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Track Your Plaque is the revolutionary approach
that shows you how heart scans and the latest medical and natural
treatments can be combined to create the most powerful heart attack
prevention program available!
In this issue:
Phytosterols―Protection or
poison?
You might know them as Benecol™ and Take Control™.
Manufacturers claim these plant cholesterols are useful for reducing
cholesterol. But not all forms may be effective, some may even be
unsafe. We help you navigate the ups and downs of this interesting
strategy.
Dan F. struggled to keep his LDL cholesterol down. It was, after all,
identified as among the important factors contributing to his coronary
plaque and heart scan score of 315.
Dan had already succeeded in boosting his HDL through weight loss,
reduction of processed carbohydrates, and fish oil supplements. His
triglycerides were under perfect control at 50 mg.
But LDL continued to be an issue. He was already on a small dose of a
cholesterol drug. He really disliked the idea of increasing his dose. So
Dan sought other healthy nutritional means to drop LDL. He added oat
bran to his breakfast choices, a handful of raw almonds and walnuts, and
tried to replace animal proteins with soy proteins whenever possible.
These strategies did succeed in dropping his LDL an additional 18
points. But Dan’s LDL was stalled at 84 mg, still above the Track Your
Plaque target of 60 mg.
So Dan decided to add 2 tbsp. per day of a phytosterol product by adding
the butter-like product to his vegetables, scrambled eggs and egg
whites, and other foods. His LDL finally dropped to the target of 60 mg.
What are phytosterols?
Plants inhabit a world parallel to ours. Just like us,
plants have a fatty substance in their cells called phytosterols, very
similar to human cholesterol’s molecular structure with several small
differences (an additional methyl group or double bond, for you
chemists).
Back in the early 1950s, Dr. O. J. Pollak observed that feeding
phytosterols to rabbits reduced blood cholesterol values. However,
enthusiasm for administering them in humans was dampened by the fact
that a rare genetic condition called sitosterolemia, in which the body
absorbs excessive quantities of “plant cholesterol”, caused premature
coronary artery disease. Sufferers would have heart attacks in their
20s. Clearly, sitosterol and perhaps other phytosterols, while they
might block cholesterol absorption when taken orally, should not enter
the blood.
Plenty has happened since Dr. Pollak’s preliminary observations over 50
years ago. Nearly a dozen clinical studies in humans have been conducted
using various phytosterol preparations to reduce cholesterol. We can now
buy phytosterol-containing products in the grocery store and in health
food stores. But are they safe? What advantage might they provide?
Lessons learned
In the mid-1990s, it became clear that phytosterols in
their natural form are ineffective for reducing cholesterol. They need
to be in an oil-based form, or “esterified”. The food vehicle for
esterified phytosterol doesn’t matter—it could be in salad oil, a butter
substitute, juice or anything else—so long as the phytosterol itself is
esterified. The non-esterified form does not work and achieves minimal
or no reduction in cholesterol. Unfortunately, the unesterified form is
the sort you’ll frequently find in health food stores contained in
cholesterol-reducing supplements.
For this reason, the first preparations to become commercially available
were butter substitutes, Benecol™ and Take Control™. More recently, an
orange juice containing esterified phytosterols has become available,
Minute Maid’s Heart Wise™. A rice milk product from Rice Dream, also
called Heartwise™, is also now on the shelves.
Several studies have examined what dose of esterified phytosterols is
required to reduce cholesterol. It became clear that 2 grams per day are
required for full benefit of reducing LDL cholesterol 15%. Less
phytosterol achieves less of an effect, more achieves no additional
effect.
There’s some concern that phytosterols will block absorption of
fat-soluble nutrients. However, the only nutrients that appear to suffer
are beta-carotene and related carotenoids. Absorption of these important
nutrients are reduced around 25% when very high doses of phytosterols
are ingested (e.g., 4 grams per day), but it appears to not be a
significant effect at the currently recommended dose of 2 grams per day.
If phytosterols work by blocking cholesterol absorption in the
intestine, should they be taken frequently throughout the day to ensure
that some is always in the intestinal tract? Thankfully, frequency of
use seems not to have any effect whatsoever. Using your phytosterol
preparation just once a day is every bit as good as several uses
throughout the day.
Do esterified phytosterols work even when cholesterol-reducing drugs are
taken? They do. In fact, studies have shown that adding 2 grams of
phytosterols to your program is as good as doubling the dose of your
cholesterol agent. If, for instance, your doctor advises you to increase
your Lipitor™ from 20 to 40 mg to further drop your LDL cholesterol, you
could do just as well by keep your drug at 20 mg but adding 2 grams ( 2
level tablespoons) of Benecol™ per day.
Cholesterol : high producers vs. high absorbers
In the groundbreaking 4S Trial of the cholesterol drug,
simvastatin, there was a 42% reduction in death from heart attack in
those taking the drug compared to placebo. However, a group within those
assigned to simvastatin showed high risk for heart attack despite taking
the drug. Investigators at the University of Finland discovered that
this unique group responded poorly to simvastatin. Further investigation
showed that this particular group demonstrated a relatively low level of
liver cholesterol production (and therefore did not respond well to
simvastatin) but a high level of cholesterol absorption in the
intestine.
Numerous subsequent reports from this group have led to the interesting
observation that inhibitors of cholesterol absorption like phytosterols
may provide special advantage to this group, despite the poor response
to simvastatin.
Unfortunately, these distinctions cannot be made outside of the research
setting. The Finnish investigators, however, have suggested that the use
of phytosterol preparations may be a practical solution to the problem.
Phytosterols, of course, block intestinal absorption of cholesterol and
may provide exaggerated benefit to people who vigorously absorb
cholesterol. People with higher triglycerides and other characteristics
of the metabolic syndrome may be people who are more likely to be high
producers of cholesterol and more responsive to statin drugs; people
without metabolic syndrome are more likely to be high-absorbers.
Perhaps in future, we will have a practical method of distinguishing who
is a high manufacturer of cholesterol from those who are efficient
absorbers. Until then, adding a blocker of absorption in the form of
phytosterols is worth considering.
Are phytosterols absorbed into the blood?
Remember the issue of sitosterolemia in which some
people absorb abnormal quantities of phytosterols into the blood and
develop premature coronary disease? How important is this issue when
using these products? Yes, they reduce cholesterol. But do they also get
absorbed into the blood and cause heart disease?
There are differences among the products. Take Control™ is a
sterol-containing product. Benecol™ is a stanol-containing product. Both
are equally effective in reducing LDL cholesterol around 15%. However,
more recent experiences suggest that there’s more to the issue.
First of all, the LDL-reducing effects of the sterol product may
diminish after several months of use, leveling off at half the initial
benefit. In other words, the initial 15% LDL reduction falls off to
7–8%. Stanol esters do not show this effect and may therefore have a
longer-lasting benefit.
The old suspicion about sterols actually contributing to heart disease
risk if they should make their way into the blood has also re-emerged.
It appears that a small quantity of sterol ester can indeed be absorbed
into the blood, while only a negligible amount from stanol esters does
so. Will this increase risk of heart disease if used chronically? This
is not entirely clear, but some investigators have raised this important
question.
Should you or shouldn’t you?
After this somewhat long-winded discussion, is adding
phytosterols to your program really worth it? And when?
We believe there’s real value in these products, particularly the stanol
ester Benecol™. Because of the sterol absorption issue, we currently do
not recommend Take Control™ or other sterol ester products until better
information on their safety becomes available. This includes Minute
Maid’s Heart Wise™ and Rice Dream’s Heartwise™ rice milk product, both
of which contain sterol esters.
If you are on a statin drug but have failed to achieve either your Track
Your Plaque LDL goal of 60 mg, or if your doctor advises that a lower
LDL is indicated, adding the stanol product can be a useful way to drop
your LDL and perhaps avoid the need for increasing the dose of your
medication. You might give it special consideration if you don’t have
the metabolic syndrome (e.g, low HDL, high triglycerides, increased VLDL,
small LDL, blood sugar>110 mg), since you are more likely to be a
high-absorber of cholesterol.
The effective dose is two level tablespoons of the stanol product per
day. Use it just as you would butter or margarine. However, these
products do not sauté well, as they tend to liquefy with heat. Use them
for flavor, as well as for the LDL reducing benefits.
Summary:
• Stanol ester product, Benecol™ butter-substitute, is
recommended for use to reduce LDL cholesterol. The effective “dose” is 2
tbsp per day.
• Sterol ester products Take Control™, Minute Maid’s Heart Wise™ and
Rice Dream’s Heartwise™ rice milk product, are not recommended due to
concerns over durability of effect and the possible entry of sterol
esters into the blood.
Selected references:
Lichtenstein AH, Deckelbaum RJ. Stanol/sterol ester-containing foods and
blood cholesterol levels. A statement for healthcare professionals from
the nutrition committee of the council on nutrition, physical activity,
and metabolism of the American Heart Association. Circulation
2001;103:1177–1179.
Miettinen TA, Gylling H. Non-nutritive bioactive constituents of plants:
phytosterols. Int J Vitam Nutr Res 2003 Mar;73(2):127–134.
Miettinen Ta, Gylling H. Cholesterol synthesis and absorption in
coronary patients with lipid triad and isolated high LDL cholesterol in
a 4S subgroup. Atherosclerosis 2003 Jun;168(2):343–349.
Miettinen TA, Gylling H. Plant stanol and sterol esters in prevention of
cardiovascular diseases. Ann Med 2004;36(2):126–134.
Ketomaki A, Gylling H, Miettinen TA. Non-cholesterol sterols in serum,
lipoproteins, and red cells in statin-treated FH subjects off and on
plant stanol and sterol ester spreads. Clin Chim Acta 2004
Mar;353(1–2):75–86.
Miettinen TA, Railo M, Lepantalo M, Gylling H. Plant sterols in serum
and in atherosclerotic plaques of patients undergoing carotid
endarterectomy. J Am Coll Cardiol 2005 Jun 7;45(11):1794–1801.
Thompson GR, Grundy SM. History and development of plant sterol and
stanol esters for cholesterol-lowering purposes. Am J Cardiol
2005;96(suppl):3D–9D.
Plat J, Mensink RP. Plant stanol and sterol esters in the control of
blood cholesterol levels:mechanism and safety aspects. Am J Cardiol
2005;96(suppl):15D–22D.
Be in the Track Your Plaque
Spotlight!
How would you like us to put together your Track Your
Plaque program for you?
We’re looking for several people to provide their personal information
relevant to the program, such as heart scan score, LDL cholesterol, HDL,
blood pressure, eating patterns, weight, etc. We will create a program
for you. We will also provide ongoing guidance and feedback for one
year.
In return, we ask permission to describe your program and progress on
our website and newsletter. You’ll provide readers with real world
experience in following a plaque-control program. We will not divulge
personal details of your life, such as name, address, etc. But the
relevant health information will be real.
If you’re interested in being considered for the program and agree to
allow us to use your story, please contact us and let us know that
you’re interested in participating in the Spotlight program.
http://www.trackyourplaque.com/fo06-00about.asp
Upcoming features on the
www.trackyourplaque.com website:
Extinguishing inflammation—part II
Inflammation spurs plaque growth, cancer, arthritis,
and diabetes. Up to 70% of people have unsuspected, asymptomatic
inflammation smoldering within. Turning off inflammation can be an
important part of your program. Part II will detail the practical
nutritional and lifestyle strategies to powerful impact on inflammation
for your program.
Chat online with Dr. William Davis, author of Track Your Plaque
and program founder. Dr. Davis will answer member questions, discuss
topics of interest, and provide feedback. Stayed tuned to the
www.trackyourplaque.com for times.
Is l-arginine dangerous? Recent media reports brim with warnings
about the dangers of l-arginine, based on a study in people following
heart attacks. Several deaths were attributed to l-arginine use. Is this
true? What implications does this have for your plaque-control program
if you take l-arginine?
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