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The Cholesterol Connection To Heart Health

The Cholesterol Connection To Heart Health

by Lisa Schofield | September 29, 2014

A managed wellness lifestyle can improve cholesterol levels.

As purveyors of dietary supplements, no doubt retailers receive a steady influx of middle-aged men and women who have recently become more concerned about lowering and/or managing healthy cholesterol levels. This is typically inspired by routine physician testing that reveals unfavorable ratios of low-density lipoproteins to high-density lipoproteins and total cholesterol.

When it comes to matters of the physical heart, “cholesterol” is the association most people make about their cardiovascular status. Beyond being prescribed daily doses of statins, the great news is that currently available dietary supplements, as well as an ever-increasing variety of tasty and much healthier foods and beverages (as part of a managed wellness lifestyle) have been linked to improved cholesterol levels, as well as overall cardiovascular status.

“Cholesterol is a big problem in the U.S.,” observed Jerry Chou, CEO of California-based HERBTHEORY. “Our diets are far from perfect and cholesterol has become a ‘buzz word.’ Our doctors tell us that we need to watch our cholesterol levels; this, in turn, pulls cholesterol management to the front of our minds.”

Heather Manley, ND, advisor to Nordic Naturals (Watsonville, CA), explained that cholesterol is a lipid normally produced in the liver. “Cholesterol is located on the outer layer of every cell, and is an important component to everyday body functioning, such as: building healthy outer cell membranes, acts as a gatekeeper to allow certain things and keep other things out of the cell membrane, aiding in the production of hormones released from certain glands, and insulating nerve fibers.”

Of all the cardio-care supplements, those aimed at supporting healthy cholesterol levels remain top of mind and sought after. And this is likely to continue as it is widely known among consumers that elevated total cholesterol and particularly LDL-cholesterol have long been established risk factors for coronary heart disease, explained Michelle Braun PhD, senior researcher at DuPont Nutrition & Health in Missouri. “Since elevated LDL cholesterol increases the risk of developing cardiovascular diseases (CVD), it comes as no surprise that consumers are now focusing on supporting healthy cholesterol levels,” she said.

Interestingly, pointed out Dr. Alfredo Galvez, chief scientific advisor at Missouri-based SL Technology (a Reliv company), a majority of the mass marketing for cholesterol management is from pharmaceutical companies, therefore many individuals associate cholesterollowering treatments with prescription medicines over dietary supplements.

Manley agreed. “Media plays a large role in advertising and gives people the sense that the only way to maintain healthy cholesterol levels is with pharmaceutical medicine,” she emphasized. As with all diseases and conditions, she pointed out, regaining health is an integrative approach that is most successfully and effectively addressed by a combination of conventional and alternative approaches. In the retail environment, “it is always necessary to inform customers about the importance of having their doctors on-board with any decision they make regarding both pharmaceutical medicines and supplements.”

Beyond pharmaceutical heavyweights such as Crestor, Braun added that cholesterol-concerned consumers are encouraged by their physicians to incorporate and practice lifestyle changes such as reducing their consumption of saturated fats, trans fats and cholesterol, maintain a healthy weight and moderate physical activity—all of which are widely acknowledged strategies to attain a healthier blood cholesterol balance.

“Further, dietary interventions that include increased intake of plant sterols, soluble fiber, and soy protein are also often recommended to enhance blood cholesterol reduction,” she stated. “The observed effects of including these ingredients in a daily healthful diet can be clinically relevant. On the basis of epidemiologic studies conducted in the U.S., it is estimated that for every one percent decrease in serum cholesterol there is a 2-3 percent reduction in the rate of coronary heart disease.”

According to Gene Bruno, MS, MHS, director of category management with New York-based Twinlab, research suggests that consumers are aware that dietary supplements can have a positive impact on maintaining healthy cholesterol levels already within normal ranges. For example, he cites, the 2012 Gallup study of the U.S. market for vitamins and other dietary supplements confirmed that cardiovascular-related supplements are more frequently associated with maintaining healthy cholesterol (43 percent) than supporting heart health (38 percent) or helping to maintain healthy blood pressure (37 percent).

And due to recent changes in guidelines that has many new people on statin therapy, your cholesterol-support inventory will be more heavily visited and surveyed by consumers than ever.

A new study from UT Southwestern found that the recently-introduced cholesterol guidelines would significantly reduce new cardiovascular events when compared to treatment based on previous cholesterol guidelines, according to a university release. The previous guidelines from the National Cholesterol Education Program/Third Adult Treatment Panel were based on a different formula that involved targeting specific cholesterol levels. The 2013 ACC/AHA Cholesterol Guidelines recommend statins for patients with existing atherosclerotic cardiovascular disease, type 2 diabetes, and very high levels of LDL cholesterol, as well as for patients with a high 10-year risk for heart disease. According to UT Southwestern researchers, some patients fall out of statin eligibility under the 2013 guidelines, however, approximately 12.8 million more are now eligible.

The study, led by Dr. Amit Khera, associate professor of internal medicine and director of the preventive cardiology program at UT Southwestern and published in August 2014 in Circulation: Cardiovascular Quality and Outcomes, reviewed a subset of patients enrolled in the Dallas Heart Study who would have newly qualified for statin prescriptions under the new guidelines. The study predicted that 3.6 to 4.9 cardiovascular events would have been prevented for every 1,000 people screened and treated according to the new guidelines rather than the old guidelines.

“This is one of the first studies to carefully predict the implications of the new guidelines in the general population beyond just the amount of increase in statin use,” said Khera. “Does it look like these new guidelines will prevent heart attacks and strokes? The answer is, ‘yes.'”

The reality is, for those people living with unhealthy or dangerous cholesterol levels and on statins, there is no “naturals versus synthetics” argument—as some industry people believe in statin therapy, at least in the beginning.

“The most compelling result of recent clinical trials on cholesterol management is that the only significant causal association between cholesterol lowering and reducing risk for CVD is by treatment with statin drugs,” explained Galvez. “This means that only statin treatment has been shown to lower LDL cholesterol and reduce the risk for CVD. All other cholesterol-lowering treatments, such as reducing absorption of cholesterol from the diet and reabsorption of cholesterol from the bile through the small intestine, may lower cholesterol levels but do not reduce the risk for CVD. The proposed explanation for these clinical results is that the LDL cholesterol produced in the liver has more probability of being oxidized than the cholesterol absorbed through diet and bile. The oxidized LDL gets absorbed by macrophages in the arteries and eventually forms into plaques to cause atherosclerosis.”

Notable Research

Research and discovery continue unabated, specifically with the effects of cholesterol levels on health and disease, in a variety of specific cohorts, as well as the effects of a range of both pharmaceuticals and nutraceuticals on cholesterol. There are ideas and supplements that our sources are excited about.

Medical expert Decker Weiss, NMD, FASA, chief medical officer of Naturopathic Paradigms, a private practice in Phoenix, AZ, observed, “There are two areas that have dramatically changed cardiology in the past year in ways that will prevent many cardiologists from practicing the same way ever again.” The first, he says, is the American Heart Association/American College of Cardiology stance that cholesterol numbers like LDL being under 100, etc. are no longer recommended, and that cardiologists should judge independently what they think their patients’ optimal numbers should be. “There was a lot of blow-back from the pharmaceutical industry but for the most part the recommendation stands,” he commented.

The second area Weiss mentions is the development of the biomarker oxLDL (oxidized LDL). “We are even starting to see nutritional supplements come onto the market, the first being NovaHue Cardio, that are clinically tested and shown to lower oxLDL. This in reality is the only ‘bad cholesterol,’ and needs to be lowered to limit, reduce, or reverse heart disease. So in summary, lowering all cholesterol is most likely— and in my opinion—a bad idea, but lowering oxLDL or the oxidized version of cholesterol is always a good idea.”

When it comes to cholesterol-support supplement research, Manley is optimistic about the findings of efficacy of several, such as omega-3 EFAs, red yeast rice, probiotics, CoQ10 and chromium.

Bruno said he personally finds plant sterols and stanols to be the most compelling of nutraceuticals that address healthy cholesterol because there are more than a dozen published human studies using plant sterols and/or stanols for this purpose. “Furthermore,” he elaborated, “clinical research has shown that a dietary intake of at least 0.4 grams (400 mg) per serving of plant sterols, eaten twice a day with meals for a total dietary intake of at least 0.8 grams (800 mg) per day and as part of a diet low in saturated fat and cholesterol, may help promote cardiovascular health and help maintain healthy cholesterol levels already in the normal range.”

Bruno pointed to another attractive factor about plant stanols and sterols— their mechanism of action. He explained that they help reduce both dietary and biliary cholesterol absorption by competing with cholesterol for the limited space in mixed micelles (lipid molecules). In addition, plant sterols and stanols don’t have to be taken with food. Taking sitostanol at any time of day, he says, seems to be as effective as multiple daily servings with meals.

Solutions for the Shelf 

Overall, a retail store’s cardiovascular supplement space will likely be largely composed of products that help support healthy cholesterol levels. And, this category is growing with more choices for customers.

According to Braun, products with soy protein are strongly viable for managing cholesterol levels. The 2002 National Cholesterol Education Program estimated the reduction in the rate of coronary heart disease for every one percent reduction in serum cholesterol, therefore, she asserted, “one can conclude that the 5 percent average reduction in serum cholesterol observed with soy protein may contribute to reduction in the rate of coronary heart disease in the U.S. Soy protein is low in fat and saturated fat, and has zero cholesterol. Twenty-five grams of soy protein per day, as part of a diet low in cholesterol and saturated fat, has been shown to decrease total and LDL cholesterol, and thus, reducing the risk for coronary heart disease.”

She added that the FDA (U.S. Food and Drug Administration) heart health claim states that “25 g of soy protein a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.” The good news for retailers, obviously, is that soy protein can be merchandised in the supplement aisle— and in the food and beverage aisles, too, for strong cross-promotional upselling.

Reliv International’s LunaRich products, said Galvez, “are the only nutritional products on the market that have a similar mechanism of action to that of statin drugs.” He explained that lunasin, a naturally occurring soy peptide—and the bioactive ingredient in LunaRich— reduces the expression of the HMG-CoA reductase gene through a patented epigenetic mechanism of action. “Lunasin binds to the histone H3 tail and inhibits H3-lysine 14 acetylation by the PCAF enzyme. HMG-CoA reductase is the rate-limiting enzyme for cholesterol biosynthesis and the enzyme that statin drugs inactivate. Although affecting the enzyme, lunasin differs from statins by reducing only the expression of HMGCoA reductase, not competitively inactivating the enzyme as statins do. This means that functional HMG-CoA reductase enzymes remain after lunasin consumption, although in lesser amounts, which in time leads to reduced LDL cholesterol levels. However, unlike statins with numerous side effects, including increased diabetes risk, muscle weakness and fatty liver disease, lunasin does not have side effects.”

As a long-time specialist in omega-3 EFA-based formulas, Nordic Naturals provides several cholesterol- specific supplements; Manley noted that the brand’s products have been used in more than 30 clinical trials, and more than 30 are currently in progress. Specifically, Nordic Naturals, Omega LDL contains essential fatty acids, red yeast rice, and CoQ10 for optimal cardiovascular support. “This synergistic formula is not only a high-quality product, and therefore highly effective, but also an all-in- one formula that offers consumers both convenience and economy,” she explained. In addition, Nordic Naturals’ Algae Omega is formulated for people who want the cholesterol-balancing benefits of preformed, long-chain omega-3 EFAs from a vegetarian source, in this case, marine microalgae.

HERBTHEORY offers Heart & LDL (30 vegetarian capsule count). Chou explained that “we have an ‘East meets West’ mentality; our products are based on traditional Chinese formulas that have been passed down through generations. In addition, we enhance these formulas with clinically tested and globally sourced ingredients. We have found that this creates a synergistic product that not only fulfills our consumer’s desires, but addresses their concerns, as well.” 

Twinlab’s Cholesterol Success provides 0.9 grams (900 mg) of plant sterols and stanols in a daily serving. According to Bruno, this allows consumers to be pro-active in their dietary program to maintain cardiovascular health. “Cholesterol Success begins to help in 30 days, with full benefits experienced in 60 days,” he said.

In his practice, Weiss said he likes a particular lycopene formula, NovaHue Cardio (NovaHue.com), for those patients with high cholesterol that enables oxidation of LDL. “NovaHue Cardio has been clinically tested and proven to reduce the oxLDL and thus protect my patient from cardiovascular disease,” he added. “I also look at the central nervous system biomarkers such as norepinephrine, DOPAC, and serotonin to look for the underlying causes of inflammation and oxidation.”

Because the cholesterol guidelines have changed and more people are on statin therapy, your cholesterol- support section will be receiving a lot of attention—and numerous questions, notably if the supplement he or she is interested in taking is safe with statins. Here, it is advisable to encourage the consumer to disclose the use of it to his/her cardiologist, as well as to direct him or her to the brand’s website for self research, and, potentially offer either a moneyback guarantee or store credit if he or she gets cold feet or an abject denial of the supplement from the cardiologist.

In addition, point out to cholesterol support-seeking consumers that the journey to regain healthier cholesterol levels is all about healthy habits—which is the very essence of your business— and give them a store tour, showing the healthier foods and beverages as well as organic produce. You may make new customers for life!

Visit vitaminretailer.com to read about how widely red yeast rice supplements vary.

For More Information:

■ DuPont Nutrition & Health, (800) 255-6837
■ Herbtheory, (800) 880-8765
■ Nordic Naturals, (800) 662-2544
■ Reliv, (800) 735-4887
■ Twinlab, (800) 645-5626

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