated to confirm these findings. Excess low-density lipoproteins (LDL) in circulation have also been found to be lowered by phytosterols (plant-based hormones) which are found in whole grains, seeds, dark leafy green vegetables, and various fruits. Nutrient supplements with these phytosterols are now in widespread use. Many patients have found that simply starting the day with a real whole grain porridge, such as steel cut oats, amaranth, etc. has resulted in considerable improvement in their LDL and cholesterol levels.

In 2010, a double-blinded placebo-controlled study of a typical combination of herbs and supplements used by a Licensed Acupuncturist and herbalist knowledgable in Complementary Medicine was conducted by the University of Naples Department of Internal Medicine in Italy. This study, cited below in additional information, with a link to the NIH summary, showed that this combination of natural medicines significantly lowered circulating cholesterol, triglyceride, and LDL, while improving arterial health and circulation, decreasing atherosclerosis, and improving insulin sensitivity. The findings were published in Nutritional Metabolism and Cardiovascular Disease in November of 2010 (20(9):656-61). The highly publicized skepticism of the standard medical community was finally put to rest. The combination of Red Yeast Rice extract, policosanols, and berberine (an active chemical in a number of Chinese herbs), achieved these results. The long-term effects of this treatment, potentiated further with acupuncture therapy, are the restoration of normal homeostatic mechanisms, overall health, and the ability to maintain these healthy levels of lipids, cholesterol and cardiovascular health, without further treatment or dependency.

A growing skepticism in the scientific community for the widespread need of cholesterol reduction, prescription of statin drugs, and even the “lipid hypothesis” itself regarding the proof that elevated cholesterol is actually linked to cardiovascular disease

An article in the British Medical Journal (BMJ) in June of 2006 (332:1330) by Uffe Ravnskov, Paul Rosch, Morley Sutter and Mark Houston (clinical professors of medicine and prominent researchers) first introduced the subject of a questioning of widespread statin drugs in preventive medicine. The effects of statin drugs in patients without a very high level of circulating cholesterol are known to be very small. The potential risks and side effects with long-term use of statins are considerable. The criteria suggested for statin prescription in 2006 was very aggressive, suggesting that a very low level of circulating cholesterol should be a goal for the general population. These authors questioned this approach. One of the healthiest nations in the world, especially concerning cardiovascular health is Norway. These researchers noted that in Norway, 85% of men over the age of 40 have circulating cholesterol levels higher than the recommended guidelines in statin prescription. To lower the circulating cholesterol levels to these recommended guidelines, a higher dosage of statin drug is also required. These professors and researchers noted the increases in adverse risks associated with higher statin dosage. Their logical conclusion was that the benefits are not apparent, but the risks are.

Is cholesterol harmful? Understanding the more important markers for cardiovascular risk and atherosclerotic plaque

How does cholesterol hurt us? Cholesterol is part of the plaque that builds up on the insides of arteries at sites where the arterial wall is weak or injured. Autopsy of young human beings shows us that arterial plaque starts to build up at an early age, even in childhood. Eventually, this plaque buildup may cause a narrowing of the artery and less blood flow to the muscles of the heart and brain (atherosclerosis), and emboli may break off of unhealth atheroscleroitic plaque, increasing the chance of heart attack or stroke. How does plaque collect on the artery wall? Most experts agree that plaque collects at sites of inflammation or injury to the cells of the arterial wall. A large study of teens that had died in accidents found that 2% of males and 0% of females, age 15-19, had severe atherosclerosis at this early age. Obesity, high intake of saturated fats (meats), and high levels of LDL (low density lipoproteins) in the blood have been linked to atherosclerosis, but so has CRP (C-reactive protein), a marker for blood heat and inflammation. In recent years, research has shown that low levels of high-density lipoproteins (HDL) present a greater risk of atherosclerotic plaque buildup than high levels of total cholesterol or LDL. On your blood tests, HDL/LDL ratio, triglyceride level, and CRP are now considered the important markers.

Study of plaque in arteries shows that some plaque is made up of normal smooth muscle cells while other plaque has a high percentage of inflammatory cells (macrophages). The cholesterol is found inside the smooth muscle cells. The arterial plaque that has a high percentage of inflammatory cells is much more pathogenic. Weakened areas of the arterial wall, and emboli producing plaque, were associated with the macrophage-rich plaque deposits associated with chronic inflammation. It is thought that unhealthy plaque collects at sites of inflamed tissue on the arterial walls. Reducing or regulating inflammation has thus become an important subject when discussing prevention of unhealthy atherosclerosis. This is why fish oils and certain essential fatty acids are now highly recommended. These beneficial essential fatty acids, EPA and DHA, called omega-3, help decrease chronic inflammation, while high levels of arachidonic acid from meats increase chronic inflammation. Lowering cholesterol may not have as great an impact on decreasing cardiovascular risk as addressing other factors that have been discovered in recent years.

These plaque deposits associated with atherosclerosis dissolve as well as collect. Sometimes, they break off and form a dangerous clot, or thrombus, that may lodge in the artery and temporarily decrease flow, causing a sudden heart attack or stroke. A common stroke caused by a thrombus is usually not as damaging as a bleeding stroke, which results from a weakened artery wall, which is often also associated with chronic arterial inflammation. Sustained high blood pressure is thought to increase the chances that a thrombus will detach from the inflamed arterial plaque, or that the inflamed or congenitally weakened areas on the artery will break and bleed. High blood pressure for short periods of time are common and the body adapts well to these periods of hypertension. Sustained high blood pressure is a risk, although if the arterial walls are maintained and inflammatory arterial plque is decreased, even sustained high blood pressure presents no threat. When the patient adopts therapeutics to help regulate inflammation and improve repair and maintenance of the blood vessels, this does more to decrease risk than drug therapies to block physiological processes.

The most important markers of cardiovascular risk and dangerous atherosclerotic plaques

More recent research has shown that a pattern of increase followed by a gradual decrease in troponin T or I is the most accurate marker for heart attacks (myocardial infarcts). Troponin is a protein of muscle that attracts calcium deposit. Calcium deposit in the muscle tissue occurs when the muscle is not firing properly (myofascial disorders) and/or when the calcium in circulation is high or unregulated. Calcium deposits harden the tissues, causing stiffness, pain, poor joint mobility, bony spurs, and increased chance of tendon and ligament tears, as well as chronic inflammatory states. Calcium deposit is also a big part of arterial plaque deposit, especially on the unhealthy inflamed arterial plaques that cause emboli, strokes and heart attacks. For this reason, poor regulation of calcium metabolism may be an important risk for atherosclerosis and cardiovascular pathology. Subclinical hypothyroid conditions, deficiency of the hormone activated Vitamin D3, or other homonal imbalances may be responsible for poor regulation of calcium deposition and can be corrected. Simple taking of a poor quality calcium supplement may contribute to calcium accumulation on the inflamed arterial plaque. Utilization of the holistic approach to health in Complementary and Integrative Medicine helps the patient to achieve better calcium regulation. In 2010, a new test was introduced with a sensitivity for lower levels of Troponin T (see additional information below). Older tests were used only in emergency situations to gauge heart damage after a heart attack, and measured only very high levels of Troponin. Studies with herbal medicine have shown that standardized Gingko biloba extract may reduce Troponin T levels, and studies of other herbs are underway.

Recent research has also confirmed that oxidized LDL (low density lipoprotein) was an important factor in dangerous plaque deposits. Antioxidants, especially those with superoxide dismutase (SOD) were found to be important in preventing oxidized LDL accumulation. SOD is found in barley grass and dark leafy greens, sprouts, seaweeds and algaes. It is also an enzyme that is produced in healthy cells to protect from free radical excess, and found to be deficient in unhealthy cells, like cancer cells. More importantly, oxidation occurs in the body in response to free radicals (oxygen radicals) when there is increased inflammatory tissue repair going on. Decreasing chronic inflammation and building healthier tissues will greatly decrease the chance of oxidized LDL accumulation. Physiotherapies to fix unhealthy tissues and decrease chronic pain and inflammation may have a significant effect on lowering arterial plaque deposit and decreasing your risk of stroke and heart attack. To learn more about the various antioxidants in your body, go to the articles on antioxidants and glutathione on this website. One important aspect of oxidation endproducts that most patients also overlook is the quick oxidation of fish and flax oil supplements, as well as cooking oils. When these oils oxidize, unhealthy oxidant products are produced. This is why krill oil is recommended for patients that want to supplement their EPA and DHA essential fatty acids, since krill oil contains a natural preservative that inhibits oxidation.

One of the most important aspects of research into the subject of atherosclerotic plaque is the research concerning AGEs, or advanced glycation endproducts. These fat protein and sugar molecules produced from the poorly regulated enzymatic process of glycosylation, and associated with high levels of oxidants as well as poor liver function, and also a diet of processed foods, are now considered to be highly linked to unhealthy atherosclerotic plaque accumulation, as well as a host of other common diseases. One of these AGEs, the A1C index, is now the most common marker for type 2 diabetes, or metabolic syndrome. Higher accumulation of AGEs are also associated with aging and stiffening of arterial walls, commonly referred to as hardening of the arteries. Increased AGEs on the arterial walls causes cross-linking of collagen fibers and loss of collagen elasticity. When this occurs, the body struggles to replace this unhealthy collagen tissue with new health collagen. One of the endproducts of excess AGE formation is nitric oxide, which coincidentally vasodilates the arteries, but in excess may do more harm than good. Pharmaceutical research has produced one drug, an inhibitor of nitric oxide synthase, to reduce the harm from AGEs, and treat atherosclerotic plaque, but it has proven ineffective in studies. A variety of herbs reduce nitric oxide synthesis and modulate inflammation, helping to curb AGEs and repair inflamed arteries. These herbs also contain potent antioxidants. Naturopathic research has uncovered a variety of supplements that reduce AGE accumulation and the harm from excess AGEs, including P5P, Vitamin B1 thiamine, L-Carnosine, N-acetyl cystine, and alpha-lipoic acid. You may go to the articles on AGEs (practitioner section), and glutathione balance on this website to learn more on this fascinating subject. A combination of these herbs, supplements, and effective collagen type 2 supplement, may be very beneficial in the overall treatment and prevention of AGEs and anterosclerosis.

A more holistic approach to understanding the variety of factors that create cardiovascular risk and dangerous atherosclerotic plaques

Obviously, the explanation for arterial plaque deposit is more complicated than the question of dietary fat intake or cholesterol levels. In fact, study shows us that people with high levels of HDL (high density lipoproteins) that primarily carry fats back to the liver, are much less likely to suffer atherosclerosis, heart attacks and strokes. Healthy cholesterol is the key, as is healthy liver function, healthy tissues, healthy inflammatory mechanisms, etc. The current model for cholesterol lowering is an overly simplistic approach. The holistic model for therapy and prevention offered in Complementary and Integrative Medicine is more complicated, but will achieve a healthier cardiovascular and metabolic system with a relatively short course.

Metabolic syndrome is a new term for adult onset diabetes. The Institute of Cardiology in Quebec, Canada states: “There is a growing body of evidence that among the risk factors that promote atherosclerosis, the metabolic syndrome is a powerful and prevalent predictor of cardiovascular events. The systemic inflammatory process associated with the metabolic syndrome has numerous deleterious effects that promote plaque activation.” You may refer to a separate article on this website to learn more about Metabolic Syndrome. This type of study finds that the immune system, and its interaction with unhealthy fat cells is a key to the process. Promoting of better health in the immune system and better formation of healthy fat cells with decreased inflammatory stress is perhaps essential to avoidance of atherosclerosis and the increased risk of heart attack and stroke. This modern approach sees cholesterol as a side issue in the preventative therapy concerning decreased cardiovascular risk. The holistic approach in Complementary and Integrative Medicine addresses restoration of a healthy metabolism and cure of the metabolic syndrome. Key aspects of metabolic syndrome are insulin resistance and problems with fat metabolism. The body converts fats to sugars to supply the body with usable energy, and utilizes the hormone insulin to stimulate the fat cell to store and release fats, which are then transported to the liver in the form of triglycerides and converted to sugars (glucose). A number of herbs are now proven to improve insulin sensitivity and normalize triglycerides and cholesterols. The extract of bitter melon is getting quite a lot of attention recently because of the number of scientific studies and clinical trials proving its efficacy. Bitter melon extract, or Ku gua in Chinese medicine, has long been used in China to resolve toxins and clear blood heat, as well as improve the liver function, although it has generally been used as a food. Some of the evidence of benefits from bitter melon extract are listed below in additional information.

Another popular supplement proven to lower high cholesterol and benefit the overall health is red yeast rice extract, or Monascus purpureus, which has been used in China medicinally for centuries, and is proven to mildly inhibit cholesterol synthesis, as well as being an aid with indigestion, poor circulation, and a tonic for the spleen and stomach. Extracts from specific rice brans and palm fruits (policosanol and sytrinol) have also been proven to lower cholesterol, as well as lowering LDL and increasing the healthy HDL (PMID: 11835043). While these simple nutrient extracts may or may not be as effective as pharmaceutical drugs, they do not have significant side effects, and are actually good for the overall health. A combination of these simple extracts could be utilized for increased effect if the desired cholesterol and lipid levels are not achieved.

Some medications may increase your risk of stroke and heart attack, and this is also an important consideration in this more thorough protocol. Vioxx, an anti-inflammatory medication, was withdrawn from the market because of the risk of heart attack and stroke. Studies show that all the anti-inflammatory medications increases this risk. Hormone replacement therapy and contraception with synthetic hormones has also been found to be a significant factor in increased risk. While death from heart attack and stroke has improved over the last 50 years, incidence of these problems has increased since the advent of statin cholesterol lowering drugs in 1989. The acute treatment of these problems has improved, thankfully, which accounts for the decrease in cardiovascular deaths, but the overall incidence of strokes and heart attacks has increased. In 2007, 2.6% of the population suffered a stroke and another 2.6% suffered a heart attack. This figure has risen a little since 1989, the year of introduction of statin cholesterol lowering drugs. Clearly, the broad application of statin cholesterol lowering drugs in the population has not had a significant effect on lowering the incidence of stroke and heart attack. The question of risk and side effects versus benefit for cholesterol lowering statins has become a key subject of debate in modern medicine, also. Chronic use of statin cholesterol lowering drugs presents serious risk of side effects and negative consequences to overall health. The real question for many patients is whether these drugs actually decrease atherosclerotic plaque and prevent strokes and heart attacks in light of research data since 1989. Many patients are wondering whether a broader protocol to improve health would produce better results than the outdated drug protocol from 1989.

How do we protect our health against this atherosclerosis in a safe healthy way? Obviously, lowering lipoprotein levels and eating less saturated fat (meat) may help a littel. But it is also obvious that this is not the whole answer. One supplement alone, such as fish oil, may not have a dramatic effect, but a holistic combination of herbs and supplements may. You should seek professional guidance when taking this course of therapy. Cholesterol control would best be achieved by improving the health of your liver as well as your general health, and there is no magic pill for this, only a comprehensive and thoughtful therpeutic course that is individually tailored. Cholesterol lowering drugs (statins) work by blocking the genetic expression of proteins, and these drugs produce many side effects because they cause misshapen proteins that don’t work right and accumulate in the tissues, eventually causing muscle and joint pain, as well as increased stress on the body to clear these bad protein fragments. In 2007, the new class of cholesterol lowering statins, torcetrapid, from Pfizer, the maker of Lipitor, was withdrawn from the market because it caused more deaths than it saved. This statin, designed to increase HDL, was effective, but the lipoproteins that it encouraged were misshapen because the statins alter the genetic expression of proteins. The blood tests showed positive changes in the levels of HDL, but quality is more important than quantity. This withdrawing of a new statin drug because of risk was alarming to many medical dctors and patients. Of course, risk versus benefit is something you should discuss with your medical doctor. The key point is that raising of HDL was recognized as more important, even in the pharmaceutical industry, than lowering LDL and total cholesterol. A number of new nutrient and herbal combinations have been found and clinically tested to increase HDL levels. The American Heart Association has also found in studies that most patients could increase HDL levels by increased aerobic activity, such as running.

A regimen of sensible changes and treatments will get you to a place where you are confident that your risk level of stroke, heart attack and atherosclerosis is reduced. A relatively short course of therapy by a knowledgeable Complementary and Integrative Medicine physician, such as a Licensed Acupuncturist and herbalist, can deliver this protocol.

The holistic regimen to achieve less risk of stroke and heart attack is more complicated than the taking of the single magic pill, which puts off many patients initially. But it is also going to make you much healthier and more productive in life, as well as solving the problem with a short course of therapy, rather than sticking you with a drug therapy for the rest of your life. This holistic regimen focuses on a healthy cholesterol metabolism, reduction of inflammation in the arteries, and healthier tissues and circulation. It involves healthier eating habits, exercise habits, stress reduction, herbal prescription, supplements and acupuncture stimulation. It may also involve physiotherapies with myofascial release to decrease chronic inflammation, calcium deposits, and oxidation/free radicals. Depending on your need, simple tests for levels of hormone D3 and other hormonal levels may be performed to guide therapy for contributing health problems. The choices in the treatment protocol are defined by the individual health profile of each patient. This type of holistic regimen should be guided by a knowledgeable Complementary Medicine physician such as a licensed acupuncturist who practices and combines all of these therapies.

While the holistic regimen is more complicated than taking a pill, there are big advantages. There are no side effects. Your health improves. You feel better and are more productive. Other health problems are prevented. Don’t be overwhelmed by the complicated regimen. You have time to clean up your body and change habits. Go step by step. Get educated and start treating with and listening to a holistic physician, such as a licensed acupuncturist. When your health improves, so does your life, your looks, your sexual life, your work productivity, your mental abilities, etc. Complementary Medicine not only treats the specific problem, but helps overall health with each course of therapy.

Information Resources

1. A growing body of medical doctors are alarmed at the widespread increase in cholesterol lowering statin drug prescription despite the new insights into cardiovascular disease and dangers of these drugs. One European medical doctor and researcher is pushing for increased public awareness on his website: http://www.ravnskov.nu/cholesterol.htm
2. A conservative but informative article from the American Heart Association explains some of the pharmacodynamics of prescription drugs and the effect on the liver, with drug-drug contraindications and explanation of ill effects on the liver metabolism with statin drugs to lower cholesterol: http://circ.ahajournals.org/cgi/content/full/109/23_suppl_1/III-50
3. A 2004 article in the European Society of Cardiology explains how AGEs (advance glycation endproducts) are implicated in atherosclerosis: http://www.cardiovascres.org/cgi/content/abstract/63/4/582
4. A 2006 book entitled the Biochemistry of Atherosclerosis identifies that AGEs (advanced glycation endproducts), created in insulin resistance, are the true biochemical cause, or root cause, of both atherosclerosis and hypertension: http://resources.metapress.com/pdf-preview.axd?code=m1ju46k021j74r60&size=largest
5. A 2010 study at the University of Maryland School of Medicine found that higher levels of Troponin T, a protein biomarker, were highly associated with cardiovascular disease, and that a new test created has a high sensitivity to detect levels, making this a significant advancement in the assessment of cardiovascular risk: http://www.umm.edu/news/releases/troponin.htm
6. A comprehensive article on the benefits of bitter melon are listed on the TCM website of Blue Poppy Press: http://www.bluepoppy.com/press/download/articles/bittermelon.cfm
7. A 2008 study at the Chia Nan University of Pharmacy and Science in Taiwan found that bitter melon extract not only reduces insulin resistance and fat cell hypertrophy more effectively than the anti-diabetic drug thiazolidinedione (Avandia, Actos, Rezulin), but also suppresses fatty liver accumulation: http://www.ncbi.nlm.nih.gov/pubmed/17651527
8. A 2002 study at the University of Bonn, in Germany, found that extracts from specific rice brans (policosanol) lowered total cholesterol by about 20% and LDL by as much as 30%, while raising healthy HDL by up to 15%: http://www.ncbi.nlm.nih.gov/pubmed/11835043
9. Studies by the UCLA Center for Human Nutrition detail the potent cholesterol lowering effects of the supplement called red yeast rice, or Monascus purpureus, that has been used as a public health remedy in China as far back as 800 AD: http://www.cellinteractive.com/ucla/natural_remedies/chinese_red_rice.html#
10. Even conservative standard medicine websites, such as this one - WebMD, now acknowledge the proven effects of herbal and nutrient medicines in lowering excess cholesterol and LDL: http://www.webmd.com/cholesterol-management/guide/high_cholesterol_alternative-therapies
11. An example of one of the Chinese herbs commonly used to aid liver function and lower cholesterol and triglycerides, Artemisia capillaris or iwayomogi, commonly Yin chen hao, is shown in this study to have significant effects to lower total cholesterol and triglycerides, increase HDL, increase glutathione capacity to aid liver detoxification, and catalase activity to clear fatty liver. No human toxicity has been found in this herb, and high dosage is needed to stimulate gastrointestinal upset from excess bitterness: http://onlinelibrary.wiley.com/doi/10.1111/j.1750-3841.2011.02385.x/abstract
12. Another herb commonly used to lower and balance cholesterol in China, Gynostemma pentaphylum, or Jiao gu lan, is well studied with numerous benefits, including aids to liver and heart function, antioxidant and adaptogenic effects. Here, a 2006 human placebo-controlled randomized clinical study of patient with non-alcoholic fatty liver disease showed that Gynostemma not only lowers and balances cholesterols and triglycerides, but also significantly lowered liver enzymes, insulin resistance, fatty liver score, uric acid levels, and even BMI (body fat index) in patients with these problems: http://www.ncbi.nlm.nih.gov/pubmed/16708768f
13. Additional health benefits from a prescription of policosanol and omega-3 fatty acids were studied at the University of Sienna in Italy, in 2009. The study showed measurable effects of increased mood stability and cognitive processes: http://www.ncbi.nlm.nih.gov/pubmed/20234035
14. A combination of Red Yeast Rice extract, policosanols, and the Chinese herbal extract berberine was studied to determine the effects on high cholesterol, lipid imbalance, and atherosclerosis, at the University of Naples Department of Internal Medicine, in Naples, Italy, in 2010. The results of this protocol, in a double-blinded placebo-controlled and peer reviewed study, showed a significant reduction in cholesterol and triglycerides in circulation, as well as low density lipoproteins (LDL), and improved arterial circulatory flow and arterial lining health, as well as improved insulin sensitivity: http://www.ncbi.nlm.nih.gov/pubmed/19699071

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.