Cholesterol Management and Plant Sterols

What is Cholesterol?

Cholesterol is a waxy, fatty substance that is present in blood. Cholesterol is necessary for life. It aids in digestion and acts as a precursor for Vitamin D and certain hormones. It is needed in minute amounts. The body manufactures all of the cholesterol it requires.

Excess cholesterol is absorbed into the arterial walls, in the heart and elsewhere in the body, causing the buildup of layers of plaque that can ultimately lead to blockages. Heart attacks, strokes, and other serious problems often result.

Not all cholesterol is the same. Low-density lipoprotein (LDL-cholesterol) is considered "bad" since it causes plaque to build up in the arteries. High-density lipoprotein (HDL-cholesterol) is referred to as "good" cholesterol since it does the opposite, carrying plaque away from the arterial wall to the liver and out of the body.

Epidemiological investigations and clinical studies have established that an elevated serum LDL-cholesterol is a major contributing factor of coronary heart disease. Furthermore, individuals who have very high total cholesterol levels (>240mg/dL) are generally twice as likely to experience a heart attack or a stroke than individuals with a moderate cholesterol level (<200mg/dL) [American Heart Association, 2003].

More important than simply lowering total cholesterol, maintaining an optimal balance among LDL, HDL, and triglycerides is key to cardiovascular health. A low-fat diet, exercise, and regular consumption of dietary supplements formulated with scientifically proven, high quality ingredients such as vitamin E, niacin, and pantethine can help you achieve a healthy blood lipid profile.
Blood in Balance

The Basic Facts About Blood Lipids

The lipids (or fats) present in human blood include:

• low density lipoprotein (LDL) cholesterol
• high density lipoprotein (HDL) cholesterol
• triglycerides (TG)

These various blood lipid components must be balanced in order for your circulatory system to function correctly. Levels of HDL cholesterol should be high, while levels of the other blood lipids, including LDL cholesterol, should be low.

Although the NCEP guidelines for total cholesterol remain the same, recent medical findings have resulted in new recommendations for:

• a lower level of LDL cholesterol a higher level of HDL cholesterol
• reduction of elevated triglycerides as a independent risk factor

Therefore, it is important to determine the levels of these blood lipids individually, in addition to your total cholesterol. These levels can be measured with a simple blood test. This test is called a "blood lipid panel" or "complete lipoprotein profile". Because food affects the levels of lipids in your blood, it is necessary to fast for 9-12 hours before the test. For convenience, the test is usually scheduled in the morning, after fasting overnight.

About Cholesterol and Heart Health

New Cholesterol Guidelines Released by U.S. National Institutes of Health Updated guidelines for the prevention and management of high cholesterol were released in May 2001 by the National Institutes of Health (a division of the U.S. Department of Health & Human Services) as part of the National Cholesterol Education Program (NCEP). Updates are made when warranted by recent advances in science. The new guidelines are the first major update to the program in nearly a decade. Total cholesterol is the measurement of all cholesterol present in your blood, including HDL, LDL, triglycerides, and all other carriers.

• Some test results will include a "cholesterol ratio". This number is total cholesterol divided by HDL cholesterol. For example, a total cholesterol level of 200 mg/dL divided by an HDL cholesterol level of 50 mg/dL would result in a ratio of 4:1. While this ratio offers a more complete picture than the total cholesterol number alone, absolute numbers for each of the blood lipids will be most helpful to your physician in determining heart health and an appropriate course of treatment.
• A person with a "high" total cholesterol level has more than twice the risk of heart disease compared to someone whose total cholesterol is "desirable".

Total Cholesterol Level Guidelines
Less than 200 mg/dL	Desirable
200 to 239 mg/dL	Borderline-high
240 mg/dL and above	High

* millimoles per litre

High density lipoprotein (HDL) is often termed the "good" cholesterol. It acts like a scavenger in the body, gathering plaque and carrying it to the liver to be eliminated. Its role in preventing plaque deposits creates its reputation as a protector of your heart.

HDL-Cholesterol Level Guidelines
Less than 40 mg/dL	Low
40 to 59 mg/dL	Near Optimal
60 mg/dL and above	Optimal

Low density lipoprotein (LDL) is the culprit in the blood lipid equation. High LDL levels can contribute to plaque formation. The more LDL in your blood, the greater your risk for plaque buildup, which can eventually block the arteries. This is why LDL is commonly referred to as being "bad" cholesterol.

LDL-Cholesterol Level Guidelines
Less than 100 mg/dL	Optimal
100 to 129 mg/dL	Near Optimal
130 to 159 mg/dL	Borderline High
160 to 189 mg/dL	High
190 mg/dL and above	Very High

Triglycerides (TG) are the form in which fat is stored in the body for use as energy. High levels of triglycerides in the blood indicate a risk for heart disease. Excessive triglycerides often accumulate around major organs, including the heart, kidneys and liver. In addition to the impact on the body's vascular system, accumulated triglyceride deposits can impair the function of the liver. This is often referred to as "fatty liver syndrome". Maintenance of the liver, the body's waste purification system, is essential for normal cholesterol processing.

Triglyceride Level Guidelines
Less than 150 mg/dL	Normal
150 to 199 mg/dL	Borderline high
200 to 499 mg/dL	High
500 mg/dL or above	Very High

Comparison of Previous and New NCEP Guidelines
Blood Lipid Level	Previous Guidelines	New Guidelines
LDL-cholesterol
optimal	< 130 mg/dL	< 100 mg/dL
above optimal	n/a	100 - 129 mg/dL
borderline high	130-159 mg/dL	130-159 mg/dL
high	160 mg/dL	160 - 189 mg/dL
very high	n/a	> 190 mg/dL
HDL-cholesterol
minimum	> 35 mg/dL	> 40 mg/dL

**From the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Cholesterol Education Program (NCEP)
National Heart, Lung, and Blood Institute (NHLBI)
National Institutes of Health (NIH)

The new guidelines reflect:

• more aggressive cholesterol-lowering treatment
• better identification of those at high risk for a heart attack
• identification of a "metabolic syndrome" of risk factors linked to insulin resistance, which dramatically increase risk
• use of a complete lipoprotein profile as the first test for high cholesterol

WHAT ARE PLANT STEROLS ESTERS OR PHYTOSTEROLS?

Phytosterols, also known as plant sterols, are a naturally occurring class of compounds found in the cells and membranes of plants. These plant lipid-like compounds are present at low levels in grains, fruits and vegetables. There are approximately 250 different sterols and related compounds in plant and marine materials with the most common ones beta-sitosterol, stigmasterol, and campesterol.

A large body of scientific research dating back to the 1950s has documented the ability of phytosterols to block the absorption of cholesterol and reduce blood cholesterol levels.

Phytosterols have a similar molecular structure to dietary and endogenously secreted cholesterol. The most abundant phytosterols (sitosterol, campesterol, and stigmasterol) differ from cholesterol only in the identity of one side chain or the presence of an extra double bond.

Because cholesterol and phytosterol molecules are similar, the human body can't tell the difference. Phytosterols compete with cholesterol for absorption in the small intestine. However, phytosterols themselves are not absorbed by the human body.

Sources, Intake & Physiology of Phytosterols:

Although the structures of sterols are similar to cholesterol, fewer sterols are absorbed as compared to approximately half of the cholesterol being absorbed from our diet. As the intake of sterols is increased, the percentage absorbed actually decreases, leading to a reduced efficiency of absorption. In addition, sterols are eliminated faster than cholesterol through the bile, and combined with lower absorption, contribute to blood levels of sterols that are less than blood cholesterol levels.

Studies conducted on foods enriched with sterols and clinical studies have shown that plant sterols can lower total cholesterol by an average of 6 to 10% and LDL cholesterol by an average of 8 to 15% (ref. 2,3, US FDA). Dietary plant sterols reduce cholesterol by competing with LDL cholesterol, thereby inhibiting the absorption of LDL cholesterol produced by the liver and dietary cholesterol (ref. 1). Sterols also help to maintain levels of HDL cholesterol, creating an overall improved ratio of cholesterol without any side effects.

Research indicates that phytosterol esters can serve as an add on therapy to cholesterol lowering medication such as fibrates or statins because they act in a different manner. The use of dietary phytosterol esters along with statins has been shown to have an additive effect on cholesterol reduction. One study found that statins reduced LDL cholesterol by 32%, and by adding phytosterol esters further reduced LDL cholesterol by anther 7%, for a total cholesterol reduction of 39% (ref. 4).

Cholesterol is absorbed in the upper third of the intestine. Phytosterols block the absorption of dietary cholesterol into the bloodstream and inhibit the re-absorption of cholesterol from bile acids in the digestive process, thus reducing the amount of cholesterol entering the bloodstream. The absorption rate of phytosterols is approximately 1/10th that of cholesterol, meaning that the pathways in the intestine are occupied by phytosterols for an extended period of time, which makes the blocking process even more effective.

Most people consume 0.2 - 0.3 grams of phytosterols each day as part of a normal healthy diet. A large and growing number of clinical trials have shown that an additional one to two grams of phytosterols in the diet can reduce blood cholesterol levels significantly.

SWISS VEGAPURE IS AN IDEAL FIRST CHOICE FOR CHOLESTEROL MANAGEMENT

Swiss Vegapure contains plant sterols or phytosterols, a class of natural, fat-like compounds whose chemical structures are similar to cholesterol.

Swiss Vegapure is an ideal first choice for cholesterol management. This supplement is effective for individuals concerned about lowering overall cholesterol levels prior to going on a cholesterol lowering therapy. For those on statins and fibrates Swiss Vegapure is a safe and effective add on to prescription cholesterol reducers.

The Swiss Herbal Innovation:

Swiss Herbal's Vegapure sterol esters are naturally sourced, primarily produced from soybean oil. These sterols are further esterified with food grade sunflower oil fatty acids, a rich source of linoleic acid. Sterols are esterified to provide an effective vehicle for delivery of sterols to the small intestine. This also increases their oil solubility ten fold. Swiss Herbal uses a patented esterification process which improves the purity of the sterol esters in Vegapure. Vegapure is composed of a total 98% sterols of which 91% are Sitosterol, Campesterol and Stigmasterol. Each capsule of the product contains 650 mg of Vegapure sterol esters, to be taken twice daily.

In 2000, the US FDA stated, "Foods containing at least 0.65 grams per serving of vegetable oil sterol esters, eaten twice a day with meals for a daily total intake of at least 1.3 grams, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease." The daily dose of Swiss Vegapure is 1.3 grams of phytosterol esters (1 capsule taken twice daily). Numerous studies have shown that 1.3 grams of phytosterol esters taken daily can help achieve an overall cholesterol lowering of between 8-15%.

References:
1. Ling, W.H., and P.J.H. Jones, Dietary Phytosterols: A Review of Metabolism, Benefits, and Side Effects. Life Sciences, vol. 57, pp. 195-206, 1995.

2. Hendriks, H.F.J. Westrate, J.A., van Vliet, T. Meijer, G.W. Spreads enriched with three different levels of vegetable oil sterols and the degree of cholesterol lowering in normocholesterolaemic and mildly hypercholesterolaemic subjects. European Journal of Clinical Nutrition 1999;53:319-327.

3. Weststrate J.A., Meijer G.W. Plant-sterol enriched margarines and reduction of plasma total- and LDL- Cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects. European Journal of Clinical Nutrition 1998;52:334-43.

4. Simons, L.A. M.D., Additive Effect of Plant Sterol-Ester Margarine and Cerivastatin in Lowering Low-Density Lipoprotein Cholesterol in Primary Hypercholesterolemia. The American Journal of Cardiology, vol. 90, pp. 737-740, October 2002.