Lowering YOUR Cholesterol, Triglycerides and Homocysteine

The Take-Aways

1. Homocysteine can easily be brought to a healthy level in over 90% of cases.

2. Triglycerides can easily be brought to a healthy level in most cases.

3. CoQ₁₀ is essential to many functions including energy production and is concentrated in key organs including the heart. Age, and cholesterol –lowering drugs (CLDs) like statins, significantly lower your body’s CoQ₁₀ levels.

4. Lifestyle, Education, Activity and Nutrition can positively impact cholesterol levels without the negative side-effects of CLDs.

5. If you are on CLDs, consult your physician before stopping your meds. But seriously consult – present the evidence from the previous newsletters and from this one, and discuss a feasible plan for you.

6. If you have moderately elevated cholesterol, and are not on CLDs, use this evidence to have a serious discussion and develop a plan with your doctor before taking statins.

Homocysteine

The same year it was reported that if we take 1000 mcg of folic acid along with Vitamins B₆and B₁₂ in supplementation each day, 92% of homocysteine levels would fall to a safe range. (2)

In 1999 Loba and associates studied a combination of low-dose folic acid combined with Vitamins B₆ and B₁₂ to reduce homocysteine levels in patients with cardio-vascular disease. Patients received 400 mcg, 1 mg or 5 mg of folic acid, 12.5 mg of B₆ and 500 mcg of B₁₂. They concluded that a daily dose of 400 mcg of folic acid combined with the B vitamins normalized homocysteine levels in patients with cardio-vascular disease. (3)

In 2000 there was an interesting randomized, placebo-controlled trial among 158 healthy siblings of 167 patients with premature atherothrombotic disease (“hardening of the arteries”). In the study, 80 of the healthy siblings were assigned placebo and 78 were assigned 5 mg folic acid with 250 mg Vitamin B₆ daily for 2 years. There was a significant decrease in homocysteine levels in those using B₆ and folic acid and they had a decreased rate of abnormal exercise electrocardiography tests – which is consistent with a decreased risk of atherosclerotic coronary events. (4)

So for most people elevated levels of homocysteine can easily be brought to a healthy level.

Triglycerides

In 2007 Darshan S Kelley et al reported in the American Journal of Clinical Nutrition that supplementation with DHA (either 7.5 g DHA oil/d and then 3 g DHA/d) or olive oil (placebo) for the last 90 d) “may improve cardiovascular health by lowering concentrations of triacylglycerols and small, dense LDL particles”. (5)

In 2011 a study by Ann C Skulas-Ray et al reported in the American Journal of Clinical Nutrition found that Omega 3 (DHA + EPA) at 3.4 g/day lowered triglycerides by 27% compared with placebo. This was a placebo-controlled, double-blind, randomized, 3-period crossover trial (8 weeks of treatment, 6 weeks of washout) that compared the effects of 0.85 and 3.4 g EPA+DHA/d in 23 men and 3 postmenopausal women with moderate hypertriglyceridemia (150–500 mg/dL). (6)

In the same year Mozaffarian and Wu noted in a meta-analysis that the effectiveness of Omega 3 in “lowering of plasma triglycerides is well recognized”. They recommend that “if significant triglyceride-lowering is a goal, then concentrated over-the-counter or prescription formulations are preferable to facilitate sufficiently high doses (>3 g/day EPA+DHA) with reasonable daily numbers of capsules”. They also note that “concerns have been raised over potential harm from contaminants present in some fish species, such as methylmercury, dioxins, and polychlorinated biphenyls (PCBs)”. (7)

So if you buy Omega 3 oil you need to be certain that all contaminants have been removed by a double molecular distillation process. Double molecular distillation improves quality and stability – removes heavy metals including mercury, pesticides, PCBs, and organic residues. At least one company , and definitely not all, guarantees the purity and potency of its Omega 3.

This graphic from the Mozaffarian and Wu meta-analysis (7) outlines the range of benefits associated with Omega 3 and Cardio-Vascular Disease.

CoEnzymeQ₁₀

Our ability to metabolize CoQ₁₀ from food sources decreases quite dramatically with age as seen in the following graph. So as we age we make less of this critical element that is concentrated in your heart and other critical organs like the liver, kidney and pancreas.

In 1989 Anders Kalen et al reported in Lipids that in human pancreas and adrenal the CoQ₁₀ content was highest at one year of age, whereas in other organs the corresponding peak value was at 20 years of age, and was followed by a continuous decrease upon further aging. This is illustrated in the following graph. (8)

Supplementation with CoQ₁₀ has been shown to be an effective treatment for people with isolated systolic hypertension (ISH) - higher blood pressure number (systolic) is elevated. When patients were supplemented with 120 mg/day CoQ₁₀ or placebo for 12 weeks, those on CoQ₁₀ experienced and average 18 mm Hg reduction in systolic dropping from 165 to 147 mm Hg while the placebo group experienced a negligible reduction of 2 mm Hg. At least 5 clinical trials had similar results. (9)

An earlier double blind, placebo controlled study had similar outcomes when 60 mg of CoQ₁₀ were administered twice daily for 8 weeks to 30 patients and a B vitamin complex was administered to 29 patients: all patients were known to have essential hypertension and were presenting with coronary artery disease (CAD). All patients were already receiving antihypertensive drugs. In the CoQ group both systolic and diastolic blood pressure were reduced along with fasting insulin, glucose, triglycerides, and lipid peroxides. (10)

Other studies replicating these results can be found in a 2010 review article by Marcia Wyman, PharmD. (11)

Improving the HDL Ratio of Total Cholesterol

Lowering Your LDL

Transfats raise LDL and decrease HDL. That is, of course, not the way you want to go. Transfats are heavily used in processed foods in the form of vegetable oils (corn, soy, or safflower). Previous newsletters on GMOs explain that a very, very high proportion of corn and soy crops are GMO, another reason to avoid them.

Health Canada (new window) recognized in August 2012 that "replacing saturated fats with polyunsaturated and monounsaturated fats (from vegetable oils) helps lower/reduce cholesterol.”

Monounsaturated fats include olive oil (always buy Extra Virgin in a dark bottle to prevent degradation), canola oil (which I don’t recommend because so much canola is genetically modified); nuts, seeds, avocados, and olives.

Polyunsatured fats are found in nuts (almonds and walnuts are very good), seeds (chia, flax, quinoa, pumpkin and squash) and oils from sunflowers.

When you cook with olive oil remember “in order to preserve virgin olive oil bioactive components heating time should be reduced to the minimum”. Think about the fact that “as most of its bioactive components, including phenolic compounds, are gradually lost, it is economically advantageous to use lower olive oil grades and frequent replenishment under prolonged thermal processing” i.e. cooking. (14)

Another alternative is to use coconut oil in cooking, especially frying.

The effects of mono-unsaturated fats were assessed in a 2004 study. In a parallel-arm design study, 53 overweight and obese healthy men and women were randomly assigned to a low fat (18% of energy intake) or moderate (33% of energy intake) diet for 6 weeks to achieve weight loss followed by 4 weeks of weight maintenance. For the moderate fat diet monounsaturated fats (MUFA) were used – 50% of the fat consumed in this group was from peanuts, peanut butter and peanut oil – all MUFAs. In the moderate fat diet group HDL (good) cholesterol was unchanged and triacylglycerol and ratios of total and non-HDL to HDL cholesterol were all improved. In other words LDL dropped in the moderate fat diet group while HDL remained constant. The low fat diet did not achieve positive changes in cholesterol; in fact they decreased HDL by 12%, not a good outcome. (15)

In a large scale study a detailed medical and lifestyle history, including diet, was obtained through an interview. 4466 adult participants of the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study were involved. “The wide age range, the availability of data across many centers, and the large sample size are strengths of the study.”

The data showed that the consumption of fruit and vegetables is associated with lower concentrations of LDL cholesterol in a dose-response manner. The more fruit and vegetables, the lower the LDL. (16)

In a 2006 review article in the Journal of Lipid Research Lichtenstein noted that in previous studies “the total cholesterol-to-HDL cholesterol ratio is similar and more favorable for polyunsaturated and monounsaturated fatty acids than for saturated fatty acids. Similarly, observational data suggest polyunsaturated and monounsaturated fatty acid, relative to saturated fatty acids, intakes are associated with reduced CVD risk”. (17)

LEAN

So what’s it mean?

Lifestyle

Education

Activity

Nutrition

Let’s examine some key elements of each as they relate to healthy cholesterol levels. Lifestyle will be covered in the next Newsletter because it is too large to cover here.

Education means informing yourself with evidence–based information. Watch out, because the Internet, magazines, TV, radio talk shows, newspapers, web blogs and many books are filled with superficial and/or incorrect information. The old maxim Caveat Emptor – Buyer Beware definitely applies in the Information Age. Sure you can find information on any topic at the click of a mouse. But you really need to be sure that it is accurate and valid – that it is evidence-based. That is why I make every effort to provide you with the findings of scientific medical research found in peer-reviewed medical journals.

Activity can assist in lowering lipid levels. Exercise is known to improve lipoprotein levels, whereas an elevated body mass index (BMI) is associated with less favorable lipoprotein levels.

This study by Garry and McShane evaluated the lipid-lipoprotein profiles in a group of 70 professional football players from one NFL team to determine the association between these profiles and the players’ BMIs. Measurements included BMI (kg.m-2 ), and fasting serum lipid analysis. Linemen have the highest mean BMI, 38.1 kg.m-2 . Comparing mean lipid values among BMI categories demonstrated lower HDL, higher triglycerides (p<0.005) higher total cholesterol/HDL ratios with an increasing BMI. They concluded that among the elite athletes in this study with the highest BMIs, exercise may not confer the same protective benefits on cardiovascular risk as it does in those athletes with normal BMIs. (18)

Both uphill and downhill exercise were shown in a small (45 people) randomized, crossover study to be heart healthy with some differences between the two forms of exercise (concentric and eccentric respectively). The sedentary, non-diabetic subjects were randomized to 2 months of hiking up mountains (gondola down) or to hiking down mountains (gondola up) at least 3-5 times per week. After 2 months the tasks were reversed for each group. Triglycerides were lowered only by concentric exercise (uphill) and glucose tolerance was most improved by eccentric exercise (downhill). Uphill exercise reduced LDL cholesterol by 10.2% and downhill by 8.9%. Other forms of concentric and eccentric exercise should produce similar results. (19) So hike up and hike down. Steep hills would be an option. Come live in White Rock, North Vancouver or San Francisco and walk everywhere.

Physical activity throughout life reduces the risks for cardiovascular disease. A study by Sandrock et al in the 2008 British Journal of Sports Medicine compared a number of indicators between two groups of men. One group of 51 men (mean age 64.48 years) had been physically active throughout life; the second group of 50 men (mean age 64.37 years) had not been physically active. All the men in both groups were “healthy”. There was a significant difference between the two groups (in favour of the active group) on a number of measures – LDL cholesterol and triglyceride levels, roughness of intima-media, atherosclerosis in the common carotid artery. (20)

A meta- analysis in the same journal covering 459,833 participants (male and female) who were free from CVD at the outset, were followed for walking patterns. A total of 19,249 had died by follow-up. The analysis showed that those in the highest walking category had 0.69 the risk of those in the lowest walking category. The best results were more highly linked to those who walked faster than to those who walked the most. (21)

A 2008 study at McMaster University involved 28 older men and women (mean age 68.5 +/- 5.1 years) in whole body resistance training for 14 weeks. Prior to and 72 hours after the last exercise routine biopsies were taken from the largest part of the thigh quadriceps muscle. Urine samples were also taken. No changes were noted in the mitochondrial DNA. An increase in complex IV of the electron transport chain (see CoQ₁₀ above) suggests increased antioxidant effect as a result of this exercise regimen. (22)

These studies and others illustrate the importance of exercise throughout the life span, from childhood to the 90’s. So wherever you are it’s not too soon to start and it’s not too late. But the sooner you start the greater the benefit throughout your lifespan.

Nutrition, you might have noticed, is a big part of what is already covered in this Newsletter. Your food selections have a lot to do with cholesterol (HDL, LDL and other forms), homocysteine and triglycerides.

Think of the old ditty about computers: GIGO – Garbage In Garbage Out. While that’s true of computers it’s also true of our bodies, except that the Garbage Out part refers to the garbage that after processing by our digestive system, goes to our cells. If you’re sleepy after eating it’s likely that you are practising Garbage In, or you are simply consuming too much food.

A good rule of thumb, in food choice, is to shop around the perimeter of your supermarket where the whole foods, including fruits and vegetables are usually found. Stay away from the rows of aisles in the center where the processed and junk foods are found.

The Take-Aways

Yours in health and wellness.

Roger

BTW Want to support moms fighting against GMOs? (new window)

Footnotes

2. Lancet 1995; (345):85-89

3. Am J Cardiol 1999; 83:821-5

4. Lancet 2000; 355(9203):517-22

5. Am J Clin Nutr 2007;86:324 –33

6. Am J Clin Nutr 2011:93 (2) 243-252

7. J Am Coll Cardiol 2011;58(20):2047-2067

8. Lipids 1989 24(7):579-84

9. South Med J 2001; 94: 1112-1117

10. J Hum Hypertens 1999 Mar;13(3):203-8

11. Cleveland Clinic Journal of Medicine July 2010 vol. 77 7 435-442

12. Circulation 2004; 110: 227-239

13. J Hypertens Suppl. 1994;12(7):S23-31

14. Food Research International 2013 (54):2016–2024

15. Am J Clin Nutr 2004;79:204-212

16. Am J Clin Nutr 2004:213-217

17. The Journal of Lipid Research, 2006; (47):1661-1667

18. Prev cardiol 2001; Summer 4(3): 103-108

19. AHA 2004 Scientific Sessions :Abstract 3826 (Nov 10)

20. Br J Sports Med 2008; 42:839-844

21. Br J Sports Med 2008; 42:238-243