Cholesterol: The Good and The Bad


Cholesterol levels are the mainstay of the debate on how to prevent heart attacks and reduce the risk of strokes and other chronic diseases like Alzheimer's disease. While it is a given that lower amounts of low-density lipoprotein (LDL) generally tend to promote heart health, only recently has emphasis been placed on increased levels of high-density lipoprotein (HDL). In fact, it has been argued that increments in HDL levels may be of greater import in preventing heart attacks and strokes."

The association between low levels of HDL and increased risk of cardiovascular disease (CVD) is corroborated by epidemiological and clinical studies. This relationship is supported by the potential anti-atherogenic effect of HDL, including reverse cholesterol transport (in which cholesterol from sundry tissues is returned to the liver for excretion in the bile), alleviation of the inflammatory response, and improvement in the endothelial tone.

Statins are among the most commonly used pharmaceutical agents to regulate cholesterol synthesis. In addition, at least some of the statins have been reported to increase HDL while lowering LDL, and to mitigate the inflammatory response. Among other options are bile acid sequestrants, fibrates, niacin, and ezetimibe.

Bile acid sequestrants lower LDL by about 10 to 20 percent and are often prescribed with a statin to decrease cholesterol levels more aggressively. These agents, however, may cause bloating, nausea and constipation. Fibrates reduce triglyceride levels by 20 to 50 percent, while increasing HDL by 10 to 15 percent. They are, however, not effective in lowering LDL cholesterol. While side effects of fibrates are usually mild, they can increase the risk of gallstones and augment the effects of blood-thinning drugs Inasmuch as nicotinic acid (niacin) lowers LDL and triglyceride levels, it also elevates HDL, so it should be used only under competent clinical supervision, despite its ready availability over the counter. Finally, ezetimibe is a new class of drugs that interferes with absorption of cholesterol in the intestine, and may be used either alone or along with a statin. Its side effects include back and joint pain. Of course, the side effects of statins are widely known as well, including muscle pain, neurological problems and, in some cases, memory loss.

In light of this, it is hardly surprising that alternatives are being actively sought to both lower LDL (and triglycerides) and increase HDL levels without side effects. It is interesting to note that availability of these agents is not especially conducive to motivate users to modify their dietary and lifestyle habits. Even moderate exercise and low-fat diet are indispensable for healthy hearts and prevention of attendant conditions, such as pre-hypertension, pre-diabetes, and other risk factors.

Of course, the most pragmatic approach to manage adverse cardiac events lies in prevention. It is with this implicit understanding that those at risk for CVD are literally clamoring for alternatives--especially diabetics, who are at high risk for CVD, so their regimen must be expressly aggressive. Over the past 15 years or so, type II diabetes has become a major public health concern worldwide. By and large, however, clinical trials with diabetics without overt CVD symptomatology have focused on lowering LDL levels. As such, nutritive means to manage heart health, including pre-diabetics, has assumed center stage.

Enzymes used systemically have been shown to help resolve inflammatory response, one of the major culprits in a number of chronic conditions, including CVD, prediabetes and even obesity. To assess the effects of systemic enzymes--consisting primarily of nattokinase, papain, bromelain, and bioflavonoids--was administered to diabetics with CVD presentation. Within as short a period of dispensation as four weeks, the subjects showed improvement in their HDL levels. (Fig. 1) Furthermore, this composition of enzymes decreased triglyceride levels in conjunction with HDL increase.(**)(Fig. 2)

As noted above, HDL is the single most critical factor in steering a favorable outcome in CVD, either co-presented with diabetes or by itself. Despite the ease of use of pharmaceutical agents, it hardly needs to be over-emphasized that physical activity and changes in dietary and lifestyle habits are essential for maintaining cardiovascular health, keeping fluctuations in blood pressure in check, and preserving the integrity of vasculature. Combined with systemic enzymes and bioflavonoids, as the study results showed, heart health may well be within reach.

(*) For a complete list of references, send SASE to the Editor, ROSE, 4404 E, Elwood, Phoenix, AZ 85040

(**) For details of the study, visit

GRAPH: Fig. 1

GRAPH: Fig. 2


By Lucia Desser, Ph.D.

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