Natural Approaches to Cholesterol #6

Continued from 01.13.11

Fish is a food item found in many traditional diets that has been shown to help reduce unhealthy cholesterol levels. Fish oil, rich in the omega-3 eicosapentaenoic acid (EPA), was as effective as statin drugs in reducing unhealthy cholesterol levels in hypercholesterolaemic patients in the large Japan EPA lipid intervention study (JELIS).30 Researchers examined more than 18,000 Japanese men with total cholesterol of 6.5 mmol/L between 1996 and 1999. Patients were randomly assigned to receive either 1,800 mg of EPA daily with statin (EPA group; n=9,326) or statin only (controls; n=9,319). At mean follow-up of 4.6 years, the researchers found a 19-percent relative reduction in major coronary events (P=0.011), with post-treatment LDL cholesterol concentrations decreasing by 25 percent, from 4.7 mmol/L in both groups. And not supplementing with fish oil may be detrimental to cholesterol management, as the GISSI-Prevention Study, a prospective randomized control trial of 11,000 patients with preexisting heart disease, found LDL cholesterol levels increased by 2.5 percent six months after patients were no longer receiving 850 mg of EPA and docosahexaenoic acid (DHA).31 With science like this, FDA allows supplements to claim supportive, but not conclusive research shows consumption of EPA and DHA omega-3 fatty acids may reduce the risk of CHD. Additionally, the agency ruled intakes of up to 3 g/d of marine omega-3 fatty acids are GRAS (generally recognized as safe), and the ruling included specific consideration of the reported effects of omega-3 fatty acids on LDL cholesterol.

Krill oil, another marine source of EPA and DHA, offers more omega-3s than a comparable amount of fish oil, which could be the reason a 2010 study found it significantly improved the HDL cholesterol/triglyceride ratio compared to fish oil.32 The study was performed by researchers at Akershus University College and University of Oslo, Norway, using Aker BioMarine’s Superba™ krill oil in healthy volunteers.

Omega-3s from plant sources, such as walnuts, are also effective treatments for cholesterol, according to a University of Barcelona, Spain, study.33 In the randomized, crossover trial, 49 men and women (mean age, 56 years) with polygenic hypercholesterolemia (a condition caused by a susceptible genotype aggravated by one or more factors, including excessive intake of saturated fat, trans fat, and cholesterol; obesity; and sedentary lifestyle) ate a Mediterranean diet or a diet of similar energy and fat content in which walnuts replaced approximately 35 percent of the energy obtained from monounsaturated fat for six weeks. Compared with the Mediterranean diet, the walnut diet decreased total cholesterol levels by 4.1 percent, LDL cholesterol levels by 5.9 percent and lipoprotein levels by 6.2 percent. Lipoproteins are molecules made of proteins and fat that carry cholesterol through the blood.

Similarly, the omega-3s in flaxseeds may be behind their ability to aid those with high cholesterol levels. Flaxseeds are one of the richest sources of alpha-linolenic acid (ALA) and lignans (a type of phytosterol), as well as a good source of soluble fiber. Human studies have shown flaxseed can modestly reduce serum total cholesterol and LDL cholesterol. In a double blind, randomized study, postmenopausal women who were not on hormone replacement therapy were instructed to consume 40 g/d of either ground flaxseed or wheat-based comparative control regimen for three months.34 Flaxseed supplementation lowered both serum total cholesterol and LDL cholesterol by 6 percent, whereas the comparative control regimen had no such effect.

And perhaps it was the omega-3s in the various nuts examined in a 2010 JAMA pooled analysis of data from 25 trials that showed consuming them was associated with improvements in blood cholesterol levels.35 Joan Sabaté, M.D., of Loma Linda University, Loma Linda, CA, and colleagues pooled primary data from trials conducted in seven countries and involving 583 women and men with high cholesterol or normal cholesterol levels. All the studies compared a control group to a group assigned to consume nuts; participants were not taking lipid-lowering medications. Participants in the trials consumed an average of 67 g/d (about 2.4 ounces) of nuts. This was associated with an average 5.1-percent reduction in total cholesterol concentration, a 7.4-percent reduction in LDL cholesterol and an 8.3-percent change in ratio of LDL cholesterol to HDL cholesterol.

Nuts and fish are dietary staples much like rice is, and all three can help naturally address cholesterol issues. Red yeast rice is produced by fermentation of rice using the fungus Monascus purpureus. It produces active compounds that inhibit HMGR. A study published in the American Journal of Clinical Nutrition found healthy subjects (46 men and 37 women aged 34 to 78 years) with hyperlipidemia who were not being treated with lipid-lowering drugs and received 2,400 mg/d of red yeast rice containing, by weight, 0.4 percent HMGR inhibitor, had a significant reduction of total cholesterol (16 percent) and LDL cholesterol (22 percent) after 12 weeks of treatment, as compared to placebo.36

While not historically known for being part of healthy diet, chocolate has made its debut into the healthy natural ingredient spotlight, due in part to its ability to lower cholesterol levels in individuals at risk for heart disease. A Chinese study found cocoa, when consumed in moderate amounts providing 260 mg of polyphenols—antioxidants found in fruits, vegetables and chocolate—can lower both total cholesterol and LDL levels by about 6 mg/dL.37 Researchers reviewed eight trials (involving 215 participants) and focused on short-term data to evaluate the effects of cocoa on plasma lipid. Cocoa consumption significantly lowered LDL cholesterol by 5.87 mg/dL (P<0.05) p ="0.08)." p="0.23)."

For those who would rather have a cup of tea than hot chocolate, they may want to choose yerba maté to boost cholesterol health. The plant has been used for centuries by native South Americans to reduce stress, increase energy and focus, and encourage a sense of well being. Its rich variety of polyphenols is thought to be beneficial for a number of human health issues, including protecting HDL and LDL from oxidation. A group of researchers from Touro University, Vallejo, CA, investigated whether the polyphenol-rich beverage, obtained from extract of Ilex paraguariensis (IP), prevented the loss of paraoxonase 1 (PON-1), an antioxidant enzyme carried mainly by HDL that offers cardioprotective effects.38 Healthy volunteers drank either 0.5 L of IP extract, 0.5 L of coffee and milk or nothing. PON-1 activity increased an average of 10 percent above the changes seen in the coffee and milk group (P<0.05).

Coffee is another breakfast beverage that may reduce levels of oxidized cholesterol. According to research from FutureCeuticals, a single serving of ingredients produced using a proprietary technology from the whole fruit of the coffee plant, Coffea Arabica (as CoffeeBerry®), may stimulate the activity of a human blood enzyme associated with maintenance of healthy cholesterol levels; the company said the ingredient has also been shown to possibly reduce levels of oxidized LDL cholesterol. The company also noted an independent expert panel recently affirmed the GRAS status of its CoffeeBerry products, including CoffeeBerry Whole Fruit Powder, Juice Concentrate Powder and Forte Soluble Concentrate.

Whether in a beverage, a food fortified with soy protein or a supplement of PMFs, nutritional product formulators have a lot of options to help consumers meet their cholesterol goals in 2011. These natural ingredients, along with a healthy diet and exercise, can help raise the good and reduce the bad, which is what we’re all looking for this time of year.

References:

30. Yokoyama M., et al. “Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis.” Lancet. 2007 Mar 31;369(9567):1090-8.
31. [No authors listed] “Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico.” Lancet. 1999 Aug 7;354(9177):447-55.
32. Ulven SM, et al. “Metabolic Effects of Krill Oil are Essentially Similar to Those of Fish Oil but at Lower Dose of EPA and DHA, in Healthy Volunteers.” Lipids. 2010 Nov 2.
33. Zambón D, et al. “Substituting walnuts for monounsaturated fat improves the serum lipid profile of hypercholesterolemic men and women. A randomized crossover trial.” Ann Intern Med. 2000 Apr 4;132(7):538-46.
34. Lucas EA et al. Flaxseed improves lipid profile without altering biomarkers of bone metabolism in post-menopausal women. J Clin Endocrinol Metab 2002; 87:1527
35. Sabaté J, Oda K, Ros E. “Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials.” Arch Intern Med. 2010 May 10;170(9):821-7.
36. Heber D., et al. “Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement.” Am J Clin Nutr. 1999 Feb;69(2):231-6.
37. Jia L., et al “Short-term effect of cocoa product consumption on lipid profile: a meta-analysis of randomized controlled trials.” Am J Clin Nutr. 2010 Jul;92(1):218-25.
38. Menini T, et al. “Protective action of Ilex paraguariensis extract against free radical inactivation of paraoxonase-1 in high-density lipoprotein.” Planta Med. 2007 Sep;73(11):1141-7.
39. Heck CI, de Mejia EG. “Yerba Mate Tea (Ilex paraguariensis): a comprehensive review on chemistry, health implications, and technological considerations.” J Food Sci. 2007 Nov;72(9):R138-51.

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