Hypercholesterolemia, or hyperlipidemia—abnormally
high levels of fats (cholesterol, triglycerides, or both) in the
blood—may be present without symptoms and yet put the
patient at risk for generalized atherosclerosis, coronary artery disease or
carotid artery disease. The risk of having a heart attack or stroke increases as
a person's total cholesterol level increases. Total cholesterol level is ideally
about 140 to 200 milligrams of cholesterol per deciliter of blood (mg/dL) or
less. Moderate risk is 200 to 240 mg/dL; high risk is 240 mg/dL or higher.
Cholesterol and triglyceride levels are highest in people with hereditary
hyperlipidemia, sometimes regardless of their diet and exercise level.
Hereditary hyperlipidemia, or hyperlipoproteinemia, is a condition that
interferes with the body's ability to metabolize and eliminate fats. Each of the
five main types of hyperlipoproteinemia produces a different profile and
- Type I hyperlipoproteinemia (familial hyperchylomicronemia) is a rare
disorder, present at birth. Patients have recurrent bouts of abdominal pain and
an enlarged liver and spleen, and develop xanthomas on their skin.
- Type II hyperlipoproteinemia (familial hypercholesterolemia) results
in accelerated atherosclerosis and early death, usually from a heart attack.
Patients have a high level of LDL cholesterol, and xanthomas grow in the tendons
- Type III hyperlipoproteinemia leads to high levels of VLDL
cholesterol and triglycerides. Atherosclerosis often blocks arteries and reduces
blood flow to the legs by middle age.
- Type IV hyperlipoproteinemia is common and affects several members of
a family. A high level of triglycerides may increase a person's risk of
- Type V hyperlipoproteinemia is uncommon. The body can't metabolize
and eliminate excess triglycerides. Although hereditary, it can result from
alcohol abuse, poorly controlled diabetes, kidney failure, or eating after a
period of starvation.
High fat levels:
- A diet high in saturated fat and cholesterol
- Cirrhosis of the liver
- Poorly controlled diabetes
- Underactive thyroid gland
- Overactive pituitary gland
- Kidney failure
High triglyceride levels:
- Excess calories in diet
- Acute and chronic alcohol abuse
- Severe uncontrolled diabetes
- Kidney failure
- Certain drugs (estrogens, oral contraceptives, corticosteroids, and
to some extent thiazide diuretics)
- Elevated serum insulin
- Diet rich in saturated fat
- Sedentary lifestyle
- Hereditary hyperlipidemia
|Signs and Symptoms|
High fat levels may cause few, if any, symptoms. Diagnosis is usually made
through blood tests. Severe symptoms may include:
- Fat deposits that form growths, or xanthomas, in the tendons and
- Extremely high levels of triglycerides (800 mg/dL and higher), which
may cause enlargement of the liver and spleen and symptoms of pancreatitis, such
as severe abdominal pain
- Obstructed liver disease
- Nephrotic syndrome
See "Signs and Symptoms" above.
A blood sample determines total cholesterol. A sample used to measure HDL
cholesterol, LDL cholesterol, and triglycerides is most effective after 12 hours
of fasting. The following results represent the ideal range:
- Total cholesterol: 120 to 200 mg/dL
- Chylomicrons: None (after 12 hours of fasting)
- Very-low-density lipoproteins (VLDL): 1 to 30 mg/dL
- Low-density lipoproteins (LDL): 60 to 160 mg/dL
- High-density lipoproteins (HDL): 35 to 65 mg/dL
- LDL to HDL ratio: less than 3.5
- Triglycerides: 10 to 160
- Clinical observation of suspected hypercholesterolemia or a routine
health screening will provide laboratory confirmation of elevated cholesterol
- Serum or urinary homocysteine
- Diet should be low in cholesterol and saturated fat to reduce LDL
- Exercise to reduce LDL cholesterol level and increase HDL cholesterol
- Drinking a small amount of alcohol on a regular basis may raise HDL
cholesterol level and lower LDL cholesterol level, but more than two drinks
daily could have the opposite effect.
- Maintain an appropriate weight.
- Stop smoking.
- Avoid caffeine (may increase cholesterol levels).
- Consider a lipid-lowering drug for high cholesterol levels if
behavioral intervention trial is unsuccessful.
- When cholesterol levels are very high and don't respond to usual
treatments, specific blood tests are in order to identify the exact cause of the
condition and to treat it
- Bile acid sequestrants:
cholestyramine/cholestipol—used to treat elevated LDL
by promoting bile acid excretion and increasing LDL receptors in liver. One to
six packets per day. Common side effects include bloating, constipation, and
- Nicotinic acid—used to treat elevated LDL
and VLDL by decreasing VLDL synthesis. 500 mg to 3 g/day to tid can cause
cutaneous flushing, GI upset (which usually resolve over a few weeks), and
elevated glucose, uric acid, and liver function tests
- HMG-CoA reductase inhibitors (statins): pravastatin, simvastatin,
atorvastatin, fluvastatin, and lovastatin treat elevated LDL. 20 to 80 mg/day,
single or divided dose. These drugs inhibit cholesterol synthesis and upregulate
LDL receptors in the liver. Side effects include myositis (muscle inflammation),
arthralgias (joint pains), GI upset, and elevated liver function
- Fibric acid derivatives: gemfibrozil—used to
treat elevated triglycerides and elevated remnants by stimulating lipoprotein
lipase (an enzyme that breaks down lipids in lipoproteins). May decrease VLDL
synthesis. Side effects include myositis (muscle inflammation), GI upset,
gallstones, and elevated liver function
|Complementary and Alternative
The digestion, metabolism, and utilization of fats, as well as minimizing the
effects of hypercholesterolemia, are areas in which alternative therapies can be
very effective. Begin with dietary suggestions and nutritional support, as
needed. Herbs can be used to facilitate the metabolism of
- Avoid saturated fats which contribute to cholesterol synthesis and
contribute to oxidative stress.
- Vegetable proteins have been shown to lower cholesterol levels, while
animal and milk proteins have been shown to raise them. Thus a vegetarian or
semi-vegetarian diet has been shown to be efficacious in lowering
- Increase foods high in omega-3 oils which can help decrease
cholesterol (cold water fish, nuts, and seeds).
- Reduce consumption of sugar and simple carbohydrates. The digestion
of these foods causes a rise in serum insulin which can lead to an increase in
- Include foods that help reduce cholesterol, such as those high in
water-soluble fiber—legumes, grains, and fruits
- Increase foods that support the liver, such as beets, carrots, yams,
artichokes, dark bitter greens, and lemons.
- Consider digestive enzymes in cases where poor fat digestion is a
- Omega-3 fatty acids (1,000 to 1,500 mg bid to tid) decrease
synthesis, increase breakdown of triglycerides, and lower total cholesterol
levels. Found in fish oil capsules (EPA's eicosapentaenoic acid) and
- Niacin reduces total cholesterol while increasing the levels of the
protective lipoprotein HDL. The amount of niacin needed to achieve these results
is very high. Inositol hexaniacinate (IHN) 500 mg tid causes no short-term
reactions, and is safe for the liver.
- Selenium (200 mcg/day) is needed for normal lipid
- l-Taurine (200 mg/day) conjugates cholesterol and facilitates its
- Vitamin C (1,000 mg tid) and vitamin E (400 to 800 IU/day) decrease
oxidative stress and are needed for cholesterol metabolism.
- B complex, especially vitamin B12 (1,000 mcg/day), folic acid (400 to
800 mcg/day), betaine (1,000 mg/day), and vitamin B6 (50 to 100 mg/day), are
essential to methionine metabolism. The addition of these vitamins will reduce
high levels of homocysteine.
- Coenzyme Q10 (50 to 100 mg/day) is an antioxidant and reduces
oxidative damage to the circulatory system.
- Chromium (200 mcg one to three times a day) helps to stabilize
glucose levels and reduce lipid oxidation secondary to diabetes.
- Magnesium (200 mg bid to tid) is needed for many metabolic pathways
and has blood pressure lowering effects.
- Panthenine (500 mg tid) is a form of pantothenic acid that has shown
effectiveness in reducing serum
Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites, or tinctures (alcohol extracts). Unless otherwise indicated, teas
should be made with 1 tsp. herb per cup of hot water. Steep covered 10 to 20
minutes and drink 2 to 4 cups/day. Tinctures may be used singly or in
combination as noted.
- Garlic (Allium sativum) has the effect of reducing
cholesterol. It is most effective when included in the diet in the raw form, or
taken in capsules.
- Herbs that support the liver, and promote bile production and
excretion may be taken singly or in combination. Herbs to consider include milk
thistle (Silybum marianum), dandelion root (Taraxacum officinale),
burdock root (Arctium lappa), blue flag (Iris versicolor),
greater celandine (Chelidonium majus), and blue vervain (Verbena
hastata). Greater celandine should be taken with caution (no more than 2
ml/day) as it can lead to bilary colic. Tinctures (15 to 20 drops/dose), or
infusions (1 heaping tsp./dose), are best taken 10 to 20 minutes before
- Hawthorn berries (Crataegus laevigata) help to lower high
blood pressure, promote cholesterol metabolism, and suppress cholesterol
synthesis, as well as strengthen connective tissue and cardiac muscle. Dried
extracts are taken 200 mg bid to tid, or tincture 30 drops tid.
- Ginger (Zingiber officinale) has been shown to lower
- Alfalfa (Medicago sativa) has been shown to lower cholesterol
An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every 1 to 4 hours until
acute symptoms resolve. Constitutional homeopathy is useful as a supportive
Acupuncture can assist with improving liver/gallbladder function, and in
strengthening the cardiovascular system.
Avoiding high-fat foods can help reduce cholesterol, and some foods actually
have a cholesterol-lowering effect (see
Lifestyle changes (quitting smoking, eating a low-fat diet, exercising, and
reducing stress) are recommended first. If these actions aren't adequate, then
lipid-lowering drugs can be prescribed.
- Coronary heart disease
Maintaining an appropriate weight, eating a low-fat diet, and exercising can
have a significant impact on the patient's cholesterol level and long-term
Auer W, Eiber A, Hertkorn E, et al. Hypertension and hyperlipidaemia: garlic
helps in mild cases. Br J Clin Pract. 1990;44:3-9.
Barrie SA, Wright JV, Pizzorno JE. Effects of garlic on platelet aggregation,
serum lipids and blood pressure in humans. J Orthomelec Med.
Bordia A. Effect of garlic on blood lipids in patients with coronary heart
disease. Am J Clin Nutr. 1981;34:2100-2103.
Bordia A, Bansal HC, Arora SK, et al. Effect of the essential oils of garlic
and onion on alimentary hyperlipemia. Atherosclerosis. 1975;21:15-19.
Jain AK, Vargas R, et al. Can garlic reduce levels of serum lipids? A
controlled clinical study. Am J Med. 1993;94:632-635.
Johns Hopkins Health Information. Accessed at http://www.intelihealth.com on
January 25, 1999.
Murray MT, Pizzorno JE. The Encyclopedia of Natural Medicine. 2nd ed.
Rocklin, Calif: Prima Publishing; 1998.
Silagy C, Neil A. Garlic as a lipid lowering agent—a
meta-analysis. JR Coll Physicians Lond. 1994;28:39-45.
Steiner M, Khan AH, Holbert D, Lin RI. A double-blind crossover study in
moderately hypercholesterolemic men that compared the effect of aged garlic
extract and placebo administration on blood lipids. Am J Clin Nutr.
Vorberg G, Scneider B. Therapy with garlic: results of a placebo-controlled,
double-blind study. Br J Clin Pract. 1990;7-11.
Warshafsky S, Kramer RS, Sivak SL. Effect of garlic on total serum
cholesterol: a meta-analysis. Ann Intern Med. 1993;119:599-605.
Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats
Yamamoto M. Serum HDL-cholesterol increasing and fatty liver improving
actions of Panax ginseng in high cholesterol diet-fed rats with clinical
affect on hyperlipidemia in man. Am J Chin Med.
Copyright © 2000 Integrative Medicine
CommunicationsThis publication contains
information relating to general principles
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