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Cholesterol Lowering - Are There Alternatives To Statins?    

Keeping cholesterol levels healthy is a key factor in maintaining a healthy heart and circulatory system. After much consideration by the authorities of both the risks and benefits of statin drugs for cholesterol lowering, they have been made freely available without prescription from your Pharmacist.  However, as potent and licensed medicines there are risks of side effects, and although relatively rare, they can also be serious.

For this reason many people are seeking alternative ways to lower cholesterol before deciding to take up the statin option. The good news is that if this describes you, there are a number of effective and natural approaches that can be used to lower and maintain cholesterol levels at a healthy reading.

Cholesterol Lowering Diets         

Modifying your diet to avoid cholesterol rich foods is always a positive first step towards reducing your cholesterol levels.  In particular, avoiding foods such as shellfish, fatty meats and meat products such as sausages, pate, as well as avoiding unhealthy foods which are high in refined carbohydrates is a lifestyle change every individual can take. 

However, dairy foods and hard cheese are particularly high in cholesterol, and are also a primary source of calcium in the diet. Calcium is an essential mineral and is a nutrient used in normal cardiovascular function, muscle function, and is a principle component of bone structure . Avoiding all dairy products in your diet on a long term basis without compensating with other calcium rich food sources is likely to result in a calcium deficiency, and this is potentially an issue in relation to an increased risk of developing osteoporosis .  Therefore, the best option with respect to dairy foods and cholesterol lowering is to select low fat options wherever possible. If you do choose to cut dairy food out altogether, try to substitute with other calcium rich foods such as eating sardines or pilchards regularly, seek low fat calcium enriched dairy alternatives in the shops, or consider taking a daily calcium supplement to achieve at least the Recommended Daily Allowance of 800mg/day from all sources.

In addition to these steps, increasing your intake of dietary fibre and particularly Phytosterols in your daily diet can reduce cholesterol levels by up to 10%. For maximum cholesterol lowering benefit, these phytosterol rich roods should be eaten about half an hour before a meal with cholesterol content, such as meat.  If phytosterol rich foods are eaten at the same time as foods containing cholesterol they will still produce cholesterol lowering effects, but to a lesser extent.

Phytosterols - What Are They And Why Do They Lower Cholesterol?

Phytosterols, and in particular Beta-Sitosterol are the plant world’s equivalent of cholesterol.  In terms of chemical structure, Beta-Sitosterol and cholesterol are very nearly identical to each other.  However, the key difference as far as we human beings are concerned is that our body cannot burn beta-sitosterol and other phytosterols for energy, and the body can only absorb a very small amount of beta-sitosterol into the bloodstream.

When we eat foods rich in beta-sitosterol and other sterols, the evidence suggests that these compounds occupy the special cholesterol absorption sites in the intestines and block cholesterol from being taken up into the bloodstream.  Instead, the cholesterol is excreted with other waste matter.  This reduces the amount of LDL ‘ bad’ cholesterol absorption from the diet, reducing blood cholesterol levels overall.  

However, our body does need some cholesterol for health and metabolism.  Therefore, once the amount of LDL cholesterol in our bloodstream falls too low, the body will compensate by increasing its production of HDL or ‘good’ cholesterol to maintain total or overall cholesterol levels at the correct balance that is needed for health.

A very small amount of beta-sitosterol is absorbed by the body (about 10%), and is broken down by the liver and excreted.

So What Foods Are Rich In Phytosterols?  How Can You Increase Them In Your Diet?

Phytosterols are found to a small extent in all plants, but in high concentrations in nuts, seeds and wholegrains.  Unfortunately, modern food processing methods remove a significant proportion of these substances from foods so if you wish to increase these naturally you need to opt for unprocessed, wholegrain foods which includes plenty of beans and pulses and unprocessed wholegrain rice or soy.  Alternatively there are now a number of phytosterol enriched foods available on the market, such as yoghurts and spreads.  However, whilst these will limit cholesterol absorption from these food types which are also sources of calcium, they need to be consumed about half an hour before any main meals to have any significant effect on cholesterol absorption from meat and meat products.

As an additional alternative, there are also beta-sitosterol food supplements available extracted from soy and rice which can be taken with a glass of water half an hour before your meal.  The advantage of these is that they are concentrated forms of phytosterols with no added calorie content, and it is easier to assess how much you have increased your dietary phytosterol intake.

Studies show that for the best cholesterol lowering effects, between 1 - 2g of phytosterols need to be consumed every day.

Are There Any Other Effects Of Increasing Phytosterols In Your Diet?

There are quite a few clinical and epidemiological (population group) studies that show that increasing dietary phytosterols can have benefits in helping to keep the prostate gland healthy and reduce the symptoms associated with a condition called Benign Prostatic Hypertrophy . Whether these benefits are in fact more associated with an overall reduction in cholesterol levels (which is positively linked to a reduced risk of prostate disease) or arise from some other mechanism of action of beta-sitosterol in the blood is not yet clear.

There have been a very large number of studies on beta-sitosterol and its cholesterol lowering effects since these food components were first discovered in the 1950s, and no serious side effects have been recorded from increasing dietary levels. You can expect your stools to become softer however, as more cholesterol is excreted.

A small number of people suffer from a genetic condition called sitosterolaemia, which means that they cannot metabolise and excrete absorbed sterols, and a build up occurs.  This is a condition that tends to be identified in early life as these components are widely found in the diet and this condition is very rare.  Anyone who suffers from this condition is advised to avoid foods containing phytosterols.

How Does Increasing Phytosterols In Your Diet Affect You If You Already Taking A Statin?

Phytosterols work by reducing the amount of cholesterol that can be absorbed from your food, whereas Statin drugs work inside the body on the processes that control cholesterol metabolism.  As a result of this, whilst there is no evidence of a direct interaction between statins and phytosterols,  the cholesterol lowering effects of each approach have been found to be additive.

So that your health providers can monitor and look after your health properly, they always need to know what steps you are taking to look after your own health.  Therefore, you should always advise them if you have chosen to increase phytosterols through either diet or supplements, as this may mean that a lower dose of statins may be advisable for you and this should be monitored.

Summary

For many people, taking a dietary approach to cholesterol lowering by reducing your intake of cholesterol rich foods and increasing phytosterol intake can produce good results.  If the cholesterol lowering effects that these dietary modifications produce are not great enough after 1 - 3 months, a statin can be added.  Always advise your health provider of what dietary steps you have already taken to lower your cholesterol levels, whether through diet alone or diet and supplementation.

Full Reference List

De Angelis G. The influence of statin characteristics on their safety and tolerability.
Int J Clin Pract. 2004 Oct;58(10):945-55.

Graham DJ, Staffa JA, Shatin D, Andrade SE, Schech SD, La Grenade L, Gurwitz JH, Chan KA, Goodman MJ, Platt R. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. JAMA. 2004 Dec 1;292(21):2585-90.

Abrams SA. Calcium turnover and nutrition through the life cycle. Proc Nutr Soc. May2001;60(2):283-9.

Bostick RM, Kushi LH, Wu Y, et al. Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol 1999;149:151-61.

Dawson-Hughes B. Vitamin D and calcium: recommended intake for bone health. Osteoporos Int. 1998;8 Suppl 2:S30-4.

Dawson-Hughes B. Calcium Supplementation and Bone Loss: A Review of Controlled Clinical Trials. Am J Clin Nutr. Jul1991;54(1):274S-80S.

Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. Sep1997;337(10):670-676.

Drexel H, Breier C, Lisch HJ, Sailer S. Lowering plasma cholesterol with beta-sitosterol and diet. Lancet. 1981 May 23;1(8230):1157.

Heinemann T, Kullak-Ublick GA, et al. Mechanisms of action of plant sterols on inhibition of cholesterol absorption. Comparison of sitosterol and sitostanol. Eur J Clin Pharmacol. 1991;40(Suppl 1):S59-63.

Miettinen TA, Gylling H. Non-nutritive bioactive constituents of plants: phytosterols. Int J Vitam Nutr Res. 2003 Mar;73(2):127-34. Review.

Richard E Ostlund, Jr. Phytosterols in human nutrition . Annu.Rev. Nutr. 2002. 22:533 - 549.

Bhattacharyya AK, Connor WE, Lin DS. The origin of plant sterols in the skin surface lipids in humans: from diet to plasma to skin. J Invest Dermatol. 1983 Apr;80(4):294-6.

Miettinen TA. Regulation of serum cholesterol by cholesterol absorption. Agents Actions Suppl. 1988;26:53-65.

Pollak OJ. Effect of plant sterols on serum lipids and atherosclerosis. Pharmacol Ther. 1985;31(3):177-208.

Pelletier X, Belbraouet S, Mirabel D, et al. A diet moderately enriched in phytosterols lowers plasma cholesterol concentrations in normocholesterolemic humans. Ann Nutr Metab 1995;39:291–95.

Grundy SM, Ahrens EH Jr, Davignon J. The interaction of cholesterol absorption and cholesterol synthesis in man. J Lipid Res 1969;10:304–15 (review).

Ling WH, Jones PJ. Dietary phytosterols: a review of metabolism, benefits and side effects. Life Sci. 1995;57(3):195-206.

Awad AB, Chan KC, Downie AC, Fink CS. Peanuts as a source of beta-sitosterol, a sterol with anticancer properties. Nutr Cancer 2000; 36 (2): 238-41

Lees AM, Mok HYI, Lee RS, et al. Plant sterols as cholesterol-lowering agents: Clinical trials in patients with hypercholesterolemia and studies of sterol balance. Atheroscler 1977;28:325–38.

Miettinen TA, Gylling H. Plant stanol and sterol esters in prevention of cardiovascular diseases. Ann Med. 2004;36(2):126-34. Review.

CJ Lewis, EA Yateley. Health claims and observational human data: relation between dietary fat and cancer. American Journal of Clinical Nutrition Vol69, No 6 1357S - 1364S, June 1999.

Willet, W. Estimates of cancer deaths avoidable by dietary change. J Natl Cancer Instit., 1996; 86,14:948.

Sadao Suzuki et al. Health Professionals Follow Up Study. American Journal of Clinical Nutrition 2002.

Alan Kristal et al. Cancer Epidemiology, Biomarkers and Prevention. Fred Hutchinson Cancer Research Centre.

Awad AB, Harati MS, Fink CS. Recent developments in the epidemiology of prostate cancer. Journal of Nutritional Biochemistry December 1998, vol. 9, no.12 p 712-717

Dearnaley DP. Current Issues in Cancer: Cancer of the Prostate. BMJ 1994,308:780-784

Epidemiological data: IEH Report 1997

Hebert JR, Hurley TG, Olendzki BC et al. Nutritional and socioeconomic factors in relation to prostate cancer mortality: a cross national study. J Natl. Cancer Inst. 1999; 90, 1637-47.

Berges RR, Windeler J, Trampisch HJ, et al. Randomised, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Lancet 1995;345:1529-32.

Klippel KF, Hiltl DM, Schipp B. A multicentric, placebo-controlled, double-blind clinical trial of ß-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. Br J Urol 1997;80:427-32.

Kobayashi Y; Sugaya Y; Tokue A. Clinical effects of beta-sitosterol (phytosterol) on benign prostatic hyperplasia: preliminary study Hinyokika Kiyo 1998 Dec;44(12):865-8

Wilt TJ; MacDonald R; Ishani A. Beta-sitosterol for the treatment of benign prostatic hyperplasia: BJU Int 1999 Jun;83(9):976-83.

Lutjohann D, von Bergmann K.Phytosterolaemia: diagnosis, characterization and therapeutical approaches. Ann Med. 1997 Jun;29(3):181-4. Review.

Clark LT. Optimizing lipid lowering in patients at risk. Clin Cardiol. 2004 Jun;27(6 Suppl 3):III22-6. Review.

Miettinen TA, Gylling H, Lindbohm N, Miettinen TE, Rajaratnam RA, Relas H; Finnish Treat-to-Target Study Investigators. Serum noncholesterol sterols during inhibition of cholesterol synthesis by statins. J Lab Clin Med. 2003 Feb;141(2):131-7.

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If you are on a weight loss diet, or a low cholesterol diet,

Are you watching your calcium levels?

If you want to take care of your heart, then following a low fat, low cholesterol diet is a sensible and positive step to take.  High or elevated cholesterol levels are a known biochemical marker for heart disease, and as a result, both fatty foods and foods rich in cholesterol should be cut back or eliminated from your diet.

However, there is one potential problem with a severe or long term restriction in your intake of dairy products.  Dairy foods, and in particular hard cheeses such as cheddar are a primary source of calcium in the diet. Therefore, if you eliminate dairy foods from your diet without increasing your calcium intake from other sources your diet could easily become calcium deficient, with possible long term and negative consequences for the strength of your bones.

This article takes a look at the mineral calcium, why it is important for your health, and what alternative dietary options there are to ensure that you are getting enough daily calcium to keep bones healthy and reduce your risks of developing osteoporosis.

What is Calcium?

Calcium is a mineral that is essential for normal muscle and nerve function, blood clotting and a host of other metabolic functions including involvement in the regulation of blood pressure.  Calcium is also the primary constituent of teeth and bones, and helps to provide bones with their structural integrity and strength.

In nature, calcium exists in many different forms, but for our bodies to absorb it into our bloodstream it has to be fully dissolved and ionised (that is stripped from its carrier compound) and in a slightly acidic environment. About 50% of the calcium in our blood reforms into complex molecules and 50% remains in its ionic form in the blood ready for the body to use. Excess calcium is either stored in our bones or excreted in the urine.

Why Is Calcium So Important For Healthy Bones?

Calcium is one of the main nutritional factors in the diet that can help to keep bones strong, along with Vitamin D and Magnesium.  Vitamin D is essential to help your body absorb calcium efficiently; Magnesium is both a major constituent of bones and directly influences how much calcium can be absorbed from your food.  

When bones become excessively demineralised or lose too much calcium, they can become weak and break easily: this condition is called osteoporosis or ‘fragile bones’.   At present in the United Kingdom, one in three women and one in twelve men will have osteoporosis by the age of 50, so this is a serious and relatively common problem.  So is there anything you can do to avoid becoming one of these statistics?

What Factors Determine If You Are At Risk Of Osteoporosis?

There are many different factors that affect our bone strength throughout our lives.  Some are beyond our control, such as our genetic profile, the levels of circulating hormones, the age of menopause for women, and some illnesses or medications can affect bone metabolism, bone strength and density.   However, our diet, how much exercise we take and the kind of lifestyle we follow are all directly within our control and also affect how strong our bones will be throughout our lives.   Following a healthy diet and lifestyle does not guarantee that you will never develop osteoporosis or fragile bones, but it will help to keep your individual risks of developing this condition as low as possible.

Building And Keeping Healthy Bones

During childhood and adolescence we are programmed to build strong and healthy bones according to our genetic profile. A diet rich in calcium and vitamin D (from the diet and from exposure to sunshine) along with regular weight bearing exercise helps bones to become strong and dense.  Once we get past the age of about 30, our metabolism begins to slow down and we reach what is called ‘peak bone mass.’ After this time, we stop increasing our bone density and bones will naturally start to erode and very gradually become weaker.

This is a normal and natural process, and as long as we have built plenty of bone mass during this early period of our lives, and we continue to make sure that we eat enough daily calcium in our diet and take plenty of regular exercise, most of us will have enough reserves of bone strength to last our whole lives without developing major problems. 

However, if we fail to eat enough calcium in our daily diet to power our metabolism and make up for losses of calcium from perspiration and excretion, our body will rob calcium reserves from our bones, accelerating this rate of bone loss. What is more, once we have passed the age of peak bone mass not all of the calcium will be put back later when we eat calcium rich foods.  If this situation is kept up over time, bones become progressively weaker and demineralised until eventually osteoporosis develops.

How Much Calcium Do We Need in Our Daily Diet?

Recommendations for the amount of calcium we need from our daily diet are drawn primarily from the amounts we need to keep our bones healthy, and these amounts vary slightly according to our sex and our age.

The Recommended Daily Allowance is set at 800 mg of calcium every day, which is defined as the minimum amount required to avoid a deficiency.  Men over the age of 65 should aim to consume at least 1000mg of calcium per day to keep bones healthy, and women at and beyond the age of the menopause should be consuming at least 1000mg of calcium per every day for optimal health . In some cases, if your doctor feels that you are at a particularly high risk of osteoporosis, then you may be told to supplement your diet with up to an extra 1500mg of calcium per day.  Your doctor will be able to help and advise you if you feel that you may be at particularly high risk, so if you are concerned, do ask them.  There are also a number of prescription medicines available for people with low bone density or individuals who are thought to be at a particularly high risk of osteoporosis.

Whilst too little calcium can be harmful, excessive amounts are also unhealthy.  Current advice is that no-one should consume more than about 2000mg of calcium per day from all sources, as this could cause or exacerbate other health problems.

Which Foods Do We Get Our Calcium From?

There are many different types of foods that contain calcium, but only a few that contain large amounts that can significantly contribute to the daily amount of calcium we need in our diet.  In general terms, everyone should aim to eat at least 4 portions of calcium rich foods everyday and preferably five.

Alternative Sources Of Low Cholesterol Calcium

If you are seeking to lower your cholesterol intake through your diet by reducing or eliminating dairy foods, you need to ensure that you maintain your calcium intake to preserve the strength and density of your bones. Sensible advice to achieve this would be:

• Choose low fat dairy products such as skimmed milk and very low fat yogurt.
• If you choose low fat soft cheeses in your diet, you need to allow for the fact that these contain approximately half the amount of calcium as hard cheeses such as cheddar
• Consider dairy food options that include added plant sterols to lower cholesterol absorption, or take a sterol supplement before eating dairy or cholesterol rich produce
• Seek out fat-free calcium enriched foods, such as calcium fortified drinks or orange juice
• Increase your consumption of bony fish such as pilchards or sardines, or other low cholesterol foods such as broccoli, baked beans or tofu
• Consider taking a daily calcium supplement.  However, if you choose this option ensure that the supplement you take also contains Vitamin D and preferably magnesium.  Supplements must be taken with plenty of water and ideally should not contain more than 400mg of calcium per serving; this is the maximum amount the body can absorb at one time. 

Summary

The benefits of a low cholesterol diet to keep your heart healthy are without question, and are especially necessary if you have any cardiovascular health problems.  However, if you are choosing a dairy free diet, make sure that you are still getting enough calcium in your daily diet to keep your bones healthy by compensating with other calcium rich food sources, or consider taking a daily calcium supplement.  If you have any concerns consult your doctor, dietician or nutritionist for expert advice or guidance.

REFERENCES

Bronner F. Calcium nutrition and metabolism. Dent Clin North Am. 2003 Apr;47(2):209-24.

Expert Vitamin and Mineral Report: Calcium 2003.  UK Scientific Committee on Safety of Foods

del Puente A, Esposito A, Savastano S, Carpinelli A, Postiglione L, Oriente P. Dietary calcium intake and serum vitamin D are major determinants of bone mass variations in women. A longitudinal study. Aging Clin Exp Res. 2002 Oct;14(5):382-8.

Tranquilli AL, Lucino E, Garzetti GG, Romanini C. Calcium, phosphorus and magnesium intakes correlate with bone mineral content in postmenopausal women.

Gynecol Endocrinol. 1994 Mar;8(1):55-8.

Spencer, H : Fuller, H : Norris, C : Williams, D  Effect of magnesium on the intestinal absorption of calcium in man.  J-Am-Coll-Nutr. 1994 Oct; 13(5): 485-92 

Lifestyle advice for fracture prevention.  Drug-Ther-Bull. 2002 Nov; 40(11): 83-6 

Juby,-A-G; Davis,-P A prospective evaluation of the awareness, knowledge, risk factors and current treatment of osteoporosis in a cohort of elderly subjects. Osteoporos-Int. 2001; 12(8): 617-22

Tucker, K L : Hannan, M T : Kiel, D P  The acid-base hypothesis: diet and bone in the Framingham Osteoporosis Study.  Eur-J-Nutr. 2001 Oct; 40(5): 231-7 

Olszynski WP, Shawn Davison K, Adachi JD, Brown JP, Cummings SR, Hanley DA, Harris SP, Hodsman AB, Kendler D, McClung MR, Miller PD, Yuen CK. Osteoporosis in men: epidemiology, diagnosis, prevention, and treatment. Clin Ther. 2004 Jan;26(1):15-28.

Flynn,-A. The role of dietary calcium in bone health. Proc-Nutr-Soc. 2003 Nov; 62(4): 851-8

Schaafsma, A : de Vries, P J : Saris, W H  Delay of natural bone loss by higher intakes of specific minerals and vitamins.  Crit-Rev-Food-Sci-Nutr. 2001 May; 41(4): 225-49 

Ensrud, K E : Duong, T : Cauley, J A : Heaney, R P : Wolf, R L : Harris, E : Cummings, S R  Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake. Study of Osteoporotic Fractures Research Group.  Ann-Intern-Med. 2000 Mar 7; 132(5): 345-53 

Looker AC. Interaction of science, consumer practices and policy: calcium and bone health as a case study. J Nutr. 2003 Jun;133(6):1987S-1991S.

Schleiffer, R : Galluser, M : Kachelhoffer, J : Raul, F  Dietary calcium supplementation, blood pressure, and intestinal calcium absorption.  Am-J-Med-Sci. 1994 Feb; 307 Suppl 1S116-9