Cholesterol treatment guideline

The new Cholesterol guideline was published in November and is the result of a joint task force of the American College of Cardiology and the American Heart Association. The report was published in the journal Circulation.

Cholesterol moleculeFirst, a couple of caveats: Dietary supplements by law cannot claim to treat or prevent any illness. So to some degree, it makes sense that clinicians would not turn to them first to help patients who already have high cholesterol. Also, it should be noted that the guideline would be aimed first and foremost at specialists, who likely would be consulted only after a patient has been referred with a treatable condition.

Paucity of information on Cholesterol prevention

Nevertheless, it is telling that so little effort is spent in the guideline on discussing how to help patients to keep from crossing over the line into the treatment category, rather than spending page after page on how to fix the boat after it has sprung a leak. In the 120-page document, which includes 69 pages of actual text, only two short sections were devoted to lifestyle factors in the prevention of development of hyperlipidemia.

“Patients should consume a dietary pattern that emphasizes intake of vegetables, fruits, whole grains, legumes, healthy protein sources (low-fat dairy products, low-fat poultry (without the skin), fish/seafood, and nuts), and nontropical vegetable oils; and limits intake of sweets, sugar-sweetened beverages, and red meats,” the guideline states.

One other section of the guideline addresses prevention specifically.

“Primary prevention of ASCVD over the life span requires attention to prevention or management of ASCVD risk factors beginning early in life,” the guideline states. It then refers the reader to a table that includes one statement about encouraging a healthy lifestyle and then devotes the rest of the information on statin therapy, starting as early as age 8.

Lipid ingredients, polyphenols shown to have effects

A number of dietary ingredients have been researched for their positive effects on blood lipid profiles including lipid ingredients and many plants and fruit extracts rich in phytochemicals.

Omega-3s, for example, have been shown to have positive effects on high triglyceride levels, but the effects on LDL cholesterol specifically are less clear-cut. Levels can actually increase slightly, but the size of the LDL particles changes as well, which is a good thing. And HDL (the “good” cholesterol) goes up, too, indicating a generally positive overall trend.

Extra virgin olive oil, which is rich is some polyphenolic compounds such as hydroxytyrosol, has been suggested to benefit blood lipid profiles via a multifaceted action that includes both anti-inflammatory aspects and the promotion of cholesterol efflux. Olive is, of course, one of the main components of the Mediterranean diet, which is frequently recommended for heart health.

Drug hits one target –  supplements hit many

But this multifactorial approach doesn’t fit neatly into the mostly drug-focused paradigm of the new guideline, said James Kennedy, Ph.D. president of ingredient supplier Polyphenolics, which has a line of grape seed extracts which are among the more comprehensively researched polyphenol-based ingredients on the market.

“There is no question that statins can dramatically reduce your blood cholesterol levels,” Kennedy told NutraIngredients-USA. “They absolutely can reduce cholesterol much further than any polyphenol from a fruit or vegetable.”

“But for me it’s about lifestyle first. It just struck me as odd that here is a group concerned about our heart health and they were pretty much exclusively recommending drugs,” he said.

Kennedy said that cardiovascular disease is a multifaceted condition. Statins target one aspect of this situation and hits that nail squarely on the head. But natural ingredients, perhaps especially when offered in combination, take a more comprehensive approach to the problem.

Polyphenolics offers a line of grape seed extracts that includes MegaNatural BP, which has been researched for its effect on supporting blood pressure in the healthy range. That effect takes into account the healthy flow dynamics of the circulatory system, something that a myopic focus on cholesterol numbers glosses over.

Evidence backing many polyphenols

Grape seed extracts are just one of many polyphenol-based ingredients on the market that have been researched for their benefits in ameliorating the risk factors of CVD.

grapes are recommended in low cholesterol diets

“If you look at cardiovascular disease as a whole, a lot of polyphenols – and grape seed extract in particular – address the various areas including blood pressure and blood glucose as well as hypercholesteremia. Our industry offers a food-first approach which makes sense to consumers. They look at supplementation as a complement to everything else they are doing to address all aspects of heart disease, not just one piece of it” Kennedy said.

The entourage effect implied by the research backing polyphenols (they all appear to do slightly different things) is now starting to be borne out by research. A recent study in the journal Nutrients showed that just two weeks on a polyphenol-poor diet could alter vascular biomarkers in a group of healthy men.

And a recent review article in the journal Molecules had this to say: “Consumption of polyphenols from plant extracts and fruits increases antioxidant levels in plasma which protect vasculature and improve anti-inflammatory and lipid profiles, blood pressure, HDL-C, and vascular function.”  The review focuses on a number of polyphenols and other naturally occurring compounds, including gallic acid and punicalagin from pomegranate.

Combo products increasing in popularity

Kennedy said there is increasing interest among supplement product formulators in taking advantage of the evidence supporting the multifactorial effects of polyphenols.

“We do come into contact with customers who say they want to put together a heart health formula and want to know what they can combine our grape seed extract with,” he said.

“Recently we had a customer who wanted to combine our grape seed extract with a blueberry extract and a bergamot extract. When you go into the store you frequently see our extract in formulation with other ingredients,” Kennedy said.

The beauty of the natural approach to heart health is these ingredients can be combined with virtually no concern about antagonistic interactions, Kennedy said. Polyphenolics has continually worked on its GRAS dossier, with higher and higher dosages proven to be safe, he said.

“For the most part these are natural products and they are not known to have any cross indications. With statins, you have to dial the dose in and the patient has to be monitored very carefully.”

 

Natural colon cleansing

This post explores the concept of natural colon cleansing. A colon cleanse is a popular alternative remedy that some people claim removes waste and toxins from the colon. However, there is little scientific evidence to support the use of natural colon cleansing routines, except for those that doctors prescribe.

Most of what researchers know about safe colon cleansing comes from studies that aim to find ways to improve the colonoscopy procedure rather than to boost energy levels or treat intestinal problems.

People may refer to colon cleansing methods by different names, including:

  • bowel cleanses
  • detoxes
  • flushes
  • juice diets

Most colon cleansing products supposedly help detox the colon or remove harmful substances, such as mucus and dry stool. Some people also use colon cleanses to help relieve constipation.

In this article, we discuss some popular colon cleansing methods and the science behind them. We also consider their potential benefits and risks.

Water

Woman drinking water as part of natural colon cleanseDrinking water regularly can naturally cleanse the colon.

Using water is one of the easiest and safest natural colon cleansing available, and the easiest way to cleanse the colon naturally. Water moistens stool and gives it bulk, facilitating its passage through the colon.

A person who is dehydrated will have fewer bowel movements because their body is trying to retain water. It will reabsorb water from the bowel, which results in the stool becoming dry, hard, and difficult to pass.

Everyone’s daily hydration needs are different, but it is vital to drink plenty of water throughout the day.

Other beverages, including caffeinated ones, contribute toward a person’s daily water intake, but plain water is the best option as it does not contain any calories.

In a 2013 study, researchers in Jordan found that drinking more than four cups of water daily decreased the risk of colorectal cancer, but the results were not statistically significant.

The same study identified constipation as a significant risk factor for colorectal cancer. Drinking at least eight glasses of water a day can help prevent constipation, and it offers many other health benefits too.

Fruit and vegetable juice

Raw fruit and vegetable juices contain many elements that may help cleanse the colon, including fiber, phytochemicals (beneficial plant chemicals), and natural sugars that act as laxatives, such as sorbitol and fructose.

Proponents of juice cleanses recommend the following types of juice:

  • apple, including the peel
  • prune
  • pear
  • banana
  • kiwi
  • grape
  • plum
  • persimmon
  • lemon

Some colon cleanse plans recommend consuming only fluids for a few days at a time to help cleanse the colon and digestive tract.

Most health authorities recommend against juice cleanses. Raw fruit juices can contain compounds that are hard on the kidneys and liver. Without any treatment to kill harmful bacteria and viruses, these juices can also make people ill. They may pose significant dangers for those with medical conditions, such as diabetes.

It is best to consume fruit and vegetable juices in the form of smoothies to keep all the fiber, water, and nutrients intact.

Fiber

Natural colon cleansing found in fiber adds bulk to stool, which reduces the time it spends sitting in the colon and increases the number of bowel movements that a person has. Many natural, whole foods are rich in fiber, including:

  • nuts
  • beans
  • seeds
  • berries
  • whole grains and cereals

People who find it difficult to get enough fiber through their diet can try taking fiber supplements. Popular fiber supplements include:

  • psyllium (Metamucil)
  • polycarbophil tablets (FiberCon)
  • methylcellulose

Fermented foods aid natural colon cleansing

Baked tempeh on tray
Tempeh is a fermented food that may benefit gut health.

Fermented foods often contain high levels of probiotics, which are beneficial bacteria that contribute to gut health.

These bacteria help the bowels move stool out of the colon regularly and reduce the risk of gas, bloating, constipation, and infection.

Common fermented foods that contain probiotics include:

  • yogurt and Greek yogurt
  • apple cider vinegar
  • kefir
  • skyr
  • kimchi
  • sauerkraut
  • pickles
  • miso
  • tempeh
  • kombucha
  • beer and cider
  • some types of cheese

Research suggests that probiotics may help prevent and possibly treat colon cancer, but researchers agree that more studies are necessary to understand these effects. A healthy gut biome offers numerous other benefits for overall health and immune function.

Resistant starches

Some foods contain resistant starches, which are types of sugar that are difficult for the body to break down. These starches remain mostly undigested and become bulk in the stool.

The more bulk there is in the stool, the sooner the bowel is stimulated into action, possibly helping cleanse the colon.

Foods high in resistant starches include:

  • potatoes, sweet potatoes, and yams
  • sugar beets
  • sugar cane
  • sweet corn
  • green bananas
  • beer and cider
  • vegetable stems, tubers, and roots
  • rice
  • buckwheat and millet
  • al dente pasta
  • white bread
  • cornflakes and muesli

Unlike other starches, digesting resistant starches produces compounds that research shows may help:

  • prevent colon cancer
  • improve macronutrient regulation
  • alter hormone levels, potentially improving mental and physical health
  • prevent or control diabetes
  • prevent or control obesity

Lemon juice

Regularly drinking lemon juice can have a positive effect on digestive health and help natural colon cleansing. It seems that people experience the most benefit when they drink it on an empty stomach, which allows the compounds in the lemon to interact more easily with the gut mucosa.

Having a clean colon is crucial for certain screening tests, such as colonoscopies. Most people receiving colonoscopies have to consume a colon cleansing preparation the night before the procedure.

In a 2015 study on colonoscopies, one group of participants received a preparation of ascorbic acid, or vitamin C, in addition to the standard fluid mixture of polyethylene glycol (PEG). The participants who took vitamin C had better bowel preparation than those in the other groups.

Lemon juice is very high in vitamin C so it may be an effective natural colon cleanser.

Herbal teas

Some herbal teas used in natural colon cleansing may be beneficial for digestive health.

Australian research from 2014 found an association between herbal tea consumption and a lower risk of colon cancer.

Other natural teas, such as ginger or lemon tea, may also help digestion.

Possible benefits of colon cleanses

Senior couple smiling outdoors jogging.
People who support colon cleanses claim they can improve energy levels, though there is no scientific evidence to prove this.

There are currently no proven benefits of colon cleanses, natural or otherwise. However, people who promote colon cleanses claim that they provide major health benefits, including:

  • increasing energy
  • removing toxins
  • improving liver function
  • boosting the immune system
  • aiding weight loss
  • relieving bloating, cramps, and gas
  • reducing the risk of colon cancer
  • improving mood

Safety and risks

Some of the potential risks of colon cleansing include:

  • weakness
  • irritability
  • electrolyte imbalance and dehydration
  • vomiting and nausea
  • abdominal cramps
  • dizziness and fainting
  • loss of healthful gut microflora and increased risk of infection
  • diarrhea
  • bowel ulcerations, which are open cuts and sores
  • bowel infection
  • kidney damage and failure

People with preexisting bowel conditions should avoid bowel cleansing methods unless a doctor performs or prescribes them.

The United States Food and Drug Administration (FDA) do not regulate natural colon cleanse products. The FDA have also taken legal action against companies who were using unproven medical claims to promote cleanse products, stating that they could reduce the risk of cancer or treat serious medical conditions.

The U.S. National Institutes of Health also point out several possible risks of cleanses, including:

  • diarrhea, which could lead to dehydration
  • bacterial infection from unpasteurized juice
  • lack of nutrients
  • headaches
  • weakness and fainting

People with kidney conditions should avoid drinking large quantities of juice because it can contain too much oxalate, which can cause kidney problems.

People with diabetes and other metabolic conditions should also avoid detoxes or extreme diets and instead follow a healthful, doctor-recommended diet.

Severely restricting calorie intake, which is often part of colon cleanses, can also be damaging to a person’s overall health. It rarely contributes to long-term weight loss or well-being.