HIGH CHOLESTEROL

ELEVATED BLOOD CHOLESTEROL IS ONE of the most common medical conditions. This blood chemical plays a major role in atherosclerosis, heart attacks, strokes and other life-threatening health problems. So keeping watch over your own levels of cholesterol and a similar group of chemicals called triglycerides is an important step in staying healthy.

Since you can't 'feel' your own levels of blood fats - and because they can change slowly over time - you may have no idea that they're high. It's becoming increasingly common for older people to know their own cholesterol and triglyceride levels, but, for other high-risk folks, it can be important to be tested regularly, starting as young as age 19.

What is cholesterol, anyway? It's no more than a special type of fat, one required by every cell in the body to function properly. Approximately 25 per cent of your cholesterol supply comes from your diet; the other 75 per cent is manufactured in your liver. When your body is working as it should, it burns dietary fat for energy and uses cholesterol to manufacture hormones (such as oestrogen and cortisone) and nutrients (such as vitamin D). However, when your body makes excessive cholesterol or triglycerides, or its systems for disposing of the excess are inefficient, these blood fats build up along with calcium deposits, clogging and hardening blood vessels.

You've probably heard low-density lipoprotein (LDL) referred to as 'bad' cholesterol, and high-density lipoprotein (HDL) referred to as 'good' cholesterol. That's an oversimplification, but it's essentially true. LDLs carry the type of cholesterol that can build up in the arteries; the cholesterol that HDL carries actually reduces heart-disease risk by removing fats from the bloodstream.

Researchers have discovered that it's not the amount of cholesterol, but the ratios of total cholesterol to HDL and of triglycerides to HDL that matter most. In both cases, the lower it is, the better.
Millions of prescriptions are written every year for drugs that lower blood cholesterol and triglycerides. While these drugs may reduce your risk of high blood fats giving you a heart attack or stroke, studies haven't proven that they'll increase your life span. Your best bet for lowering cholesterol is an approach that combines dietary and lifestyle changes with other natural remedies - plus cholesterol-lowering drugs if your doctor thinks it's critical to lower your cholesterol quickly.

THE VITAMIN THAT'S A DRUG
Since the 1950s doctors have prescribed niacin, or vitamin B„ for lowering cholesterol. The dosages recommended - 500 to 3,000 milligrams per day - make this use of the vitamin more like a drug. Niacin lowers not only total cholesterol but also LDL, triglycerides and fibrinogen, a blood protein responsible for clot formation. It also raises HDL levels. Pure, crystalline niacin can cause a harmless but unpleasant flushing reaction. Taking an aspirin tablet before taking niacin, or using timed-release niacin, can prevent flushing. There have been reports of liver damage, however, with some forms of timed-release niacin. It should probably be avoided for this reason.

A better choice is inositol hexaniacinate, which is niacin bound to inositol, a B-complex-like vitamin. This substance has been used for years in Europe and appears to avoid niacin's side effects on the liver. All forms of niacin have side effects for some people, so consult your doctor to calculate a dosage.


DOING THE NUMBERS
What should your cholesterol levels be? Agencies and researchers are continually revising their recommendations. Here are the current guidelines.
· Total cholesterol: below 5.5 mmol/L
· LDL: below 3.7 mmol/L
· HDL: above 1 mmol/L
· otal cholesterol to HDL ratio: less than 5
· Triglycerides: below 1.5 mmol/L
· Ratio of triglycerides to H DL: controversial, but some experts recommend
a ratio of less than 3

FIRST THINGS FIRST
You've surely heard it before, but it remains as true as ever: the single most important natural way to lower a high cholesterol level is to change your diet. Reducing your intake of saturated animal fats can help. Cut back on high-fat red meats and avoid fried foods and lard. Replace saturated oils and fats with monosaturated ones, such as olive and avocado oil, and with polyunsaturated fats such as those found in raw nuts, seeds, flaxseed oil and fish oils. This approach can lower LDL levels without significantly lowering HDL levels.
Increase your fibre intake by adding crispy vegetables and fibrous whole grains, especially oat and rice bran. Aim for a total fibre intake of 50 grams or more per day.
Try eating more soya, too. Soya protein and other soya foods have also been shown to reduce cholesterol when included regularly in the diet.
In addition, an exercise programme consisting of both aerobic and weight resistance, performed at least three times per week, has been shown in medical studies to increase HDL levels while decreasing LDL levels.

DRUG TREATMENT
Bile Acid Sequestrants
Colestyramine (Questran), colestipol (Colestid). Function: help the bowel excrete the body's excess cholesterol. Side effects: wind, bloating, constipation, impaired absorption of fat-soluble vitamins; may increase triglyceride levels.

Fibric Acid Derivatives
Gemfibrozil (Lopid), clofibrate (Atromid-S), fenofibrate (Lipantil). Function: lower triglycerides by blocking their production in the liver and activating an enzyme in muscles that breaks them down into simple fats. Side effects: potential liver damage, gallstones, abdominal pain, nausea; possible increased risk for breakdown of muscle tissue and cancer.

HMG-CoA Reductase Inhibitors
Referred to collectively as statins: atorvastatin, cerivastatin and others. Function: compete with the key liver enzyme involved in the manufactureof cholesterol. Side effects: liver damage, muscle aches, nausea, headaches, coenzyme Q10 deficiency, insomnia, fatigue, rashes.

HERBAL TREATMENT

Guggul (from the myrrh tree, Commiphora mukul)
This sticky resin is used extensively in the ancient Indian system of medicine known as Ayurveda. An extract of this resin, called gugulipid, has been shown to lower LDL cholesterol and triglycerides while raising HDL cholesterol. It also appears to protect the heart from damage by unstable molecules called free radicals. Gugulipid is sold as an extract standardised to contain 5 to 10 per cent of guggulsterone, the active ingredient. Typical dosage: 25 milligrams of guggulsterone three times per day with meals. You may have to take it for one to three months for it to have an effect on cholesterol, but guggulsterone appears to have no significant side effects and it can be taken long-term.

Artichoke (Cynara scolymus)
The artichoke plant's leaves and roots contain a chemical called cynarin. This substance blocks the absorption of cholesterol in the intestines and inhibits its production in the liver. Cynarin also affects triglycerides; in one medical study, patients saw their triglycerides drop after six weeks of use. Similar to its cousin, milk thistle, artichoke appears to assist the liver in breaking down toxic chemicals. Although eating artichoke leaves on a regular basis can definitely help lower cholesterol, to get a more consistent effect, use a powdered extract. Typical dosage: 500 to 3,000 milligrams per day, divided into three doses, taken before meals. Caution: Do not use if you have gallstones or gallbladder problems.

Garlic (Allium sativum)
This pungent bulb has been used medicinally in many cultures for more than 3,000 years. Its active ingredient is a compound called allicin; sometimes you'll see products standardised to a particular percentage of this chemical. Garlic inhibits at least two of the enzymes involved in the production of cholesterol by the liver, thus lowering cholesterol synthesis. Typical dosage: 1 to 3 raw or briefly cooked garlic cloves per day; or in tablets or capsules, enough to total at least 4,000 micrograms of allicin potential daily.

Psyllium (Plantago ovata)
The seed of the psyllium plant is rich in mucilage, the soluble fibres similar to those found in oat bran, flaxseed meal and guar gum. Traditionally used to treat constipation, research shows that psyllium seed also reduces high cholesterol and triglyceride levels. Exactly how it does this isn't known, but it appears to bind with dietary cholesterol and fat to prevent their absorption. It also binds bile acids and prevents their reabsorption in the intestines, thus taking cholesterol out of circulation. Psyllium needs to be consumed quickly, because, once you combine it with water, it quickly thickens to the point of undrinkability. Typical dosage: 2 to 4 teaspoons of powdered seed or 1 tablespoon of the ground seed husks dissolved in 1/4 litre of water, once or twice per day. Caution: may cause wind, bloating or diarrhoea; to avoid these side effects, start with half the above dose and build up slowly.

THE DYNAMIC Duo
Combining garlic with fish oil (such as salmon or cod-liver extract) has been shown to increase the effectiveness of both products in lowering LDL cholesterol and triglycerides. A typical dosage of fish oil might be 1,000 to 3,000 milligrams per day.