Nutritional Protocol for Hypercholesterolemia

A diet rich in plant-based foods (vegetables, fruits, whole grains and legumes, high in mono-unsaturated fatty acids and omega-3 fatty acids, and low in arachidonic acid (saturated animal fats) has been shown to greatly reduce the risk of mortality from CAD [1,2].

Niacin is often thought of as difficult to use and somewhat dangerous. While some forms of niacin (slow-release) can be hepatotoxic, the non-flush form (inositol hexaniacinate) is well-tolerated and has great therapeutic benefit. In the famed Coronary Drug Project, niacin was the only cholesterol-lowering agent that reduced overall mortality. Even 15 years after stopping supplementation, the benefits of niacin supplements were evident [3]. Niacin has been shown to affect multiple aspects of atherosclerosis, including lowering overall cholesterol, lowering LDL, raising HDL and lowering lipoprotein (a) [4].

Since most cholesterol synthesis occurs during sleep, inositol hexaniacinate should be taken just before bed [5]. Dosing begins with 500 mg/day, increasing the dose by 500 mg every two weeks until the therapeutic dose of 1500-3000 mg/day is achieved. If after three months, cholesterol levels are normal, withdraw inositol hexaniacinate. If cholesterol remains high, consider including guggulipid in addition to niacin. Liver enzymes should be checked before ensuing the protocol and every three months. No one with pre-existing liver disease or elevated liver enzymes should be given niacin in any form.

This is the stable form of pantothenic acid (B5), the most important component of Coenzyme A (CoA). CoA is essential for the utilization of fats within the cell. Pantethine (not pantothenic acid) has been shown to be effective in lowering blood lipids, especially triglyceride levels [6,7].

Both garlic and onion impact atherosclerosis at several steps. In several studies, the supplementing of garlic at doses of 10 mg of alliin or a total allicin potential of 4000 mg can lower total serum cholesterol by about 10-12%, LDL by 15% and increasing HDL by10% and a reduction of triglycerides by 15% [8,9].

The guggulsterone fraction of gum guggul was shown to exhibit impressive anti-inflammatory and hypocholesterolemic activity. The standardized extracts (E-guggulsterone and Z-guggulsterone) are well-tolerated with no known side effects. Guggulipid is also appropriate for the rare patient that cannot tolerate inositol hexaniacinate. Dosing is 25 mg, three times per day of guggulsterones is effective for elevated cholesterol, elevated triglycerides, or both [10].

Ascorbic acid (Vitamin C) works as an antioxidant in aqueous solutions, both inside and outside of the cell. Along with Coenzyme Q10, it regenerates vitamin E (the primary fat-soluble antioxidant) in the body. Even in smokers, vitamin C is extremely effective in preventing oxidation of LDL [11]. Vitamin C supplementation at 500 mg/day along with 272 IU/day of vitamin E for six years was demonstrated to reduce the progression of carotid artery atherosclerosis by 53% in men and 14% in women [12]. Taking high doses of vitamin C can cause diarrhea. This usually happens in doses above 2500 mg/day.

There are conflicting studies regarding vitamin E and its ability to prevent LDL oxidation even though it has been clearly demonstrated that vitamin E is able to become incorporated into the LDL molecule. The higher dosage of vitamin E, the greater degree of protection from oxidation. Most researchers agree that 400 IU are needed to get clinically significant effects [13,14].

Given the large number of patients that cannot tolerate statin drugs, combined with the serious side-effects they are associated with, alternatives for dyslipidemia are more attractive than ever. These alternatives can provide equal and sometime superior effects than statin drugs alone. Considering cost, safety and efficacy, practitioners can be confident that using these alternatives may provide more desirable outcomes.

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