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By Julene Tripp Weaver
Understanding Cholesterol/Triglycerides - Part I
We are hearing about the changes in fat metabolism, especially now with
the use of the Protease Inhibitors. It is estimated that ten percent of
those who take Protease Inhibitors have these effects. Visible effects of
these metabolic changes are being named "Protease Paunch," and
the "Buffalo Hump." These are the labels that indicate fat redistribution
or its scientific name, lipodystrophy. For women it is showing up as enlarged
breasts and increased waist size. In both men and women there is thinning
of the face and extremities while the mid section of the body enlarges.
In cases where the hump has been surgically removed it has regrown. Also
there are dramatic increases in blood cholesterol and triglyceride levels.
What does all this mean? I was asked to address this issue and to elaborate
on alternative ways to help lower and stabilize fatty substances found in
Cholesterol is essential to our lives, it is a waxy, fat-like substance
formed in the liver and found in all animal tissues. It is important to
note that cholesterol is not a fat, it belongs to the family of steroids.
Cholesterol is needed to make and maintain nerve cells, and to synthesize
steroid hormones, bile acids, and vitamin D. It exists in muscles, red blood
cells, and it is vital in making cell membranes. Under normal circumstances,
increased cholesterol levels may be genetic, may be in response to increased
stress levels, or may be tied to diet and life-style habits such as over
consumption of saturated fats, coffee, refined sugar and cigarette smoking.
Blood chemistry screens will monitor cholesterol. The average American standard
for a reading of total blood cholesterol is less than 200 mg/dl.(1) Increased
levels can indicate circulatory problems such as arteriosclerosis (hardening
& thickening of the arteries), high blood pressure, and excessive clotting;
any of these problems may lead to coronary heart disease. The bulk of heart
attacks occur when the reading is between 200 - 250 mg/dl. Cholesterol is
also elevated in diabetes mellitus, liver disease, kidney disease, hypothyroidism,
and during pregnancy. Decreased values of cholesterol will appear with cachexia,
malabsorption, hyperthyroidism, pernicious anemia, during estrogen therapy,
or drug therapy such as treatment with antibiotics.
LDL vs. HDL Cholesterol
In addition to the total cholesterol there are two kinds of Cholesterol
results to monitor; LDL, or low-density lipoprotein cholesterol ("bad
cholesterol"), and HDL, or high-density lipoprotein cholesterol ("good
cholesterol"). LDL cholesterol should read less than 130 mg/dl. HDL
cholesterol should read greater than 35 mg/dl.
Together they have a combined function in maintaining a cellular balance
of cholesterol: LDL brings cholesterol from the liver to all the cells.
If the cells have enough cholesterol the excess continues to travel in the
blood. It is this extra LDL that get stuck in the artery walls and begin
the buildup of plaque that leads to arteriosclerosis. LDL is the greatest
contributor to high cholesterol levels and is related to eating saturated
fat in our diets.
HDL gathers up and returns the unused cholesterol to the liver, there it
is removed from the blood and excreted from the body. So high levels of
HDL are protective to the body and do not have the same high risk of cardiovascular
disease as the LDL. It is important to have these tests separated out to
get a truer picture of what is going on. High levels of LDL are dangerous,
whereas high levels of HDL are protective.
Triglycerides are fats that are normally present in the blood, they
are used to produce energy for the body. The triglyceride level is an indication
of the bodies ability to metabolize fat. Triglycerides are metabolized by
the central nervous system so their levels will also be indicative of the
nervous systems functioning. Triglycerides will show up in our blood after
they have been absorbed from the intestines, or has been converted from
glucose and are being moved to the fat cells to be stored for future use.
Triglycerides will be elevated if there is poor fat utilization, diabetes,
biliary obstruction, kidney disease, alcoholism, liver disease, pancreatitis,
hypothyroidism, hyperlipidemia, or use of oral contraceptives. Excess zinc
will also stimulate the conversion of sugars and amino acids to fat. It
may also indicate an increased risk for atherosclerosis. A reading of triglycerides
should be somewhere between 50 to 150 mg/dl. Decreased values of triglycerides
may be related to hyperthyroidism, malabsorption, malnutrition or a deficient
Life-style and Dietary therapy
Dietary changes will help lower increased cholesterol and triglyceride levels,
and there are many nutrients that can be used. A healthy diet would include
many fresh fruits and vegetables, a diverse assortment of whole grains,
and the incorporation of healthy fats. In addition to dietary changes, simple
increases in the amount of exercise can have a beneficial effect; regular
exercise reduces LDL's and increases HDL's. Smoking cigarettes helps destroy
good cholesterol (HDL) and boosts the risk of heart attack to twice that
of a nonsmoker.
It is important to highlight the use of many non-processed grains and beans.
All beans are a source of choline, a lipotrophic agent that controls fat
metabolism. Whole, unprocessed grains contain plant fiber and are a source
of both vitamin B3 (niacin) and vitamin E. This combination is essential,
in Germany niacin is prescribed to lower cholesterol. Using rye, quinoa,
amaranth, and buckwheat along with the more common grains of rice, barley
or oats will help lower cholesterol.
A low fat diet is important, however, taking all fat our of our diet is
not healthy. It is advised to keep an average of twenty to thirty percent
of all daily calories from fat. There are three basic types of edible fat
that are important to all the cells in our brain, nervous system, liver
1) unrefined oils such as extra virgin olive oil and canola oil. These oils
are considered monounsaturated fat, and are healthy fats which can lower
the "bad" LDLs.
2) Saturated fats such as butter, lard, and coconut oil are very stable.
They are sold at room temperature and can be used in cooking. Eating smaller
amounts of healthy fat, such as organic butter, is safer than using margarine
which is hydrogenated.
3) Cold pressed flax oil and hemp oil are rich in essential fatty acids,
EFAs, that are necessary to maintain a healthy body, these would be used
in salad dressings, in smoothies, or added on top of a cooked meal. Cold
pressed oils are destroyed when cooked.
The use of these types of fat will help maintain vital functions such as
the integrity of cell walls, and vitamin D metabolism. It is wise to consume
a variety of these healthy fats.
Increasing nut and seed intake will provide healthy fat, provided you buy
non-roasted nuts, and preferably those that are still in their shell. Crack
and eat them fresh to avoid rancidity which is destructive to all cells.
Avoid hydrogenated or partially hydrogenated fats which can disturb the
metabolism of fats in the body. Margarine, including soy margarine, is an
example of a hydrogenated fat. Deep fried fats should be avoided.
Medications prescribed to lower cholesterol and triglycerides should be
used as a last resort, they actually have been shown to increase the risk
of heart attacks. And their side effects can be quite toxic, causing deficiencies
of fat-soluble vitamins (A, D, E, and K), gallstones, liver damage, gastrointestinal
upset, and may lead to premature death.
Alternatives to address increased cholesterol/triglycerides Part II
Part I reviewed some basic information about Cholesterol and triglycerides,
what to watch for on lab results and some dietary and life-style changes
to begin to think about. In this second part I want to give information
of the specific alternatives that can be incorporated.
Garlic and onions both lower blood lipids, specifically they lower
the LDL ("bad") cholesterol and triglycerides while raising the
HDL ("good") cholesterol levels. They will also lower high blood
pressure. If you eat one clove of garlic a day or half an onion per day
it will lower total cholesterol by 10 to 15 percent in most people, some
will require more. It is best used raw, but even cooked will give some of
the beneficial effects. Because these are natural antibacterial and antifungal
agents they act as a broad-based prophylactic agent.
Ginger has cholesterol lowering action. This herb/food acts as a
heart tonic and stimulates peripheral circulation which increases blood
flow to muscles and joints.
Lecithin in its natural form is present in nearly all beans, and
is especially high in soybeans and mung beans. In addition, lecithin can
be found in lentils and peas. These natural sources of lecithin are beneficial
when it comes to breaking up deposits of fat and lowering cholesterol. A
primary component of lecithin is choline, a lipotrophic agent that controls
fat metabolism. Lecithin can be bought in a liquid or granular form than
can be added to your food, it is also available in capsule form.
Several types of mushrooms have the effect of lowering cholesterol and blood
pressure, as well as building and protecting the body from disease: Reshi
(Ganoderma Lucidum), Maitaki (Grifola Frondosa), and Shiitake
(Lentinula Edodes). All three of these mushrooms have been used to fortify
the body and studies (mostly in Japan) show effects against HIV. Powders
are available that can be added to food, or used in cooking.
Niacin, or vitamin B3, is used in Germany by doctors to lower blood
cholesterol levels. It is not used commonly here because the dosage required
causes symptoms than need to be monitored by a doctor, and doctors here
are not trained in alternative approaches. The upper dosage used to lower
cholesterol is one gram three times a day and the side effects of this high
dosage could include: flushing of the skin, stomach irritation, diarrhea,
ulcers, liver damage, fatigue, hypotension, and ocular side effects. Taking
a timed-release dosage can reduce the skin flushing reactions. If self treating,
the form of niacin that is safest to use is inositol hexaniacinate,
which is available in health food stores. This is the form commonly used
in Europe at dosages from 600 to 1,800 milligrams per day. One suggestion
to guard against the undesirable side effects of high dose niacin is to
use a lower dosage and to combine it with Chromium (see below). It
is advised if you have experienced any blurred vision, dry eyes or any other
eye problems not to use this as a primary treatment.
Gugulipid is the standardized extract of the mukul myrrh tree that
is native to India. It is used in the Ayurveda system of healing which originated
in India. This cholesterol and triglyceride lowering substance is without
side effects, and has a similar effect to western medications. It has been
proven safe and is even usable during pregnancy. It works by increasing
the liver's metabolism of LDL cholesterol. A 25 milligram tablet three times
per day is effective and it can be taken at higher doses.
Pantethine is the stable form of pantetheine, the active form of
vitamin B5 or pantothenic acid. It is specific for lowering triglyceride
levels; it is a component of an enzyme that transports fats to and from
cells, and it helps our body use fats to create energy. The standard dose
of 900 milligrams per day reduces serum triglyceride and cholesterol levels
while increasing HDL cholesterol levels. No toxicity has been found.
A deficiency of chromium or vitamin C will lead to elevated cholesterol
levels. Supplementation will correct this deficiency. Vitamin C has been
shown to be effective at lowering cholesterol when consumed at the level
of two grams per day.
Vitamin E at the dosage of 400 IUs daily, has been demonstrated to
reduce the risk of coronary disease by 40%. A study by Boston's Brigham
and Women's Hospital and the Harvard School of Public Health determined
this finding. It is also necessary for B and T cell production, for wound
healing and for tissue repair.
Many people living with AIDS who are using Protease Inhibitors are using
an assortment of supplements, diet tips and exercise which are listed below.(2)
-Strong, high-end multivitamin with vitamins A, D, E, chromium and calcium
-L-glutamine (HIGH DOSE:10-15 GRAMS or more/day)
-Alpha lipoic (thioctic) acid: at least 300-600 mg/day
-NAC 2000-4000 mg/day
-Chromium GTF (or chromium polynicotinate or picolinate 1000 mcg/day)
-Strong B complex
-EPA fish oils
-Carnitine (prescription version is called Carnitor) 3-4 gm/day
-Cottage Cheese (1st choice) or Whey protein powder drink (2nd choice)
-More protein and less simple (high-glycemic) carbohydrates (less sweets).
-On the list of carbohydrates to avoid is the sugar called fructose,
which is known to promote insulin resistance, and raise cholesterol. (listed
on ingredient panels as fructose or high fructose corn syrup).
-Moderate the intake of carbohydrates that release into the blood stream
quickly (pasta, breads, and processed grains); If you want to include grains
in your diet cream of rye, oatmeal and brown rice have a relatively lower
glycemic index than most wheat products, but be careful to moderate the
amount of these high calorie starch sources.
-Increase the intake of complex carbohydrates from vegetables, which are
more nutrient dense and less calorie dense. Good carbohydrate sources are
beans, yams, green peas, and whole fruits like oranges, grapes, apples,
pears and cherries.
-Reduce any excessive intake of fats. Not necessarily a "low fat diet",
but a reduction in excess saturated fats, while trying to maintain a healthy
moderate intake of essential fatty acids with plenty of omega 3 fatty acids,
like those found in fish.
-Diets high in the sulfur-containing amino acids (cysteine, methionine)
Weight-bearing (especially), aerobic (but, not if you are losing lean body
You may or may not be familiar with some of these alternatives. I'll give
a brief statement on some of them.
Because a deficiency of chromium will lead to increased cholesterol
levels some are using it to ensure it maintains. Chromium is deficient in
populations that consume a high carbohydrate diet, especially diets high
in simple sugars. A form that is used is Chromium picolinate, it
is a non-toxic form of elemental chromium that has been chelated to picolinic
acid which has a higher absorption rate. It has been used by athletes to
burn fat and helps the metabolism of carbohydrates, lipids and branched
L-glutamine is the pure powder form of Glutamine, it acts
as an antioxidant. Glutamine is the most common amino acid in the body and
is essential to metabolism and maintenance of muscle tissue. It is the primary
fuel, or energy source for the immune system and is necessary to DNA synthesis,
cell division, wound healing and tissue repair.
Alpha lipoic (Thioctic) acid is a liver protecting coenzyme. It functions
as an antioxidant and helps improve intracellular gluthathione. It helps
lower liver enzymes that are raised due to pharmaceutical drugs.
NAC short for N-Acetyl-L-Cysteine indirectly increases cellular levels
of glutathione which is critical to prevent disease prevention. NAC may
also block tumor necrosis factor (TNF) and inhibit the growth of HIV.
Chromium GTF (Glucose Tolerance Factor) is involved in the metabolism
of glucose and is needed for energy. It maintains stable blood sugar levels
through proper insulin utilization in both the diabetic and hypoglycemic.
Super EPA (NOW), is a cholesterol free fish oil that is a rich source
of Omega-3 fatty acids. The use of a rich supply of essential fatty
acids will reduce excessive free radical release. Other good sources of
Omega-3 fatty acids would be to introduce flax seeds into the diet.
Carnitine usually sold as L-Carnitine is an amino acid compound
that is essential in the intercellular transfer of energy, and necessary
to fat metabolism and the utilization of fatty acids for energy. It prevents
protein (i.e. muscle or lean body mass) from being used as energy source.
It helps to move fatty acids into and within cells. It also is helpful to
lower triglyceride levels. Your doctor can also prescribe it for you, its
prescription name is Carnitor and it is used at the dosage of 330
mg three times per day, it comes in tablet form. This drug is nontoxic and
will inhibit disease-progressing immune messengers. State medicaid programs
will pay for the medication. (3)
Whey protein powder comes in several brands. Whey has the ability
to restore the integrity of the gut so the body can adequately utilize nutrients
being consumed. In test tube studies undenatured whey inhibited both HIV
production and cell-suicide (apoptosis), one ingredient, lactoferrin, showed
anti-HIV activity. It helps weight gain and has very little lactose. (Some
brands include: Optimune, Designer Protein by Next Nutrition, Met-Rx Protein
Powder, Immunocal(4), and OSMO Whey Protein Powder(5)). Whey protein powder
is available very cheaply at some health food stores. Cottage Cheese
is also an excellent source of protein (a reminder that as usual with dairy
organic is best).
(1) mg/dl = milligrams per deciliter (Greek and Latin words form the
prefixes for the units on most lab tests. A miligram is a thousandth of
a gram [a gram is about the weight of a paper clip]. A deciliter is one
tenth of a liter [a liter being just over a quart].)
(2) The original posts are from Michael Mooney (firstname.lastname@example.org,
and Chester Myers (private post) (email@example.com "A Rationale
for NAC", available within the website <www.catie.ca>, by searching
for "myers".) Where the dosage was not given, it is supplied from
Lark Lands' (firstname.lastname@example.org) recommendations.
(3) DAAIR Buyers' Club has an information package that contains the original
research on L-carnitine in HIV/AIDS, if your doctor needs more information
you can request a copy be sent to your doctor. Call 1-888-951-LIFE. (I am
not sure if you need to be a DAAIR member for this service.)
(4) Hotly contested due to its high cost.
(5) Sweetened naturally with Stevia, no additives.
Disclaimer: Please be advised this is a sharing of information that is not
meant to be used to replace medical treatment and your own intuitive sense
of your body and what it needs. Please see your medical provider (Dr., Naturopath,
Acupuncturist, etc.) to follow up on suggestions.