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Elevations of blood cholesterol levels, particularly the bad form of cholesterol – LDL – is definitely a risk factor, but has its importance been overstated? Perhaps, although important an elevation in cholesterol it is just one piece of the puzzle as over half of the people that die of a heart attack or stroke have normal to low cholesterol levels.
Other risk factors
While the major risk factors such as smoking, elevated cholesterol, diabetes, high blood pressure, and physical inactivity are undeniably important, there are numerous other factors which on occasion have been shown to actually be more significant than the "major" risk factors in causing heart disease. In fact, over 300 different risk factors have been identified including:
* insulin resistance
* low antioxidant status
* elevations of C-reactive protein
* low levels of omega-3 fatty acids
* increased platelet aggregation and fibrinogen formation
* low thyroid function
* low levels of magnesium and potassium
* elevated levels of homocysteine
* "type A" personality
While there is considerable evidence that all of these risk factors and more can play a significant role in the pathogenesis of heart disease, much of the current research has focused on the central role that inflammatory processes play. In particular, C-reactive protein (CRP), a substance associate with inflammation and insulin resistance, has been identified as an independent risk factor for coronary artery disease. Fortunately, CRP levels can be lowered effectively with diet, lifestyle, and nutritional supplements.
Reducing CRP levels with diet
One of the most powerful dietary interventions in the prevention and treatment of heart disease is the traditional "Mediterranean diet." Not surprisingly, this diet has been shown to lower CRP levels. This term has a specific meaning. It reflects food patterns typical of some Mediterranean regions in the early 1960s, such as Crete, parts of the rest of Greece, and southern Italy. It has the following characteristics:
* Olive oil is the principal source of fat.
* It centers on an abundance of plant food (fruit, vegetables, breads, pasta, potatoes, beans, nuts, and seeds).
* Foods are minimally processed and there is a focus on seasonally fresh and locally grown foods.
* Fresh fruit is the typical daily dessert, with sweets containing concentrated sugars or honey consumed a few times per week at the most.
* Dairy products (principally cheese and yogurt) are consumed daily in low to moderate amounts.
* Fish is a consumed on a regular basis.
* Poultry and eggs are consumed in moderate amounts (1-4 times weekly) or not at all.
* Red meat is consumed in low amounts.
* Wine is consumed in low to moderate amounts, normally with meals.While several components of the Mediterranean diet have been evaluated independently, it is important to stress that the total benefits reflect the interplay among the many beneficial compounds rather than any single factor. Nonetheless, the importance of omega-3 fatty acids deserves special mention.
The Omega-3 Index
The level of the omega-3 fatty acids EPA and DHA within red blood cells has been shown to be a highly significant predictor of heart disease. This laboratory value has been termed the Omega-3 Index. An Omega-3 Index of =8% was associated with the greatest protection, whereas an index of =4% was associated with the least. In one analysis, the Omega-3 Index was shown to be the most significant predictor of coronary artery disease compared to C-reactive protein; total, LDL, or HDL cholesterol; and homocysteine. Researchers subsequently determined that a total of a combined 1,000 mg of EPA and DHA daily from a pharmaceutical grade fish oil is required to achieve or surpass the =8% Omega-3 Index target.
The findings with the Omega-3 Index are not surprising as a wealth of information has documented a clear relationship between dietary intake omega-3 fatty acids and the likelihood of developing coronary heart disease — the higher the omega-3 fatty acid intake, the lower the likelihood of coronary heart disease. It has been estimated that raising the level of the long-chain omega-3 fatty acids through diet or supplementation may reduce overall cardiovascular mortality by as much as 45%.
Lowering Cholesterol with Plant Sterols and Sytrinol
Based latest clinical research, it looks like the absolute best natural approach to lowering cholesterol levels is the combination of plant sterols and Sytrinol - a special extract of citrus peel standardized to contain greater than 30% polymethoxylated flavones. This mixture provides a comprehensive formula that addresses high cholesterol, high LDL cholesterol (the "bad" cholesterol), and high triglyceride levels. This formula also contains a significant anti-inflammatory component, as inflammation has been shown to be a risk factor for heart attack.
While statin drugs like Lipitor, Pravachol, and Crestor are enormously popular for lowering cholesterol levels, they are also associated with significant side effects including:
* Liver problems and elevated liver function tests.
* Interference with Coenzyme Q 10 production resulting in tissue damage to muscles (rhabdomyolysis) and nerves (polyneuropathy).
* Impaired brain function.
In addition, these drugs are expensive with a cost per day, depending on dosage in the range of $3-8 per day.
How this combination works
Blood cholesterol levels are derived from two sources: endogenous synthesis (made by the body) and from dietary sources. Plant sterols work to lower cholesterol levels primarily by blocking the absorption of dietary cholesterol and the reuptake of bile acids made from cholesterol in the liver. Plant can inhibit absorption of cholesterol in the small intestine by up to 50%, and lower LDL blood cholesterol by up to 14%.
Sytrinol works by blocking the enzymes in the liver responsible for manufacturing cholesterol and triglyceride production. For example, the polymethoxylated flavones in the extract have been shown to decrease the production of apolipoprotein B, a structural protein needed for the endogenous synthesis of LDL cholesterol.
Clinical results have shown that the special citrus extract exerts effects very similar to statin drugs, but without side effects. Specifically, it has been shown to lower total cholesterol levels up to 30%, LDL cholesterol levels up to 27% and triglyceride levels up to 34% within four to twelve weeks of use.
Comprehensive approach
There is little doubt that in most cases heart disease is directly related to diet and lifestyle. Treatment and prevention include reducing all known risk factors, not just cholesterol. What follows is a general approach to lower heart disease risk.
Dietary recommendations:
* Follow the Mediterranean diet
Lifestyle recommendations:
* Achieve ideal body weight
* Obtain regular aerobic exercise
* Do not smoke
Supplements
The three key dietary supplements that I recommend to provide a strong foundation for a proper nutritional supplement plan are:
* A high-potency multiple vitamin and mineral formula (MultiStart).
* A "greens" drink product (Enriching Greens).
* A pharmaceutical grade fish oil supplement (RxOmega-3 Factors).
* The specific products that I recommend are manufactured by Natural Factors - one of the leading manufacturers of nutritional supplements in the world.
By Michael T. Murray, ND
Michael T. Murray, N.D., is widely regarded as one of the world's leading authorities on natural medicine. He is a graduate, faculty member, and serves on the Board of Trustees of Bastyr University in Seattle, Washington. Dr. Murray is Director of Product Development and Education for Natural Factors Nutritional Products.
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