There are over 50 million Americans with high cholesterol. High cholesterol is a risk factor for heart disease, stroke and Alzheimer's disease. Cholesterol is a fatty substance necessary for hormone production and insulating nerve fibers. When there is too much cholesterol, it builds up on the arterial wall, causing narrowing of the arteries and impeded blood flow. "Bad," or LDL, cholesterol represents cholesterol moving through the body. Elevated levels of LDL increase the risk of heart disease. "Good," or HDL, cholesterol protects against heart disease as it measures cholesterol being cleared from the body. Triglycerides are also associated with a risk of heart disease and diabetes. It is ideal to keep triglyceride levels below 150 mg/dL; total cholesterol below 200; LDL below 130; and HDL above 40.
 
Although drugs can be used to lower cholesterol, side effects are common and include digestive complaints; dizziness; headaches; rashes; and muscle and liver damage. Exercise and diet recommendations are extremely important in treating high cholesterol. We also recommend that patients with high cholesterol have a daily stress reduction and exercise program. This is believed to be protective against heart disease, and has many other health benefits, such as lowering high blood pressure and diabetes risk.
 
Dietary Recommendations
Eat plenty of fruits and vegetables. These contain fiber and antioxidants. Soluble fiber has been shown to reduce LDL and total cholesterol if you consume 5 grams to 10 grams daily. Good sources of soluble fiber include beans; lentils; oats; barley; apples; citrus fruits; pears; brussel sprouts; carrots; and flaxseed. If you are not allergic to soy products, they also reduce cholesterol levels. It is also important to avoid trans fats, which are found in many margarine and processed foods, such as vegetable shortening, hydrogenated fats or partially hydrogenated fats. Similarly, refined carbohydrates, such as those found in cookies; cakes; crackers; chips; and sodas should be avoided, as they can increase triglycerides and may lower HDL cholesterol. Dairy products are not advised, as they contain saturated fat. All meat and poultry consumed should be lean.
 
Must You Avoid All Fat?
 
Olive oil has been found to lower LDL cholesterol. Extra virgin olive oil is rich in antioxidants that protect LDL cholesterol from oxidation, an early step in plaque formation. Fish oil and flax oil also appear to protect the heart, and may support normal cholesterol levels. Fish containing omega-3 fatty acids, such as salmon, tuna, mackerel and sardines, can be eaten as much as desired. The dosage of flax is one to three tablespoons per day in the form of freshly ground seeds or oil, which can be used as a salad dressing or cooked vegetable garnish. Finally, moderate intake of nuts may also protect against heart disease, high triglycerides and cholesterol levels. A handful of almonds, walnuts or cashews are recommended.
 
Gugulipid
Gugulipid is derived from a species of myrrh called commiphora mukul. This plant is traditionally used to treat obesity and fat obstruction. This has led scientists to study gum guggul and its extracts in order to lower cholesterol and triglycerides, and to aid in weight loss. In scientific studies, gugulipid has been shown to lower bad LDL cholesterol and triglycerides, and raise beneficial HDL cholesterol. As reported in the May 30, 2002 issue of Science, a research team at Baylor School of Medicine found that the plant sterol guggulsterone may block a receptor in the liver cells involved with cholesterol metabolism. This receptor is known as FXR (farnesoid X receptor). FXR plays a crucial role in cholesterol metabolism by mediating the rate of bile acid produced by the liver (cholesterol is eliminated from the body through bile release). For example, in a 12-week study with a controlled diet, gugulipid significantly reduced total cholesterol and triglycerides levels in 78.9 percent of patients.
 
Policosanol
Policosanol is a plant product derived from rice bran or sugar cane that has been demonstrated in multiple clinical studies to safely reduce LDL ("bad") cholesterol while significantly raising HDL ("good") cholesterol. In addition, it can be used to improve pain-free walking distance for people with intermittent claudication (hardening of the arteries). Policosanol is comprised of the long chain fatty acids octacosanol; hexacosanol; tricontanol; tetracosanol; and dotricontanol.
 
Policosanol has also been compared with drugs. For example, in a trial involving 113 patients, 59 patients received 10 mg per day of policosanol with a low-cholesterol diet, and 54 patients were given besafibrate at 400 mg per day while on a low-cholesterol diet for eight weeks. In policosanol-treated subjects, LDL cholesterol fell by 18 percent and triglycerides by 15 percent, while in the drug group, LDL fell 11 percent and triglycerides by 6 percent. To test the effects with coronary heart disease (CHD) and high cholesterol, a 23-patient, double-blind study was conducted. Electrocardiogram (ECG) and serum blood samples were followed for 14 months. The policosanol group showed a reduction of total and LDL cholesterol, and 5 of 12 patients exhibited a tendency to improve their CHD. Further studies have indicated equal effectiveness to the chemical drugs lovistatin, simvastatin and provastatin. It is hypothesized that policosanol inhibits cholesterol synthesis in the liver. Not all studies show a triglyceride-lowering effect.