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The Complexity Of Cholesterol

Retailers are in a prime position to educate, assist and become an invaluable resource to an ever-increasing customer base seeking natural cholesterol control options.

Every day, the Healthy Alternative (Dayton, OH) retail sales staff receives customers with questions about lowering their cholesterol. While grateful that awareness is up and customers are addressing a clear problem for the American population (according to the American Heart Association’s latest statistics, an estimated

102. 2 million adults in the US have total blood cholesterol values of 200mg/dL and higher, and of these about 35.7 million American adults have levels of 240 or above), it’s become clear to Tony Hause, president of the three-store chain, that too often customers are misguided and rightfully confused.

Hause breaks down his cholesterol customers into three equal groups: the first group thinks all cholesterol is bad and it just needs to be obliterated; the second group knows cholesterol is something they need to address, but they’re unclear if nutrition or pharmaceuticals are the answer; the final group has been taking cholesterol-lowering medications and is “fed up” with the side effects, such as achy limbs.

“The vast majority of my customers have no idea about what cholesterol really is and what it means to their bodies.

They hear their doctors say they have to worry about their cholesterol, meaning their LDL, but they don’t tell them that HDL is actually good,” said Hause, adding that the market has grown considerably, especially as the medical community continues to lower what it considers safe levels, offering an example of one customer coming in saying his doctor told him he needed to get his levels below 180. 

“They’re looking for some direction and it’s up to us to educate them.” What Healthy Alternative is facing isn’t uncommon—retailers across the country have customers just like Hause’s. While it can be a challenge, especially as retailers have to keep the ordinances of DSHEA in mind, with properly trained staffs and the right supplier products and support, retailers have the opportunity to be a valuable and appreciated resource for those customers.

Clearing Up Misconceptions

According to Mateo B. Dayo III, MD, MBA, cardiovascular, thoracic and vascular surgeon at Venice-Ocala Heart Institute, the top two myths about cholesterol are that all cholesterol is bad and that cholesterol only affects “older people.” 

“Not all cholesterol is bad. In fact, cholesterol is produced by the body to cell membranes and contributes to the formation of certain hormones, vitamin D and bile acids,” he said. “It is important to know that there are two types of cholesterol. HDL is the ‘good’ kind and LDL is the ‘bad.’ The key to healthy levels is finding and maintaining that perfect balance between the two.” 

“Oftentimes our customers are only thinking about the ‘bad cholesterol’ just because this is the only side that mainstream media and some doctors portray that you need to take care of, when in fact all cholesterol is needed in the right amounts,” said Robert Rohder, senior manager for the, WA-based retail store Super Supplements. “There is a misconception that exists and an opportunity to educate our customers on the role all cholesterol plays in our bodies.” 

“Some customers may learn about LDL and HDL cholesterol and triglycerides when they find out they have elevated levels,” added John Kenny, Super Supplements’ product educator, “but in general it is not well understood.” 

In regards to Dayo’s second myth that cholesterol problems only affect older people, “cholesterol can begin affecting Individuals in their childhood,” he said.

“Many people don’t realize the importance of a healthy diet during their 20s and 30s especially if the effects do not show up in the form of weight gain,” he explained. “However, consistently eating unhealthy foods can lead to atherosclerosis, which occurs when cholesterol builds up in and gradually narrows the arteries, and, in turn, restricts the blood flow.” While diet, exercise and pharmaceuticals have been the primary treatment for consumers, the supplement industry has evolved to create specific options that work in concert, and the public is clearly interested.

“Heart health has become an increasingly important topic for health care providers and their patients. With around 50 percent of American adults suffering from elevated blood cholesterol levels, a key risk factor for heart disease, sales of such products have exploded in recent years,” said Jay Levy, director of sales with Wakunaga of America Co., Ltd. (Mission Viejo, CA).

“According to market research conducted between 2003 and 2007, cholesterol lowering supplement sales increased 37 percent in natural foods markets and 20 percent in mainstream sales. With growing concern over the safety of statin drugs, an increasing number of consumers are looking toward natural supplements and lifestyle changes to help them control their cholesterol.”

Pharmaceutical Path to Natural

One reason consumers are looking toward natural methods is the rising news about the side effects of statin medications, one of the top-selling prescribed medications in the world. Jack Grogan, CN, CSO with Uckele Health & Nutrition (Blissfield, MI), offered that reports show statins can deplete Co- Q10, which is shown to be critical in maintaining normal energy production in The heart muscle. “This information encourages interest in more natural methods of balancing cholesterol that will not deplete other necessary cardiovascular support,” he said.

Kenny pointed out that interest in the cardiovascular category has always been high, but it began to peek as negative information about pharmaceutical side effects began to spread. “It is one of the most asked about categories with a possible increase in awareness over the last two years,” he said. “According to one of our stores, many customers will research on their own and tell their doctors to give them three to six months to lower on their own with diet and supplements.” While the majority of Super Supplements’ customers are looking for natural alternative suggestions for bringing their cholesterol into acceptable levels, in one of its stores it’s estimated that eight out of 10 people come in knowing exactly what they want.

“Some of the time the customer asks for a specific product, with the most popular being red yeast rice extract— usually on a doctor’s recommendation,”

Said Rohder. “Any red yeast rice-containing product is the most popular the last few years in probably most stores due to the many advertisements and articles touting its benefits.” One of the reasons for red yeast rice’s popularity, according to Kaori Dadgostar, PhD, technical specialist with Jarrow Formulas (Los Angeles, CA), is its close approximation to statins.

“Red yeast rice, which contains monacolins, naturally occurring substances that are known to regulate cholesterol synthesis by inhibiting an enzyme called HMG Co-A reductase (HMGR). This mechanism is also used in prescription drugs known as statins, and the cholesterol-lowering effects of red yeast rice are comparable to statins even at low dosages,” explained Dadgostar, adding that even though red yeast rice has been used for more than 1,200 years in China as a preservative, spice and food coloring as well as a traditional medicine to treat poor circulation, gastrointestinal issues and indigestion, recent studies have shown that red yeast rice can provide additional cardiovascular benefits including improved circulation.

Jarrow Formulas provides a highquality red yeast rice extract that is free of the undesirable fermentation byproduct citrinin, and includes Co Q10, which complements red yeast rice in supporting healthy cardiovascular function.

Uckele formulated its popular combination product, Lipisterin, for those conConcerned about cholesterol levels, and in particular, the negative effects statins can have on the liver. “This unique ingredient formulation includes guggul extract, red rice yeast, plant sterols with naturally ocurring policosanol, and contains nutrient support factors that can directly improve the liver’s ability to properly metabolize cholesterol,” said Grogan.

Addressing Mechanisms of Action

Consumers who want additional cholesterol health boosts are looking for herbal formulation products with scientifically documented ingredients that target various cholesterol lowering mechanisms and antioxidative properties.

The most popular ingredients, according to Dadgostar, include red yeast rice, artichoke and sesame seed oil and extract (which in addition to tocotrienols make up Jarrow’s ChoLess Optimizer) and well-documented antioxidants including vitamins C and E, resveratrol and alpha lipoic acid.

ChoLess Optimizer provides an optimal combination of powerful antioxidants and natural ingredients that recent clinical and pre-clinical studies have shown improve lipid metabolism while preventing LDL cholesterol accumulation and oxidation.

Tackling Inflammation

“The concept that elevated inflammatory stress contributes to high cholesterol levels is about 20 years old, but is being revisited, and is just as important a factor in supporting cardiovascular health as the cholesterol values are in and of themselves,” explained Uckele’s Grogan. 

“Recent research linking chronic inflammatory stress with elevated cholesterol is also a major contributing factor toward consumers seeking out supplements that support and manage excessive inflammatory stress.” 

A growing number of people are looking for multi-pathway supplements that can enhance lipid and cholesterol metabolism, which, in turn, decreases bad cholesterol and increases good cholesterol. 

“This can happen by regulating underlining cellular functions while producing anti oxidative effects to prevent oxidation of bad cholesterol and inflammation in the cardiovascular System,” said Dadgostar, who pointed out an overwhelmingly popular choice for addressing inflammation is omega-3 fatty acids (e.g. fish oil and krill oil), which comes from its lowering effect on total cholesterol and triglycerides, as well as bad cholesterol, particularly oxidized LDL, while it increases the levels of good cholesterol.

Also addressing inflammation is a product from BSP Pharma, Inc. (Marmora, NJ) called FlexNow® with 100% SheaFlex70. While better known as a joint care product, it has been shown to impact cholesterol, reduce inflammation, build cartilage and reduce pain due primarily to SheaFlex70™, which is exclusive to the product. SheaFlex70, a 70 percent concentrate of shea triterpenes, is considered to be one of the most powerful inflammation fighters found in any botanical, according to the company, and is the subject of over 30 clinical trials and studies.

Repairing Damage by Balancing ‘Good’ and ‘Bad’ The idea that teenagers and 20-somethings can eat whatever they want is a part of the cholesterol problems in the US. As Dayo pointed out, atherosclerosis, or the gradual narrowing of the arteries restricting blood flow due to a build up of cholesterol, is often the result of consistently eating unhealthy foods.

To that end, consumers, particularly those at Healthy Alternative, have been fans of Wakunaga, which began its cardiovascular research in the 1970s and continues today. The foundation of its efforts has been garlic, which has had consistent consumer awareness for the benefit of heart health and specifically cholesterol benefits by addressing both “good” and “bad,” according to Levy.

“Successive clinical trials and research out of UCLA Medical Center showed that Kyolic Aged Garlic may have the ability to reduce elevated cholesterol, reduce homocysteine and decrease coronary calcification, or atherosclerosis,” he said. “Meaning Kyolic not only reduces ‘bad’ cholesterol, but also increases ‘good’ cholesterol.” It’s this focus on research and Wakunaga’s willingness to share it with its retailer partners that makes it a Favorite of Hause’s—especially as many suppliers have cut back on the materials they share.

“We used to receive a lot more information from manufacturers in the past, yet Wakunaga continues to provide us with anything that we need,” said Hause. “It has a team of PhDs continuing to research garlic, and it offers more information on its products and ingredients than any other company. Its products are very popular with our customers, and it continues to innovate by adding proven nutrients to create specific products.” Acknowledging another cholesterol-lowering supplement that is gaining momentum among consumers— phytosterols, which are known to reduce cholesterol absorption in the intestines—Wakunaga created Kyolic® Formula 107, a proprietary blend of Kyolic Aged Garlic Extract and phytosterols for a uniquely synergistic cholesterol-lowering supplement.

The company also offers ModuChol®, a potent blend of plant sterols in capsule form free of dairy, gluten, animal derivatives, artificial colors, preservatives and sugar.

Education Navigation

From omegas through herbs and botanicals, cholesterol is one category in which customers are faced with all too often too many products. To overcome This challenge, Don Ryan, with Quest Products Inc. (Libertyville, IL), which co-branded with Cargill’s popular CoroWise™ plant sterols to create Cardio Chews™, suggested that retailers create cholesterol sections in their stores.

“When cholesterol products are placed in the basic vitamin aisle with over 3,000 other SKUs, it gets hard to identify great cholesterol items,” he said. “Build a heart health section in the store with direct focus [or subsection] on cholesterol.” Sometimes that’s easier said than done, but Super Supplements has made this strategy work. Its overall assortment has a broad level cardiovascular category that includes High Blood Pressure, Circulation and Cholesterol. Its primary category is comprised of 240 or so SKUs with about 50 percent of those living in a specific “Cholesterol” home.

“This excludes items like garlic, turmeric and niacin, which live in their own respective categories,” said Letty Miller, category manager. The chain’s secondary level items have a broader reach and encompass more than 200 SKUs within the “cardiovascular sections” the fish oils specific to cardiovascular fall into this secondary category, but are not necessarily primarily driven by it.

“As with all categories you can fall into a situation where the category is too diluted and so can be confusing in terms of choice for the customer. We try to create a cohesive cardiovascular set that includes functional foods like garlic, plant sterols, Sytrinol and nattokinase but also include the red yeast rice, policosanols and cholesterol-specific complexes,” explained Miller. “We have an interrelated cardiovascular set to include items for circulation and high blood pressure as well.” Making products easy to find is almost as important as being able to address consumers’ questions. When Faced with confused customers, in particular about cholesterol, Healthy Alternative takes a three-fold approach.

“First, we train our staff every month in each store about topics like cholesterol.

We’ll spend a whole session talking about nothing but cholesterol and the questions [our staff] is likely to get,” said Hause, adding that they will go through every product offered for the specific condition being discussed and what it does.

Super Supplements also puts a strong emphasis on educating its staff through vender trainings, in-store trainings, trainings on specific topics as well as product demonstrations, but Rohder believes there can always be more help on this front.

“Providing the latest science on their products and giving the retailer information that can be shared with the consumer on the sales floor is the most helpful,” he said. “If the suppliers/manufacturers could continue to invest in training the sales person in the store this will create more informed sales that create return customers.” This leads to the second step at Healthy Alternatives: resources.

“We encourage our staff to familiarize themselves with and use our research area filled with materials we get from our vendors,” said Hause, “but more importantly, with the research we’ve compiled independently on our own.” Hause and his team have labored to create files on every ailment to which the staff can refer, pulling from trade publications and numerous other scientific sites.

“At the store level, customers are looking for scientific evidence when they compare products, and the presence of quality scientific data definitely makes the consumer feel secure and comfortable about the products,” said Jarrow’s Dadgostar.

Even though Super Supplements appreciates vendor assistance, Kenny has observed that in some stores staffs are more interested in vendor-independent materials. “Some stores prefer unbiased material, so they turn to Aisle 7 kiosk, trusted resource books or research articles in the store library that aren’t product specific,” he said.

These are some of the most valuable Tools, in Kenny’s eyes, especially as the store strives to make sure it is DSHEA compliant.

“We are very conscientious about the need for DSHEAcompliant information,” he said. “As a company, we don’t recommend specific products for lowering cholesterol in order to be DSHEA compliant, but we point out the best sellers, get them information from Aisle 7 (formerly Health Notes) or other reading material and share positive customer feedback, but we note that doesn’t guarantee they will have the same result.” 

And that’s an important differentiation customers need to understand, according to Richard D. Johnson, president and CEO of BSP Pharma. “In general, we all want products that work … for us,” he said. “When considering established ingredients and products, the product experience and recommendations of retail associates as well as word-of-mouth consumer experience may be the best and most valued indicators of quality and efficacy.” 

The last step at Healthy Alternative is one-on-one counseling, according to the retailer. “Everyone thinks their situation is unique, so it’s comforting for them to go over with our staff what they’re dealing with and what they’re looking for,” he said. “When customers see that we’re confident and educated, and most importantly looking them in the eye, they’re much more at ease, and sometimes that can make all the difference.”

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