HIGH CHOLESTEROL VS LOW CHOLESTEROL

HIGH CHOLESTEROL vs LOW CHOLESTEROL

Dr. dr. Anna Khuzaimah, M.Kes

Dr.dr.Anna Khuzaimah, M.Kes

Balai Kesehatan Tradisional Masyarakat (BKTM) Makassar
 Your body needs cholesterol
• Cholesterol is not the enemy.
• body needs cholesterol
- make hormones,
- cell membranes,
- brain cells,
- testosterone (sex drive and function)
- make CoQ10 January 22, 2013 By Caitlin Weeks
- neurological problems.
• prescribe medications statins: host of problems
- muscle damage,
- brain damage,
- memory issues,
- Parkinson’s-like symptoms,
- and muscle aches and pains
 Bad fats
- Trans fat
- Slows your metabolism
- Causes weight gain
- Increases inflammation
- Lowers your good cholesterol
- Raises your bad cholesterol
- Diabetes, obesity, heart attacks, strokes, dementia, cancer
- FDA has officially declared trans fats to be unsafe and
has banned their use
• hidden fat (look on the label for the word hydrogenated)
- microwave popcorn
- cupcakes, cookies, donuts
- many fried foods
- pizza
- baked foods, frozen foods
 Cholesterol Myths
• high-fat diet causes cholesterol problems,
→ this isn't entirely true.
• type of fat you eat more important than amount of fat
- trans fats or hydrogenated fats and saturated fats
= abnormal cholesterol
- omega-3 fats and monounsaturated fats
= improve type and quantity
DHEA(Dehydroepiandosterone)
• biggest source of abnormal cholesterol is sugar
→ sugar converts to fat in your body
→ high fructose corn syrup.
(sodas, many juices, and most processed foods) is
primary cause
→ type of fats, sugar and refined carbohydrates is concern
 Fat Does Not Make You Fat
• Dr. Key’s Seven Countries Study decades ago
- examined heart risk based on lifestyle and dietary habits
→ people ate more fat; were more cases of heart disease
problem with this study: “correlation is not causation”
→ events happen at the same time
• now learning that sugar is the true culprit, not fat
• American Journal of Clinical Nutrition no correlation
• British Journal of Medicine hammers home the same point
• lowering saturated fat = may lower total cholesterol,
→ lowering the good kind of cholesterol
• In fact, studies show that 75% of with a heart attack
→ have normal overall cholesterol levels.
→ do have is pre-diabetes.
→ diabesity: eating sugar and refined carbs
 The truth about cholesterol
Why Cholesterol May Not Be the Cause Of Heart Disease
“Mark Hyman”
• we are not getting the right cholesterol test
→ need to get the test of the 21st century
- not just your cholesterol by weight (mg/dl),
- but it measures the number of particles and the size
• cholesterol consisted largely of those small, dense chol esterol
→ cause heart disease.
- like golf balls that bang around arteries and cause da mage,
- opposed to large, fluffy beach ball-like ones that just bounce off
- decrease the amount of sugar and flour
- not fat that causes your cholesterol to go up.
→ It’s sugar or anything that turns to sugar like flour
• when you eat sugar (fructose - high fructose corn syrup)
→ cholesterol-producing factory in your liver to turn on.
→ high triglycerides low HDL high cholesterol
→ fix it is to get off flour and sugar
• eat more quality fat (nuts, avocados, seeds, and coconut butter
→ good quality protein : balancing insulin
 The Benefits of High Cholesterol
Uffe Ravnskov, MD,
International Journal of Epidemiology 26, 1191--1202, 1997.

live the longest (Dr. Harlan Krumholz)

→ Department of Cardiovascular Medicine at Yale Univ),
- old people with low cholesterol died twice
→ as often from a heart attack as old people with
a high cholesterol.
• high cholesterol is not a risk factor for CAD
- 11 studies of old people came up with that result
- 7 studies found that high cholesterol mortality
→ 90 % of all CVD seen in people above age 60
→ high cholesterol is not a risk factor for women.
- high cholesterol is only a risk factor for ≤ 5 % of
heart attack.
• much better to have high than to have low cholesterol
 Protects Against Infection
• 19 large studies of more than 68,000 deaths
(reviewed by Prof. David R. Jacobs)
Division of Epidemiology at the University of Minnesota,
→ low cholesterol increased risk of dying from G.I. and
respiratory
→ most have an infectious origin.
• together with Dr. Carlos Iribarren,
- 100,000 healthy individuals
- 15 yrs studies
→ low cholesterol more often been admitted to the
hospital because of an infectious disease.
 Why Women Should Stop Their
Cholesterol Lowering Medication
• Archives of Internal Medicine
- statins increase risk of DM by 71% in post-menopausal
• diabetes is a major cause of heart disease
→ calls into question current recommendations and guidelines
→ take statins to prevent heart attacks in women more harm
• Statins have been proven to prevent second heart attacks
→ but not first heart attacks.
• New Study: 48 % Risk of DM in Women Who Take Statins
→ statin prescriptions (153,840 women w/o diabetes)
→ average age of 63.2 years.
→ about 7% taking statin medication between 1993 -1996.
- 10,242 new cases were reported
- a whopping 71% increase in risk
- 48% risk of getting diabetes
 Do I
stop statin?
CHOLESTEROL
•LOW
CARB
Lp (a)
• FOOD
hs CRP CARE
Adiponectin
•NATURO
CEUTICAL
 6 steps to healthy cholesterol
Cut out or dramatically reduce flour and sugar,
1 because those are the things that turn on the cholesterol
factory in your liver.
Eat the right fats—avocados, nuts, seeds, coconut
2 butter, olive oil, and fish oil. These are the good fats that
help balance your blood sugar, balance your insulin, and
correct lipid problems.

3 Have protein for breakfast and at every meal (nuts,

seeds, eggs, chicken, fish, grass-fed meats).
4 Exercise.

5 Manage your stress

6 Take naturoceutical to help balance the whole system.

Aged Garlic
Pharmacokinetic
Garlic extract 600-1200 mg
→ divided and given three times daily.
Standardized garlic powder extr containing 1.3% alliin
- Aged garlic extract 600 mg to 7.2 grams per day
- Aged garlic typically contains only 0.03% alliin.
- Fresh garlic 4 grams (± one clove) once daily
- Fresh garlic typically contains 1% alliin
Red Yeast Rice
Summaries for patients. Red yeast rice to treat cholesterol problems
in patients who cannot tolerate statin therapy because of muscle
pain.
Ann Intern Med. 2009 Jun 16;150(12):I28

Tolerability of red yeast rice (2,400 mg twice daily) versus

pravastatin (20 mg twice daily) in patients with previous statin
intolerance
Am J Cardiol. 2010 Jan 15;105(2):198-204

The role of red yeast rice for the physician

Curr Atheroscler Rep. 2011 Feb;13(1):73-80

Red yeast rice: a new hypolipidemic drug

Life Sci. 2004 Apr 16;74(22):2675-83.

Red yeast rice may be a statin substitute. People who are

statin-intolerant due to side effects of muscle pain may
benefit from this ancient Asian dietary and medicinal staple
Duke Med Health News. 2009 Sep;15(9):1-2
 Major interaction
• side effects are usually mild.
→ headaches and upset stomach
→ statin, immunosuppressor, antifungal, certain antibiotics,
or protease inhibitors (for HIV).
• avoid grapefruits, as well, alcohol
→ increase risk of liver damage
• very high cholesterol, DM, or a high risk of CAD or CVD
→ need a more powerful
 Moderate interaction
Alcohol, Hepatotoxic drugs
acetaminophen, amiodarone, carbamazepine, INH, MTX,
methyldopa, fluconazole, itraconazole, erythromycin, phenytoin,
lovastatin, pravastatin, simvastatin
- increase risk of liver damage
Cyclosporine, Gemfibrozil
- affect the muscles
Cytochrome P450 3A4 (CYP3A4) inhibitors
- can increase the effects and side effects
amiodarone , clarithromycin , diltiazem, erythromycin, indinavir,
ritonavir, saquinavir and many others
Statins
- increase the risk of adverse effects
Niacin
- can affect the muscles
Pharmacokinetic
• Lecithin is a fat that is essential in the cells
• found in foods, including soybeans and egg yolks.
• taking one 400 - 1,200-milligram capsule before meal
- help the body digest fats and fat-soluble vitamins
(vitamin A, D, E)
- egg lecithin may help symptoms of AIDS, herpes, CFS
& autoimmune
• no Recommended Dietary Allowance (RDA) for lecithin
- most suggest 2 tablespoons of lecithin granules/day
J Am Diet Assoc. 2003 May;103(5):577-81.
Fat-free foods supplemented with soy stanol-lecithin powder reduce
cholesterol absorption and LDL cholesterol

Food Nutr Res. 2008;52.

Plant sterols/stanols as cholesterol lowering agents: A meta-analysis of
randomized controlled trials

J Acad Nutr Diet. 2013 Nov;113(11):1494-503.

Cholesterol-lowering efficacy of plant sterols/stanols provided in capsule
and tablet formats: results of a systematic review and meta-analysis

Eur J Clin Nutr. 2000 Sep;54(9):671-7.

Effects on serum lipids, lipoproteins and fat soluble antioxidant
concentrations of consumption frequency of margarines and shortenings
enriched with plant stanol esters.

Mayo Clin Proc. 2003 Aug;78(8):965-78.

Efficacy and safety of plant stanols and sterols in the management of blood
cholesterol levels

Am J Cardiol. 2005 Jul 4;96(1A):15D-22D.

Plant stanol and sterol esters in the control of blood cholesterol levels:
mechanism and safety aspects
 Major interaction
Lecithin is LIKELY SAFE
It can cause some side effects including
(diarrhea, nausea, abdominal pain, or fullness)
.
Special Precautions & Warnings:
Pregnancy and breast-feeding
- dizziness,
- nausea, and vomiting
(especially in megadoses of this supplement)
Pharmacokinetic
Policosanol is a chemical obtained from sugar cane
- 5 – 40 mg/day
mixture of long chain alcohols extract from plant waxes
- intended to lower LDL cholesterol
- increase HDL cholesterol

used for conditions that affect the heart and blood

vessels
→ including high cholesterol
→ leg pain due to poor circulation
(intermittent claudication),
→ narrowing of the blood vessels that serve the heart.
 Int J Clin Pharmacol Res. 2001;21(1):43-57
• Policosanol (higher aliphatic primary alcohols)
→ isolated from sugar cane wax
• cholesterol-lowering effects proven for a dose 5-20 mg/day
→ in hypercholesterolemia and dyslipidemia
→ associated with NIDDM
• randomized, double-blind study
• efficacy & tolerability of policosanol 20 compared 40 mg/day.
→ placebo (n=30), policosanol 20 mg/day (n=29) or 40 mg/day (n=30).
RESULTS
- changes in LDLas the primary efficacy endpoint. 6 weeks
- after 24 weeks, policosanol at 20 and 40 mg/day significantly
→ (p < 0.00001)
- lowered LDL by 27.4% and 28.1%,
- total cholesterol ↓ by 15.6% and 17.3%,
- and the LDL/HDL ratio ↓ by 37.2% and 36.5%,
- ratio total cholesterol/HDL ↓ by 27.1% and 27.5%,
- while HDL (p < 0.001) by 17.6% and 17.0%
Curr Ther Res Clin Exp. 2006 May;67(3):174-92.
Effects of combination treatment with policosanol and omega-3 fatty acids
on platelet aggregation: A randomized, double-blind clinical study

Drugs R D. 2005;6(1):11-9.
Effects of concurrent therapy with policosanol and omega-3 fatty acids on
lipid profile and platelet aggregation in rabbits

Pharmacotherapy. 2005 Feb;25(2):171-83.

Meta-analysis of natural therapies for hyperlipidemia: plant sterols and
stanols versus policosanol.

JAMA. 2006 May 17;295(19):2262-9.

Effect of policosanol on lipid levels among patients with
hypercholesterolemia or combined hyperlipidemia: a randomized controlled
trial.

Altern Med Rev. 2002 Jun;7(3):203-17.

Policosanol: a new treatment for cardiovascular disease

Br J Clin Pharmacol. 2010 May;69(5):508-15.

Pharmacokinetic and pharmacodynamic interactions of echinacea and
policosanol with warfarin in healthy subjects
Pharmacokinetic
• the consensus dosage of 30-50mg/day.
• “The Mutitherapeutic Properties and its Novel Vitamin E”
→ quoted daily intake of 34-42.5mg of pure tocotrienols
→ obtained from palm oil
• Tocotrienols : members of the vitamin E
• vitamin E is made up of:
- 4 tocopherols (alpha, beta, gamma, delta) and
- 4 tocotrienols (alpha, beta, gamma, delta)
• slight difference between tocotrienols and tocopherols
- lie in the unsaturated side chain
- having 3 double bonds in its farnesyl isoprenoid tail
• Tocotrienols are natural compounds found in vegetable
(rice bran, palm oil, wheat germ, barley, saw palmetto, anatto)
(certain other types of seeds, nuts, grains, and the oils derived)
 Comparison of tocotrienol and tocopherol

- tocotrienols are more potent in their anti-oxidation

and anti-cancer
- unsaturated side-chain in tocotrienols
→ causes to penetrate tissues with saturated fatty
layers more efficiently
→ ideal for anti-aging oral supplements and the
skincare range
- Tocotrienols are better able than tocopherols
→ at combating oxidative stress of skin that
→ exposed to UV rays of the sunlight
- In vivo,
tocotrienols are more powerful antioxidants,
lipid ORAC values are highest for -tocotrienol
Cocoa
 Labu Siam
(Sechium edule)
Daun Kelor(Moringa Oleifera)
Madu(Honey)
Jahe(Ginger)