Understanding Cholesterol/Triglycerides Part I & II

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Health Corner
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 the blood.

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 metabolism.

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 and blood:
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)

SUPPLEMENTS:
-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)
DIET:
-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)
EXERCISE:
Weight-bearing (especially), aerobic (but, not if you are losing lean body mass)

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 chain aminos.

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 (mmooney@internetconnect.net, website: http://www.medibolics.com) and Chester Myers (private post) (cdm@canadian-agra.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' (larklands1@aol.com) 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.