Cholesterol and Lipid Imbalance

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Lowering cholesterol has long been a goal to reduce the risk of stroke, heart attack and atherosclerosis. Complementary and Integrative Medicine (CIM) is useful to the patient to further reduce risk, to reduce or clear atherosclerotic plaque, and to improve the health of the systems that create and regulate the various types of cholesterol carriers, lipoproteins and triglycerides in the body. The ultimate goal in cholesterol health is to normalize unhealthy types of cholesterol-lipoprotein conjugates (LDL-C), as well as triglyceride metabolism, and to promote higher levels of healthy cholesterol carriers, and high density lipoproteins (HDL). To dumb down this health issue as just good and bad cholesterol has led to poor patient understanding and overuse of one type of drug, statins. As scientific study of this problem reveals the various aspects of the cholesterol metabolism more specifically, we find that we need more than just a single pill to achieve our goals, and in fact, there may be even more important predictors of cardiovascular problems that need to be addressed. We now know that C-reactive protein (hsCRP), e-selectin, AGEs and RAGE, and osteopontin (OPN) are more important biomarkers of atherosclerotic cardiovascular risk, and research is revealing that specific herbal and nutrient medicines significantly reduce risk of progression of atherosclerosis. Incorporating Traditional Chinese Medicine (TCM) into the preventive and treatment protocol may do more to reduce this cardiovascular risk within a simple holistic regimen than current pharmacological care, with virtually no adverse health effects.

With a 2011 study showing a modest 17 percent reduction of risk of stroke or heart attack with a long-term high-dose statin regimen, but a 12 percent increased risk of developing diabetes with the drug, and no decrease in atherosclerotic cardiovascular risk from adding a fibrate drug (fibric acid derivative), new guidelines from the American Heart Association were released in 2013 that suggests use of statins for a more select group of patients at higher risk of atherosclerotic heart disease, and more caution with patients diagnosed with Metabolic Syndrome. In 2015, two large studies confirmed that statin drugs dramatically lowered the immune responses to the flu vaccine in older patients, posing many more questions regarding risks versus benefit. Natural herbal statins, based on red rice yeast, had much less effect on immune antibodies. Many studies around the world now suggest that when needed, a lower dose of a statin drug may be combined with herbal and nutrient medicine safely, and that a mild increase of daily activity or exercise, a more plant-based diet, and inclusion of plant sterols and stanols in the diet or treatment protocol can significantly reduce high lipoprotein cholesterol in circulation and improve the health of arterial membranes, heart tissues, and liver function significantly. A more comprehensive long-term strategy is becoming more attractive to many proactive and health-conscious patients with high cholesterol and lipid imbalance, and a realization that ignoring overall health and relying on pills is not a strategy for success. The American Heart Association recommended targeting higher dose statin therapy only for patients with LDL-C (low density lipoprotein cholesterol) greater than 190 mg/dL, diabetic patients with high LDL-C, patients actually diagnosed with atherosclerotic cardiovascular disease, and those with a 10-year atherosclerotic cardiovascular risk greater than 7.5%. More studies are now recommending that guidelines for older patients be revised to acknowledge that higher hemoglobin A1C and systolic blood pressure is normal with aging, and that intensive drug regimens may pose more risk than benefit for many patients, and calling for deintensification of drug protocols for many patients. This means that a lot of patients now taking statin drugs to lower cholesterol need to look for a new protocol to reduce their risk of stroke or heart attack, and Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) provides the professional holistic approach that is now recommended.

Cardiovascular outcomes and decrease in mortality may be largely attributed to population changes in diet and lifestyle. By 2014, studies in prominent University Medical Schools, such as Oxford, showed that a plant-based diet could lower risk of ischemic heart disease by 32 percent, and a daily simple exercise routine could further reduce risk by 30 percent. When compared to the findings of reduction of risk by statin drugs and forced cholesterol lowering of 17 percent, it is obvious what is the better plan. Many large studies also show that risk is greatly reduced by reducing or eliminating sugar, especially high-fructose corn sugar, and trans-fats from the diet. Another large cohort study in 2015, from the University of Texas Health Science Center (PMID: 25780952), called the SALSA study, showed that consumption of artificial synthetic sweeteners in 'diet' foods and beverages was strongly linked to abdominal weight gain and Metabolic Syndrome, as well as obesity and cardiovascular risk in the aging population. Similar large population studies in Europe have shown that 'diet' sodas and foods were strongly linked to childhood and youth obesity, Metabolic Syndrome, Type 2 Diabetes and cardiovascular risk. Public dietary guidelines have been a public health disaster. Each individual could greatly reduce cardiovascular risk, according to abundant evidence, by adopting an individualized preventive medicine protocol. Professional help in this regard is available from Complementary and Integrative Medicine (CIM) physicians, such as Licensed Acupuncturists and Naturopathic doctors, who provide treatment, prescription and sound advice. Each individual has the opportunity to devise their own preventive protocol based on personal choices utilizing these professional physicians with extensive medical school training in dietary, lifestyle and preventive health, something sorely missing from standard university medical schools. For patients choosing to take the standard pharmaceutical regimen, these same CIM/TCM physicians can help to improve the preventive habits and treatment protocols and avoid the adverse health effects of long-term drug use, as well as alleviate the side effects of the chronic drug protocols.

The first step in deciding on the need for complementary and integrative therapies is to understand the health problem and take a pro-active approach. Below is some useful information to get you on your way, although the total body of scientific understanding of benefit and risk of cholesterol-lowering statin and fibrate drugs, as well as the overall needs in long-term reduction of cardiovascular risk, is large and confusing. If you choose to integrate Complementary Medicine into your therapy, such as herbal prescription, nutrient supplement and dietary advice, as well as acupuncture, you may not only be able to reduce chronic dependency and dosage of these problematic drugs, as well as increased reduction of cardiovascular risk, but you may also see progress in overall health and related problems, such as weight loss, diabetes, metabolic syndrome, cardiovascular health and function, and improved hormonal health. While utilization of Complementary Medicine, and a holistic approach in Traditional Chinese Medicine (TCM), is more complicated than just taking a single pill, the results are rewarding, and with health restoration, the therapy will not be needed in the long-term.

Protecting yourself from cardiovascular risk and achieving a healthy lipid homeostasis is one of the most important health goals that you can set for yourself. Cardiovascular death is the number one cause of death behind iatrogenic cause in the United States, and cardiovascular accidents in the form of transient ischemic attacks (TIA) and heart attack, as well as peripheral artery disease (PID), thrombosis (circulating embolism), etc. are problems that most of us will face as we age. While many of us are now under the impression that reducing cholesterol with drugs will prevent these health problems, statistics show that this approach has not significantly reduced cardiovascular deaths or disease in the United States. High cholesterol in circulation is associated with a broader health problem, and addressing the underlying health problems is the actual way to decrease cardiovascular risk. In addition, there are a number of foods and herbs that will reduce excess circulating cholesterol in a healthy way without side effects. The standard advice that emphasized a reduction of dietary cholesterol and adoption of a low-fat diet has also been proven to be not only wrong and misleading, but actually has hurt the public health. A 2016 report on current study of dietary cholesterol from the U.S. NIH shows that many large studies continue to show that dietary cholesterol has no significant bearing on cardiovascular risk, but that eating healthy foods with healthy fats provides considerable benefit in this regard. To see this report, click here: . We have been sold a bill of goods that an emphasis on cholesterol, statin drugs and low-fat and 'diet' foods and drinks will protect us. The statin drugs used by standard medicine were derived from a chemical found in a Chinese herb called Hong qu mi, or Red Yeast Rice, which is a medicinal yeast grown on rice and popularly used in herbal medicine and common food preparation and coloring in China for centuries. These natural aids to healthy cholesterol metabolism are without any risk, and should be just part of a holistic protocol of prevention and treatment. The goal of cholesterol reduction in Complementary Medicine, though, is not to have the patient take an herbal extract for the rest of their life, but to actually restore the normal lipid homeostasis and allow the body to maintain healthy lipid levels without treatment. Restorative and preventive medicine is the key to success, and Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) provides such care and advice.

In 2012, a serious reassessment is occurring in standard medicine concerning widespread statin drug prescription. Renowned medical institutions, such as the Cleveland Clinic, now recommend that when high low density lipoprotein cholesterol in circulation (LDL-C) is found, or when cardiovascular risk is a concern, that the first line of treatment should not be a prescription of statin drugs, but rather adoption of a plant-based diet with low saturated fats (less meat), and introduction of whole grains, legumes, fresh nuts and seeds, and a variety of unprocessed polyunsaturated and monounsaturated oils, as well as healthy fats in such foods as avocado and papaya. The second line of therapy to reduce LDL-C and cardiovascular risk should be the use of about 2 grams per day of phytosterols and stanols. This use of phytosterols and stanols, found in foods and herbs, as well as nutritional supplements, is proven to reduce LDL-C by 10 percent, and with combination of the plant-based whole grain diet mentioned above, 20 percent. This is a greater benefit than the statin drugs, with no adverse effects. The side effects are improved overall health and reduction of cancer risk. Complementary Medicine can help achieve this goal, as a number of common Chinese herbs contain phytosterols, and prescribed professional nutritional medicines are a dependable source for these beneficial phytosterols and stanols. By incorporating these dietary protocols and utilizing the treatments from a Complementary Medicine physician, such as a Licensed Acupuncturist and herbalist, cardiovascular risk may be dramatically reduced. Finally, standard medicine is promoting what Complementary Medicine and TCM physicians have been utilizing for decades. The research supporting this regimen is now substantiated and links to research can be found below in additional information. This advice mirrors the U.S. National Institutes of Health 2002 Final Report on evidence-based medical protocols to treat high cholesterol, which was finally adopted about 10 years after the report was issued.

An article in the March 10, 2013 New York Time Sunday Magazine outlined the rethinking of the medical community regarding the importance of cholesterol reduction in the overall protocol to reduce cardiovascular risk. This article, entitled Eat Your Heart Out, takes a lighthearted look at the advice to lower natural saturated fats in the diet, such as butter, but cites some important evidence that lowering cholesterol may not be the most important aspect of a regimen to reduce cardiovascular risk. The author cites a 1973 Australian study of men with heart disease resurrected recently by the National Institutes of Health that showed that those put on a diet rich in polyunsaturated fats, such as salmon, olive oil, soy, walnut and sunflower seed, reduced their cholesterol dramatically compared to men on a diet rich in saturated fats, achieving lower levels of cholesterol averaging a 13 percent reduction, but that the risk of heart attack and overall mortality risk actually was a little higher than the group that continued with their normal diet. At the time, researchers did not want to see such statistics, and the large study was largely ignored in medical journals. Today, researchers are looking at studies such as these to reassess the failures of our protocol to further reduce cardiovascular risk, and realizing that inflammatory factors, and a balance of fatty acid types, the precursors to inflammatory regulating prostaglandins, are more important to this equation than simple reduction of cholesterol production. One of the prominent researchers cited, Philip C. Calder, a professor of nutritional biology at the University of Southamptom, in Great Britain, noted that research now shows that poor inflammatory regulation, not just levels of cholesterol, initiates cardiovascular disease. Dr. Calder notes in correspondence to the author of this article that "the link between cholesterol and heart disease is not actually as strong as we think." This new evidence points to the need to achieve a balance of essential fatty acids types, commonly called omega-3, omega-6, and omega-9, and utilize healthy fats, avoiding processed transfats, and food rich in advanced glycation endproducts (AGEs), such as fast food and common snack foods.

In 2014, a landmark study at Cambridge University Medical School, headed by Dr. Rajiv Chowdhury, showed that the longstanding emphasis on low-fat diets and lowering cholesterol in low density lipoproteins was indeed incorrect. This study, published in the Annals of Internal Medicine, March 17, 2014, found that incidence of heart disease was not higher in individuals who ate moderately high levels of saturated fat, and that a simplistic approach of replacing saturated fat with polyunsaturated or monounsaturated fat was not enough to lower risk of heart pathology. Of course, the study looked at heart disease and not the full implications of vascular disease. What this study did find in finally taking a more nuanced look at fatty acids and heart disease was that the type of low density lipoprotein cholesterol (LDL-C) was important, or in other words, that healthy molecules that carry healthy cholesterol was the determining factor. The small and dense type of LDL, more easily oxidized, is associated with cardiac disease, while the normal healthy LDL is not associated with cardiac disease. The researchers term this unhealthy LDL-C Pattern B, and note that it is associated with increased vascular inflammation, high triglycerides, and relatively higher high density lipoproteins (HDL), which carry stored fats back to the liver, and have long been associated with decreased cardiovascular risk. Pattern A consists of healthy LDL-C that is largely and appears fluffy, or less dense, and healthy saturated fats in the diet actually increases this type of healthy LDL-C as well as HDL-C. In other words, healthy fats, including butter, cheese and eggs, is good for you, and a strategy of eliminating fats, purchasing processed low-fat foods, is bad for you. Of course, this isn't new news, since decades ago researchers noted that populations in Europe that ate larger amounts of healthy fats had less cardiovascular disease.

Of course, the American media, influenced by their advertisers, published this information with the headlines that it was now proven that you should eat more hamburgers and steaks, and forget your plant-based diets for cardiovascular health. This is a complete misreading of the data from this study, and the lead authors, when interviewed, stated that this would be a health mistake, and that a European diet, commonly called a Mediterranean Diet, should be followed, and that fatty acids found in dairy and fish did reduce cardiac risk. The authors noted that participants that consumed omega-3 fish oil supplements did not show benefit, but that this subset consisted mostly of patients with cardiovascular disease, indicating that omega-3 supplements, like krill oil, could be useful as a preventive medicine, not a medicine taken to cure the disease. The researchers also noted that the balance of essential fatty acids was important, as well as the quality, with some polyunsaturated omega-6 fatty acids found in processed foods and commercial vegetable oils potentially posing health risks. As usual, the questions concerning human physiology and health cannot by dumbed down, and as usual, the media will try to dumb down even this study to confuse the public and help their advertisers sell unhealthy foods. The real message from this study is that standard medicine, promoting decades of advice to eat a low-fat processed diet and just take cholesterol-lowering statin drugs to reduce cardiac risk, was wrong. Maintaining healthy LDL-C, aiding liver health and metabolism to reduce high triglycerides and promote relatively higher HDL-C, and eating a balance of healthy fats in the diet is the proven and correct strategy. Integrating Complementary Medicine into your healthcare can help you to achieve these goals.

In February of 2015, the top nutrition advisory panel of the U.S. government, chaired by Dr. Marian Neuhouser, announced that the longstanding advice that we should avoid so-called high cholesterol foods was indeed wrong. The panel announced that dietary cholesterol was no longer "a nutrient of concern", and that for most people, eating foods that are called high in cholesterol will not significantly affect the level of cholesterol in the blood circulation or liver. The advice was still to decrease saturated fats, and eat healthier fats, such as plant-based fats, lean meat and fish. The Washington Post quoted many renowned experts as supporting this change in advice, such as Professor Walter Willett, head of the nutrition department at Harvard, Professor Naomi K. Fukagawa of the University of Vermont, a former committee panel vice-chairman, Professor Robert Eckel of the University of Colorado, and Professor John P.A. Ionaddis of Stanford University.

Assessing the real reasons for progress in reducing cardiovascular incidence and death in the United States historically

The debate grows concerning the reductions in cardiovascular deaths seen in the late 1960s through the 1980s. Many experts now agree that changes in diet and lifestyle, combined with improved acute care in hospitals and emergency rooms, are primarily responsible for the statistical improvement during this era. In the 1980s, statin drugs were introduced to block cholesterol production in the liver, and many objections to their approval emerged from the expert FDA panel, with modest benefits and concern over a number of issues of long-term risk. Nevertheless, this strategy, along with overprescription of hypertension medication, emerged as the only tools pushed in standard medicine from the 1980s to the present. Today, reviewing statistics, we see that from 1997 to 2009, incidence of hypertension has increased from less than 200 per 1000 adults to more than 250 per 1000, and rates of heart disease, coronary heart disease, and stroke have stayed the same, despite an enormous increase in the prescription of statin drugs. Deaths from cardiovascular disease, especially coronary heart disease, continue to fall, but reduction in deaths from stroke and myocardial infarction have been minimal during this span (U.S. CDC data). This is primarily attributed to improving acute care in hospitals for serious heart attacks. There has been little emphasis on reduction of heart disease in standard medicine, but greater emphasis on increasing drug prescription for patients with heart disease.

In 2013, the University of Oxford, United Kingdom, Nuffield Department of Clinical Medicine, released a long-term comprehensive study of 44,561 men and women enrolled in the European Perspective Investigation into Cancer and Nutrition (EPIC), and found that those with a predominantly vegetarian diet had a 32 percent lower risk of ischemic heart disease than non-vegetarians, adjusting for other risk factors. Vegetarians had lower non-HDL cholesterol, BMI, and systolic blood pressure (Crowe FL et al; Am J Clin Nutrition 2013 Jan 30; PMID: 23364007). These researchers stated that "few previous prospective studies have examined differences in incident ischemic heart disease (IHD) risk between vegetarians and nonvegetarians." This study shows dramatically that improvement in diet and lifestyle, and attention of overall health, has been, and still is, the number one reason for improvement in cardiovascular health. A 32 percent lowered risk of cardiovascular disease is decidedly more dramatic than that achieved by pharmacological treatment, and the only side effects are better overall health and energy. By improving one's health, integrating Complementary Medicine as well as simple dietary and lifestyle routines, the dramatic lowering of cardiovascular risk can be accomplished, with less need for pharmaceutical intervention.

In 2011, ABC News reported that standard medicine has not only increased prescription of statin cholesterol-lowering drugs in recent years, despite uncertain benefits, but has doubled the prescription of fibrate drugs as well, often prescribing both a statin and a fibrate drug, despite major studies showing that there was no measurable benefits in reduction of cardiovascular risks with this protocol.

Fibrate drugs have been developed and heavily marketed in recent years to lower triglycerides, but studies such as the Action to Control Cardiovascular Risk in Diabetes (ACCORD), which followed 10,000 patients with diabetes, showed that there was no decrease in stroke, heart attack, or cardiovascular mortality with the addition of a fibrate drug added to a statin drug regimen. The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial, also following 10,000 patients since 2005, reported a failure of fenofibrate (Triglide, Tricor, Lipofen, Lofibra, Fenoglide, Antara) to decrease cardiovascular deaths more than a placebo. In response, the chairman of cardiovascular medicine at the esteemed Cleveland Clinic Foundation, Dr. Steven E. Nissan, was quoted: "The use of fibrates in America is very troubling." The sentiment expressed is that the 200 percent increase in the prescription of fibrate drugs (Lopid, TriCor, TriLipix, Fibricor) in the United States, but not in Europe or Canada, is due to aggressive marketing tactics, and not scientific evidence-based medicine. In November, 2013, the American Heart Association finally came out with new guidelines to reduce atherosclerotic cardiovascular risk, and recommended that we stop adding fibrates and other drugs to the statin drug regimen, that we identify specific subgroups of patients that actually may need statin cholesterol lowering drug treatment, identify high intensity and moderate intensity patients, utilizing reduced dosages of statins when necessary, respond to adverse health effects of statins when they occur and either reduce or stop the statin therapy as needed, and instruct the patient in what side effects may occur with chronic use, in the use of plant stanols and phytosterols to better control cholesterol, and encourage patients to increase daily exercise and activity, and lose weight, when necessary.

Understanding Cholesterol

Cholesterol is the most abundant steroid hormone in the human body. It is an abundant nutrient, especially in meat fat. Cholesterol circulates in the human body attached to various proteins in the blood, and is essential to build many hormones (e.g. estrogen and testosterone) which are made from cholesterols, to maintain cell membranes, to create bile to digest fats, to create activated Vitamin D to regulate calcium, and many other processes. The body naturally makes cholesterol in every cell to perform numerous functions. Much production of cholesterol hormone occurs in the liver, which is the main metabolic organ in our bodies, and both breaks down cholesterol and regulates storage and transportation as well. Cholesterol hormone itself is a healthy and essential molecule. Cholesterol is carried to and from the liver attached to lipoproteins, which are fat and protein molecules. Increases in high-density lipoproteins (HDL), which mainly carry cholesterols and triglycerides back to the liver from storage in fat cells, has been shown to reduce atherosclerotic plaque.

Cholesterol is produced in our livers, but also in peripheral tissues, where it is also stored and released into circulation. Statin drugs block production of cholesterol in the liver. Peripheral tissues produce and release cholesterol as needed as well, and this results in the increase in high density lipoprotein (HDL) a beneficial carrier of triglycerides from our fat cells back to the liver for processing to glucose as needed. Thus, circulating cholesterol levels are not an entirely clear problem. Even in patients with high circulating levels of cholesterol, the metabolic picture may not always indicate a need for blocking the production of cholesterol in the liver. There is a possiblity that in many patients that high circulating cholesterol is a healthy aspect of the lipid metabolism. Research in recent years has shown that LDL-C (low density lipoprotein with cholesterol) is a component of arterial plaque in smooth muscle cells, but that the danger in this arterial plaque is related to the fat cells that produce higher levels of macrophages in response to inflammatory dysfunction, not the part of the plaque composed of smooth muscle cells.

While total reduction of arterial plaque is helpful in patients with such buildup, the focus should be on the part of the arterial plaque associated with inflammatory changes and advanced glycation endproducts. While there is enormous economic and philosophical incentive to attribute progress on cardiovascular disease to statin drugs and lowering cholesterol, more and more experts are questioning this staunch adherence to a perhaps outmoded concept. In addition, we now know that there are variations in the quality of low density lipoprotein cholesterols (LDL-C), and that a Class B type, composed of denser and small LDL molecules, is associated with the inflammatory changes in the vascular membranes, as well as higher triglycerides and relatively lower HDL, commonly termed the "good cholesterol". Healthy LDL, termed Class A, is associated with less inflammation on the vascular walls, and thus less cardiovascular risk and atherosclerosis. Healthy LDL-C is also associated with normal triglyceride levels and relatively higher levels of HDL-C, which carries stored fats back to the liver to be processed. It is becoming apparent that the strategy of chemically inducing changes in the expression of these LDL lipoproteins may be forming this unhealthy type of LDL-C, and contributing to overall negative factors in cardiovascular risk. An oversimplified and profit-driven approach to the subject has not been the most beneficial approach for the public.

Carrier proteins in our blood are called lipoproteins, and it is these that are often mistakenly referred to as cholesterols when high cholesterol is discussed with patients, or in advertisements, because they transport cholesterols to and from the liver. Since cholesterol is produced in all human cells, dietary intake does not have a significant direct relationship on the amount of cholesterol in the body, although cholesterol may be taken in from the diet, primarily from meats and dairy products. Since the body depends on a steady supply of cholesterol to function well, the liver is very good at producing cholesterol and breaking it down, as well as producing the lipoproteins that carry it to and from the liver. Excess cholesterol in the diet may either be broken down efficiently by a healthy liver, or it may need to be stored in your body fat. Cholesterol levels in the body are different from cholesterol levels in circulation. It is impossible to measure cholesterol levels in the body, and the circulatory levels are the only measurement we have. Three things may cause high cholesterol in your blood circulation: (1) poor liver function, (2) excess unhealthy fat in the diet, or (3) increased need for cholesterols in your metabolism. High cholesterol in circulation in thus not a simple thing to analyze, and has little bearing on atherosclerotic plaque. As time has gone by, and further research into what constitutes unhealthy atherosclerotic plaque has been performed, we have learned that a number of other factors are much more important in reducing the unhealthy atherosclerotic plaques that lead to the emboli which cause strokes and heart attacks, and to the unhealthy areas on arteries that lead to aneurysms and arterial bleeding.

Cholesterol reduction in and of itself may present some health problems. Are there health problems with low cholesterol? Research has linked depression and suicide to low cholesterol levels, as well as anxiety and hormone deficiency. This does not mean that anyone with these problems has low cholesterol, or that low cholesterol is causing your depression, anxiety or hormonal deficiency, but this should be a consideration when assessing these health problems. Low cholesterol is seen in hyperthyroid disorders, liver diseases, intestinal diseases, manganese deficiency, and other nutritional deficiencies. An article in the July, 2007 Journal of the American College of Cardiology reported that a study at Tufts University School of Medicine found that patients lowering cholesterol to a very low level for 5 years increased their risk of cancer, with one more person per 1000 acquiring a cancer diagnosis in this group. Chemical reduction of cholesterol production has its long-term risks, besides side effects. Another question in recent years is the quality of cholesterols produced in the long-term when taking drugs that inhibit genetic expression of cholesterol and lipoproteins. Poorly formed cholesterols may have negative consequences to the health, since cholesterol is a hormonal building block for all steroid hormones and the Vitamin D3, or hormone D3 prohormone, cholecalciferol. In fact, statin drugs that inhibit cholesterol expression will also inhibit the cellular antioxidant CoQ10 (via inhibition of mevalonate), which is also referred to as Coenzyme Q10, and ubiquitone (because it is ubiquitous, or in all cells). Chronic use of these statin drugs eventually puts increased oxidative stress on our cells, which is highly associated with cardiovascular disease. This is the catch 22. There is speculation that chronic use of statin drugs may result in too many dysfunctional cholesterol hormone molecules, and that this could create increased demand in the body for cholesterol production. It is not unusual for a patient to experience a quick reduction in circulating cholesterol levels after starting the statin drugs, and then an eventual rise in circulating cholesterol levels with chronic use, prompting prescribing medical doctors to utilize a high-dose statin therapy. This practice and potential health threat is what prompted the study at Tufts University School of Medicine. And then we must consider that the circulating levels that are measured are not an accurate measurement of the active cholesterol in the body, since cholesterol is produced by a wide variety of cells in the body.

Newer drugs to lower cholesterol include the monoclonal antibodies Alirocumab (Sanofi and Regeneron Pharmaceuticals) and Evolucumab (Amgen Pharmaceuticals), which have shown in preliminary trials that they lower LDL-C to unprecedented levels, as low as 15 (70 is considered ideal in patients at high risk of cardiovascular disease). In a June 11, 2015 New York Times article, entitled Panel Tells F.D.A. to Back Second Drug to Help Heart, leading cardiologists, such as Dr. Philip Sager of Stanford University, stated that "maybe extremely low is just absolutely fine, but there is a lack of data...on the other hand there is not much data (showing) that having and LDL level less than 40 shows much benefit." The monoclonal antibody is a clone of an immune molecule that can be designed to target any cell receptor and inhibit expression of genetic processes. This new drug targets a gene called PCSK9 that is involved in controlling expression of LDL. Individuals with a gene mutation of PCSK9 were found to have much lower levels of LDL-C, and fewer heart attacks. Dr. Jerome Avorn of Harvard Medical School stated that large long-term human clinical trials were needed to assess potential long-term risks, and stated that "it would be cavalier to assume that nothing could possibly go wrong. We've not ever done anything like this with drugs before." Monoclonal antibodies have been useful in treating cancer and autoimmune diseases, blocking expression of key pro-inflammatory cytokines and growth hormone receptors, but the benefits of drastic reduction of lipid cholesterol are not known, and dependent on beliefs that are being challenged in recent years. Fully human monoclonal antibodies carry the risk of adverse immune modulation at any stage of therapy, and the potential adverse effects for drastic decrease in LDL-C expression have not been well evaluated. As stated, studies in the past have linked low cholesterol levels to an array of neurohormonal disorders, as well as an increased risk of cancer, but the exact mechanisms and level of risk has never been evaluated. With drugs that drastically lower LDL-C, there is also the potential for patients and physicians to ignore a more holistic approach to decreasing cardiovascular risk, perpetuating the mistaken belief that simply taking a medication to lower cholesterol will allow individuals to ignore other important considerations of diet and lifestyle, as well as safe protocols in Complementary Medicine, to decrease cardiovascular risk and improve overall health and homeostasis.

As this new type of drug to inhibit proteins produced by the PCSK9 gene, Praluent, came on the market in 2015, the cost of therapy was set at about $14,600 per year! Fast track approval allowed this drug on the market years before clinical trials would show that it actually worked to decreased cardiovascular events, though, and like the expensive Hepatitis C drugs that were fast-tracked, and cost between $100,000 and $200,000 for a course of two of treatment, many think that the high pricing reflects not the value of the drugs, which is still unknown, but the fact that they might not last on the market once the long-term data is finally known. Profits might need to be made quickly, before the potential bad news is revealed. This type of stategy has many alarmed. For now, medical experts are trying to limit prescription of these PCSK9 inhibitiors, such as Praluent, to a select subset of patients that current drugs do not help and who have sustained alarming levels of low density lipoprotein cholesterol (LDL-C), or who have not been able to tolerated the adverse health effects of statin drugs. In a July 25, 2015 New York Times article, entitled New, and Costly, Drug Sharply Lowers Cholesterol, Dr. Rita Redberg, a cardiologist at the University of California San Francisco (UCSF), stated: "This is treating a lab value (not the disease). I don't think we should rush into it." Katherine Wilemon, who heads an advocacy group called FH Foundations, was thrilled, as she has suffered a heart attack and current drug strategies did not lower her cholesterol, which was still at about 167. When she started on Praluent her LDL-C level fell to below 50, but as stated, there may be negative consequences to this low of a level of cholesterol, a useful hormone in the body, and the precursor to all steroid hormones.

An increasing number of warnings and adverse health risks, as well as an increasing number of doubts about overall efficacy of cholesterol-lowering statin drugs

Cholesterol lowering statin drugs come with a variety of long-term risks and potential harmful effects. Besides inhibiting the pathways for the hormone Vitamin D3 and CoQ10, statins have created problems with protein catabolism that has resulted in accumulation of broken proteins in tissues, which creates muscle and joint pain, and in a severe situation creates a dangerous stress for the kidney in clearing protein fragments. When this situation is severe, rhabdomyolysis, or excess breakdown of protein fragments, occurs. One statin drug, Baycol (cerivastatin) was withdrawn from the market because of confirmation of about 100 rhabdomyolysis-related deaths. As of January 2006, over 6000 court cases of wrongful death were pending against Bayer for this injury, and 3082 had been settled, though without acknowledgment of liability (settlements exceeded $1.5 billion). The implications are that milder problems with protein fragment accumulation occur in many patients taking statin drugs, resulting in the eventual increase in muscle and joint pain, and potentially increased stress for the kidney. An increasing incidence of prescription of multiple drugs that may increase the risk of rhabdomyolysis, such as SSRI antidepressant and anti-anxiety drugs, antipsychotic medications, which are increasingly prescribed for off-label purposes, diuretics, and neuromuscular blocking agents prescribed for chronic pain, prescribed together and with statin drugs, increase the risk of protein fragment (peptide) accumulations considerably. Patients without acute severe symptoms are rarely evaluated and diagnosed.

Many patients wonder whether these warnings of risks for statin drugs actually affects them if they do not personally see signs of adverse effects and their prescribing medical doctors insist that the drugs are not harming them. A 2013 study at the renowned Duke University Medical Center in Durham, North Carolina, finally studied the real effects of statin drugs on muscle function, and found some surprising adverse effects for everyone. Researchers divided a group of patients with Metabolic Syndrome and obesity into two groups, one receiving simvastatin and the other taking no statin drug, and put them through a 12-week aerobic fitness program. The group not taking statin drugs increased cardiorespiratory fitness by 10 percent, and the group taking statins by only 1.5 percent, and the group not taking statins increased muscle function and growth by 13 percent, but the group taking statins by only 4.5 percent. The benefits of such aerobic exercise have already been demonstrated as having more benefit than statin drugs in the lowering and balancing of lipoprotein cholesterol, as well as reduction of cardiovascular risk. This study may finally signal an end to the automatic prescription of statin drugs for patients with Metabolic Syndrome and obesity. As research into healthier therapies to improve the lipid profile progresses, proof is emerging that a combination of mild exercise, improvement in diet with a more plant-based diet and healthy fats, and the use of herbal and nutrient medicines can not only achieve a dramatic improvement in the lipid profile, but provide healthy side effects, not adverse ones. For instance, a 2004 study at the Chinese Academy of Medical Sciences, in Beijing, China (cited below), found that a well known chemical found in Chinese herbs, berberine, taken for 3 months, lowered cholesterol by 29 percent, triglycerides by 35 percent, and LDL by 25 percent in humans with chronic high cholesterol. The berberine works through different pathways than statin drugs, which themselves are synthetic equivalents of a chemical found in a common Chinese food additive called Red Yeast Rice. The natural statins in Red Yeast Rice, like synthetic statins, do inhibit production of health CoQ10 enzymes, and a combination of berberine, Red Yeast Rice extract, and CoQ10 may provide a safe, healthy and dependable supplement to help reduce high cholesterol that can easily be adjusted in dosage as the lipids are monitored in blood tests. As the patient establishes a better exercise and dietary regimen and monitors progress with their medical doctor, the need for the medicine may be eliminated. Such a protocol gives the patient a safe and conservative program for regaining metabolic health without a chemical dependency and long-term adverse effects.

In 2011, the FDA announced new restrictions, contraindications, and dose limitations for simvastatin (Zocor) to "reduce the risk of muscle injury". These June 8, 2011 updates on the statin warnings include acknowledgement that a higher dosage of statin drugs come with considerable risk of muscle pain, tenderness, or weakness, as well as an elevation of a muscle enzyme in the blood circulation called creatine kinase (CK). A severe harm, in the form of rhabdomyolysis, where the accumulated peptides and metabolites from muscle dysfunction and breakdown overwhelm the kidneys occurs in 4.9 of every 100,000 patients taking simvastatin for one year, and 4.4 of every 100,000 patients taking atorvastatin (Lipitor) or pravastatin (Pravachol or Selektine). Milder forms of induced muscle injury and dysfunction occur in a relatively high percentage of patients, though, and a number of other concurrantly taken medications will increase the level of the statins in the body, including the antibiotics erythromycin, clarithromycin, telithromycin, cyclosporine, HIV inhibitors, danazol (Danocrine, to treat endometriosis and fibrocystic breast disease), nefazadone (Serzone, an antidepressant), gemfibrozil (Lopid or Gemcor, to treat high triglycerides), posaconazole (Noxafil, an antifungal and antiyeast infection drug), itraconazole (Sporanox, an antifungal), and ketoconazole (Feoris or Nizoral, an antifungal). Added to this list of drugs that should never be taken concurrently with statins, in February of 2012, are posaconazole (an antifungal), and boceprevir, teleprevir (protease inhibiting antivirals used to treat Hepatitis C). The revised risks for muscle pathology and rhabdomyolysis for simvastatin were 5 per 1000 person-years, and 2 per 1000 person-years respectively (or 10 percent of patients taking statins for 20 years are expected to have an incidence of muscle pathology). These figures represent diagnosed cases, and assuredly underestimate the percentage of patients affected with muscle pathology that is not diagnosed or attributed to statin use. In addition, the increase in CK, indicating more rapid muscle breakdown and dysfunction, is a prime marker for the autoimmune diagnoses of polymyositis and dermatomyositis, and may be associated with misdiagnosis of these pathologies. The data for these FDA revised warnings came from the SEARCH study, a 7 year, randomized, double-blinded clinical trial of simvastatin 80 mg in survivors of myocardial infarction, as well as the FDA adverse event reporting system (AERS) database. With the imminent loss of patent protection and the advent of generic status for statin drugs, with availability without prescription, the public should be aware of the acknowledgement of these risks, which reflect very conservative views on the statin drugs, dosages and interactions.

In February of 2012, the FDA issued yet another warning concerning cholesterol-lowering statin drugs, citing serious consideration of wide reports of clinical anecodotal evidence of memory impairment and cognitive dysfunction, including transient global amnesia (TGA). Scientific study of cognitive and memory dysfunction caused by statin drugs has not yet been completed, but the FDA advisory panel felt that the clinical evidence was substantial. In addition, this FDA warning finally acknowledged the fact that a rise in blood sugar levels and the A1C advanced glycation endproduct occur with the use of statins, but downplayed this warning by stating that after 20 years of scientific evaluation it has just now established that the threat of serious liver damage and need for monitoring of liver enzymes has not been really necessary. The health risks of statin drugs have been downplayed for decades while the patients have been told that if their liver enzymes are normal on blood tests, there is no harm. How the statin drugs cause memory impairment, cognitive dysfunction, and temporary global amnesia is the key question. Experts now believe that the unnecessary lowering of cholesterol and the impaired quality of cholesterol has reduced the function of the cholesterol hormone in maintenance of the brain tissues. Data from the Framington Heart Study demonstrated that older people with low total cholesterol (under 200) are much more likely to perform poorly on tests of mental function than those with high total cholesterol (over 240). Inhibition of the expression of coenzyme Q10 (CoQ10), or ubiquinol, a ubiquitous cellular detoxifier and antioxidant, is also thought to be important to this pathology. Statins may also adversely affect tau proteins in the brain, with poor expression of this regulatory protein promoting formation of neurofibrillary tangles, as they have been called in studies of neurodegenerative diseases, especially Alzheimer's disease. When tau proteins are defective, their function of stabilizing microtubules in brain neurons is impaired. Increased phosphorylation of tau proteins results in the formation of tangles that impair neurological function. In some neurodegenerative diseases, tau isoforms (poorly expressed tau proteins) are found in aggregate depositions that are integral to the neurodegeneration. Excess phosphorylation occurs when a misformed tau protein has the signaling sites on its membrane fully saturated with phosphate groups, preventing cell cycle events. This leads to cellular dysfunction and neurodegeneration. Since the events leading to neurodegeneration are complex, the direct evidence of statin causation is elusive, and the FDA states that no proof of permanent neurodegeneration caused by statin use exists. Neurodegenerative diseases are still poorly understood pathologically, despite decades of intensive research, but the alarming rise in neurodegenerative diseases coincides with the presecription of the most widely prescribed drug in medical history, statins. This has set off alarm bells for many medical experts. Some small studies have shown that cognitive impairment related to statin use has appeared to reverse when discontinuing the drug.

While there has been a paucity of studies exploring the negative health effects of statin drugs, finally, in 2012, alarm bells are ringing with the unexpected results of a number of studies. A meta-review of clinical trials by Harvard Medical School and the Joslin Diabetes Center, published in 2012 in the New England Journal of Medicine, followed up on the JUPITER trial, a large study to reassess the use of statins in diabetes prevention. This study (cite below in additional information with a link) shows that there is a 25 percent increased risk of developing diabetes for pre-diabetic patients with Metabolic Syndrome that are prescribed statins.

The meta-analysis shows also that a 13 percent risk of statin-induced diabetes is seen in a review of tens of thousands of patients. Experts are reassessing the treatment protocols with cholesterol-lowering statin drugs, and will assuredly look to a more comprehensive approach and decrease in the dependency on statin drugs and biguanidine synthetics such as glucophage (Metformin) in the treatment of Metabolic Syndrome or the pre-diabetic state. While such drugs may be necessary in the treatment of diabetes type 2, overuse of the drugs when healthy alternatives exist may be discouraged in the near future. This comes coincidentally at the same time as the loss of patent protection for the statin drugs. Increased integration with Complementary Medicine presents healthy treatment protocols, and perhaps aids the more widespread acceptance and adherence to diet and lifestyle changes that would dramatically improve the metabolic health and maintain improved lipid balance and cardiovascular health.

Added to these adverse effects and warnings, a 2012 study authored by Dr. Beatrice Golomb of the University of California in San Diego, published online in the June 11 Archives of Internal Medicine, found a significant association of fatigue with chronic statin use. In this study, 1016 men and women with levels of LDL-C between 115 and 190 were followed in a placebo-controlled randomized trial. One third of the group received simvastatin (Zocor), one third pravastatin (Pravachol), and one third placebo, for six months. Both of the statin groups reported significant fatigue, both overall and with exertion, with the adverse effect more apparent in women. Dr. Golomb suggested that if fatigue was noted by the patient, that a minimal step would be to have a trial of discontinuation of the drug to see if the energy level improved. In an interview published in HealthDay News, Medline Plus, Dr. Golomb stated: "So far, the only group for whom the benefits of taking statins has clearly been shown to outweigh the risks has been men under the age of 70 who have heart disease. The findings have been, at best, equivocal for women, even if they have heart disease. And the same is true even for most middle-aged men at high risk who don't have heart disease. When you add to that the fact that these drugs can have a strong negative effect on a patient's quality of life, I think there is a rationale for rethinking their use among many individuals. Preventive medicine should only be used when the benefits clearly outweigh the risks." The U.S. National Institutes of Health (NIH) funded this study.

We can clearly see that chronic mild fatigue would be a significant problem in maintaining cardiovascular health and preventing disease. In 2011, researchers at the University of Texas Southwestern Medical School, and the Cooper Institute in Dallas, Texas, released data from long term studies that shows that cardiovascular maintenance, not cholesterol level, is the key factor in assessing future cardiovascular risk. Two reports, published in the medical journals Circulation and the Journal of the American College of Cardiology, found that the level of aerobic cardiovascular fitness maintained between the ages of 40 and 50, was the greatest indicator of cardiovascular risk. A person in the higher realm of cardiovascular fitness during this phase of life had a 10 percent lifetime risk, while those that fell into the lower realm of cardiovascular fitness had a 30 percent lifetime risk. Those persons in the higher realm of fitness were not always high level athletes, as any man that could run a 8 or 9 minute mile was in the moderate to high level of cardiovascular fitness, and this was mainly maintained by increased walking and stair climbing, and general activity. The recommendations were not to start running miles as fast as you can, the lead researchers stated, which could lead to strain and injury, but to increase the daily aerobic activities, get up from the desk and the couch, use the stairs, walk to work, and start a weekly routine of modest exercise. This may be the reason why populations, such as those mentioned in Spain, had such a lower incidence of cardiovascular disease. In addition to these lifestyle changes, dietary improvements, especially concerning healthier fats, whole grains and beans, and a more plant-based diet, as well as the utilization of health maintenance in the form of herbal and nutrient medicine, acupuncture and physiotherapy, are the keys to a simple but dramatic decrease in overall cardiovascular risk.

So we see from reliable study that modest cardiovascular fitness has a profound effect on cardiovascular risk. In 2013, a study at Duke University Medical Center, Durham, North Carolina, U.S.A., found that statin drugs actually impair the ability of patients with Metabolic Syndrome from gaining the benefits of aerobic exercise. In the first study published that actually investigated whether the chemical effects of statin drugs on muscle health, both muscles of our organs, such as the heart, and of our skeletal muscles, could actually impair muscle fitness, patients with Metabolic Syndrome and/or obesity were randomly assigned to either take a statin or not as they went through a 12 week aerobic fitness program. Scientists measured whether cardiorespiratory fitness and skeletal muscle gains and found that the group taking the statins had most of the benefits of this cardio workout routine nullified (see study link below). This study followed the negative findings of the JUPITER trial of statin benefits at Harvard Medical School, the 2012 findings that statins created fatigue at the University of California San Diego, and a 2012 FDA update on statin warnings that noted that statins actually increased the risk of developing diabetes in patients with Metabolic Syndrome, commonly called a pre-diabetic state. As studies all over the world affirm the amazing benefits of a plant-based healthy diet and modest exercise routine, as well as the significant benefits from researched herbal and nutrient medicines on cardiovascular health and reduced risk of stroke and heart attack, more and more studies are now showing how the standard protocol for treating cardiovascular risk have perhaps been introducing more risks than benefits. Why this information is just now coming out, over 30 years after the wide introduction of statin drugs into the protocol, and just as the patent protections of these drugs expire, is a question of some merit.

Of course, the belief in standard medicine is that these cholesterol lowering drugs provide such a remarkable benefit that even bringing up the subject of health risks has been taboo, and many studies have been designed to discount any evidence of major health risks. As these drugs are now losing their patents and going generic, though, the reports of health risks are increasing in the medical journals. The patient population will soon face the probability that these statin drugs, once generic, will be marketed by the pharmaceuticals as over the counter drugs, available without prescription. This will inherently imply that there must be no safety concerns. The fact is that the FDA nearly refused to approve statin drugs when they were introduced in the mid 1980s for a reason, and the cavalier prescription and promotion of statins for a majority of the overall patient population is a matter of concern. The lowering of total cholesterol for a subset of patients with excess cholesterol associated with lipid imbalance hasresulted in health benefits for these patients, but has the benefits versus risks of long-term use been properly considered? The question of whether these lipid imbalances and underlying health problems were properly addressed is the more important question. A more complete treatment protocol would have utilized statin drugs temporarily as the underlying health problems were addressed with Integrative and Complementary Medicine, avoiding the serious adverse health effects and risks associated with long-term use of statin drugs. This protocol would result in a healthier patient. The intelligent patient is beginning to understand that there are many other ways to decrease the risk of cardiovascular disease and death which may be much more effective, and certainly have less long-term risk, than taking statin drugs long term. The implication that one is safe as long as they take statin drugs to lower the cholesterol and hypertension medications is simply not true, and the promotion of this belief in the patient population is doing more harm than good. The question is not whether we should utilize standard medical treatment or an alternative, but whether we should intelligently integrate health regimens in Complementary Medicine into the overall protocol for better long-term results.

New directions in pharmaceutical treatment of cholesterol lipid balance and cardiovascular risk

In response to the rising tide of studies showing adverse effects of the cholesterol lowering statin drugs, the pharmaceutical industry introduced a new type of drug that would allow lower statin drug dosages and perhaps achieve the goals set by Complementary Medicine in providing a better homeostatic balance between HDL-C and LDL-C. These new drugs utilize a high dose of niacin (nicotinic acid) combined with a synthetic chemical, laropiprant, that was designed to prevent a side-effect of niacin, the cardiovascular flush. The ultimate goal was to combine this new drug with lower dosage statins to preserve the patent protection and profits as statins went generic. Unfortunately, in 2012, the results of a large worldwide human clinical trial of the drug, conducted by Oxford University School of Medicine, called the HPS2-Thrive Study, showed that this Merck drug Tredaptive did not significantly reduce the risk of cardiovascular disease over 4 years, and did significantly increase the incidence of various adverse health events. Some researchers have raised the concern that the chemical laropiprant actually undermined the positive effects of niacin, which has long showed benefits in human clinical studies in improving the balance of HDL and LDL. In the meantime, nutrient medicine has found that non-flushing types of this B vitamin (B3), such as niacinamide and inositol hexacotinate, are effective and can be utilized as part of a more comprehensive holistic treatment protocol, without the side effect of the niacin flush experienced by a significant percent of patients. Used alone, a dosage of up to 2000 mg per day of niacin is needed to reduce LDL-cholesterol, but when combined with other benign natural cholesterol-lowering herbal and nutrient chemicals, a more practical, and safer, dosage of this B vitamin nutrient may be utilized. Some experts are puzzled by this use of laropiprant and high-dose niacin with statins in an expensive new medication, when a combination of low-dose statins could easily and inexpensively be combined with niacinamide or inositol hexacotinate, and other natural cholesterol-lowering herbal and nutrient chemicals, to achieve the same results. Since low-dose statin drugs are now generic and inexpensive, this protocol would be very much less expensive than the new Merck drug. This new drug offering appeared to be designed for failure, and perhaps to discourage doctors and patients from utilizing niacin and non-flushing niacin derivatives, such as niacinamide and inositol hexacotinate.

The ploy to heavily advertise and provide incentives for fibrate drugs added to the statin protocol has also been questioned as a perhaps cynical strategy now that we see clinical evidence from a decade ago finding no benefits in reducing atherosclerotic cardiovascular risk with fibrate drugs. In response to the growing skepticism that adding drugs to a statin regime to achieve ever lower levels of lipoprotein-carried cholesterol is a good idea, especially when long-term studies have shown no actual benefits in preventing cardiovascular events such as stroke and heart attack, a new focus on a different way to block low-density lipoprotein and lower LDL-cholesterol is emerging in pharmaceutical research. As the statin drugs finally lose patent protection and become generic, and much less expensive, a new class of drugs called PCSK9 (proprotein convertase subtillsin/kexin type 9) inhibitors is being introduced to the market. This injectable drug inhibits an enzyme that is often inactive, but is produced in the vascular membranes, and when activated, binds to the low-density lipoprotein (LDL) receptor (LDLR) and induces receptor degradation. This is proven to lower high LDL cholesterol more dramatically than statin drugs, which block the mevalonic acid pathway of production of lipoproteins. Unfortunately, PCSK9 plays an important role in modulating lipoprotein metabolism, binding to the LDL receptor when activated in the liver, and breaking down both the LDL as it is brought back to the liver, and the LDL receptor, decreasing the rate that liver breaks down excess LDL and its cholesterol. While this will lower LDL-cholesterol more dramatically in most patients than statin drugs, the actual benefits in reducing cardiovascular risk, once again, is not proven, and will not be for a number of years. Nevertheless, the U.S. FDA has stated that it may approve these new drugs before cardiovascular risk benefit is proven in long-term studies (once again). In 2015, the U.S. and Europe did approve 3 PCSK9 monoclonal antibody drugs that inhibit the PCSK9 protein and receptor regulation, evolocumab (Regeneron), bococizumab and alirocumab. PCSK9 may also have a role in differentiation of cortical neurons, and affect epidermal growth factors, and variations of PCSK9 have been shown to reduce circulating cholesterol as well, creating a complexity of potential long-term adverse effects that will need to be studied more thoroughly to evaluate the health implications in the long-term. A 2014 U.S. FDA warning concerned potential cognitive adverse effects of the drugs, and the FDA aksed the companies to include neurocognitive testing into their stage III clinical trials, although it is suspected that long-term use will create this substantial risk, not the short-term use observed in the human clinical trials. In the meantime, studies have shown that the herbal chemical Berberine, from the Chinese herb Coptis chinensis (Huang lian), and others, also inhibits PCSK9, without any adverse health effects. Berberine has been standardized by the Chinese, and is proven effective in reducing atrial and ventricular fibrillation, heart arrhythmia, lowering or prostaglandin 1, the chief inflammatory cytokine in the body, as well as platelet aggregation and thrombus.

Studies of PCSK9 in 2007, by researchers at Eli Lilly and Company, noted that the statin drug atorvastatin (Lipitor) significantly increased circulating PCSK9 levels, by as much as 34 percent over placebo. Rather than noting the irony that one cholesterol-lowering drug, a statin, actually works by increasing PCSK9, rather than inhibiting it, these researchers noted that perhaps we could add the PCSK9 inhibitor to the statin to counter this effect (Journal of Lipid Research Nov. 21, 2007; Holly E Carsekey et al). Such logic is alarming to some medical experts, who are concerned by the contradictions, and concerned about potential adverse effects on lipoprotein and cholesterol metabolism. The same researchers, at Eli Lilly, noted that: "This novel serine protease causes the degradation of hepatic (liver) LDL receptors by an unknown mechanism...PCSK9 is present in human serum, likely not associated with specific lipoprotein particles." (Clinical Chemistry; Aug. 16, 2007; William E. Alborn, Holly E. Careskey et al). The inhibitors of PCSK9 appear to be antibodies, or anti-sense oligonucleotides (DNA or RNA designed to bind to RNA and inactivate it), both posing potential disruption of immune function, or effects on genetic expression, that are undesirable. Whether scientists can design such a complex drug to target only the low-density lipoprotein receptors, when the exact functional mechanism remains unknown, is the perpetual question. All of these debates, on long-term safety and adverse risks, on whether the drugs will actually decrease cardiovascular risk significantly, and on the actual benefit of cholesterol reduction in the overall scheme, obscure the fact that the expert FDA panel reviewing these drugs for approval are hoping for just incremental reduction of cardiovascular risk from these strategies. What is ignored is the need for more than just lipoprotein and cholesterol reduction.

As stated, the Chinese herb Huang lian, or Coptis chinensis, contains the chemical berberine, which safely and naturally inhibits PCSK9, but also provides a host of other benefits. These complex arguments over cholesterol-lowering drugs once again diverts the attention of the patient and the doctor from addressing the bigger picture of prevention and treatment of atherosclerotic cardiovascular disease with a more holistic protocol. The Chinese have also produced tetrahydroberberine from this herbal extract, which has shown to be effective against cerebral ischemic disease. Berberine and Huang lian have also been shown to inhibit liver cancer Hep-62 cell growth and may inhibit promyelocytic leukemia, as well as being well known as an anti-inflammatory and antibacterial herb. A 2015 study by the U.S. Veterans Affairs Palo Alto Health Care System, in Palo Alto, California, found that not only was berberine a inhibitor of PCSK9, but also accelerated degradation of hepatocye nuclear factor 1alpha (HNF1alpha) induced by ubiquitin. Such study demonstrates that this aspect of the TCM therapy provides a number of beneficial effects for both cholesterol lowering, and cardiovascular and liver health. To see this study summary, click here:

In 2002, the U.S. National Institutes of Health (NIH) and the National Heart, Lung, and Blood Institute, released the ATP III (Adult Treatment Panel III), billed as the final report on treatment of high cholesterol in adults, and noted that patients who consider taking drugs to lower LDL-C (low-density lipoprotein cholesterol) should have a sustained LDL-C level of greater than 160 mg/dL, and show multiple risk factors after trying dietary therapy to reduce LDL-C. These experts stated that for those patients with one or less risk factors, that sustained LDL-C levels of 160-189 mg/dL after trying dietary therapy, may consider taking these cholesterol lowering drugs. They stated that emphasis on weight reduction and increased mild physical activity to enhance cardiovascular risk reduction is important. Patients with Metabolic Syndrome, especially when showing occurrence of coronary heart disease with multiple risk factors, should be urged to utilize intensified therapeutic lifestyle changes. High-density lipoprotein cholesterol (HDL-C) should be maintained as greater than 40 mg/dL, and elevated triglycerides should be emphasized more as a risk factor when considering drug therapy. In blood labs, LDL-C, HDL-C and triglycerides should always be measured as the initial test in evaluation, not just the total cholesterol and LDL-C. Physicians should emphasize and encourage the use of plant stanols and sterols (phytosterols in herbal and nutrient medicine), and increased soluble fiber in the diet, for lowering LDL-C. Patients should consider drug therapy only when triglyceride levels exceed 200 mg/dL. The multiple risk factors noted in this report included atherogenic dyslipidemia (signs include obesity, abdominal obesity, insulin resistance, and physical inactivity), heavy cigarette smoking, high intake of processed carbohydrates, Metabolic Syndrome, high triglycerides, and the taking of beta-blockers and anabolic steroids. Modifiable risk factors also included high blood pressure and a diet high in saturated fats (meats) and foods with processed salt (high sodium in processed and fast foods). Recommendations to reduce this dietary risk included changes of diet to incorporated more vegetables, whole grains, fruits and unsaturated fatty acids, as well as antioxidants, folic acid, B vitamins such as B6 and B12, omega-3 fatty acids, and other micronutrients. This emphasis on safe and effective Complementary Medicine, and the emphasis on using cholesterol-lowering drug therapies for only those patients with multiple risk factors and LDL-C above 160, HDL-C below 40, and triglycerides above 200, not for patients without this degree of risk, was largely ignored.

In 2013, the American Heart Association put out new treatment guidelines for use of cholesterol-lowering drugs, which immediately appeared to cause of lot of confusion. The new guidelines stressed that 4 groups were identified that could benefit from statins in efforts to reduce atherosclerotic cardiovascular risk, that the Expert Panel failed to find evidence to support specific treatment targets for reduction of LDL-C, and that use of statins should be limited to those patients most likely to benefit. This was vaguely worded, as usual, but implies that the touted goal of getting the low-density lipoprotein cholesterol levels as low as they will go for the entire population is in fact ridiculous. The panel also stated that non-statin drugs added to the regimen were no longer supported to reduce atherosclerotic cardiovascular risk, and the potential adverse risks outweighed the benefits in this multidrug regimen, which has become routine. The panel emphasized that doctors should identify those patients with higher risk and focus therapy on these patients, rather than just prescribing statins to almost all patients, and that the doctors should discuss the proven adverse effects of long-term statin use and provide expert guidance on management of the statin-associated adverse effects, including muscle symptoms, which most prescribing doctors have told their patients do not exist. The panel also noted that other biomarkers of cardiovascular risk should be utilized in the 4 groups targeted for benefit. All of these recommendations mirror the data provided in this article.

The panel also stressed the need to clarify high-intensity and moderate-intensity statin therapy, and not use a one-size-fits-all model for prescription any more. The 4 groups targeted include 1) patients with clinically diagnosed atherosclerotic cardiovascular disease, 2) primary elevations of LDL-C above 190 mg/dL (raised from the 2002 levels of 160), 3) diabetic patients age 40-75 with LDL-C in the range of 70-189 mg/dL, and 4) patients with an estimated 10-year atherosclerotic cardiovascular risk greater than 7.5% (which is poorly defined). Somewhere in this lengthy guideline paper we must see the actual definition of atherosclerotic cardiovascular risk greater than 7.5%, but I am still searching, which of course leaves the prescription guidelines very open. Nevertheless, the report clearly states that combining statins with fibrates and other drugs is not recommended, that niacin is effective, that diet and lifestyle treatments should be discussed, and that monitoring each individual for their reactions to statin dosage is necessary. Unfortunately, the guidelines do not differentiate true diabetes from Metabolic Syndrome, also leaving prescribing doctors the open guidelines to still prescribe statins to all patients with a pre-diabetic state that is loosely termed diabetes. We see from numerous large studies that prescription of statin drugs to patients with Metabolic Syndrome, commonly called a pre-diabetic state or mild diabetes, results in about a 25 percent increased risk for these patients acquiring true diabetes eventually, and drastically reduces the benefits of modest exercise in weight loss and muscle cell function. Immediately after this new set of conservative guidelines from the most standard organization possible, The American Heart Association, was issued, a flood of articles stating that these guidelines would greatly increase statin prescription was seen, which is directly contradictory to the advice in the guidelines themselves. This shows that extent to which the pharmaceuticals manufacturing these statin drugs will go to continue the enormous profits for as long as possible.

The two most important issues concerning the new 2013 American Heart Association guidelines for cholesterol lowering and statin drug prescription are the nuances of the term diabetes, identifying exactly what type or severity of diabetes warrants the statin use to counter atherosclerotic cardiovascular risk, and the calculator of the 10-year atherosclerotic cardiovascular risk. Immediately upon publication of these guidelines, the New York Times, in the November 19, 2013 edition, noted in an article entitled Flawed Gauge for Cholesterol Risk Poses a New Challenge for Cardiologists, that experts from Harvard Medical School, Dr. Paul M Ridker and Dr. Nancy Cook, revealed that the new calculator exaggerated the true risk of a heart attack or stroke by an average of 100 percent. These experts also noted that the committee that developed the calculator of risk knew that this online tool was inaccurate, yet told doctors to use it anyway. It turns out that the calculator was based on data that was 20 years old and outdated, and based on a mathematical model that assumes that risk rises in a straight line. For example, the rise in systolic blood pressure from 100 to 130 would assume the same the measurement of risk as a blood pressure that rose from 150 to 180, although no competent cardiologist would admit that this was true. Apparently, the authors of these guidelines, and the creators of the online tool to measure atherosclerotic cardiovascular risk, were unable to program changing values into the software program, and were unaware of the concepts of algorithms. They had no choice but to use an outdated and flawed computer software program for something so complicated, I guess, and so went with a calculator of the 7.5 percent or greater atherosclerotic cardiovascular risk that overestimated risk by 100 percent. We can be sure that the billions of dollars of extra profit from the unnecessary prescriptions of statin drugs had nothing to do with this.

Naturally occurring statins for the lowering of high cholesterol without side effects

A number of foods and herbs are now confirmed to effectively lower excess cholesterols. Red rice yeast is a nutritional aid long used in China that is proven effective. Oyster mushrooms contain a nutrient chemical also proven effective, which has been identified as a naturally occurring lovastatin. A number of wild mushrooms, or cultivated varieties, contain up to 2.8 percent lovastatin on a dry weight basis. Variance in the differing types of cultivated Red rice yeast and mushrooms produce a variance in the dosage of these naturally occurring statins, and use of these products should include monitoring of the cholesterol levels to assess dosage over time. Fluctuating levels of cholesterol impose no immediate risk. Naturally occurring statin molecules are also found to be modulating within the evolved array of chemicals in the these foods, helping the organism to maintain a homeostatic cholesterol level, unlike the effects of synthetic statin chemicals.

Other scientific studies have confirmed that aged garlic extract, guggulipid (an herbal resin from the mukul myrrh tree), and policosanol (from sugar cane - not found in processed sugar, though) also significantly lower excess cholesterols. As of 2010, there are also competing scientific studies that have called these initial studies into question, and this subject is being further studied by the NIH. Other herbal products have also demonstrated mild cholesterol reducing capabilties. Fenugreek seed, artichoke leaf extract, turmeric, and even rosemary extract are being investigated to confirm these findings. Excess low-density lipoproteins (LDL) in circulation have also been found to be lowered by phytosterols (plant-based hormones) which are found in whole grains, seeds, dark leafy green vegetables, and various fruits. Nutrient supplements with these phytosterols are now in widespread use. Many patients have found that simply starting the day with a real whole grain porridge, such as steel cut oats, amaranth, etc. has resulted in considerable improvement in their LDL and cholesterol levels.

In 2010, a double-blinded placebo-controlled study of a typical combination of herbs and supplements used by a Licensed Acupuncturist and herbalist knowledgable in Complementary Medicine was conducted by the University of Naples Department of Internal Medicine in Italy. This study, cited below in additional information, with a link to the NIH summary, showed that this combination of natural medicines significantly lowered circulating cholesterol, triglyceride, and LDL, while improving arterial health and circulation, decreasing atherosclerosis, and improving insulin sensitivity. The findings were published in Nutritional Metabolism and Cardiovascular Disease in November of 2010 (20(9):656-61). The highly publicized skepticism of the standard medical community was finally put to rest. The combination of Red Yeast Rice extract, policosanols, and berberine (an active chemical in a number of Chinese herbs), achieved these results. The long-term effects of this treatment, potentiated further with acupuncture therapy, are the restoration of normal homeostatic mechanisms, overall health, and the ability to maintain these healthy levels of lipids, cholesterol and cardiovascular health, without further treatment or dependency.

A growing skepticism in the scientific community for the widespread need of cholesterol reduction, prescription of statin drugs, and even the "lipid hypothesis" itself regarding the proof that elevated cholesterol is actually linked to cardiovascular disease

An article in the British Medical Journal (BMJ) in June of 2006 (332:1330) by Uffe Ravnskov, Paul Rosch, Morley Sutter and Mark Houston (clinical professors of medicine and prominent researchers) first introduced the subject of a questioning of widespread statin drugs in preventive medicine. The effects of statin drugs in patients without a very high level of circulating cholesterol are known to be very small. The potential risks and side effects with long-term use of statins are considerable. The criteria suggested for statin prescription in 2006 was very aggressive, suggesting that a very low level of circulating cholesterol should be a goal for the general population. These authors questioned this approach. One of the healthiest nations in the world, especially concerning cardiovascular health is Norway. These researchers noted that in Norway, 85 percent of men over the age of 40 have circulating cholesterol levels higher than the recommended guidelines in statin prescription. To lower the circulating cholesterol levels to these recommended guidelines, a higher dosage of statin drug is also required. These professors and researchers noted the increases in adverse risks associated with higher statin dosage. Their logical conclusion was that the benefits are not apparent, but the risks are. The fact that populations such as this have such a high rate of high cholesterol, but such a low rate of cardiovascular disease, reveals that the simple equating of lowered circulating cholesterol to improved cardiovascular health is not a sensible assumption. A growing chorus of experts have been expressing this opinion since 2006.

In 2009, a large cohort study conducted at UCLA Medical Center, in Los Angeles, California (Sachadeva et al; American Heart Journal 2009, Jan;157(1):111-117; PMID: 19081406), reviewed 136,905 hospital admissions with cardiovascular disease, and found that almost half of these patients had admission LDL-C levels of less than 100, more than half had HDL levels less than 40, and less than 10 percent of these patients had HDL greater than 60, a marker of healthy lipid balance. The findings clearly showed that low and normal levels of LDL-cholesterol are not a clear indicator of serious problems with cardiovascular disease, and that a poor LDL/HDL ratio appears to be all-important. Yet, the conclusion of the researchers was that perhaps we needed to increase the use of statins, and dosage of statins, to lower LDL to even lower than normal levels! There was no concern regarding raising HDL-C to a healthy level. This study and these recommendations are what caused alarm in the medical community that led to serious study of the harmful effects of higher dosage of statins, and prescription to more patients. On the other hand, such clear findings did not prompt the medical community to integrate therapies to improve the quality of HDL and LDL/HDL ratio. Today, finally we are having a serious discussion of these issues, perhaps prompted by so many pro-active patients researching the subject themselves, and asking the obvious questions. There are a number of ways to improve lipid balance with herbal and nutrient medicine, and combining this protocol with acupuncture will perhaps result in even better outcomes. Responding to unhealthy low levels of circulating high-density lipoprotein cholesterol (HDL-C), or the carrying of lipids and spent cholesterol back to the liver for processing, by suggesting that we should just lower the LDL-C levels below normal so that the LDL/HDL ratio looks better statistically, is obviously a cynical and illogical solution to the problem. Such advice treats patients like they are too stupid to understand this issue.

Is cholesterol harmful? Understanding the more important markers for cardiovascular risk and atherosclerotic plaque

How does cholesterol hurt us? Cholesterol is part of the plaque that builds up on the insides of arteries at sites where the arterial wall is weak or injured. Autopsy of young human beings shows us that arterial plaque starts to build up at an early age, even in childhood. Eventually, this plaque buildup may cause a narrowing of the artery and less blood flow to the muscles of the heart and brain (atherosclerosis), and emboli may break off of unhealth atheroscleroitic plaque, increasing the chance of heart attack or stroke. How does plaque collect on the artery wall? Most experts agree that plaque collects at sites of inflammation or injury to the cells of the arterial wall. A large study of teens that had died in accidents found that 2% of males and 0% of females, age 15-19, had severe atherosclerosis at this early age. Obesity, high intake of saturated fats (meats), and high levels of LDL (low density lipoproteins) in the blood have been linked to atherosclerosis, but so has CRP (C-reactive protein), a marker for blood heat and inflammation. In recent years, research has shown that low levels of high-density lipoproteins (HDL) present a greater risk of atherosclerotic plaque buildup than high levels of total cholesterol or LDL. On your blood tests, HDL/LDL ratio, triglyceride level, and CRP are now considered the important markers.

Study of plaque in arteries shows that some plaque is made up of normal smooth muscle cells while other plaque has a high percentage of inflammatory cells (macrophages). The cholesterol is found inside the smooth muscle cells. The arterial plaque that has a high percentage of inflammatory cells is much more pathogenic. Weakened areas of the arterial wall, and emboli producing plaque, were associated with the macrophage-rich plaque deposits associated with chronic inflammation. It is thought that unhealthy plaque collects at sites of inflamed tissue on the arterial walls. Reducing or regulating inflammation has thus become an important subject when discussing prevention of unhealthy atherosclerosis. This is why fish oils and certain essential fatty acids are now highly recommended. These beneficial essential fatty acids, EPA and DHA, called omega-3, help decrease chronic inflammation, while high levels of arachidonic acid from meats increase chronic inflammation. Lowering cholesterol may not have as great an impact on decreasing cardiovascular risk as addressing other factors that have been discovered in recent years.

These plaque deposits associated with atherosclerosis dissolve as well as collect. Sometimes, they break off and form a dangerous clot, or thrombus, that may lodge in the artery and temporarily decrease flow, causing a sudden heart attack or stroke. A common stroke caused by a thrombus is usually not as damaging as a bleeding stroke, which results from a weakened artery wall, which is often also associated with chronic arterial inflammation. Sustained high blood pressure is thought to increase the chances that a thrombus will detach from the inflamed arterial plaque, or that the inflamed or congenitally weakened areas on the artery will break and bleed. High blood pressure for short periods of time are common and the body adapts well to these periods of hypertension. Sustained high blood pressure is a risk, although if the arterial walls are maintained and inflammatory arterial plque is decreased, even sustained high blood pressure presents no threat. When the patient adopts therapeutics to help regulate inflammation and improve repair and maintenance of the blood vessels, this does more to decrease risk than drug therapies to block physiological processes.

How diet and lipid imbalance affect the cholesterols

Modern civilization has grown to accept the notion that blood lipids are the same as cholesterol. This misconception plays a large role in the inability to sensibly fix the problem of cholesterol, lipid imbalance, and cardiovascular risk. Hopefully, the patient that educates themselves to the physiology of cholesterol, lipid metabolism, lipoproteins, and the array of markers of cardiovascular disease besides circulating cholesterol levels, will gain the understanding of what is truly important to prevent our biggest health problem with aging, cardiovascular disease. The single-minded neurotic focus on circulating cholesterol levels as the only important aspect of preventive medicine with cardiovascular disease has become a public health disaster. While little of our cholesterol derives from our dietary intake, the diet nevertheless does affect the lipid balance, stored fatty metabolism, inflammatory physiology, and the stress levels associated with advanced glycation endproducts. These important issues have a huge impact on cardiovascular health, and on healthy cholesterol metabolism in the body.

One of the key issues with diet and public health in recent decades is the subject of high-fructose corn syrup, and other high fructose sweeteners in our foods. While the response to fructose studies, and education of the public to the dangers of excess fructose consumption, have been met with strong criticism, sponsored, of course, by the food industry, which even lobbies our government to delay the inevitable regulations prohibiting this practice of promoting excess fructose consumption, reasonable people see now that excess fructose consumption has created enormous harm to the public health. Studies in recent years have clearly elucidated how this harm occurs. For instance, researchers in 2008 at the Center for Human Nutrition at the University of Texas Southwestern Medical Center, the Department of Biomedical Engineering at the University of Texas at Arlington, and the Department of Food Science and Nutrition at the University of Minnesota, worked together to confirm the measurable effects of fructose. The conclusion: "Acute intake of fructose stimulates lipogenesis and may create a metabolic milieu that enhances subsequent esterification of fatty acids flowing to the liver to elevate triglyceride synthesis postprandially (after a meal)." In other words, eating high fructose foods stimulates fatty tissue stores (lipogenesis and triglycerides) in the liver, and alters the essential fatty acid homeostasis, which is very important to our health (re: omega-3 and omega-6 fatty acids). Subsequent studies in 2011, published in the Journal of Endocrinology (1/6/2011 Paul W Caton et al), showed that this increased fatty tissue production, and elevated gluconeogenesis (glucose creation) after consuming high fructose foods leads to insulin resistance and dyslipidemia (imbalance of cholesterol-carrying lipoproteins and stored fats). The digestion, absorption, and metabolism of fructose differs greatly from that of normal sugar, and of glucose. The metabolism of fructose, unlike glucose, does not stimulate the regulating effects of insulin and leptin on blood sugars and appetite, but instead contributes essentially to fat stores. While consumption of normal sugars and sweet high caloric foods would create a response of satiety and meeting of acute energy needs, the intake of high-fructose sugars would not appreciably send signals that these energy needs have been met. In other words, food researchers knew that switching to high-fructose corn syrup as a sweetener would contribute to overconsumption, especially if the industry "super-sized" soft drinks and sweet snacks. This, in turn, would create insulin resistance, or metabolic syndrome, fatty liver syndrome of dysfunction, and obesity.

Further research has proven that high fructose consumption contributes greatly to both acute and chronic health problems. A February 2012 issue of the Journal of Nutrition reported that high fructose consumption may increase cardiovascular risk due to the generation of organ fatty tissue accumulation, not only in the liver. A study of 559 14 to 18 year old subjects in Georgia also showed that higher fructose consumption was associated with increased systolic blood pressure, C-reactive protein (a marker for cardiovascular inflammation), and reduced high density lipoproteins (HDL), commonly called "good cholesterol" euphemistically. The researchers, led by Norman K. Pollock (Georgia Health Sciences University), found that these cardiovascular and metabolic (or diabetic) signs of pathology were all related to an immediate increase in organ fatty tissue accumulation. While industry researchers continue to claim that high fructose corn syrup is not proven to directly cause these pathologies, this research proves that indirectly, high fructose consumption leads to an immediate cascade of harmful effects due to the nature of the beast, namely how the fructose is transformed and stored. What is the food industry response to this enormous public health threat? Food researchers have confirmed that high fructose corn syrup has caused enormous harm to public health, and have cynically suggested that the industry replace this disease-causing sweetener with artifical sweeteners, themselves proven to cause disease. This cynical and harmful approach, intended clearly to benefit profits, and not the public, should be scrutinized and assessed logically by the public.

A second issue that is poorly understood by the public in relation to cardiovascular health and their diet is the importance of healthy balance in essential fatty acids. Numerous studies have shown a direct relationship between imbalances of omega-3 and omega-6 essential fatty acids in the diet and chronic inflammatory dysfunction that lies at the heart of ill health of the cardiovascular system. These essential fatty acids are naturally balanced in natural whole foods in a common human diet. Unfortunately, in recent decades, our diet in richer industrialized countries is no longer natural. The result is widespread chronic imbalances between these essential fatty acids that create the pro-inflammatory and anti-inflammatory prostaglandins that are essential to regulating the inflammatory system. Now, inflammation is not a bad process, and is only bad when an imbalance of pro-inflammatory and anti-inflammatory processes occurs, leading to chronic excess inflammatory activity, or chronic deficient pro-inflammatory activity. The inflammatory process is the mechanism our immune systems utilizes to repair and replace old and injured tissues, and protect against harmful invaders, such as bacteria, viruses, fungi etc. The imbalance of inflammatory mediators presents a considerable problem for our bodies. An imbalance of these building blocks of inflammatory mediators, or essential fatty acids, creates a high risk of cardiovascular ill health.

A third issue that is poorly understood in relation to diet and cardiovascular ill health is the subject of advanced glycation endproducts (AGEs). These complex chemicals that combine sugars with proteins and fats are a source of much stress in the human body. As with carbohydrates and fats, they are not all bad, but an excess of them, or bad types of AGEs, are a considerable risk factor for atherosclerotic plaques and cardiovascular disease, as well as diabetes and Metabolic Syndrome. In the diet, these AGEs are consumed as foods and snacks that are obviously composed of fats, sugars and proteins, such as fried breaded meats, corn chips, french fries, etc. In other words, fast food and common snacks will increase the AGE load dramatically. The movie Supersize Me demonstrates how quickly these types of foods, with AGEs, high-fructose corn syrup, and imbalanced essential fatty acids, can create cardiovascular disease, diabetes, and Metabolic Syndrome. Apparently, this frightening movie was not seen by many people, or they did not pay attention, as the sales of these unhealthy foods have continued to rise. The subject of diet and nutrition is a large subject, though, and other articles on this website go into more detail concerning this subject.

Finally, in 2013, the first serious large cohort study to determine just how much dietary change can improve cardiovascular health and reduce risk of ischemic heart attack was conducted as part of the large European Prospective Investigation into Cancer and Nutrition (EPIC) conducted by the University of Oxford, United Kingdom. In this study of 44.561 men and women over a number of years, a predominantly vegetarian diet was shown to reduced risk of ischemic heart attack by a whopping 34 percent, with significant reductions in non-HDL cholesterol, BMI, and systolic blood pressure.

The dramatic benefits to healthy diet and lifestyle have been understated to promote a pharmacological approach, and in many patients, an assumption has been made that merely taking these pharmaceuticals allows them to ignore diet and lifestyle, and overall health. This study shows that the most dramatic benefits have been from healthy metabolic homeostatic changes. Specific chemicals, such as the sulfur-containing glucosinolates in cruciferous vegetables, that form isothyocyanates in the body, are proven to reduce oxidized low-density lipoproteins significantly by attenuating oxidative stress (PMID: 23836589). By incorporating a plant-based diet, improved lifestyle routines, nutrient medicine, herbal medicine and acupuncture, this holistic package of care could reduce overall cardiovascular risk well beyond 34 percent, perhaps as much as 50 percent, and compared to the most generous assessments of statin drugs to reduce cholesterol, which proclaim a 12 percent decrease in cardiovascular risk for a subset of patients, this is a considerable benefit. Since cardiovascular disease is the biggest health concern in the United States, serious consideration needs to be paid to this integration of Complementary Medicine in the realm of cardiovascular medicine. Unfortunately, most people still just take the statin drugs with their significant adverse health effects with chronic use, and most Medical Doctors in cardiovascular health still just tell their patients to take these drugs and avoid Complementary Medicine, which is now scientifically illogical.

Testing to evaluate types of lipoprotein cholesterol - refining the laboratory analysis to aid individualized treatment

A number of new tests to evaluate cardiac risk, cholesterol and lipids now exist, although they still are not routinely performed, and may need to be requested. Often, we now see Hs-CRP (high sensitivity C-reactive protein), a marker of vascular inflammation, and lipid imbalances, but VAP (vertical auto profile), HDL with apoC-III, and fibrinogen levels are now also measured to refine cardiovascular risk and lipid quality in relation to disease. Finding a medical doctor to order these tests and provide a more thoughtful and individualized patient-centered approach to cardiovascular risk is still difficult, though, and finding a doctor willing to work with the patient with an integrative approach, utilizing Complementary Medicine is even harder. Patient understanding of these new markers for cardiovascular risk is important. Hs-CRP is a selective protein created by the liver in acute inflammation, but also in chronic circumstances. Its purpose appears to be to activate the complement immune responses to dead and dying cells, or some types of bacteria, binding to the phosphocholine on the cell surface. CRP has been shown to increase in response to signals by macrophages and fat cells. Since macrophages in arterial plaques are associated with more pathogenic atherosclerosis, and inflammation in fat cells making up what is called white adipose tissue (WAT) is associated with obesity and Metabolic Syndrome, CRP is useful to refine diagnostic evaluation in lipid imbalance. While Hs-CRP is released in response to a wide variety of health problems, and thus non-specific, it has been shown to be a valuable marker for cardiovascular disease, predictive for myocardial infarction, stroke and sudden cardiac death, and so adds to the diagnostic evaluation. HsCRP > 3 mg/L indicates high risk.

VAP (vertical auto profile) is a more comprehensive diagnostic tool, and provides a direct measurement of LDL (unlike standard tests), LDL density with a tendency toward a Pattern B (small, dense, and indicating greater risk) versus Pattern A (large, buoyant, and with little risk). VAP also profiles analysis of other lipoprotein subclasses that may be beneficial, or may be indicating higher risk, such as IDL (intermediated lipoprotein) and Lp(a). Intermediate density lipoproteins are formed from the degradation of the very low density lipoproteins, and carry these free triglycerides and free fatty acids back to the liver to be broken down or used to form low density lipoproteins, which carry fatty sugars and cholesterol to cells and membranes in the body. Very low density lipoproteins (VLDL) are formed in the liver and carry triglycerides to fatty tissue and muscle. This complex system of lipoprotein carrier cell functions is largely guided by ApoE, which is associated with the lipoprotein affinity for certain receptor types. VAP also includes an estimate of metabolic syndrome risk from a variety of these factors in relation to one another, or homeostatic balance and function.

Fibrinogen is a protein associated with blood clotting and hardening of tissues, and can also be measured in blood tests. Evaluation of fibrinogen is a strong indicator of cardiovascular disease risk. Fibrinogen levels are higher with obesity, diabetes, hypertension, dyslipidemia and elevated hematocrit, and once again, an intelligent analysis is needed, not just a one-size-fits-all lab value. HDL with apoC-III (apolipoprotein C-III) levels reveal increased cardiovascular risk when higher than 13 percent of HDL, as ApoC-III appears to turn normally beneficial HDL bad by blocking the breakdown of triglyceride-rich lipoproteins and impairing lipoprotein lipase and hepatic uptake of triglyceride-rich lipoprotein remnants. ApoC-III is often overproduced in Metabolic Syndrome, is associated with development of high triglyceride levels, and is a component of very low-density lipoprotein (VLDL). Such testing gives the physician the ability to provide a more complex assessment of the lipid and cholesterol profile, and cardiovascular risk. This also provides an integrative Complementary Physician with the tools to devise an individualized treatment, utilizing a number of herbs and nutrient medicines that are researched and found to be specific to these various health parameters. Instead of utilizing these advances in analysis of lipid metabolism to guide more individualized therapy, we have seen a consistent paring, or reduction, of tests in blood labs to analyze the risk of atherosclerotic cardiovascular disease risk, rather than expanding the tests and analysis as new research refines this process. More and more patients are realizing that this tactic is designed to dumb down the individualized analysis to convince more and patients to accept a one-size-fist-all model and take a very simplified, and more profitable, drug treatment strategy. Expert advice around the world is not changing this strategy, and perhaps only demand by a more intelligent and proactive patient population, demanding healthier and more individualized treatment protocols for their cardiovascular health will affect this change in the health industry.

The most important markers of cardiovascular risk and dangerous atherosclerotic plaques

More recent research has shown that a pattern of increase followed by a gradual decrease in troponin T or I is the most accurate marker for heart attacks (myocardial infarcts). Troponin is a protein of muscle that attracts calcium deposit. Calcium deposit in the muscle tissue occurs when the muscle is not firing properly (myofascial disorders) and/or when the calcium in circulation is high or unregulated. Calcium deposits harden the tissues, causing stiffness, pain, poor joint mobility, bony spurs, and increased chance of tendon and ligament tears, as well as chronic inflammatory states. Calcium deposit is also a big part of arterial plaque deposit, especially on the unhealthy inflamed arterial plaques that cause emboli, strokes and heart attacks. For this reason, poor regulation of calcium metabolism may be an important risk for atherosclerosis and cardiovascular pathology. Subclinical hypothyroid conditions, deficiency of the hormone activated Vitamin D3, or other homonal imbalances may be responsible for poor regulation of calcium deposition and can be corrected. Simple taking of a poor quality calcium supplement may contribute to calcium accumulation on the inflamed arterial plaque. Utilization of the holistic approach to health in Complementary and Integrative Medicine helps the patient to achieve better calcium regulation. In 2010, a new test was introduced with a sensitivity for lower levels of Troponin T (see additional information below). Older tests were used only in emergency situations to gauge heart damage after a heart attack, and measured only very high levels of Troponin. Studies with herbal medicine have shown that standardized Gingko biloba extract may reduce Troponin T levels, and studies of other herbs are underway. Current studies show reduction in Troponin T (cTnT) achieved with use of the herbs Salvia miltiorrhiza (Dan shen), Chuan xiong, and Lian qiao (Forsythia suspensa), with other herbal studies underway in China. In addition, herbal saponins are found to alleviate calcium overload, and Chinese formulas provide an array of cardioprotective benefits, with antioxidant and anti-inflammatory effects predominant.

Recent research has also confirmed that oxidized LDL (low density lipoprotein) was an important factor in dangerous plaque deposits. Antioxidants, especially those with superoxide dismutase (SOD) were found to be important in preventing oxidized LDL accumulation. SOD is found in barley grass and dark leafy greens, sprouts, seaweeds and algaes. It is also an enzyme that is produced in healthy cells to protect from free radical excess, and found to be deficient in unhealthy cells, like cancer cells. More importantly, oxidation occurs in the body in response to free radicals (oxygen radicals) when there is increased inflammatory tissue repair going on. Decreasing chronic inflammation and building healthier tissues will greatly decrease the chance of oxidized LDL accumulation. Physiotherapies to fix unhealthy tissues and decrease chronic pain and inflammation may have a significant effect on lowering arterial plaque deposit and decreasing your risk of stroke and heart attack. To learn more about the various antioxidants in your body, go to the articles on antioxidants and glutathione on this website. One important aspect of oxidation endproducts that most patients also overlook is the quick oxidation of fish and flax oil supplements, as well as cooking oils. When these oils oxidize, unhealthy oxidant products are produced. This is why krill oil is recommended for patients that want to supplement their EPA and DHA essential fatty acids, since krill oil contains a natural preservative that inhibits oxidation. Research has also revealed that various chemicals in Chinese herbs, such as shikonin in Zi cao (Lithospermum erythrorhizon), protects against oxidized low-density lipoprotein (oxLDL) by suppressing key inflammatory pathways of reactive oxygen species (ROS/NFkappaB) that are responsible for ICAM and E-selectin (PMID: 25541286). E-selectin is an important biomarker for atherosclerotic cardiovascular disease, and is an endothelial-leukocyte adhesion molecule (ELAM) expressed only on endothelial cells (e.g. arterial membranes) activated by pro-inflammatory immune cytokines. An important consideration with such herbal research is that modulation of such underlying causes of atherosclerosis such as E-selectin expression is also protective against various cancers. As such research progresses we are finding more and more reasons to integrate TCM therapy into a preventive and treatment protocol. The array of safe and simple treatments revealed by this research can be combined in therapy to produce a greater effect with virually no adverse side effects. The only side effect to TCM therapy is better overall health, disease prevention, and better quality of life.

One of the most important aspects of research into the subject of atherosclerotic plaque is the research concerning AGEs, or advanced glycation endproducts. These fat protein and sugar molecules produced from the poorly regulated enzymatic process of glycosylation, and associated with high levels of oxidants as well as poor liver function, and also a diet of processed foods, are now considered to be highly linked to unhealthy atherosclerotic plaque accumulation, as well as a host of other common diseases. One of these AGEs, the A1C index, is now the most common marker for type 2 diabetes, or metabolic syndrome. Higher accumulation of AGEs are also associated with aging and stiffening of arterial walls, commonly referred to as hardening of the arteries. Increased AGEs on the arterial walls causes cross-linking of collagen fibers and loss of collagen elasticity. When this occurs, the body struggles to replace this unhealthy collagen tissue with new health collagen. One of the endproducts of excess AGE formation is nitric oxide, which coincidentally vasodilates the arteries, but in excess may do more harm than good. Pharmaceutical research has produced one drug, an inhibitor of nitric oxide synthase, to reduce the harm from AGEs, and treat atherosclerotic plaque, but it has proven ineffective in studies. A variety of herbs reduce nitric oxide synthesis and modulate inflammation, helping to curb AGEs and repair inflamed arteries. These herbs also contain potent antioxidants. Naturopathic research has uncovered a variety of supplements that reduce AGE accumulation and the harm from excess AGEs, including P5P, Vitamin B1 thiamine, L-Carnosine, N-acetyl cystine, and alpha-lipoic acid. You may go to the articles on AGEs (practitioner section), and glutathione balance on this website to learn more on this fascinating subject. A combination of these herbs, supplements, and effective collagen type 2 supplement, may be very beneficial in the overall treatment and prevention of AGEs and anterosclerosis.

In 2011, experts at the University Medical Center Utrecht, The Netherlands, published a paper in the journal Current Cardiology Reviews that showed that cardiovascular disease and atherosclerotic plague, the target of statin drugs, was now shown to be "a systemic inflammatory disease", defined more by "local plaque vulnerability", not just the level of total circulating lipid cholesterol. The search for a reliable biomarker, or biomarkers, of actual disease risk was stressed, due to the fact that "the predictive power of classical risk factors is limited". The need to identify vulnerable plaque deposits on arteries affected by chronic systemic inflammation, rather than just prescribe statin drugs to all patients, when studies now show that considerable disease risk is engendered by this one-size-fits-all approach, was stressed. Classical biomarkers of atherosclerosis were found inadequate, as long-term research showed clearly that "more than half of all vascular events occur in individuals with normal cholesterol levels", and research into highly sensitive C-reactive protein (hsCRP) showed that this inflammatory biomarker was elevated in many types of inflammatory disease, and was not specfici to atherosclerosis. Inducing a lowered expression of CRP did not necessarily clear the reason that the body expressed more CRP, as well. The research into various biomarkers of vulnerable arterial plaque deposits, and even MRI studies, at this time, did not satisfy these cardiologists. The combination of fibrinogen and NT-proBNP (N-terminal pro-brain natriuretic peptide) contained valuable predictive information, but the use of expensive PET scans to assesss the concentration of proteolytic enzymes such as MMPs was deemed impractical. The study of plague osteopontin (OPN) after carotid endarterectomy showed taht OPN levels in the highest quartile of levels had a nearly 4-fold risk for development of future cardiovascular events. Osteopontin is an acidic protein involved in a number of processes, including bone remodeling, but also in attracting immune leukocytes to calcified arterial plaque. The protein is expressed from a large variety of cells , and so pharmacological blocking of the genetic expression would produce a variety of adverse side effects. Like hsCRP, such biomarkers are not the cause of the disease, and so a sensible strategy for decreasing risk would be to utilize a more holistic treatment protocol to address the underlying causes of these elevated biomarker expressions, not just block the biomarkers. We are not protected from threats by destroying the messengers.

A more holistic approach to understanding the variety of factors that create cardiovascular risk and dangerous atherosclerotic plaques

Obviously, the explanation for arterial plaque deposit is more complicated than the question of dietary fat intake or cholesterol levels. In fact, study shows us that people with high levels of HDL (high density lipoproteins) that primarily carry fats back to the liver, are much less likely to suffer atherosclerosis, heart attacks and strokes. Healthy cholesterol and lipids are the key, as is healthy liver function, healthy tissues, healthy inflammatory mechanisms, etc. Dietary changes should pay attention to the balance of essential fatty acid types, and avoidance of transfats, high-fructose corn syrup, and advanced glycation endproducts, meaning that a natural, whole, plant-based, Mediterranean Diet model should be the basis for each individual, not a low-fat, sugar substitute, low sodium model that has been encouraged for decades. CIM/TCM can provide both comprehensive individualized treatment and sound advice for these dietary and lifestyle considerations in prevention and treatment of cardiovascular disease.

A 2014 Time Magazine article on the research related to healthy fats in the diet and the relation of saturated fats to cardiovascular disease attempted to expand understanding of this subject, but instead once again created controversy by an assumption that the authors were attempting to once again just simplify the subject to a statement that butter and pork fat was good for you. While the choice of the magazine editors to use a picture of butter on the cover of the magazine was perhaps unwise, the content of the article was correct, and showed that abundance research for decades has shown that the protocol of buying refined foods with low saturated fat and sugar, with the food industry replacing healthy whole fats with transfats, and natural sugars with high-fructose corn syrup, has been disastrous for patients with cardiovascular risk, while the inclusion of a modest amount of healthy fats and sugars in the diet, even with butter, organically raised meats, and a little sugar cane, provides a much better health profile. Moderate consumption of natural fats and sugars is the key, with a predominantly plant-based whole food diet. In other words, even Time magazine now admits that the evidence is overwhelming that the food industry has created enormous ill health while advertising their profiteering tactics as health conscious. It is time that the public quit dumbing down their dietary intelligence and started paying attention to the details in maintaining health. Increased low-level exercise, such as daily changes in frequent walks, using the stairs, etc. is also important in cardiovascular health, and these simple changes in dietary protocol and daily activity are not difficult to achieve. The current standard model for cholesterol lowering, i.e. just taking a high-dose statin drug and not paying attention to a healthy diet and routine of daily activity, is an overly simplistic approach, and should not be emphasized as taking care of the problem by itself. The holistic model for therapy and prevention offered in Complementary and Integrative Medicine is more complicated than this magic pill approach, but will achieve a healthier cardiovascular and metabolic system with relatively short courses of repeated therapy.

Metabolic Syndrome is a new term for most cases of adult onset diabetes. The Institute of Cardiology in Quebec, Canada states: "There is a growing body of evidence that among the risk factors that promote atherosclerosis, the Metabolic Syndrome is a powerful and prevalent predictor of cardiovascular events. The systemic inflammatory process associated with the Metabolic Syndrome has numerous deleterious effects that promote plaque activation." You may refer to a separate article on this website to learn more about Metabolic Syndrome. This type of study finds that the immune system, and its interaction with unhealthy fat cells is a key to the process. Promoting of better health in the immune system and better formation of healthy fat cells with decreased inflammatory stress is perhaps essential to avoidance of atherosclerosis and the increased risk of heart attack and stroke. This modern approach sees cholesterol as a side issue in the preventative therapy concerning decreased cardiovascular risk. The holistic approach in Complementary and Integrative Medicine addresses restoration of a healthy metabolism and cure of the metabolic syndrome. Key aspects of metabolic syndrome are insulin resistance and problems with fat metabolism. The body converts fats to sugars to supply the body with usable energy, and utilizes the hormone insulin to stimulate the fat cell to store and release fats, which are then transported to the liver in the form of triglycerides and converted to sugars (glucose). A number of herbs are now proven to improve insulin sensitivity and normalize triglycerides and cholesterols. The extract of bitter melon is getting quite a lot of attention recently because of the number of scientific studies and clinical trials proving its efficacy. Bitter melon extract, or Ku gua in Chinese medicine, has long been used in China to resolve toxins and clear blood heat, as well as improve the liver function, although it has generally been used as a food. Some of the evidence of benefits from bitter melon extract are listed below in additional information.

Another popular supplement proven to lower high cholesterol and benefit the overall health is red yeast rice extract, or Monascus purpureus, which has been used in China medicinally for centuries, and is proven to mildly inhibit cholesterol synthesis, as well as being an aid with indigestion, poor circulation, and a tonic for the spleen and stomach. Extracts from specific rice brans and palm fruits (policosanol and sytrinol) have also been proven to lower cholesterol, as well as lowering LDL and increasing the healthy HDL (PMID: 11835043). Beta sitosterol from soy, gamma oryzanol from rice bran oil, niacinamide or inositol hexacotinate Vitamin B3, gugulipid gum extract (Commiphor mukul), bitter melon extract, saw palmetto, reishi mushroom, Ashwaghanda, bderberine, and other herbal extracts are also studied as phytosterols and show potential for lowering high cholesterol. While these simple nutrient extracts may or may not be as effective as pharmaceutical drugs, they do not have significant side effects, and are actually good for the overall health. A combination of these simple extracts could be utilized for increased effect if the desired cholesterol and lipid levels are not achieved.

Some medications may increase your risk of stroke and heart attack, and this is also an important consideration in this more thorough protocol. Vioxx, an anti-inflammatory medication, was withdrawn from the market because of the risk of heart attack and stroke. Studies show that all the anti-inflammatory medications increases this risk. Hormone replacement therapy and contraception with synthetic hormones has also been found to be a significant factor in increased risk. While death from heart attack and stroke has improved over the last 50 years, incidence of these problems has increased since the advent of statin cholesterol lowering drugs in 1989. The acute treatment of these problems has improved, thankfully, which accounts for the decrease in cardiovascular deaths, but the overall incidence of strokes and heart attacks has increased. In 2007, 2.6 percent of the U.S. population suffered a stroke and another 2.6 percent suffered a heart attack. This figure has actually risen a little since 1989, the year of introduction of statin cholesterol lowering drugs. Clearly, the broad application of statin cholesterol lowering drugs in the population has not had a significant effect on lowering the incidence of stroke and heart attack. The time has come to finally integrate holistic Complementary Medicine into the protocol of cardiovascular prevention. The question of risk and side effects versus benefit for cholesterol lowering statins has become a key subject of debate in modern medicine, also, as the numerous studies explained above in this article demonstrates. Chronic use of statin cholesterol lowering drugs presents serious risk of side effects and negative consequences to overall health. The real question for many patients is whether these drugs actually decrease atherosclerotic plaque and prevent strokes and heart attacks in light of research data since 1989. Many patients are wondering whether a broader protocol to improve health would produce better results than the outdated drug protocol from 1989. In 2014, abundance evidence points to the need to improve underlying factors in cardiovascular health and end the dependence on long-term use and high-dose statin drugs.

How do we protect our health against this atherosclerosis in a safe healthy way? Forming a more intelligent and comprehensive strategy for disease prevention is the answer. Obviously, lowering overall lipoprotein levels and eating less unhealthy saturated fat (meat) may help a little. But it is also obvious that this is not the whole answer. One supplement alone, such as fish oil, may not have a dramatic effect, but a holistic combination of herbs and supplements may. You should seek professional guidance when designing this more holistic course of preventive therapy. Cholesterol control would best be achieved by improving the health of your liver as well as your general health, and there is no magic pill for this, only a comprehensive and thoughtful therpeutic course that is individually tailored. Cholesterol lowering drugs (statins) work by blocking the genetic expression of proteins, and these drugs produce many side effects because they cause misshapen proteins that don't work right and accumulate in the tissues, eventually causing muscle and joint pain, as well as increased stress on the body to clear these bad protein fragments. In 2007, the new class of cholesterol lowering statins, torcetrapid, from Pfizer, the maker of Lipitor, was withdrawn from the market because it caused more deaths than it saved! This statin, designed to increase HDL, was effective, but the lipoproteins that it encouraged were misshapen because the statins alter the genetic expression of proteins. The blood tests showed positive changes in the levels of HDL, but quality is more important than quantity. This withdrawing of a new statin drug because of risk was alarming to many medical dctors and patients. Of course, risk versus benefit is something you should discuss with your medical doctor. The key point is that raising of HDL was recognized as more important, even in the pharmaceutical industry, than lowering LDL and total cholesterol, and the tactic of designing synthetic statins to inhibit this melavonic acid metabolic pathway rather than restoring the homeostatic mechanisms is not an intelligent tactic. A number of new nutrient and herbal combinations have been found and clinically tested to increase HDL levels. The American Heart Association has also found in studies that most patients could increase HDL levels by increased aerobic activity, such as running. The key to cardiovascular prevention is intelligently designed changes in diet and lifestyle, enhanced by a little utilization of experts in Complementary Medicine, with the Licensed Acupuncturist and Naturopathic Doctor providing this expertise.

Even today, over 5 percent of the U.S. population suffers a stroke or heart attack each year. A regimen of sensible changes and treatments will get you to a place where you are confident that your risk level of stroke, heart attack and atherosclerosis is significantly reduced. A relatively short course of therapy by a knowledgeable Complementary and Integrative Medicine physician, such as a Licensed Acupuncturist and herbalist, combined with sound advice on diet and lifestyle that is individually tailored can deliver this protocol.

The holistic regimen to achieve less risk of stroke and heart attack is more complicated than the taking of the single magic pill, which puts off many patients initially. But it is also going to make you much healthier and more productive in life, as well as solving the problem with a short course of therapy, rather than sticking you with a drug therapy for the rest of your life. This holistic regimen focuses on a healthy cholesterol metabolism, reduction of inflammation in the arteries, and healthier tissues and circulation. It involves healthier eating habits, exercise habits, stress reduction, herbal prescription, supplements and acupuncture stimulation. It may also involve physiotherapies with myofascial release to decrease chronic inflammation, calcium deposits, and oxidation/free radicals. Depending on your need, simple tests for levels of hormone D3 and other hormonal levels may be performed to guide therapy for contributing health problems. The choices in the treatment protocol are defined by the individual health profile of each patient. This type of holistic regimen should be guided by a knowledgeable Complementary Medicine physician such as a licensed acupuncturist who practices and combines all of these therapies.

While the holistic regimen is more complicated than taking a pill, there are big advantages. There are no side effects. Your health improves. You feel better and are more productive. Other health problems are prevented. Don't be overwhelmed by the complicated regimen. You have time to clean up your body and change habits. Go step by step. Get educated and start treating with and listening to a holistic physician, such as a licensed acupuncturist. When your health improves, so does your life, your looks, your sexual life, your work productivity, your mental abilities, etc. Complementary Medicine not only treats the specific problem, but helps overall health with each course of therapy.

Herbal medicine, research, and the specific benefits for reestablishing a healthy lipid metabolism

Much research has demonstrated the potency of herbal and nutrient medicine to reduce high cholesterol and achieve lipid balance in the last decade. While synthetic medicines are able to inhibit pathways allopathically to reduce cholesterol and lipid production, these herbal and nutrient medicines have been shown to modulate lipid metabolism and improve liver function, working holistically to achieve the healthy homeostatic metabolism that insures better health. Thus, there is no worry about excess effects, and no need for chronic use, as these herbs and nutrient chemicals work to correct the underlying problems and reestablish a healthy lipid and cholesterol metabolism. As stated, the statins that are widely used in standard medicine were derived from an herbal/nutrient medicine long used in China, Red Yeast Rice extract. A number of other herbs and nutrients long used in Chinese Herbal Medicine, and in the diet of Asia, have also been proven effective and are now combined to provide a thorough and synergistic effect at low dosage to restore health and prevent atherosclerosis and cardiovascular risk. Of course, physicians practicing Complementary Medicine would also urge and instruct the patient to take advantage of a plant-based diet, daily aerobic exercise, and avoidance of processed foods that are shown to increase cardiovascular risk. This package of care is without the troubling long-term adverse health effects of the standard pharmaceutical protocol.

Curcumin is an herbal chemical that is gaining much poplular reknown for its ability to reduce inflammation, fight infection, reduce cancerous tumors, and even promote liver function and act as a choleretic agent (stimulating bile flow). Research in 2011 (cited below in information resources) shows now that taking of a low dose of curcumin long-term has a cholesterol reducing and protecting effect against atherosclerotic lesions that is at least comparable to statin drugs without the side effects. Chinese herbal medicine has made much use of curcumins, with three herbs in the common Materia Medicia, Curcumin zedoaria, longa and kwangsensis, and use of an aromatic curcumin, turmeric, in the dieatary protocols of India and southern China. Studies showed that curcumins exert a variety of effects, improving genetic expression of inflammatory mediators (PPAR, LXR, APO), and reducing markers of cardiovascular and liver inflammation, C-reactive protein (CRP), hepatic complement factor D (Cfd), and improving glutathione detoxification. These curcumin herbs are often included in common Chinese herbal formulas, and today, extracts of curcumin, or turmeric, are widely prescribed as well as specific nutrient medicines. Because the bioavailability of the curcumin in oral herbal extracts is not optimal, researchers have created a more bioavailable higher dose curcumin, called LongVida. These researchers found that encapsulating the higher dosage of standardized curcumin extract with a fatty coating allowed more curcumin to reach fat cells to decrease adipose inflammation. Combining the Traditional Chinese Herbal formulas with curcuma, and other herbs, and this optimized curcumin that more greatly affects fat cells, provides the potential for a dramatic treatment of high cholesterol as well as Metabolic Syndrome.

The benefits of curcumin over statins are apparent. The effects are similar, but the side effects are very different, there are no side effects to the herbal chemicals. Curcumins affect a broad array of deleterious disease mechanisms, whereas statin drugs basically inhibited the expression of key proteins in the metabolism of cholesterol formation, also inhibiting production of the Vitamin D3 prohormone (cholecalciferol) and CoQ10 (ubiquinol). Curcumins directly benefitted the cardiovascular health, lowering CRP, adhesion molecules associated with atherosclerotic plaque, and improving the natural detoxification and anti-inflammatory mechanisms in the body. Curcumin also normalized triglycerides, HDL, and liver apolipoprotein A-1, the most important aspects of lipid balance and health. Curcumins may also be combined in herbal and nutrient medicine with other effective herbs and nutrient chemicals, such as bitter melon extracts, Red yeast rice extract, N-acetyl cysteine, L-carnosine, policosanol, etc. A comprehensive protocol in Complementary Medicine can be individually tailored to correct the underlying mechanisms of cardiovascular disease and not rely on perpetual use of these chemicals. Statin drugs, which block normal expression of genetic pathways, need to be taken forever to be effective, with increasing danger of adverse effects over time, and considerable health spending. Using herbal and nutrient medicine with acupucture may restore healthy metabolism and end drug dependence to reduce cardiovascular risk and restore healthy lipid metabolism.

Curcuma longa (Jiang huang), the main medicinal herb in the curcuma family (E zhu and Yu jin) used in Chinese Herbal Medicine, not only contains curcumin, but an array of herbal chemicals proven to aid cardiovascular health. Curcuma longa contains quercetin, phytosterols, niacin, beta-sitosterol, beta-pinene, flavonoids, riboflavin, selenium, thiamin, zinc, potassium, chromium, borneol, and a host of chemicals with more difficult names. While many of these chemicals are now widely studied and standardized in nutritional medicine, presenting the physician in Complementary Medicine more choices in select prescription, the benefits of traditional herbal extracts and formulas are apparent as well. Both the use of higher dose standardized medicinal chemical derived from herbs and foods, and traditional herbal formulas, which utilize a synergistic array of these chemicals in lower dosage, are effective. Study of these traditional herbs reveals the many potential benefits with use of Chinese Herbal Medicine, and the very low possibility, almost nonexistent, of side effects. Once again, these choices are not binary, one over the other, and a TCM physician can help each patient to utilize the variety of treatment protocols and options in the most sensible and individualized manner. Just relying on advertising infomercials on the internet to guide your care is not sensible when you can utilize a physician with a medical license and Medical School education, such as a Licensed Acupuncturist and Herbalist to properly guide your care.

Berberine is another active chemical in Chinese medicinal herbs, like curcumin, that is now highly studied and producing proof of remarkable effects in treating Metabolic Syndrome and preventing atherosclerotic cardiovascular disease. Studies have found that berberine, a primary constituent of Coptis chinensis (Huang lian), but like curcumin, also found in a number of other commonly prescribed Chinese herbs, is an alkaloid isoquinoline derivative that has been shown to exert significant anti-inflammatory and antioxidant effects, decrease ventricular fibrillation, act a an alpha-adrenergic inhibitor, or modulator of beta and alpha-adrenergic stimulation to control hypertension, inhibit platelet aggregation and reduce thromboxane content to protect against cerebral ischemia, inhibit low-grade bacterial endotoxicity, inhibit candida overgrowth, and act as an anti-viral. Courses of berberine have also been shown to decrease high triglycerides, and improve insulin sensitivity, as well as contribute to weight loss, especially with midsection fatty accumulation. The most remarkable findings in randomized controlled human clinical trials of berberine is the ability to increase high-density lipoproteins to a healthy level, showing that this herbal chemical exerts a modulating and restorative effect, not just a chemical inhibition of cholesterol-carrying lipids.

Gamma oryzanol, commonly called rice bran enzymatic extract, has been well studied in recent years to reduce high cholesterol as well. A 2013 study at the University of Seville, Spain (see study link below), found that laboratory in vitro studies showed that this extract reduced circulating levels of triglycerides and total cholesterol, and increased high-density lipoproteins to a healthy level, without altering non-esterified fatty acids. Insulin sensitivity and hypertension were also benefited in this study, and restoration of adiponectin and inflammatory modulation were also noted. Policosanol, a nutrient chemical found in palms, sugar canes, yams, beeswax, and other foods and products, has also been proven to significantly reduce total cholesterol and triglycerides, and more importantly, increase high-density lipoproteins to a healthier level. These and other herbal and nutrient medicines are now being studied in small randomized controlled human clinical trials over the entire globe, consistently proving positive effects. In addition, other highly studied herbal chemicals, such as quercetin and resveratrol, are shown to exert significant metabolic and inflammatory modulating effects as well. These particular herbal and nutrient chemicals are being combined into better and better formulas, able to achieve the variety of biochemical goals to restore cholesterol homeostasis, without blocking key chemical processes that lead to eventual adverse effects or ill health.

Research with Acupuncture and its Effects on the Lipid Metabolism and Underlying Factors of Cardiovascular Health

Acupuncture stimulation works by encouraging natural homeostatic mechanisms programmed into the genetic code to affect positive change. While this effect is less direct than taking a synthesized drug to block parts of the homeostatic metabolism, the overall effects with a course of acupuncture are obviously healthier than the allopathic approach and may be integrated to enhance standard treatment. To make acupuncture work more effectively, physicians that have specialized in Traditional Chinese Medicine (CIM/TCM) have devised comprehensive and holistic protocols, utilizing a combination of treatments to achieve better success. Propaganda in the business of standard medicine has succeeded in obscuring this medical specialty that has just been called Acupuncture, rather than the correct term, TCM, or Traditional Chinese Medicine. To utilized needle stimulation effectively to reduce cardiovascular risk the patient needs to objectively understand how this treatment works, and how to effectively incorporate it into their health regimen. Repeated short courses of acupuncture from a competent physician, combined with short courses of a variety of herbal and nutrient medicines, and steady improvement in diet and lifestyle, with advice from the Licensed Acupuncturist and herbalist, who has extensively studied this subject in medical school, is a sensible approach, and should be individually tailored, not performed in a one-size-fits-all manner.

Many people may still ask what research actually confirms the benefit of acupuncture needle stimulation in this overall protocol. Nobody wants to get stuck with needles with no proof of benefit. In 2014, researchers at Peking University in Beijing, China, one of the premier universities in the world, showed that in a randomized controlled trial of acupuncture that a short course with just stimulation at 2 points, P6 and ST40, showed a lowering of the expression of the key inflammatory mediator in the liver associated with fatty liver disease, IL-17 (Interleukin-17) in both circulating blood and liver tissues, significantly more than the study subjects treated with a statin drug (PMID: 24778705). In 2013, researchers at Chongqing Medical University, in Chongqing, China, found in a randomized controlled human trial that a short course of electroacupuncture at just 4 points, ST36, ST40, SP6 and LV3, using a 2Hz stimulation alternated with a 100 Hz stimulation, significantly suppressed high blood sugars, serum insulin needs, insulin resistance, and IL-18 levels in subjects with fatty liver (PMID: 24006666). In 2012, these same researchers at Chongqing Medical University found that the same short course of electroacupuncture could increase healthy serum adiponectin and high-density lipoproteins (HDL), and lower unhealthy levels of serum leptin, low-density lipoproteins (LDL), free fatty acids, total cholesterol, and triglycerides significantly over controls (PMID: 23387211). Today an abundance of research has proven that these short courses of acupuncture stimulation significantly benefit the patient in prevention of cardiovascular disease and resolution of the underlying problems that create lipid imbalance and contribute to atherosclerosis. The intelligent patient would be wise to choose an intelligent Licensed Acupuncturist and herbalist to receive such therapy, and combine this with short courses of the proven medicines described above, as well as constructive advice in improving the dietary and lifestyle habits. The herbal and nutrient medicines obtained from this professional Complementary Medicine physician are usually from professional companies with guaranteed quality, compared to the unregulated products on the market in the United States, which when bought at the store or online are often not what they say they are. Integrating such short course of therapy into your health treatment is relatively easy, inexpensive and effective, and the only side effects are better overall health.

Not only research in China, but in Europe, South Korea, Japan and Brazil is revealing the exact mechanisms by which acupuncture stimulation may normalize the complex lipid metabolism and control that is linked to high circulating cholesterol in the carrier molecules, or lipoproteins, associated with atherosclerotic plague and cardiovascular disease. As stated, today most experts agree that high total lipoprotein cholesterol, an unhealthy imbalance between the lipoproteins called HDL and LDL (high-density and low-density), high triglycerides in blood circulation, and insulin resistance, all hallmarks of Metabolic Syndrome, are the greatest cardiovascular risks associated with high cholesterol. It is ironic that the only drug used to treat high cholesterol actually comes with a very high risk of pushing the patient from Metabolic Syndrome to true diabetes. It is even more ironic that this information has not discouraged the widespread prescription of statin drugs, especially with a number of FDA warnings now attached to these drugs. Research into the use of acupuncture to address these factors in high cholesterol has proven very promising around the world. For instance, in 2014, at the University of Gothenburg, in Gothenburg, Sweden, researchers found that a short course of electroacupuncture with 2Hz stimulation at just a few points significantly improved insulin sensitivity and leptin metabolism in fat cells, and worked synergistically with moderate exercise to achieve a more complete benefit. These effects were attributed to regulation of adipose tissue metabolism (PMID: 18399196).

Much research has elucidated the array of physiological effects from acupuncture that help regulate the mechanisms leading to obesity as well. Obesity is defined by the inability to regulate fatty stores in the body, not just by a tendency to eat too much, although many chemicals in the hormonal system, and many chemicals added to processed foods do stimulate increased appetite exceeding the energy demands in the body. By normalizing the homeostatic mechanisms underlying obesity the patient is assured of more than just weight reduction, but an actual decrease in the health risks associated with obesity. In 2014, research at Qingdao University, in Qingdao, China, found that one of the hormones produced in the endocrine cycle related to obesity is called Nesfatin-1, which works with other hormones related to appetite and the energy metabolism, such as Leptin, Adiponectin, Insulin and Glucagon. Nesfatin-1 was described in 2011 by researchers at the Lund University Diabetes Research Center in Malmo, Sweden, as a newly discovered regulatory protein peptide hormone expressed in the brain that mainly regulates glucagon secretion from the pancreatic beta cells, and is associated with Type 2 Diabetes, or Metabolic Syndrome, as well as immunoreactivity in these patients (PMID: 22108805).

The researchers at Qingdao University investigated the effects of acupuncture in relation to Nesfatin-1 in 64 adult patients diagnosed with obesity, compared to 58 control patients without obesity, in a randomized controlled human clinical trial. Nesfatin-1 levels were consistently lower than normal in obese patients, while serum insulin, insulin resistance, BMI and lipoprotein cholesterol levels were consistently higher. After a short course of acupuncture, plasma Nesfatin-1 levels were increased in the obese patients (PMID: 24813558). Numerous studies now show that Nesfatin-1 levels are consistently lowered in children with obesity as well as adults, demonstrating that this aspect of the complex feedback cycle of regulation of energy metabolism, fat stores, and lipoprotein cholesterol is perhaps a key factor. While the pharmaceutical industry naturally explores novel chemicals that may affect the specific Nesplatin-1 expression, which may be difficult, as the problem involves a deficient expression, not an excess expression than can be chemically blocked, Traditional Chinese Medicine and acupuncture is shown to work by affecting the whole cycle of dysfunction, modulating the mechanisms of not only Nesfatin-1, but Insulin resistance in the fat cells, the underlying inflammatory dysfunctions, the metabolism of Leptin and Leptin resistance, the expression of adiponectin, etc. Obviously, this holistic array of modulatory effects should play a big part in the treatment protocol. By characterizing TCM and acupuncture as an alternative to standard medicine and statin drugs to decrease cholesterol, your Medical Doctor is doing you a gross disservice. He or she should be encouraging you to adopt any of these healthy regimens to solve your health problem, utilizing diet, lifestyle, exercise and Complementary Medicine to achieve the goals of reduction of cardiovascular risk and normalization of the cholesterol metabolism.

Additional Information and Information Resources

  1. A growing body of medical doctors are alarmed at the widespread increase in cholesterol lowering statin drug prescription despite the new insights into cardiovascular disease and dangers of these drugs. One European medical doctor and researcher is pushing for increased public awareness on his website:
  2. The website of the University of Maryland Medical Center in 2014 summarizes the current scientific knowledge of the cholesterol and lipid metabolism, and the adverse dosage-dependent effects of chronic use of statin and fibrate drugs, supporting the information presented on this website:
  3. In 2012, the U.S. FDA issued warnings concerning the chronic use of statin drugs to lower cholesterol, with evidence of increased risk of onset of type 2 diabetes, the potential for muscle damage over time manifesting as a slowly progressing muscle weakness and pain, risk of memory loss due to CNS degenerative changes, and liver injury, as well as citing the fact that many medications prescribed concurrently with statins used the same catabolic pathways in the liver and resulted in slowly rising circulating dosages and accumulations in many patients, increasing these adverse health effects. Clearly, the unstated recommendation was to try to improve metabolism of lipid cholesterol with other therapies and try to reduce long term statin use:
  4. A 2014 review of statin drug therapy for reduction of cholesterol and cardiovascular risk, by the Seoul National University College of Medicine, the Gachon University Cardiovascular Research Institute, and the Hokko Memorial Clinic department of Cardiovascular Medicine, in South Korea and Japan, noted that a European committee has finally expressed concerns about using statin drugs for a large fraction of the population for extended time periods due to increased risk of diabetes and Metabolic Syndrome, deterioration of glucose homeostasis, and adverse effects on kidney function that are dose-dependent, in addition to other serious non-metabolic adverse health effects with chronic use. While statin drugs are still valuable in therapy, prescription for all patients is a bad idea, and limiting dosage and chronic use with an integration of Complementary Medicine is obviously needed to limit these adverse health effects:
  5. A 2013 study at The Johns Hopkins University School of Medicine, in Baltimore, Maryland, U.S.A. noted that statins are commonly associated with a variety of degrees of muscle dysfunction, or myopathy, even autoimmune myopathy with progressive symptoms. This study suggests that a marker of anti-HMGCR antibodies should be used to differentiate patients on statin drugs that develop such autoimmune muscle diseases (e.g. dermatomyositis), and that statin drugs should be discontinued and patients monitored for improvement before starting immunosuppressive therapy. HMGCR (a coenzyme A reductase enzyme) is a target of the statin drugs, and chronic use may induce an autoimmune antibody response:
  6. A 2014 study at the Veteran Affairs Western New York Healthcare System, in Buffalo, New York, concluded that adverse effects on muscle function noted with long term statin drug use was linked to lower hormone Vitamin D levels. What is not mentioned is that statin drugs inhibit the melavonic acid pathway the body uses to create cholecalciferol, the precursor to hormone Vitamin D. Of course, these effects vary widely based on the individual metabolism and hormonal health, and so other studies have concluded that there is no correlation:
  7. A 2014 multicenter study by the University of Parma School of Medicine, in Italy, the University of Texas School of Medicine, in the U.S., Uppsala University, in Sweden, and others, noted that lowered hormone Vitamin D levels were clearly associated with increased cardiovascular dysfunction, as this hormone is involved in vasodilation in women, but not in men. The conclusion by these many experts around the world was: "In older women, but not in men, (hormone) Vitamin D is positively and independently associate with EIDV (endothelium-independent vasodilation)". Of course, vasodilation lowers blood pressure:
  8. An overview of fibrate drugs, introduced to be added to statin drugs when lipid and triglyceride metabolism is still unhealthy, is presented on this webpage of the U.S. National Institutes of Health. These drugs, first introduced in 1981 but not widely used due to adverse health effects, have a still poorly understood mechanism of action, but inhibit sterol synthesis in the liver, as well as key regulatory enzymes of lipid metabolism. As the NIH overview suggests, both limitations of effectiveness and serious adverse health effects are associated with fibrate drugs:
  9. A 1987 meta-review of scientific studies by the Heart Disease Prevention Center in Minneapolis, Minnesota, showed that fibrate drugs did not produce a clinically significant benefit over placebo, even in reduction of high triglycerides, and that in fact, both placebo and dietary controls in studies performed better than these fibrate drugs:
  10. A conservative but informative article from the American Heart Association explains some of the pharmacodynamics of prescription drugs and the effect on the liver, with drug-drug contraindications and explanation of ill effects on the liver metabolism with statin drugs to lower cholesterol:
  11. The revised 2013 treatment guidelines for statins and other drugs to treat high cholesterol caused quite a reaction in the medical community, suggesting that evidence clearly does not support the widespread use of statins that have been promoted, that drugs such as fibrates, routinely combined with statins, should not be prescribed to lower statins due to poor benefits and increased cardiovascular risks, and that adverse effects of long-term use of statins is indeed proven and should be monitored and discussed with the patients:
  12. In 2015, two large studies were released that showed a dramatic decrease in antibody response to the flu vaccine in older patients taking statin drugs. Those patients taking natural herbal statins, in the form of red rice yeast extract added to herbal formula, had a dramatically less effect on the immune system. These results presented confusing data that suggested that interference with the metabolic pathways by statin drugs could be another risk of long-term and high dose regimens, and researchers sought to mollify concerns by suggesting that these statin drugs may just be providing anti-inflammatory effects, but this is not a reasonable explanation:
  13. A report by Dr. Julian Whitaker of the Virginia Hopkins health watch, associated with the late Dr. John R. Lee, the pioneering general practitioner and health researcher responsible for our use of bioidentical hormones and understanding of hormonal balance in disease, summarizes some of the data in 2012 concerning neurodegeneration and memory impairment associated with statin drug use:
  14. A 2014 meta-review of scientific studies, by the University of Salerno and Institute of Endocrinology and Oncology Experimentation, in Italy, and the Brain and Vision Laboratory of Boston University, in the U.S.A, notes that with warnings of widespread use of statin drugs to lower cholesterol lipids that now off-label uses of statin drugs had increased, yet the data supporting the prescription of statin drugs to prevent neurodegenerative diseases such as Alzheimer's disease, Parkinson disease, multiple sclerosis, stroke and primary brain tumors are not univocal (unambiguous or straightforward), and that use of these problematic drugs needs to be conclusively proven in human clinical trials to recommend such prescription:
  15. A 2012 FDA update on statin drug warnings and label changes:
  16. An April 25, 2012 study from the Harvard Medical School and Joslin Diabetes Center outlined findings that the commonly prescribed drugs to reduce cholesterol, statins, increased the risk of inducing or acquiring diabetes onset by 13 to 25 percent, according to 7 very large studies, and a meta-analysis, the JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), and a Harvard meta-analysis of 6 statin trials that included 57,593 patients. The implications are that the protocol of prescribing statin drugs to nearly everyone with minimal evidence of a lipid imbalance or a metabolic syndrome may come with higher risk than benefit. Reducing cardiovascular risk with a healthy treatment regimen, including care from Complementary Medicine, seems like the sensible approach for most of these patients.
  17. A 2012 FDA update on statin drug consumer advice concerning reports of memory loss and cognitive impairment, increased risk of diabetes, rise in blood sugars and A1C, and the increased risk for muscle damage:
  18. A 2015 study at the University of Debrecan, in Hungary, noted that muscle pain and fatigue contribute greatly to the poor adherence to long-term statin therapy, perhaps due to adverse effects on calcium homeostasis, with both Coenzyme Q10 and the hormone called Vitamin D3 inhibited via the blocking of the mevolonic acid pathway by statin drugs. This study found that supplementation with CoQ10 significantly benefited calcium metabolism in muscles in laboratory animals subjected to statin therapy:
  19. A 2012 NIH study at the University of California San Diego, authored by Dr. Beatrice Golomb, associate professor of medicine, showed that statin drugs were associated with significant fatigue, and she expressed the opinion of a growing chorus of experts that the widespread use of statin drugs should be reevaluated, as the benefits do not outweigh the risks for most patients:
  20. A 2013 study at Duke University Medical Center, in Durham, North Carolina, U.S.A., found that statin drugs to lower cholesterol actually impairs the benefits of aerobic exercise for patients with Metabolic Syndrome and obesity, reducing gains in muscle mitochondria and cardiorespiratory fitness. Half of the patients in this study did not take statins during the 12 week aerobic fitness routine, and increased cardiorespiratory rates by 10 percent and skeletal muscle development by 13 percent, but those who took statin drugs achieved only a 1.5 percent increase in cardiovascular fitness and a 4.5 percent increase in muscle growth and function:
  21. A 2009 study at UCLA Medical Center, in Los Angeles, California, found that a review of records for 136,905 patients admitted with cardiovascular disease showed that almost half had low levels of LDL (less than 100 mg/dL), more than half had HDL levels less than optimum (less than 40 mg/dL), and less than 10 percent had what is considered a more optimum level of the so-called good cholesterol HDL-C (greater than 60 mg/dL). Instead of concluding that current therapy to reduce LDL was inadequate, though, the researchers concluded that perhaps we should prescribe higher dosages and more statins:
  22. A 2007 study at Massachusetts General Hospital and Harvard Medical School, in Boston, Massachusetts, found that patients with a high HDL level and cardiovascular disease (CAD) often had a lower prevalence of the traditional risk factors of CAD compared to patients with normal HDL levels. It appeared that for many patients, increased HDL in relation to LDL was very important in lowered cardiovascular risk. Since this study, refined research has discovered that the percentage of HDL with apoC-III is important to understanding why many patients with high HDL have lowered cardiovascular risk, but not all:
  23. A 2011 review of scientific studies by Maastricht University in the Netherlands shows that plant sterols and stanols (phytosterols), found in healthy foods and herbal medicine, are proven with many clinical studies to reduce cardiovascular risk substantially, both reducing low-density lipoprotein cholesterol excess, and improving endothelial vascular dysfunction and reducing atherosclerosis:
  24. The first major scientific meta-review of clinical studies of phytosterols and stanols in regards to cholesterol reduction and cardiovascular risk was published in the United States in a Mayo Clinic journal, with the research review conducted by Wageningen University in the Netherlands. The reduction in human clinical studies of 10-20 percent in LDL cholesterol showed a greater benefit than statin drugs. Phytosterols in common prescription include extracts of saw palmetto, bitter melon, fennel seed, sea buckthorn seed, gou qi zi berry, mai men dong, tian men dong, huang qin, American ginseng, sheng di huang, shu di huang, ling zhi mushroom (reishi), zhu ling, hawthorn flower, black cumin seed, ashwagandha (Withania), gan cao (licorice root), evening primrose oil, Annona cheimola seed, and gotu kola:
  25. A study by the Stanford University School of Medicine Prevention Research Center found that a plant-based diet was dramatically more effective than a low-fat, low-cholesterol diet touted for decades by public health experts:
  26. A 2004 article in the European Society of Cardiology explains how AGEs (advance glycation endproducts) are implicated in atherosclerosis:
  27. A 2006 book entitled the Biochemistry of Atherosclerosis identifies that AGEs (advanced glycation endproducts), created in insulin resistance, are the true biochemical cause, or root cause, of both atherosclerosis and hypertension:
  28. A 2010 study at the University of Maryland School of Medicine found that higher levels of Troponin T, a protein biomarker, were highly associated with cardiovascular disease, and that a new test created has a high sensitivity to detect levels, making this a significant advancement in the assessment of cardiovascular risk:
  29. A 2011 study at the China Academy of Chinese Medical Sciences in Beijing, China, found that the commonly used Chinese herbs, Dan shen (Salvia miltiorrhiza) and Chuan xiong lowered circulating Troponin T (cTnT) in laboratory studies, as well as other markers of cardiovascular risk, such as 6-keto prostaglandin F(1 alpha):
  30. A 2010 study at Yantai University in Yantai, China, found that the common Chinese herbal chemical forsythoside B (FB), found in Forsythia suspensa (Lian qiao), offered cardioprotective aid by lowering circulating Troponin T (Tn-T), as well as cardioinflammatory markers, such as interleukin 6 (IL-) and TNF-alpha. Such herbal chemicals may be used to either rescue heart muscle after a heart attack, or to prevent heart attack or stroke within a broader protocol:
  31. A 2015 study at China Medical University and Asia University, in Taiwan, showed that an active chemical in the Chinese herb Zi cao, or Lithospermum erythrorhizon, called shikonin, signficiantly reduces the adhesioin factors that are now key biomarkers for dangerous atheroscleratic plaque and cardiovascular risk, E-selectin and ICAM, by suppressing oxidant inflammatory levels, clearing or preventing oxidized low-density lipoproteins (oxLDL) and atherogenesis:
  32. A 2014 study at China Medical University and Asia University, in Taiwan, also showed that an active chemical in the Chinese herb Chuan xin lian (Andrographis paniculata), called andrographolide, significantly inhibits key inflammatory mechanisms which induce enothelial artery adhesioin molecules (ICAM) linked to atherosclerosis:
  33. A 2013 study at the Korea Institute of Oriental Medicine found that an alcohol extract of the Chinese herb Xia ku cao (Prunella vulgaris) suppresses chronic inflammatory induced expression of endothelial arterial adhesion molecules such as ICAM and E-selectin that are linked to dangerous atherosclerotic plaque:
  34. A 2006 report from the University of Dusseldorf, Molecular Cardioprotection and Inflammation Group, found that current pharmacological interventions had so far failed to reduce myocardial reperfusion injury related to coronary artery occlusion, or atherosclerotic stenosis, and suggested fibrin derivatives as potential future aids to provide reperfusion therapy. Fibrins are natural coagulants derived from fibrinogen, produced by the healthy liver, which are highly controlled in the coagulation cascade, and aids to fibrin clearing, regulation and function are highly utilized in Complementary Medicine now, including niacins, enzymes (nattokinase), and herbal chemicals:
  35. A 2011 review of scientific studies at Nanjing University in China found that recent studies have elucidated the various mechanisms by which Chinese medicinal herbs are now proven to exert cardiac protections and prevent ischemia-reperfusion injury in case of a heart attack. The array of beneficial effects, including anti-inflammation, anti-oxidant effects, immune modulation, alleviation of calcium overload, modulation of nitric oxide metabolism, and inhibition of apoptosis in cardiac cells, provide a holistic and comprehensive benefit for cardioprotection with Chinese herbal formulas:
  36. A comprehensive article on the benefits of bitter melon are listed on the TCM website of Blue Poppy Press:
  37. A 2008 study at the Chia Nan University of Pharmacy and Science in Taiwan found that bitter melon extract not only reduces insulin resistance and fat cell hypertrophy more effectively than the anti-diabetic drug thiazolidinedione (Avandia, Actos, Rezulin), but also suppresses fatty liver accumulation:
  38. A 2002 study at the University of Bonn, in Germany, found that extracts from specific rice brans (policosanol) lowered total cholesterol by about 20% and LDL by as much as 30%, while raising healthy HDL by up to 15%:
  39. A 2013 randomized controlled human clinical trial at Logan University, in Chesterfield, Missouri, U.S.A. showed that supplementation with calcium carbonate and the hormone Vitamin D3 can significantly help in lowering serum triglycerides and lipophilic micronutrients (showing improved utilization of carotenoids):
  40. A 2004 study at the Chinese Academy of Medical Sciences, in Beijing, China, found that a chemical in common Chinese herbs, called berberine, lowered total cholesterol by 29 percent, triglycerides by 35 percent, and LDL by 25 percent in patients with high cholesterol, and achieved these results not through the statin mechanisms of blocking regulatory protein expression, but by activating the ERK pathway:
  41. A 2009 study at th Veterans Affairs Palo Alto Health Care System, in Palo Alto, California, found that the Chinese herbal chemical berberine both up-regulates the low density lipoprotein receptor and inhibits the PCSK9 to lower cholesterol lipids. Berberine also reduces hepatocyte nuclear facor 1alpha an d SRBP2, the pathway of PCSK9 inhibition, and thus exerted a modulatory effect to restore cholesterol homeostasis. Newer pharmaceuticals work with recombinant DNA to inhibit PCSK9, but may force to much inhibition of the LDL-C and too much accumulation in liver cells. These new drugs also must be taken forever and will cost nearly $15,000 per year. For many patients, berberine as part of a holistic treatment protocol presents a healthier and inexpensive way to lower excess lipid cholesterol:
  42. A 2012 study by the Avera Institute for Human Genetics, Sioux Falls, South Dakota, U.S.A. found that obese patients given 500 mg berberine extract three time per day for 12 weeks achieved average decreases in high triglycerides of 23 percent and high cholesterols of 12.2 percent, replicated in controlled studies of laboratory animals:
  43. Studies by the UCLA Center for Human Nutrition detail the potent cholesterol lowering effects of the supplement called red yeast rice, or Monascus purpureus, that has been used as a public health remedy in China as far back as 800 AD:
  44. Even conservative standard medicine websites, such as this one - WebMD, now acknowledge the proven effects of herbal and nutrient medicines in lowering excess cholesterol and LDL:
  45. An example of one of the Chinese herbs commonly used to aid liver function and lower cholesterol and triglycerides, Artemisia capillaris or iwayomogi, commonly Yin chen hao, is shown in this study to have significant effects to lower total cholesterol and triglycerides, increase HDL, increase glutathione capacity to aid liver detoxification, and catalase activity to clear fatty liver. No human toxicity has been found in this herb, and high dosage is needed to stimulate gastrointestinal upset from excess bitterness:
  46. In 2013, a study of a Chinese Herbal Formula with Artemesia capillaris (Yin chen hao), that has been proven to be able to reverse nonalcoholic fatty liver disease, was thoroughly tested at Shanghai University of TCM, Institute of Liver Diseases, and found to decrease fatty droplets in liver tissue, lower LDL cholesterol, lower liver enzymes, and reduce a number of essential markers of nonalcoholic fatty liver disease, reversing the free fatty acid-induced decrease in phosphorylation levels of AMPK and ACC. The formula, Qushi Huayu Decoction, consists of Artemesia capillaris (Yin chen hao), Polygonum cuspidatum (Hu zhang), Hyperici japonici (Di er cao), Curcumae longae (Jiang huang) and Gardenia jasminoides (Zhi zi):
  47. Another herb commonly used to lower and balance cholesterol in China, Gynostemma pentaphylum, or Jiao gu lan, is well studied with numerous benefits, including aids to liver and heart function, antioxidant and adaptogenic effects. Here, a 2006 human placebo-controlled randomized clinical study of patient with non-alcoholic fatty liver disease showed that Gynostemma not only lowers and balances cholesterols and triglycerides, but also significantly lowered liver enzymes, insulin resistance, fatty liver score, uric acid levels, and even BMI (body fat index) in patients with these problems:
  48. Additional health benefits from a prescription of policosanol and omega-3 fatty acids were studied at the University of Sienna in Italy, in 2009. The study showed measurable effects of increased mood stability and cognitive processes:
  49. A combination of Red Yeast Rice extract, policosanols, and the Chinese herbal extract berberine was studied to determine the effects on high cholesterol, lipid imbalance, and atherosclerosis, at the University of Naples Department of Internal Medicine, in Naples, Italy, in 2010. The results of this protocol, in a double-blinded placebo-controlled and peer reviewed study, showed a significant reduction in cholesterol and triglycerides in circulation, as well as low density lipoproteins (LDL), and improved arterial circulatory flow and arterial lining health, as well as improved insulin sensitivity:
  50. Research in 2011 at Kyungpook National University Center for Food and Nutritional Genomics Research, in Daegu, South Korea, found that long-term treatment with the herbal chemical curcumin (Curcuma aromatica, longa, zedoaria, and kwangsensis, or turmeric, Jiang huang, E zhu, and Yu jin) suppresses early atherosclerotic lesions and lowers cholesterol in way that is comparable to the effects of statin drugs. Optimized curcumin has also been produced to deliver higher active dosage to cells (LongVida), without the long-term adverse effects of statin drugs, and providing significant clearing of low-grade bacterial and viral inflammation, and anti-cancer effects as well:
  51. A 2013 meta-review of the effects on blood lipids of the Chinese herbal chemical berberine, now much studied for a variety of effects in cardiovascular medicine and liver health, by Tongji Medical College of Huazhong University of Science and Technology, in Hubei, China, analyzed 11 randomized controlled human clinical trials that met modern standards, which included 874 participants, and found that berberine produced a significant reduction of total cholesterol, triglycerides, and low-density lipoproteins, and a remarkable increase in high-density lipoproteins (HDL), with no serious adverse effects. These studies were small and contained methodological flaws due to poor funding, but do provide scientific proof of efficacy, and will be followed by larger randomized, controlled human clinical trials. As berberine became studied and touted in this regard, a number of small studies were created to provide inconsistent data, but like curcumin, berberine, found in Coptis chinensis, and other Chinese medicinal herbs, and now standardized in extracts, has become the focus of much interest in finding safer and healthier holistic regimens to reduce cardiovascular risk:
  52. Research in 2013, at the University of Seville, Spain, showed that the nutrient medicine gamma oryzanol, commonly called rice bran enzymatic extract, exerted a number of beneficial metabolic effects, reducing triglycerides, total cholesterol, and increasing high-density lipoproteins (HDL), while also modulating inflammation, improving insulin sensitivity, and restoring healthy adiponectin levels:
  53. Research in 2013, at Southern Medical University, Guangzhou, China, found in randomized, controlled human clinical trials, that adding the nutrient medicine policosanol, derived from plant waxes in palms, sugar canes, yams and beeswax, to a statin medication regimen, achieved greater reduction in LDL-C (low density lipoprotein cholesterol), and triglycerides, than simvastatin alone, allowing for reduced dosage and less side effects. There were no adverse health effects with this combination of drug and herbal medicine:
  54. Research in 2012, at the Chinese University of Hong Kong, showed that 2 common herbal extracts, from Salvia miltiorrhiza (Dan shen) and Pueraria lobata (Ge gen), commonly used in Chinese Herbal formulas to reduce atherosclerotic plaque, showed significant benefits, measured by reduced macrophage foam cell formation, anti-inflammation, and reduced platelet-derived growth factor-induced excess vascular smooth muscle cell proliferation:
  55. Research in 2008, at the University of Granada School of Pharmacy, found that the Chinese herbal extract quercetin, found in a number of herbs, including Apocynum venetum (Luo bu ma), Loranthus parasiticus (Sang ji sheng), Hypericum japonicum (Di er cao, similar to St. Johns Wort), and Rhododendron dahuricum (Man shan hong), was found to decrease triglycerides, total cholesterol, free fatty acids, tumor necrosis factor (TNF-alpha), and increased healthy adiponectin and nitrate plus nitrite, adding an important anti-inflammatory effect to metabolic health and balance when taken for at least 10 weeks:
  56. In 2013, finally, a large cohort study of 44,561 men and women investigated the effects of a healthy diet on cardiovascular risk. This study, conducted by the University of Oxford, United Kingdom, and part of the large European Prospective Investigation into Cancer and Nutrition (EPIC), found that a predominantly vegetarian diet reduced cardiovascular risk of ischemic heart disease by 34 percent, with significantly lowered non-HDL cholesterol, BMI, and systolic blood pressure. Such evidence points to the importance of improving the overall health holistically to counter cardiovascular disease, not just medicating to blood cholesterol production and high blood pressure. If herbal medicine, acupuncture, lifestyle changes, and nutrient medicine are added to this holistic protocol, the reduction of cardiovascular risk, and incidence of stroke, heart attack, peripheral vascular disease, and cardiac death, could perhaps be cut in half: