As a conventionally trained medical doctor, I understand and appre-ciate the value of strong science. One of the myths associated with "natural medicine" is that these natural substances are not validated using trusted scientific methods. This is true in some cases and not true in others. In the case of cholesterol management both preventing high cho-lesterol and lowering elevated levels there are some natural substances that have proven to be critical tools we can use. In this chapter, I describe some of the natural alternatives that I feel stand up to strong scientific scrutiny.
I have spent the past 15 years researching electron beam CT and multi-detector CT to identify patients at high risk of heart disease. In addition, it is a key research goal of mine to help those patients who discover their high-risk status. For this reason, I have also focused a great deal of atten-tion on studying the effects of aged garlic extract.
Aged Garlic Extract
There are several different types of garlic including raw garlic, garlic oil, crude garlic powders in tablets or capsules, and aged garlic extract as a dietary supplement. I have found that only aged garlic extract provides the concentration and standardization required for effectiveness. In my research, I use the Kyolic brand of aged garlic extract.
Kyolic features garlic that goes through an extensive two-year propri-etary aging process that removes the odor-causing compounds and en-hances and concentrates the active beneficial components of garlic. I have found that patients and research participants prefer a garlic supplement that is truly odorless. This increases compliance and ensures the product is taken consistently. I also like the fact that Kyolic uses organically grown garlic. Amazingly, there are presently well over 600 published scientific studies in peer-reviewed scientific journals featuring aged garlic extract.
Clinical studies have also shown aged garlic extract is more bioavail-able. This means it is found in blood, urine, and body tissue after con-sumption. Because it is more bioavailable, the body can utilize it more effectively. The aging process also increases the potency of S-allylcysteine (SAC), an important sulfur-containing amino acid. There are only small amounts of SAC in raw garlic. I choose aged garlic for my research because the aging process increases the health benefits of garlic.
I recently presented my most recent research on aged garlic extract at the Experimental Biology 2008 conference and also at two different meet-ings of the American Heart Association. My colleagues at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and I dem-onstrated that aged garlic extract enhances blood flow, clearing arteries of deposits and reducing multiple risk factors for heart disease. In two successive randomized trials, we have shown conclusively that aged garlic extract has cardiovascular benefit.
In one of our studies, we chose to evaluate 65 patients who were at inter-mediate risk of developing heart disease. We used Kyolic Formula 108 Total Heart Health because in addition to the aged garlic extract, it contains the three key B vitamins (B6, B12, and folate) and L-arginine, a heart-healthy amino acid. The group that took the Kyolic 108 had less calcified plaque progression, lower total cholesterol, and reduced homocysteine levels compared to the participants who received a placebo (fake pill).
We did another study using this same formula and demonstrated it sig-nificantly improved circulation and halted calcified plaque progression in the arteries of patients who did not have heart disease symptoms but did have subclinical fatty deposits in the arteries. Half of the study partici-pants took four capsules of the product daily, while the other half took a placebo. Neither the patients nor those administering the capsules knew who was getting the active ingredients and who was getting the fake pill. This is known as a "placebo-controlled, double-blind, randomized trial," which is considered the "gold standard" of research.
Aged garlic extract has a great safety record. The only key contraindica-tion is with the blood-thinning medication warfarin (Coumadin). Garlic supplements and eating raw garlic can negatively interact with this medica-tion so be sure to consult with your physician before taking garlic. Studies with Kyolic aged garlic extract, however, have demonstrated that it is safe to take with prescription anticoagulant medications such as Coumadin. Because garlic can thin the blood, if you are taking a garlic supplement, you should tell your physician prior to any surgical procedure. You will most likely be asked to discontinue the supplement until after the surgery.
My research is demonstrating that when aged garlic extract is combined with other heart-healthy ingredients such as fish oils, vitamin E, B vita-mins, and others, it can be even more effective. An important combination is aged garlic extract and CoQ10.
As mentioned previously, cholesterol-lowering prescription medications can cause a deficiency of CoQ10. This is the most important coenzyme dis-covered thus far. As a coenzyme, CoQ10 supports energy production on a cellular level. CoQ10 is responsible for transporting an electrical charge across cell membranes. Without this charge, our heart stops pumping, and the brain, liver, kidneys, and other major organs shut down. This consistent energy also helps the body pump out waste, repair damaged tissue, and de-toxify.
Foods high in CoQ10 include broccoli, spinach, mackerel, and salm-on. CoQ10 is predominantly found in meat. However, some studies have shown that vegetarians actually have higher levels of CoQ10. It is believed that plant foods help protect CoQ10 levels in the body and may even en-hance the CoQ10 synthesis that naturally occurs in the body.
In most cases, diet alone will not correct CoQ10 deficiencies. Individu-als with heart issues such as high blood pressure, mitral valve prolapse, congestive heart failure, and high cholesterol are at risk of CoQ10 deficien-cy and may need to supplement the diet. Kyolic Formula 110 provides 300 mg of aged garlic extract with 30 mg of CoQ10. I recommend a minimum of one capsule three times a day.
Editor's Note: For more information about CoQ10, refer to the Coenzyme Q10 Healthy Living Guide by Sherry Torkos, BSc Phm, available at your local, inde-pendent health food store.
In addition to aged garlic extract, essential fatty acids such as fish oils, and CoQ10, the research involving plant sterols and heart health, specifi-cally its cholesterol-lowering ability, is impressive.
One of the reasons doctors recommend that their patients with high cho-lesterol increase their consumption of vegetables is because plants contain important compounds called sterols or stanols. These compounds are so important that some manufacturers are fortifying foods with plant sterols and stanols. I prefer a dietary supplement that contains these compounds because it is easier to control the dosage and quality of the product. The makers of ModuCare for immune enhancement have now created Mo-duChol for the successful management of high cholesterol.
The plant sterols in ModuChol have been proven to help reduce harmful LDL cholesterol levels. The capsules contain a liquid form of these plant sterol compounds for more effective absorption.
Based on a variety of successful clinical studies, the FDA has approved the cholesterol-lowering health claim for plant sterols. In 2007, research-ers at East Tennessee State University confirmed the effectiveness of plant sterols. Their study featured 16 participants who took a plant sterol capsule product for four weeks. LDL levels were significantly decreased while HDL levels were increased. Of course, this is the goal of cholesterol medication. These researchers also confirmed the optimum dosage of 1.3 grams per day. Taking two capsules daily of the ModuChol supplies this optimum dosage. Plant sterols should be taken with meals as a part of a diet low in saturated fat and cholesterol.
According to a report in the Journal of The American College of Nutrition, South African researchers studied six different published clinical trials and found that plant sterols reduced total cholesterol in people with a family his-tory of high cholesterol. The researchers concluded that plant sterols and sta-nols offer an effective cholesterol-lowering strategy in this high-risk group.
Plant sterols as a dietary supplement are very safe. However, if you are pregnant or nursing, do not use this supplement without first consulting with your physician. There are no known contraindications or interactions with other supplements or prescription drugs. Some studies have demon-strated that individuals taking statin drugs may have an even greater reduc-tion of LDL cholesterol levels when they add plant sterols. Consistently, the studies have shown that plant sterols can reduce LDL cholesterol by 6 to 15 percent. I recommend ModuChol for people who have been diag-nosed with high cholesterol or those with a family history of heart disease or high cholesterol.
As mentioned previously, cholesterol is manufactured in the liver. The amount of cholesterol that the liver produces can be significant and can also contribute to elevated levels. Several studies have shown that flavonoids found in certain citrus fruits help support effective cholesterol production in the liver. These flavonoids are known in the scientific literature as citrus polymethoxylated flavones. The brand of flavones that has received the most scientific attention is Sytrinol. Preliminary research shows that Sytrinol low-ers both cholesterol and triglyceride levels.
A 12-week clinical trial completed recently demonstrated that partici-pants with moderately elevated cholesterol levels who took Sytrinol experi-enced a 30 percent drop in total cholesterol, 27 percent in LDL cholesterol, and a 34 percent reduction in triglycerides. Sytrinol worked independently of dietary changes. The dosage of Sytrinol is 300 mg per day. Sytrinol is an ingredient in a variety of heart-healthy supplements available at your local natural health store.
Supplementing The Diet
Dietary supplements are appropriately named because they are meant to be a supplement to a healthy diet. They are not meant to replace health-ful eating habits. When combined with a heart-healthy diet, these supple-ments are even more effective.
In today's fast-paced world, it can be difficult to have a meticulously healthy diet. Food processing, nutrient-deplete soil, and eating on the run can make it hard for us to get all of the heart-healthy nutrients we need from diet alone. That's when the nutrients previously mentioned come in handy.
There are lots of dietary supplements presently available. Yes, nutritional supplements have become big business. That can make it difficult to choose the best supplement for your particular situation. For cholesterol control, I prioritize my recommendations this way (in order of importance):
- Aged garlic extract
- Plant sterols
- Fish oils
Other supplements such as hawthorn berry, cayenne pepper, and lecithin
It's best to use a supplement that contains as many of the previously listed ingredients as possible. The most important aspect of the nutrients I've listed is that they are scientifically validated and proven to enhance heart health.