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Normalize your Cholesterol
through diet and lifestyle changes

Plant stanols and sterols
Plant stanols and sterols, also called phytosterols, occur naturally in plant sources such as peanuts, beans, olive oil and peanut oil. Phytosterols, like stigmasterol from soybean oil, are of current interest because they lower blood cholesterol levels, although the response varies widely. Phytosterols have the same basic structure as cholesterol, but differ in the side chains attached to carbon 17. Sterols that are fully saturated (no double bonds) are called "stanols". For example, stigmastanol has the same structure as stigmasterol, but without the double bonds. When fatty acids react with the hydroxyl at carbon 3 they form "sterol esters". Phytosterols appear to work by interfering with the absorption of cholesterol by the intestines, resulting in lower blood cholesterol levels.

Stigmasterol
Stigmasterol
(a phytosterol)

Garlic
Several studies have reported that raw garlic has cholesterol-lowering properties, but the effects do not appear to be long-lasting. Garlic capsules and other forms of garlic appear to be ineffective at lowering cholesterol. In addition, raw garlic's pungent smell and strong taste can produce bad breath and bad body odor. One scientific study in 2000 concluded that garlic is superior to placebo in reducing total cholesterol levels, but the size of the effect is modest, and the robustness of the effect is debatable. Therefore, the use of garlic for hypercholesterolemia is of questionable value.[9] A more recent study in 2007 found that there were no statistically significant changes in blood cholesterol readings from eating the equivalent of one clove of raw garlic per day.[12]

Niacin
Niacin is also known as nicotinic acid or vitamin B3. It is a water-soluble vitamin whose derivatives such as NADH play essential roles in energy metabolism. Niacin lowers total and LDL cholesterol and raises HDL cholesterol. It also can also lower triglycerides. The dose needed for treatment is about 100 times more than the Recommended Daily Allowance for niacin. High doses (75 mg or more) of niacin can cause side effects such as a burning, tingling sensation in the face and chest, and red or "flushed" skin. High doses of niacin are associated with toxic side effects that include worsening of diabetes control and exacerbation of peptic ulcer disease and gout.[15] Treatment for high cholesterol with niacin must be done under a doctor's care.

Statins
The enzyme hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase or HMGR) is responsible for making cholesterol in the liver. The level of cholesterol in the blood normally serves as a feed-back mechanism to determine how much cholesterol is made. Cholesterol inhibits the activity of HMGR by degrading the enzyme, but insulin stimulates the removal of phosphates and indirectly activates HMGR which results in extra cholesterol production.

Statins are synthetic drugs developed by pharmaceutical companies that block HMG-CoA reductase thereby lowering the level of cholesterol in the blood. Statins belong to the class of drugs called HMGR inhibitors. Some of the most common statin drugs are Lipitor, Crestor, Pravachol, and Zocor. The drugs are successful at lowering cholesterol, and they reduce morbidity and mortality in patients with risk factors for atherosclerotic disease. Unfortunately, 5% of statin users experience gastrointestinal and muscular problems. Statins inhibit not only cholesterol synthesis, but also synthesis of other substances such as Coenzyme Q10 (CoQ10) which leads to a reduction of high energy phosphates, anaerobe metabolism and mitochondrial dysfunction that sometimes cause muscle damage. Bayer Pharmaceutical Division withdrew its cholesterol-lowering drug Baycol (cerivastatin) from the U.S. market in 2001 because of reports of fatal rhabdomyolysis, a severe muscle adverse reaction involving destruction or degeneration of skeletal muscle. The following table shows the most commonly prescribed statins and their attributes.

Statin Manufacturer & Approval Attributes
mevacor lovastatin
Mevacor
(lovastatin)
Merck and generic manufacturers
Approved by the FDA in 1987
Can reduce LDL by 30 to 40 percent.
Best for patients with moderate elevation
of LDL (130 to 159 mg/dL).
Inexpensive
pravachol pravastatin
Pravachol
(pravastatin)
Bristol-Myers, Squibb
and generic manufacturers
Approved by the FDA in 1991
Least likely to cause drug interactions.
Best for patients with borderline high
LDL (120 to 140 mg/dL) and who take
other medications.
zocor simvastatin
Zocor
(simvastatin)
Merck and generic manufacturers
Approved by the FDA in 1991
Effective at raising HDL cholesterol.
Greater risk of muscle injury at its
highest dosage. Best for patients with
moderately high LDL (150 to 180 mg/dL)
and low LDL (< 40 mg/dL).
lipitor atorvastatin
Lipitor
(atorvastatin)
Pfizer
Patent expiration in 2010
Approved by the FDA in 1996
Can reduce LDL up to 55 percent.
Best for patients with high
LDL (160 to 190 mg/dL)
Expensive
lescol fluvastatin
Lescol
(fluvastatin)
Novartis
Approved by the FDA in 2000
Low risk of side effects.
Best for patients with borderline high
LDL (120 to 140 mg/dL).
crestor rosuvastatin
Crestor
(rosuvastatin)
AstraZeneca
Approved by the FDA in 2003
Potent LDL reduction of up to 60 percent.
Best for patients with high
LDL (160 to 190 mg/dL)
Expensive

Life Style Summary to Normalize Cholesterol

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References
  1. National Cholesterol Education Program
  2. Salonen JT, Salonen R, Association of serum low density lipoprotein cholesterol, smoking and hypertension with different manifestations of atherosclerosis. Int J Epidemiol. 1990 Dec;19(4):911-7. PMID: 2084021
  3. Willett WC, Ascherio A. Trans fatty acids: Are the effects only marginal? Am J Public Health 1994; 84:722-724.
  4. Hegsted DM, McGandy RB, Myers ML, Stare FJ, Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr. 1965 Nov; 17(5):281-95. [full article PDF]
  5. Hegsted DM, Ausman LM, Johnson JA, Dallal GE, Dietary fat and serum lipids: an evaluation of the experimental data. Am J Clin Nutr. 1993 Jun; 57(6):875-83.
  6. Mensink RP, Katan MB, Effect of dietary fatty acids on serum lipids and lipoproteins: A meta-analysis of 27 trials. Arterioscler Thromb 12: 911-919, 1992. [full article PDF]
  7. Anderson JW, Konz EC, Jenkins DJ., Health Advantages and Disadvantages of Weight-Reducing Diets: A Computer Analysis and Critical Review. J Am Coll Nutr. 2000 Oct;19(5):578-90. PMID: 11022871 [full article]
  8. Pedersen A, Baumstark MW, Marckmann P, Gylling H, Sandstrom B., An olive oil-rich diet results in higher concentrations of LDL cholesterol and a higher number of LDL subfraction particles than rapeseed oil and sunflower oil diets. J Lipid Res. 2000 Dec;41(12):1901-11. PMID: 11108723 [full article]
  9. Stevinson C, Pittler MH, Ernst E., Garlic for treating hypercholesterolemia. A meta-analysis of randomized clinical trials. Ann Intern Med. 2000 Sep 19;133(6):420-9.
  10. Description of the work of Michael S. Brown and Joseph L. Goldstein on the regulation of cholesterol metabolism and the cell receptors which mediate the uptake of low-density lipoprotein (LDL). Press Release: The 1985 Nobel Prize in Physiology or Medicine.
  11. Hegsted DM, Serum-cholesterol response to dietary cholesterol: a re-evaluation. Am J Clin Nutr 44: 299-305, 1986.
  12. Effect of Raw Garlic vs Commercial Garlic Supplements on Plasma Lipid Concentrations in Adults With Moderate Hypercholesterolemia: A Randomized Clinical Trial Christopher D. Gardner, Larry D. Lawson, Eric Block, Lorraine M. Chatterjee, Alexandre Kiazand, Raymond R. Balise, and Helena C. Kraemer Archives of Internal Medicine. 2007;167:346-353.
  13. De Oliveira E Silva ER, Foster D, McGee Harper M, Seidman CE, Smith JD, Breslow JL, Brinton EA. Alcohol consumption raises HDL cholesterol levels by increasing the transport rate of apolipoproteins A-I and A-II. Circulation. 2000 Nov 7;102(19):2347-52. PMID: 11067787
  14. Martijti B Katan, Peter L Zock, and Ronald P Mensink, Effects of fats and fatty acids on blood lipids in humans: an overview, Am J Cli. Nutr., 1994;60(suppl):1017S-1022S. [link]
  15. Crouse JR 3rd., New developments in the use of niacin for treatment of hyperlipidemia: new considerations in the use of an old drug. Coron Artery Dis. 1996 Apr;7(4):321-6. PMID: 8853585


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