An Open Letter to Benecol

As a cholesterol discussion moderator, and blogger I've made a decision to discontinue purchasing and recommending your products.

I've made this decision for several reasons:

1. You've cut the amount of plant stanols in your product in half, requiring users to ingest twice as much fat to get the same amount of plant stanols. Same price, less efficacy, and ultimately less healthful.

2. You've eliminated your smart chew product, with which a customer could supplement your margerine without adding additional fat to the diet.

3. Your advertising insists that you are trans-fat free. This is dishonest. Your labeling doesn't require listing the small amount, but that's not the same thing as being trans-fat free. Your customers have a right to know.

Plant Stanols can be a significant adjunct to lowering cholesterol, but your current product set, and poor business ethics prompt me to disrecommend Benecol.

Regards,

Mark Tyler

New Discussion Board

I've finally started my own discussion board at:

http://p201.ezboard.com/bloweringcholesterol

I say, "finally", but actually I'd no intention of doing so, until the discussion I was at at Natural Pharmacy's site simply became too annoying with the spam.

Join the Under 150 Club!

Cholesterol worrying you? Here is the bottom line:

CONSISTENTLY maintain your total cholesterol below 150mg/dl.

That's it.

Do it with Scientology, Cheeseburgers, Waiora, Lipitor, or "eat sensibly" as you wish.

The bottom line is, that consistently below 150mg/dl your chances of heart disease are nearly ZERO. Above that, the odds go up, _always_.

There is a huge amount of data to demonstrate the above.

Yes, there are exceptions: some people can bench press 350 lbs, some people survive car accidents because they WEREN'T wearing seat-belts, and some people will live to be 100 eating bacon and eggs every day with a cholesterol level of 220.

I'm in the second group by the way. I actually survived a car accident in my youth BECAUSE I wasn't wearing a seat-belt. For years afterwards I refused to wear one because of that. I'd discovered for instance that a small minority of people are actually killed BECAUSE they wear seat-belts.

Who knew? They don't advertise the stats, but its true. However, _nearly_ all of the time, seat-belts save lives and reduce injuries. Ultimately, I decided to join the group with the numbers on their side, and I wear a seat-belt.

So, you want to eat a cheeseburger? Fine, and good luck to you, but I urge you to do it with your eyes open.

Changing the Cholesterol Landscape

Reversal of Atherosclerosis in order to avoid CHD is a tricky business. Most can achieve it with a severe vegetarian diet a la Ornish, Esselstyn, etc, but some can only achieve arrest, and of course the vast majority of people aren't even aware that it can be done at all.

A new class of drugs could change that. Torcetrapib is one of a new series of drugs that will come online in the next 3-5 years. This drug is the first to directly increase HDL levels by interfering with a protein that decides whether LDL or HDL will be formed. Currently all methods of raising HDL are indirect, and usually involve lowering triglycerides.

Interestingly, the research for this new class of drugs started by examining people with very high HDL levels to see why they were the way they were, and this is the first result.

Here is why it may change the cholesterol landscape:

Right now Ornish type diets starve the body of saturated fat, and eliminate dietary cholesterol. This has the result in most people of drastically lowering LDL levels. TC/HDL ratios are significantly improved too, but HDL is often lowered along with LDL.

Dr. Caldwell Esselstyn's experiment showed that using diet and drugs to arrest and reverse atherosclerosis by lowering total cholesterol below 150mg/dl effected reversal, but HDL levels were below the normal range.

The reversal effect of such a regimen provides a maximum 2-5% per cent arterial diameter increase after one year, and in some cases only an arrest of progression is seen.

What if the Reverse Cholesterol Transport (RCT) mechanism that is HDL could be significantly enhanced at the same time that significant levels of LDL reduction occured? Might not the reversal effect be significantly enhanced?

I propose that this, "Drano Effect", might be accomplished with a cocktail therapy approach combining Ornish diet, nutriceuticals, and pharmaceuticals to effect a significant clearing of atherosclerotic plaque.

Who after all, would care to postulate that the reversal seen in Dr. Esselstyn's trial wouldn't have been enhanced if the average HDL level had been 74 instead of 37?

A tool that directly enhances HDL may not cure on its own, but enhancing the RCT mechanism in conjunction with existing therapies might engender regression levels previously unseen.

Activated Charcoal

I've been doing some research into activated charcoal as a cholesterol lowering agent.

A first look showed that studies began in earnest some 20 years ago, and showed it to be a promising agent that lowered cholesterol nearly as much as cholestrymine, or roughly 30% LDL reduction.

That is a lot, and easily as much as a typical low dose statin.

So, what is the catch, and why is activated charcoal virtually never discussed?

First, activated charcoal works in much the same way that all current natural remedies (that are understood) work, by clearing cholesterol from the gut.

In this case, cholesterol isn't blocked as in sterols/stanols, or binded to food as in soluble fiber, but absorbed directly into the activated charcoal, although some binding may occur.

It also means you want to take before or after meals, because that is when the largest amounts of bile acids are generated.

The charcoal does its thing and then exits the colon along with the bile acids containing cholesterol, and levels of the latter are thereby reduced.

Side effects are black stool, which is a visual thing only, and really only counts if you're big on checking out your stools. The product is supposed to be essentially inert and move directly through your digestive system, which doesn't quite explain why some get blackened teeth...ugh.

Finally, you need to be careful when you take it, because if you take other meds, it may absorb them and eliminate their function. This appears avoidable with some planning.

All of the above can either be avoided or put up with by most I think, but there is something that may be more difficult to get over...

The taste.

I haven't tasted it yet, but it can't be a real treat. There are two ways to take activated charcoal, by capsule, or by slurry. Capsules are usually in 1/2g form which means you need to take about 60 capsules per day.

Another problem with capsules is that they take time to disolve, and can minimize the effect therein.

A slurry OTOH is a direct mixture of activated charcoal powder stirred up in water and immediately drunk.

The powder dissolved in water immediately goes to work, and the effect is immediate and likely very unpleasant.

Finally, there is no long term testing on what ingesting activated charcoal does over the long haul, although it has been used as a folk remedy for generations, and is likely safe.

Still, a combination of bad taste, long term use concerns, and fears over its effects on other meds make it a second choice at best behind soluble fiber or stanols...and yes maybe even sterols.

Still, there it is; an over the counter, cheap, natural cholesterol reducing agent, that btw is a dandy remedy for thousands of organic poisons too.

The Sterol/Stanol Crisis

Plant Sterols and Plant Stanols have been a huge part of the nutriceutical scene in lowering cholesterol. In the U.S. we have margerines, candy chews, orange juice, and you can get a variety of capsule products.

However, a shadow now clouds the plant sterol part of this story. It has been known for some time that plant stanols are nearly unabsorbable by the human body, but that plant sterols are about 10 times more absorbable.

This didn't seem to alarm anyone, or deter the scientific community from recommending plant sterols, although some scientists did indicate a preference for plant stanols.

Now that situation may be changing. A recent study has shown plant sterol build-up in arterial plaques. What does this mean? Nobody knows for sure.

One distinct possibility though is that by ingesting plant sterols, you may simply be replacing one sterol for another, and be getting the same negative effect in your blood...this time without being able to detect it.

Key questions that I would like answered are:

1. Are sterols absorbed as easily as cholesterol?
2. Are sterols when absorbed as atherosclerotic as cholesterol?
3. When plant sterols absorbed, are they showing up in cholesterol tests?

Right now plant sterols are off of my menu. The fact is, they never were on my menu. After my initial research indicated that plant stanols were equal or superior in cholesterol lowering, and virtually unabsorbable, I decided not to go in the direction of plant sterols.

I will be monitoring this issue closely. There are far more plant sterol products on the market than plant stanols. In fact, I can find none at all except for those marketed by the Benecol company.

The problem is, that here in America, because of poor sales, Benecol only sells one product: margerine. It comes in a light, and a cooking version, but that is it.

They had been marketing "smart-chews", which are a candy chew that each contains 1 serving of plant stanols. Unfortunately, they didn't sell well, and they're being discontinued.

So there you are, at a time when plant sterols are coming under fire, Benecol has chosen to narrow their product line!

I've ordered an entire years supply of chews (2 per day) so that I have time to work through the plant stanol/sterol issue, and make adjustments.

I use the margerine products, but when you're on a very low fat diet, its an incredible burden adding in more than a single serving.

I've upped my soluble fiber in an effort to partially compensate for the lower dosage of plant stanols, but soluble fiber is more difficult to take in large quantities, even though its fat free.

Am I disrecommending plant sterols? For the time being yes. With sterols showing up in plaques, its difficult to argue that sterols aren't a burden on the RCT (Reverse Cholesterol Transport) system, and that makes them theoretically no better than ingesting cholesterol, unless more cholesterol is being inhibited than sterols absorbed (everything else being equal).

On the positive side, it may prove that sterols inhibit more cholesterol than gets absorbed. It may also prove out that sterols are not as atherosclerotic in the body as cholesterol, so that they provide a net loss in cholesterol, sterol or otherwise. However, until we know for sure, the treatment now has a big question mark hanging over it.

Benecol discontinues Smart-Chews

Due to poor sales, Benecol has quietly eliminated smart-chews from their product line.

Smart chews were small fat free (but not sugar free) candies that each contained a full dose of plant stanols. They allowed me to augment the use of spreads and get 4-5 doses a day without going over my fat quotient.

Benecol hasn't announced any replacement, and there are virtually NO plant stanol products produced by anyone else that I can find.

I'm still continuing that search.

This is not a good day for people trying to control their cholesterol.

Plant Sterols may be Atherogenic

There is new evidence to suggest that plant sterols used to reduce cholesterol levels, may actually contribute to atherosclerosis.

See article at: http://www.news-medical.net/?id=10846

New studies indicate that while plant sterols lower cholesterol, they are absorbed by the body and are being found in arterial plaque.



Plant sterols are a naturally ocurring substance found in very low levels in plants.

The role of plant sterols in atherosclerosis isn't yet understood, but it does cast a shadow on the use of plant sterols in large doses in food supplements to lower cholesterol.

Might they be doing as much harm as good? We don't know yet.


On the othe side of the coin, plant stanols are virtually unabsorbable by the body, and to date, plant stanols have not been detected in arterial plaque.

That's the good news. The bad news is that plant stanols require more processing, and they are very hard to find in the States with the exception of Benecol spreads. Benecol currently offers a fat free product, but they are discontinuing it because of poor sales.

Plant sterol products on the other hand, are very easy to find.

The Next Goal

Having maintained my cholesterol level below the 150mg/dl mark for three tests in a row, which translates to at least 9 months, means that I've met my initial goal. My latest reading being 116mg/dl.

So, its time for a new one.

For my next trick, I'd like to maintain a cholesterol level below 130mg/dl while reducing my Lipitor from 80mg to 10mg.

Liptitor 10mg will generally lower LDL by 37%, and 80mg will lower by 51%. That's about a 14% difference, while taking only 1/4th the medication.

Therefore, it seems likely that I could drop to Lipitor 10mg right now and still be under...barely under 150mg/dl. That means I need to drop something like 15-20 additional points to meet my goal of staying under 130. That's a pretty tall order.

I'm going to obviously need to add an additional nutriceutical to take the place of most of the Lipitor. Policosanol is probably a non-starter, which is why I quit the stuff.

I'll have some idea in 3-6 months if Teaflavin is actually doing anything or not. I'm still taking it, but I've dropped the Policosanol, so I'll be able to verify that the Policosanol did/didn't work and move forward.

The trouble is, I'm already taking the most powerful nutriceuticals now.

There is some sort of extract from the rind of tangerines that looks promising, and activated charcoal seems to be promising. However, I'm not sure if I feel more comfortable ingesting stuff that I usually grill with. Even if it lowers my cholesterol, who the hell knows what else it'll be doing?

Weight loss could result in about 4-5 points once I get down to normal weight (I'm 33 pounds off the mark even though I'm down well over 30 pounds from my high weight).

Most of what I've been doing has been to clear cholesterol from my small intestine along with bile and force my liver to produce more bile, while medicating to reduce cholesterol production in the liver. However, I think I may be starting to reach the upper limit of what that can do.

Time to put on my thinking cap.

Woohooo! 116 Total Cholesterol!

I have finally achieved the holy grail in cholesterol reduction. I've crossed below the 120 mark, and I've lowered my cholesterol more than 2/3's below the starting baseline of 351.

I no longer need to lower my cholesterol, I only need to maintain it.

What did I do more right this time than 3 months ago? So many things that its hard to sort out which did what.

First, I maintained diet much better, although exercise was minimal.
Second, I increased my Lipitor from 40mg to 80mg, however it should be noted that doubling dosage usually results in very minor reductions.
Third, I doubled my Benecol intake by using their chews to increase my dosage to maximum on the one hand, while actually reducing my fat intake on the other.
Fourth, I introduced Teaflavin GTE (Green Tea Extract), and..
Fifth I added 10mg per day of Policosanol.

I figured the Lipitor would take me down from 137 to 130 all by itself, and that improved diet might just let me creak in to the 120's, but you don't get 21pts off by accident.

My working theory is that the extra Benecol in conjunction with the Teaflavin did the trick. I can't be sure, but I think the Policosanol is a phony, and I've stopped taking it. My supply is about out anyway. The Teaflavin though, I'll continue, along with the increased Benecol. I'll also stay at 80mg of Lipitor for the time being, although as my weight continues to drop I'm going to consider cutting back to 40, and who knows, maybe I'll even be able to get away with 20mg.

For now, I'm enjoying a victory lap. This level of total cholesterol puts me into a very low risk level for CHD!

Ornish and Esselstyn

If you're not familiar with Dr's Ornish and Dr. Esselstyn, then you're missing a huge piece of the puzzle in solving your cholesterol problems.

Both of these men (and some others) came to similar conclusions more than a decade ago. That conclusion is, that although there are still aspects of atherosclerosis related heart disease that we may not understand, we do know all that we need to in order to eliminate about 95% of it.

Both of these men have authored en vivo studies that show a vegan diet arresting and even reversing atherosclerosis and preventing heart disease.

There is essentially one important difference between them. Dr. Esselstyn believes that the vegan diet is a healthy means to an end, and that end is consistently maintaining a healthy cholesterol level below 150mg/dl.

Dr. Ornish on the other hand believes that although cholesterol lowering is key, it is the intrinsic value of the vegan diet (and other parts of his approach) that provide reversal. The former will prescribe drugs to reach the 150 figure, the latter will not unless the patient cannot adhere to the vegan regimen.

Ornish may indeed not be imoveable on the issue of medication, he does in some cases prescribe it.

I think Esselstyn has the stronger position here from the individual patient's perspective. If you're following a vegan diet, and your cholesterol is above 150, or even above 200 the diet may protect you anyway, but if you can safely take meds to put your numbers below 150 where statistics say a heart attack is unlikely...why wouldn't you?

Benecol Update

I have recently (as noted in my recent regimen update) increased my Benecol dose to 4g per day.

Reading through research as well as the marketing info at Benecol led me to the following analysis and conclusions:

The 2/2.5 servings a day I was takin were giving me between 1.7 and 2g per day. Research seems to indicate that benefits top out around 3g, and the Benecol folks say 3.4, a number often parroted in research papers. Anything above that apparently doesn't provide much additional effect.

Assuming that the Benecol folks are right, then I still had some benefit I wasn't taking advantage of. However, even two servings of Benecol margerine puts 100 to 140 calories of fat into your diet. If you're trying to restrict your fat intake to well under 15%, then 4 doses of margerine (that's 4 tablespoons of pure fat)... isn't supportable, even using the light version.

What to do? Well, Benecol has non-fat "chews" that each contain a full serving of Benecol: .85g. There are a couple of problems though:

First, each Benecol chew has 3g of sugar. If like me, you're sensitive to sugar in your diet, that's an issue.

Secondly, some studies indicate that benecol is not suspended in fat, it has no beneficial effect whatsoever! There are however, a few studies that indicate that benecol when taken with a meal...whether it contains fat or not still works.

So, what I decided to do was to incorporate the chews into my diet in order to bring my stanol ester dose up to 4g, so that I might see additional benefit without adding additional fat. I do this by taking a chew after I've had a serving of Benecol margerine so that I'm taking it with food that contains a quantity of fat.

In other words, I'm trying to make the margerine give me a two-fer. Now, I say I'm taking 4 grams, but I often go as high as 6g., taking chews with non-benecol meals as well. I do this because if fat free benecol is less effective, then I need more to get the same effect as 3.4g of Benecol margerine. Alright, I also like the damn candy, okay?

Now, with shipping, these candies cost about 40 cents a chew. Considering how small they are, that's a lot more like medicine than candy. Still, how much would you pay NOT to have a zig-zag scar down the middle of your chest. I've made my decision.

The Cholesterol Wilderness

It's a lonely business trying to lower your cholesterol and get healthier. Doctors aren't always up to date with current therapy, and in any case won't give you more than a couple of minutes of their time to consider your life and health.
That's not good enough. I want a whole team at John's Hopkins working around the clock. Not gonna happen.

Then came the Internet. Meddling laymen like myself can journalize their knowledge and concerns, and we can even get snippets of actual knowledge online. I say snippets because JAMA and other journals don't think you should get medical information unless you're a professional, or pony up to get access. Okay, bills have to be paid. Nevertheless, an amazing amount of information (and disinformation) and opinion are available along with the strides science is making.

This online data and the general lack of a connection with our doctors is leading many to do their own research, and to some degree, their own medicating.

But self medicating is BAD! We aren't professionals, and the natural supplements aren't always tested, not always approved...you know...like Vioxx was. Okay, that last example is a little extreme, but if your Doctor is NEVER going to give your situation careful examination...and he isn't, then you're going to take whatever he gives you and shut up, or you're going to "go rogue" and find your own way.

If I took my doctor's advise, I'd merrily take my statin, cut back on meat and cheese a bit, and we'd both be briefly admiring my TC score of 195, and my LDL level of 120, and speculating that it could be a bit better. Thanks for playing, and see the girl at the front desk.

Today, thanks to my own meddling, my TC is 137 and going down further. My LDL is 71 and I'm on a path that will give me maximum protection from a myocardial event...Something NONE of my doctors ever even discussed with me. Yes, the statins I get are enormously helpful, but they're only one piece of the puzzle...the only piece they have time for.

Your doctor gives you the same advice that the 911 operators gave people in the Twin Towers...just stay put, help is on the way. That advice was never right then, and its not right now.

If you care about your health, wake up and take charge of it, because your doctor can't even pretend to care enough to help you. Get informed, try to think like a scientist. Find out what works and what doesn't. Make fixes in your diet and supplements and get your cholesterol down so low that heart trouble is what you WON'T have to think about.

I admit that I obsess about this subject. I have too, my doctor doesn't have the time.

Drugs and Natural Supplements

I've a problem with modern medicine. It's either too modern, or not modern enough, I don't know which.

When I was in health class in high school I was taught that many of these so-called natural medicines are made by quacks. Our instructor brought forward various products that he'd gotten hold of, and showed us how silly and worthless they were. Got it. Avoid quacks, stick with medicine.

Fast forward to 2005: There are still a lot of quacks out there peddling natural supplements that either do nothing, or even do harm...phen phen and so forth. OTOH, it has also become quite clear that some natural supplements do what they say they'll do.

Take Omega 3 fish oil for instance. I know it works, scientific study says it works, and no major drug company cares. If you want it, you have to go to secondary "natural supplement" providers. That's okay, but I'm conservative enough that I'd like to get mine from Merk and Pfizer. Why? So that I can get the same comfort factor all of those Vioxx takers get apparently...lol.

Seriously though, Omega 3's clearly produced a profound lowering affect on my trigs, but no doctor had ever suggested taking them even though I had a serious trig problem and scientific study showed both safety and efficacy.

What is missing here? I spoke to a doctor recently who had never even heard the term "nutriceutical" before. I should never know more than a doctor does about medicine or treatments of any kind, ever!

Let me make one thing perfectly clear: I am not a drug company conspiracy theorist.
What I do believe, is that the situation with respect to research on natural supplements has changed, and the medical profession largely hasn't caught up with that fact yet. First, because they're conservative, and secondly because they're uninformed.

There are a still a lot of wackos out there peddling snake-oil, but if snake-oil is efficacious, don't you have to consider the remedy separately from the source?

There was a movie called "Lorenzo's Oil" some years ago based on a true story of a boy that developed a serious illness. There was no treatment, and the parent's being very intelligent and motivated set out to investigate the disease and its treatment. Eventually they came up with an oil that completely halted the progression of the illness, but the scientific community wanted to block its usage until thorough testing had been done.

Bottom line: medical science has its agenda, and you as an individual, as a patient, and as a person at risk for heart disease have your own agenda too. There _is_ a disconnect between the professional advice being given and efficacious treatments for high cholesterol and atherosclerosis available to you. It doesn't matter that the disconnect is non-conspiratorial, what matters is that it endangers your health, and you've a responsability to bridge that gap yourself as best you can.

I would never recommend taking any supplement that didn't have a body of science behind it, but some prudent judgments can be made. In the case of cinnamon for instance, I can't be sure that it is lowering my cholesterol, and I am monitoring the internet and waiting for additional data. In the meantime, I take 1 tsp a day. Cinnamon is non toxic, and non caloric, so it'll work or not, in the meantime, I'm on the cinnamon train until science tells me to switch tracks. What have I got to lose?

With the caveat that you need to know what you're taking, what have you got to lose?

Update on Current Regimen

Here is my current regimen:

15g soluble fiber with meals
4g Benecol plant stanol esters
375mg GTE (Green Tea Extract)
10mg Policosanol
4 oz. Red Wine
3g pure EPA/DHA
1 tsp. ground cinnamon
40mg Lipitor

My next cholesterol exam will be either early or late June 05.

Diet and exercise are a problem. I eat low fat, but have trouble sticking to it, and I snack high fat snacks and occasionally binge. Exercise has been intermittant, and I've experienced some weight gain.

Policosanol II

Round 2 for Policosanol, and I just started taking 10mg last night.

I'm going to try it for 90 days and then report my cholesterol findings here. The results will be clouded somewhat by the fact that during the same period I started taking GTE (Green Tea Extract). GTE unlike Policosanol has universally shown cholesterol lowering affects. I've not seen a single study that indicated a negative result.

Not so With Policosanol. In taking it I feel a little like someone who just claimed to see BigFoot...a little silly...or at least I think I _should_ feel a little silly.

Further research on my part has been mixed. I'm now aware of 2 non Latin America studies of Policosanol. All were negative with respect to efficacy except for one.
A lab in Quebec did a 4 week test on hamsters...nothing. The Aussies did a 4 week test on rabbits...nothing. OTOH the Russians did a 10 week test on humans, and their results tallied exactly with the Cuban results.

So...so far no human study has turned out negative, but there are almost no human studies outside of Cuba except for Chile and Russia. Why? It's been years since Policosanol was put forth by the Cuban's in study's considered legitimate enough for entry into learned journals?

Critics say its because drug companies don't sponsor such testing since they've no fish to fry as it were. However, those same critics totally overlook the conflict of interest in Havana shouting to the high heavens that sugar cane product is efficacious.

Anyway, as in the case of cinnamon, all testing everywhere indicates that toxicity is virtually non-existant, so I'm giving it a try.

There are apparently some new and hot treatments involving tangerine peels...no kidding. Again, the major drug companies aren't involved, but instead the smaller companies that specialize in natural supplements. More on that in another article.

Policosanol

Okay, maybe I'm starting to go a bit too far here. I was researching new Functional Foods to lower my cholesterol further and came across Policosanol. Hmmm...some 50 studies done...excellent results...nearly as powerful as statins...no side effects...cheap to buy.

So...I've bought some. Its on the way. Meanwhile I did some additional research. It turns out that of the 50 or so studies done, about 45 of them were done in Havana, Cuba. Now...Policosanol is made from the wax of sugar cane, the number 1 export of Cuba. Starting to get the picture?

I can only find 4 studies done outside of Cuba, two in Chile and Argentina that had similar results to Cuba, and 2 in Australia and The Netherlands that returned negative findings.

I can find no U.S. studies, and no other euro or asian studies. I am therefore disturbed that Policosanol appears to lose its cholesterol lowering abilities outside of Latin America.

The two negative studies were small ones to be sure, but they concluded that there is no beneficial effect whatsoever from Policosanol.

Now I'm not sure what to do. I'm looking for more info, but I'd really like to see the stuff work outside of Castro's hometown before I start using it.

Do you miss breakfast?

...By God I do. Bacon and eggs: death on a plate...I love it...can't have it, or at least only once in a blue moon.

What to do? Well, I've found a tolerable substitute. It's a faux version of Macdonald's Egg Mcmuffin. I call it...EGG McGuffin. The goal is to minimize fat intake while preserving as much flavor as possible.

Here it is:

Egg McGuffin

2 slices of low fat whole wheat bread: 120 cals, 10 cals fat.
1 egg beater: 30 cals, 0 fat.
1 slice Kraft fat free cheese: 30 cals, 0 fat
1/2 serving Benecol Margerine (cooking kind) 35 cals, 35 fat
1/2 slice Morningstar veggie bacon 15 cals, 10 cals fat

Total calories: 230, fat 55. Saturated fat: <1g no trans fat. <5mg cholesterol.

The fat content is still a little high, but the saturated fat content is low, and the Benecol provides some help to those using it to lower cholesterol.

Directions,

Melt the Benecol in a small non-stick pan and add 1 egg beater. Season egg beater with salt and pepper to taste over low/medium heat. Toast bread, and microwave 1/2 slice of Morningstar veggie bacon on a paper plate for 1 min.

Place the egg on the toast. I like to dust a bit of butter buds on the egg to give it a little extra help, then I add the cheese, the bacon, add the top slice of toast, slice and serve. Mmmmmmm just like Mom never made!

Throw caution to the wind and fry up some potatoes O'brien in another 1/2 tbsp of Benecol and have yourself a good guzzle.

New Results, New Challenges, New Ideas

New Results, New Thoughts, New Challenges

I just got my latest cholesterol test results verbally. That means I haven’t actually seen my liver panel results, although I’m told that I’m within the normal range. That’s good news.

The cholesterol news was less good.

First let me set the stage. I’ve done a terrible job over the last 3 months of maintaining the low fat diet that I had been on, I’d reduced exercise levels, and my weight increased by about 10-15 pounds. On top of that I’d quit my Zetia while maintaining Lipitor 40.

My stupid moronic cretinous EX doctor didn’t help by sending my results to a different lab. That means I not only have to contend with diet, exercise, and nutriceutical changes, but inconsistencies between lab work.

As recounted elsewhere, I’ve dropped my Zetia because I’ve intuited that it wasn’t doing much. I based this decision on the fact that I already use two other agents to inhibit reabsorption of cholesterol into my bloodstream from my intestine. I use Benecol and Metamucil to inhibit and clear from my intestine, and a third (expensive) agent to work that same system seemed overkill. My goal was originally to measure at three months and see if it was true.

Unfortunately with a lower adherence to my diet and exercise plan it’s more difficult to gauge. Oh, and one more thing: I added cinnamon to my regimen.

My earlier results were:

TC: 134
LDL: 66
HDL: 47
Trigs: 103

Yesterday’s results were:

TC: 137
LDL: 71
HDL: 37
Trigs: 144

There is simply no way to gauge exactly what happened, but I can try and make some inferences.Zetia is supposed to inhibit trigs somewhat, and cinnamon is supposed to provide its most dependable benefit by lowering trigs about 30%. That didn’t happen in spades. On the contrary I had a 40% jump in the wrong direction.

Most interestingly, if you divide the 41 extra trig points by 5, you get 9 (and a bit). Add 9 to my new HDL score of 37 and you get 46 which is only one point off what my HDL score was last time.

I’m going to assume there is nothing accidental about that. My trigs went up, and my HDL dropped like a lead balloon. And the seesaw effect is almost exact.

If I were to pick a reason for my trigs going up it would be a significant increase in sugar during the last 3 months. Sugar is my nemesis, I love it, I crave it, and when I eat it I have a hell of a time maintaining diet. It’s also a simple carbohydrate that cranks trigs up and incurs a significant insulin response. Insulin inhibits the production of HDL. Crap.

The cinnamon was supposed to help facilitate insulin sensitivity and thus allow me to ingest more sugar.

It didn’t work. In fact, it’s not possible to say that cinnamon did anything at all. After all, my LDL actually rose 5 points too.

Here are the possibilities:

Zetia did nothing and neither did the cinnamon
Zetia did something and cinnamon compensated for its removal

There are other possibilities, but without controlling diet, weight, and exercise it’s difficult to speculate further.

The best news is that my cholesterol level is still nearly at the same overall levels, and it is likely that good adherence to diet and exercise are probably all that is needed to restore balance to my cholesterol score without adding back Zetia.

I propose therefore to make good improvements to my diet thus:

1) Reduce levels of sugar.
2) Increase Benecol levels from 3 servings to 4 to maximize benefit
3) Continue cinnamon at 1 tsp per day and not add back Zetia
4) Limit caloric intake to reduce weight
5) Increase level of exercise to min 30 minutes per day
6) Add green tea and subsequently GTE (Green Tea Extract)

The goal will be to lower total cholesterol an additional 10 points to 127, while increasing HDL cholesterol back to a minimum of 43. This will take my TC to HDL ratio just under 3.0.

Why these goals? Recent data from the Cleveland Clinic has shown that those who maintain TC levels at or below 130 achieved reversal of atherosclerosis. Secondly, Dr. Kenneth Cooper advices that patients with a history of heart disease maintain a TC/HDL ratio of less than 2.5. I don’t have a history of heart disease, but I almost certainly have significant levels of atherosclerosis, and a family history of heart disease. I therefore consider a total cholesterol level of 130 combined with a TC/HDL ratio of <3.0 a reasonable target in order to sustain atherosclerotic reversal.

It’s just a guess, but I consider it a good one.

In order to accomplish it, I’ll need to reduce LDL a bit, and trigs significantly. Here is a sample of how to achieve the goal:

TC: 127
LDL: 65
HDL: 43
Trig: 95

The goals are reasonable because the LDL level is only a single point lower than I’d previously achieved, the HDL level is actually 4 points lower than I’d earlier achieved, and the trig goal is only an additional 8 points over my previous low.

My (considerable) gut tells me that a significant reduction in sugar and the addition of GTE may well get me to the LDL goal, and stabilize my trigs. Those two aspects by themselves may well get me there, and the other four aspects should provide insurance.

Final Comments:

I had relatively poor adherence to my diet over the last three months, gained weight, didn’t exercise enough and my cholesterol level still stayed well under 150! Why? First of all, although my diet was badly maintained, I had nearly perfect adherence both to Lipitor 40, and to all of the nutriceuticals that I supplement it with. I consider this a very positive indication of what nutriceuticals can do combined with a statin as opposed to merely increasing levels of statin medication.

The key was that I soldiered on with my medicine under all circumstances as best I could. It’s worth pointing out that not many years ago few people with FH could achieve numbers like the above.

Elsewhere I’ve proposed the notion that as your total cholesterol drops below 150, your TC/HDL ratio probably matters less. Well, here I am living that scenario, and its cold comfort. I will feel better raising my HDL to levels considered minimally acceptable and improving my ratio of 3.7 to <3. I do believe that my risk of a myocardial event is lower, but tweaking and maintaining my figures as I suggest above will give me greater protection and the best chance of atherosclerotic reversal.

Reversal and not merely lowering cholesterol levels has to be the most reasonable goal in preventing heart trouble.

Green Tea

While awaiting my lastest cholesterol results involving cinnamon, I decided to research and finally add an additional nutriceutical to my arsenal: green tea.

Dr. Kenneth Cooper had discussed green tea in his book on lowering cholesterol, and as it seemed one of the weaker and more difficult functional foods to use I'd ignored it. However, I've reached the point now where my cholesterol levels are somewhat stable...I hope...and I can look to tweak my levels further.

There appear to be a number of studies that show that green tea is beneficial in lowering LDL, and especially in inhibiting Apo B which helps oxidize cholesterol in your system.

Most recently I came across a study that used Teaflavin...a brand of green tea extract (GTE) with impressive results. A 16% drop in LDL. That is roughly half as much as a low level dose of statins, and that makes it worthy of attention.

Many of you taking statins should know that after the initial dosage level, upping the dose brings diminished returns. Each doubling of the dose of a statin yields about a 6% additional reduction in LDL. Meanwhile you're doubling the amount of medication.

A nutriceutical can often yield a reduction in LDL of more than 10% without risk of serious side effects.

Now, I like green tea, and I can drink 7-10 cups a day without a problem, but I have decided to use Teaflavin instead because its the equivelant of 35 cups of black tea or 7 cups of green tea, and its in the form of a single capsule.

I'm already taking fish oil capsules along with my Lipitor, so one more won't even be noticed. Also, there's no caffiene involved, and although it is possible to get results from decaf green tea, this is easier, and I might add...cheaper.

The teaflavin capsules are about 75 cents apiece, whereas 20 bags of Celestial Seasonings decaf green tea is nearly 3 bucks. At 7 cups a day I'm spending over a buck...so the pill is cheaper. I can also take the pills with me and don't have to worry about brewing.

Will it work for me? Unknown. The fact is, my cholesterol levels are fairly low now, and there may be little gain. We'll see.

What Should your Cholesterol Level be?

How low does your cholesterol need to be?

Everyone knows lower is better, but the numbers game has been a moving target for many years. In general you can say that the more we've learned, the lower the number has gone, but even that is misleading.

There have been three general ways to measure cholesterol levels:

Total Cholesterol: a number combining HDL, LDL, and Triglycerides
The ratio of Total Cholesterol to HDL
The ratio of HDL to LDL
The latter generally gives the same result except in cases of hyper triglyceridemia.

THAT WAS THEN, THIS IS NOW
It used to be that your cholesterol would be measured and if it was below 250 you were considered normal. Why? Because after measuring many people, the average number came up at around 250. The problem with that is that the numbers represented what the average American had as a cholesterol level based on a high fat, high cholesterol diet.

Subsequently the number was changed to <200, meaning if you have a total cholesterol level less than 200 then you are normal. Unfortunately, normal in this case means absolutely nothing.

It has been understood more recently that the individual components of your cholesterol level are more important than the total number. Someone with a cholesterol level of 230 may well be healthier than someone with a total of 180 or even 170.

Why?

Because your cholesterol is made up of different types that work in conjunction with each other. LDL (the so-called bad cholesterol) has many important functions. Among them is the job of patching up your arteries when they're injured.

When you get too much LDL in your system it can begin to adhere to artery walls too much and ultimately form blockages...hence the bad reputation.

HDL's job is to remove LDL from your system, and even from artery walls. It is the so-called "good" cholesterol, and if you don't have enough of it, it can't keep your arteries clear. I could further complicate the discussion by pointing out that not all HDL is equal. Some people's HDL is better at removing LDL than others.

Think of HDL as a lint remover where some people's have a stickier surface than others. Bottom line, its better to have more than less since its difficult to control the quality (although there may be a thing or two you can do about that).

So, if more HDL is better, then how much should you have? A ratio of less than 4 to 1 appears to be an "ok" measurement. That is, if your total cholesterol is less than 4 times your HDL your level is acceptable.

For example, your total cholesterol is 205, but your HDL is 60. The ratio is about 3.4. That's <4.0 and not bad.

Another example would be someone with a total cholesterol level of 170, and an HDL of 41. This person's total is 20 pts lower than the above example, but the ratio of HDL to T.C. (total cholesterol) is now 4.1 and not nearly as good as the first example's.

THE HDL BOTTOM LINE
A ratio of less than 3:1 is probably optimal although difficult for many to achieve.

Your goal should always be to work with your own genetics to manipulate the numbers in your favor.

If you can't raise the bridge, lower the river!

If you can't get your HDL up, lower your LDL to get the desired ratio, or lower your triglycerides, or both. Optimally, you should be trying to manipulate all three numbers while lowering your total cholesterol number...sometimes a difficult thing to do.

AN UNSCIENTIFIC INTUITION

Here is a point that is entirely supposition, but is at least intuited from scientific data.

According to the Framingham Study done over several decades, nobody...but NOBODY in their study who maintained a total cholesterol level at or below 150 EVER had a heart attack.

For many years of that study they did not measure HDL levels, but it could be intuited that once total cholesterol levels are maintained below a certain level, the T.C./HDL ratio become significantly less important. At low levels of total cholesterol, the problems associated with atherosclerosis may simply dissapear!

HDL levels certainly appear to have been irrelevant to people with very low cholesterol levels in that study, unless you entertain the possibility that nobody with a level of 150 or less had low HDL levels.

Unless that is true, then an opposite corrolary might be constructed that the higher T.C. is, the lower the ratio of T.C./HDL should be to counteract it.

Zetia: The other Cholesterol Drug

I've been taking Zetia for over a year now.

If you're not familiar with it, it’s a cholesterol-lowering drug that acts by interfering with the reabsorption of cholesterol from the intestines back into the blood stream.

Your liver gets rid of excess cholesterol by tossing it down the poop chute, but little molecules called Micelles transport some of it back into your system. That's a good idea if you're eating a balanced diet, or if your liver doesn't overproduce cholesterol, but if you're in one of those two groups, or both, you've got trouble.

I don't know exactly how Zetia inhibits reabsorption because the Zetia folks offer two kinds of information...too simple and too technical.

Bottom line: it apparently works.

However, I gather that it was something of a disappointment to its manufacturer who was hoping for a product as strong as a statin. It isn't quite.

Efficacy varies, but it appears to lower LDL 15-25%, which btw does make it somewhat competitive with the lowest dose of Pravachol, one of the weaker statins.

Zetia has found a niche as an adjunct to statins. Add it onto your statin dose, and it can double or triple the statin's efficacy. That means you might be able to lower the dose of statins you take. Remember that every doubling of a dose of statins only reduces LDL further by about 6%. So the difference between 10mg of Lipitor and 80mg is only an 18% additional reduction. Theoretically you could cut from 80mg of Lipitor back to 10mg, add in Zetia and get the same effect, although your mileage may vary as they say.

The manufacturer has added it to a statin and named it "Vytorin", so that you can take the whole bang shoot in a single pill.

I've never been able to clearly measure Zetia's efficacy or any other cholesterol nostrum because mine has been a frantic search to take my levels down to a healthy level, and it took several years to figure out. Now that I am in good shape (134 total c.), I can look to tweaking my regimen.

Zetia is my first target because it is the most expensive part of my routine, even more expensive than the 40mg of Lipitor that I take.

My goal is to eliminate Zetia without raising my total cholesterol above what I consider the magic number: 150.

Currently I take two nutriceuticals: Benecol, and Metamucil that both work in the intestines in a similar fashion to Zetia. They have different mechanisms, but accomplish the same thing: they interrupt the cycle of reabsorption.

So, are 3 absorption blockers a crowd?

I plan to put it to the test:

I'm going to quit Zetia when my current supply runs out...about 2 more weeks. Then I'll wait 1 month and test my cholesterol levels. If the levels are the same or lower, I win, if its higher but still below 150, I still win. If however my cholesterol has risen above 150, then game over, I've got to add it back in.

Wildcards:

There are at least two items that will likely skew the results. First, I can't guarantee that the Zetia will be completely washed out and not depressing reabsorption past 30 days, although I think it likely. Second, I started taking cinnamon as a cholesterol-lowering agent 1 month ago, and it should be starting to approach maximum efficacy now (if it has any).

The only human study with Cinnamon to date shows a 10-25% cholesterol reduction, which is similar to Zetia at the high end, but a bit lower at the low end. So, I could get a similar result.

Cinnamon is cheap and Zetia isn't.

Here's the math:

A one-month supply of Zetia (and that is buying it from ...ahem...other sources)...
$70.00.

A months supply of Metamucil taking 3 double doses a day (I buy the large "Metamucil in a drum")...is about
$14.00.

A month’s supply of Benecol Light is roughly two tubs:
$10.00

An 8.75 oz jar of ground cinnamon (McCormick’s) costs around 13 dollars and has about 80 doses at .7tsp per day, so that makes the monthly cost about...
$5.00 per month.

Total monthly layout for those nutriceuticals:
$29.00 dollars. The savings is $41.00 per month, plus you're taking natural substances...more or less, instead of a pharmaceutical with its greater expense and requirement for a prescription.

At the end of the day dropping Zetia is about money: if I can drop it without increasing my chance of heart attack, then why not?

I won't be able to report on this effort for about 6 weeks.

Good luck to me.

mark

Cinnamon Flavored Thoughts Feb 4, 05

I've been monitoring research on cinnamon as it relates to the reduction of cholesterol. The most troubling thing is that while the response appears consistant in the few studies done, NOBODY has any idea what the mechanism is for the reduction in cholesterol.

I also find it odd that in the one human study to date no significant effect on HDL levels was found since it is understood that high insulin levels impedes the production of HDL.

Looking deeper into the study however, I found that participants took medication to regulate the need for insulin, so levels may have been in the normal range already.

That might well minimize any positive effect to HDL since insulin production is already under control.

No human studies have been done on non-diabetics yet, and it is possible that cinnamon could have a beneficial affect on HDL to the extent that it reduces insulin resistance. In other words, some people may well see HDL levels rise over time.

I speak with feeling since I have Metabolic Syndrome, and insulin resistance is one of the symptoms. I've been using alcohol to reduce it, and with good success. I'd had very low HDL for years...it was never higher than 40 and occasionally as low as 34.

Today my HDL is 47 and I suspect it will rise further. My goal is at least 50, which is quite respectable for a man and not bad for a woman either.

One problem I have, is that I'm taking so many pharmaceuticals and nutriceuticals that its difficult to say how much affect any given thing is having.

For example, when I switched to Lipitor my triglycerides fell from about 250 to 103, BUT at the same time I began taking large amounts of Omega 3 and added alcohol consumption, and I also switched labs to boot. So...how much credit can I give to each variable? Dunno...all I can do is take my very happy results and wonder.

Cinnamon and cholesterol

I learned something new today...maybe. The information isn't new, but I just came across it: apparently cinnamon can lower cholesterol and triglyceride levels. Just as important, its been found to help diabetics by increasing sensitivity to insulin.

That means its also beneficial to pre-diabetic types like me who have Metabolic Syndrome, and which is often a precursor to diabetes type 2 and not incidentally heart disease.

So okay, what's the science? Uh...I'm not sure yet. There seems to be a better understanding of how it reduces sensitivity to insulin than in reducing LDL and trigs, but I firmly believe that the former can affect the latter. Here's a link to help you decide if this is for real or not:

http://www.ba.ars.usda.gov/research/cinnamon.html

And this link has some interesting comments:

http://www.healthandage.com/Home/gc=39!gid2=2812

Meanwhile, even though I'm a bit skeptical, I'm loading up with cinnamon tomorrow. The dose? Anything from 1/4 tsp to 1.5 tsp's a day seems to be plenty. 3/4 tsp is where I'll start because I'm on the large side, but indications are that for most people 1/2 tsp is about right.

I admit that cinnamon is NOT rock solid as a nutriceutical (functional food) just yet, but I'm taking it for three reasons:

1. It can do no harm
2. The 2-4 existing studies are consistent in showing good results
3. It may positively treat my metabolic syndrome and produce good indirect results

In the case of Stanols/Sterols and Omega 3's there are significantly more studies and a preponderance in the medical community as to their efficacy. I made sure of this before taking them because both involve ingesting oils, which I find counter intuitive to lowering cholesterol levels. Cinnamon has no sugar or oil.

In contrast, I've never taken garlic because although more studies have been done, most are inconclusive at best. Should cinnamon studies develop in that direction, I reserve the right to drop the treatment like a bad habit and disavow any knowledge of having taken it.

Final note: Cinnamon is toxic at high levels. What are high levels? Nobody knows. Bottom line, If a cinnabon won't kill you, then the cinnamon by itself surely won't. Stick to ground or stick versions btw, cinnamon oil doesn't have the same properties because its not water soluble.

RCT: The Bottom Line

RCT: Reverse Cholesterol Transport. The odds are you've never heard of it, and your Doctor almost certainly never discussed it with you, but its THE most important aspect of managing your cholesterol level.

RCT is the key.

Why? First I need to explain what it is. LDL cholesterol circulates in the blood, and has some important and necessary functions, but it needs to be delivered to the liver for processing, and HDL cholesterol has that job. HDL then reverses the transport of cholesterol. HDL is the garbageman, and when the garbageman goes on strike it begins to pile up.

That's what's happening in your arteries if your RCT mechanism isn't working properly.

Bottom line: if you don't have enough garbagemen you're headed for a clog and a heart attack. If you have just enough garbagemen, then your arteries will get no worse, but they'll get no better either, however IF you have lots of garbagemen, you'll have enough manpower to not only keep up with the new garbage, but they'll start picking up the older stuff too. Translation: your arteries will actually start to UNCLOG.

So, getting the RCT mechanism past the break even point can open arteries and postpone that appolntment to saw open your chest.

Reversing Atherosclerosis: Ornish Plus

Studies over the last 10 years have shown that a vegetarian diet very low in fat can not only halt atherosclerosis, but even begin the process of reversal, where arteries actually open up...even after being completely blocked!

Dr. Dean Ornish did the pioneering work in this area, and arguably he's still at the top of that field today. Following a reversal diet isn't easy though: You need to keep your fat content down to about 10% of your diet. I do that, and believe me its no picnic.

There is another way to reverse atherosclerosis though, through medicine. Recently, several studies have shown that high doses of statins can achieve reversal along with more modest diet changes. The prove it study in particular found that most patients on the maximum Lipitor dose of 80mg a day expericenced modest atherosclerosis reversal after a year.

The reversals were more modest than those achieved by Dr. Ornish, but nevertheless measurable.

WHAT IF:

A study were done of the following:

1) An Ornish Reversal diet
2) A high dose of Lipitor
3) Nutriceuticals: Soluble Fiber, Benecol, Omega 3, Alcohol
4) A modest exercise program

All at the same time

Might not the reversal of Atherosclerosis be greater and more measureable than any of the above alone? Might not significant reversal be achieved in a shorter period of time?

No study of the above is under consideration to the best of my knowledge, but I intuit that it would be a maximum effort to achieve reversal, and I am doing it myself.

If it worked well, would most people do it? No. Most people would never do it until and unless they knew they'd die if they didn't. Look at how fat people are here in America. They know what to do, but they don't do it. Hell, most people don't even take their statin's after a year or so...they just stop.

Still, it would make a difference to some if they knew they had a real chance of avoiding a heart attack, and live a stronger healthier life.

Booze your way to health...well not really

Booze: its what's for dinner.

Why? Ever here of the French Paradox? Sure you have, if not by that name. The Frenchies eat a LOT of fat in their diet, yet they have a lower incidence of heart disease than much of the rest of the civilized world (always assuming they're part of it). Why? Its simple, they spend most of their lives sloshed.

Red Wine: It contains anti-oxidents, and no doubt they're helpful, but the real magic ingredient is alcohol. Alcohol in moderate amounts seems to increase HDL (the good cholesterol), and even in people it doesn't increase HDL in, it seems to increase levels of apolipoprotein A in the HDL, which makes it work more efficiently in the removal of LDL. That's a good thing.

Also, alcohol (although a sugar) seems to reduce insulin sensitivity. That's really important because as we get older we generally become more and more insulin resistant. Some of us even develop adult onset diabetes. Booze can reverse that trend, reducing the amount of insulin you need to process sugar.

BTW, higher levels of insulin seem to impede the production of HDL, and reducing insulin levels seems to have the opposite effect, so reducing your other sugar intake and have a drink or two a day can be very helpful.

How helpful? Well, until recently my HDL was never above 40, and in fact it had sunk to 34. In 8 weeks of booze and reduced sugar intake I raised it to 47...a very healthy reading for a man.

Its no accident.

Now comes the warning. If a little booze is good, is more better? Yeah, but unfortunately at higher levels it starts to get toxic. Therefore 1 4oz glass of wine a day will do you, or two glasses once in awhile. Dr. Kenneth Cooper recommends no more than 10 drinks a week, and that's pretty sensible.

Omega 3's: The Real Omega Glory

Here I go again: I'm about to suggest taking oil for your health. Believe me, it goes against my grain too, but facts are facts: Fish oil is good for you.

I won't bother with much of the history or medical background, you can look that up elsewhere. Suffice to say that science is on my side. Ingesting Omega 3's from fish oil can save your life.

EPA/DHA is the type of Omega 3's that have been shown to reduce incidence of heart attack. Most recommend 3g capsules a day, although that doesn't tell you much really. The capsules very considerably in their EPA/DHA content, so those three capsules could be doing more or less. However, in general if you buy them at the drugstore and take 3 a day you'll get the benefit.

However, if you look more closely at the data you'll see that larger doses of Omega 3 can reduce triglycerides in your bloodstream. It does it by impeding the liver's ability to produce them. I don't know how, but it does. How much do you have to take to get that result? Somewhere between 2-4grams a day of EPA/DHA.

BTW: that doesn't mean 2-4 1g capsules a day, look at the side of the jar and you'll notice that to get 2g's of EPA/DHA (combined) you'll have to take nearly 10 capsules a day of your drugstore brand.

Oh, and disclaimer, you're supposed to talk to your doctor before taking amounts in that large a dosage.

I take RES-Q brand which claims to have the highest EPA/DHA potency. Consequently I can get 2g's a day taking only 4 capsules. My Triglycerides which has hovered around 250 for several years have now dropped to 103 at last count. Some of that is a result of my statins and other nutriceuticals, but there's not doubt, it works.

Unless you have a serious triglyceride problem like me, I recommend staying at a low dose. You'll get the heart benefit without taking in more oil than you need.

mark

Soluble Fiber

Fiber: it really works. First of all, it'll definately put lead in your pencil. You'll notice a difference, and that's as much as I'll say.

However, in terms of lowering cholesterol its only slightly less effective than using a plant stanol/sterol margarine....sometimes just as good.

Taking large amounts of soluble fiber can lower LDL levels 4-12% give or take. You need a lot of it to see the benefit though.

7-8 g's a day minimum, and something like 15g's is better if you really need significant reductions.

That is literally a buttload of fiber. How to get it?

The easiest way is Metamucil. Its available at any drugstore. I use the smooth orange sugar free version. To get the benefit you need to take it with food. I take 2 rounded tsps 3 times a day after a meal. That gives me 12g's of soluble fiber. In addition, I usually have one or two bowls of high fiber/low sugar cereal that gives me another 2-3g's.

As you can gather, Metamucil can jump-start you way ahead of an oatmeal breakfast, so while the latter is good for you, you'd have to consume a large tub of oatmeal to get what Metamucil can do for you.

Now some don't like to take it, and I get that, but it does seem a simple measure to get a great reduction in cholesterol.

It works (we think) by binding the bile that intestinal cholesterol comes in to the food its clinging to. The result is that bad cholesterol goes out the poop shute. If you're using Benecol or another stanol/sterol margarine you'll get an additive affect, although it is likely that as your cholesterol lowers you'll get reduced benefit. After all, there'll be less cholesterol in your belly to take away.

That in my opinion is a good reason to keep it up, not to slow down or stop. That is especially true if you're genetically hyperlipidemic like me.

Bottom line: Here is another way to double or triple the effectiveness of your statins. In fact, take it with stanols/sterols and theoretically you could be getting as much as 4x of your statin dose!

You will get tired of taking this crap, but your cholesterol levels will drop like a lead balloon.

Plant Stanols and Sterols

Lots of people are talking about Benecol these days...mostly people in Europe, because Americans haven't really caught on yet.

There are two reasons: 1st, most American's don't care what they eat or how fat they get, and 2nd, it really is counter-intuitive to be told that you can lower your cholesterol by ingesting a product that is 100% fat. Fair enough, but it happens to be true.

Plant Stanols and Sterols are substances that come from plants. They are essentially the plant equivalent of cholesterol.

It has been well known in the scientific community for at least 50 years that consuming stanols and sterols can reduce your cholesterol level, but its only been in the last decade that a way has been found to incorporate them at sufficient levels into food products that won't make us gag. That method is mainly through margarine.

Finland started it with Benecol, a margarine product that contains Plant Stanol Esters. Since their initial work, something like 25 scientific studies have been done, and they all gave the same result: it works.

So...how well does it work, and how does it work?

In short, when you consume Benecol or a like product, the stanols/sterols compete with cholesterol in your intestine for absorption by micelles. Micelles are molecules that transfer cholesterol from the intestine back into the blood stream.

Here is the sequence:

Your liver dumps excess cholesterol into your gall bladder, your gall bladder dumps it into your small intestine, and your micelles absorb the cholesterol in your small intestine back into your blood stream, and the great circle of atherosclerosis continues.

The plant stanols/sterols enter your intestine and compete for absorption by the micelles. Result? You can easily cut your cholesterol reabsorption rate in half. Where does the bad stuff go? Out the poop shute where it belongs.

In the average person 70% of intestinal cholesterol comes from your liver, and the rest comes from diet. The stanols and sterols don't care whether its dietary or home grown, it competes aggressively with it.

How well does it work? It will generally lower LDL levels from 5 to 15% ...sometimes more than 15%, but usually not less than 5%. The higher your cholesterol is, the better it works and the more likely you'll see a larger reduction.

Is that a lot? YOU BET! Remember that every time you double the dose of a statin you only get an additional 6% reduction in LDL. That means that just adding in Benecol or Take Control (another brand) into your diet is the equivalent of doubling or tripling your statin dose! THAT IS A BIG DEAL!

The reduction is dose specific. There are two implications of that. First, you have to eat a minimum amount in order to get an effect. That minimum dose is somewhere around 1.5g's per day. The more you eat the more you reduce, but at the high end there are also diminishing returns. Anything above 3g's a day and you're mostly eating it for fun.

I take 2g's a day, and sometimes 2.5.

"But margarine's full of fat!!!", you say. Yeah, but its almost all monosaturated, which means it does no harm. There is a little bit of saturated fat, but the efficacy of the stanols/sterols more than compensates. There is also a tiny bit of trans-fat used to make the margarine semi-solid for spreading, but its a tiny amount and again can be overlooked as long as you stay within dose limits.

How does it taste? Well, there are better tasting margarines, but its not bad and in my opinion an easy trade off for the health benefit. Certainly if you're eating that dreadful "Heartbeat" fat free spread, this is a BIG step up and will do you some good besides.

Minute Maid now has orange juice with plant sterols. I don't use it because I'm sensitive to sugar intake, but for others it appears to be a nice way to get sterols without ingesting fat.

Bottom line, you'll never come across a simpler and easier way to lower cholesterol significantly.

Here is a wonderful article from the Mayo clinic in PDF format giving all the gory details:

http://www.mayo.edu/proceedings/2003/aug/7808r1.pdf

Mark

Nutriceuticals, an important toolset

Unless your situation is extreme, I think the first avenue to lowering cholesterol before you even consider exercise or dietary changes are neutriceuticals.

Why first? Because they are changes you can make that can significantly lower your cholesterol without requiring serious and difficult changes to your daily routine.

Easy should come first, right?

Technically these are dietary changes, but in general they don't amount to changing much.

The three most powerful are:

Soluble fiber 7-15g per day
Stanol and Sterol esters 2.6g per day
Fish Oils 3g per day (reduces triglycerides)

The combination of these can lower your LDL cholesterol and Triglycerides by as much as 30%! That's as much as an entry level dose of statins!!

Does it work? Yes, there have been numerous studies on all of the above, and they proved efficacious in most people. In subsequent blogs I'll discuss each in detail.

mark

Statins etc

Drugs. I didn't want to take them. I wanted to lower my cholesterol naturally. I tried VERY hard. It didn't work. I've got F.H. (Familial Hyperlipidemia) and I need more than nature on my side. Most people don't. They could go on the godawful Ornish diet that I'm on, and get their cholesterol down to nothing. Ironically, those are the people who don't bother.

They just take a Lipitor, and keep on slamming donuts. Its probably working too...dammit.

I'll skip over two older classes of drugs: Fibric Acid, and Bile Acid Sequestrants. They work. Some people are still taking them, but they are simply NOT the way to go if you don't have to.

Statins are the bottom line today. Does it matter which one? You bet it does. At first I just left it up to my doctor thinking that one statin is pretty much like all the others, but they're not. Some are stronger than others.

The most powerful is Crestor. It is sometimes called a superstatin. At 10mg's it will reduce the average person's LDL cholesterol by nearly 46%! At the same dosage Pravachol will reduce it by 20%. Lipitor, the second strongest drug comes in at nearly 37%.

Which do you want to use? Don't answer yet.

Crestor has had a lot of problems at higher doses, mostly involving the kidneys and liver. Nevertheless, if you need serious reduction, this is a good place to start. I currently take 40mg of Lipitor, and that provides barely a 2% average additional reduction over the small dose of Crestor.

Interestingly, Lipitor can claim to reduce the incidence of heart disease and heart attacks, whereas Crestor cannot. Why? Because a scientific study proved it in Lipitor's case, but no such study has yet been done on Crestor, so even though Crestor uses a similar mechanism, and is somewhat stronger, it can't make the claim.

What should you think? It seems reasonable that if lowering cholesterol is the mechanism to lowering the incidence of heart disease that Crestor should actually be more effective than Lipitor.

Why do I take Lipitor then? Because its working and I'm meeting my goals. However, I may very well switch at some point.

My doctor first put me on Pravachol. As you can see above, Pravachol is the weakest of the statins. Why at this point would ANYONE take such a weak product? There are two possible reasons. First, you may be attempting to take a statin that avoids negative side effects from one of the other products, and secondly you may want the mildest possible reduction.

The first reason makes some sense, but the second seems a bit of a stretch. Nevertheless my doctor put me on Pravachol in larger and larger doses, until I was taking 80mg a day and STILL not meeting my goals.

Switching to a lower dose of Lipitor (40mg) produced an 11% additional reduction and I saved some money on the prescription and possibly reduced the load on my liver at the same time.

An important point about Statins that is seldom emphasized by doctors:

Doubling the dose of a statin does NOT double the response.

On average doubling the dose of a statin will produce an additional 6% reduction in LDL cholesterol.

However, recent evidence indicates that higher doses of statins can actually cause reversal of atherosclerosis. Assuming that the reversal was caused by the greater reduction in LDL (and consequently lower total) cholesterol, attention should be given to: higher doses of statins, and other ways to lower cholesterol.

Dr. Ornish's success at reversing atherosclerosis with an extreme low fat diet suggests that a blending of the two methods could produce a more practical regimen that will achieve reversal in a large percentage of people. That is pure speculation on my part, but it does seem perfectly reasonable. However, nobody has attempted to study the effects of combining the two. Personally, I don't recommend you wait for it to happen if your cholesterol is high.

A word about statin side effects. Side effects are few, but in a small percentage they can be quite serious, so keep an eye out for problems.

Finally, a word about Zetia. I take it in conjunction with Lipitor. It uses a different (and so far unfathomable) method of lowering cholesterol by interfering with its reabsorption into the bloodstream from the intestines. It has low side effects, and only provides a mild additional reduction, but if you need it, its worth it.

mark

Exercise

Man, if I've ever written a blog nobody will read, this has to be it. Who wants to be told to exercise? Nobody.

However, its important to know that a minimal amount of exercise can reduce incidence of heart disease, and it does through several mechanisms.

First, it makes the heart stronger, right? However, it also burns calories and helps you reduce weight and raise your metabolism. The result of that is often a higher HDL (good cholesterol) number.

How much then? According to Dr. K. Cooper of aerobics fame says that 30 mins a day of brisk walking will do it. That's EVERY day. Maximum benefit seems to come with about 5-7 hours a week. Once you reach the 5 hour mark you're doing much more to burn calories and get more fit than you are to improve heart health.

I believe in doing enough, so I do 5+ hours a week, and no more. Doing that is supposed to get me 80-85% of all the benefit an athlete gets. That's good enough for me.

However, while I was working to lose weight I walked a lot more than that, even as much as 3 hours a day. It was very hard on my feet, and really did nothing for my HDL. Was I one of those who's HDL didn't benefit from exercise? Apparently, but later when I addressed my problem with sugar (which I'll discuss in another blog) my HDL shot up from its low of 34 all the way up to a comfortable 47 in only 8 weeks!

I hate walking on my treadmill, but I do it, and I'm slimmer and healthier for it.

Okay, end of sermon. You already knew most of this.

mark

Four Paths to Success

There turn out to be four ways to successfully lower your cholesterol:

Diet
Exercise
Pharmaceuticals
Nutriceuticals

I started with diet, and I chose Dr. Dean Ornish's program to accomplish my goals. Why? I'd seen his special many years ago on PBS. On that show, people with heart trouble modified their diet severely to minimize fat and cholesterol. The result was a dramatic reduction in cholesterol and over several years a measureable opening of clogged arteries.

The reversal diet calls for a 10% fat intake including a severe reduction in saturated fat, and almost no cholesterol at all.

In my case my baseline total cholesterol of 351 came down to 216 after 4 months on the diet. My HDL was a marginal 40, and my LDL and cholesterol were still much too high. I'd had a good reduction, but not what I was led to expect, particularly on such a severe diet.

What happened? Three things. First, I found out later that I had not followed the diet correctly. The diet calls for only whole grain breads such as whole wheat. I had switched to wheat alright, but hadn't bothered to notice that most of what I was eating wasn't whole grain. I also ate a lot of processed diet foods such as diet cupcakes that are loaded with sugar and even have some trans fat in them.

Secondly, some research uncovered that I was not mearly hyperlipidemic, but had Familial Hyperlipidemia (F.H.). That means that I have a genetic limitation in that I have only half of the cholesterol receptors in my body that normal people have. What is more, they tend to operate inefficiently so that my cholesterol "thermostat" doesn't shut down cholesterol production when it should.

Third, I discovered still later that I have something called Metabolic Syndrome. A primary symptom of it is insulin resistance. This happens to most people as they grow older, but in some there is a genetic disposition towards it...like me. Insulin resistance can impede HDL production.

I believe now that correcting errors in diet, and significantly reducing sugar intake that today I could get my cholesterol just under the 200 mark without any other medicines or adjustments to diet, but just by following the Ornish plan.

However, the Ornish plan has several weaknesses specific to F.H.

First, Dr. Ornish never specifically studied people with F.H. He does mention in his book on Reversal that even those who didn't get their cholesterol below 200 saw some reversal of arterial clogging, but he didn't or couldn't explain why.

Dr. Ornish feels that if you're following the diet, that even if your cholesterol doesn't fall below the magic 200 mark that you are probably protected. That is a pretty vague perspective when you're following a very difficult diet and your very life is at stake. If the diet is protecting your health, you ought to be able to say why. Ornish pointed out that in the famous Mass. study done over a period of 25+ years that nobody who maintained a cholesterol level at or below 150 ever suffered a heart attack.

If you're working your heart out dieting, exercising etc, isn't that the group you want to be in?

Bottom line: I still believe in Dr. Ornish's research, and I still follow his diet, but for me it was not enough, and for others there may be an easier way.

A Journey not a Destination

My cholesterol level started at 351 and my triglycerides were 657. I had a fatty infused liver, and my family history promised a heart attack was only a few years away, and that it had a better than 50/50 chance of killing me. That was in 1998. Today (2004), my cholesterol is 134 and my triglycerides are 103. That is nearly a 2/3's reduction over all.

Getting there was not easy. I found I had to read many books and actually understand the processes taking place in my body. I made mistakes along the way, and frankly so did my doctors. My mistakes came from ignorance, and their mistakes came from a lack of attention. Most doctors don't have time to fill you in, and what you don't know can kill you.

I went to the experts: Johns Hopkins, The Cleveland Clinic, The Mayo Clinic, Harvard, Yale, and Oxford Medical schools were among those that I sought information from. I've steered clear of any treatment or evidence that was not backed up by recognized authority.

I found out that it might be possible to prevent a heart attack, reverse artery clogs, and get some positive side affects along the way. Much of this can be accomplished without drugs, although drugs figure prominently in my own case.

There is little or no controversy in what I found out, its just that most people don't know it because it can't be fit into a sound byte.

I will post a series of hopefully pithy articles about what I've learned and how others can benefit from it.

Mark Tyler
A Recovering Hyperlipidemic