Cholesterol is a “four-letter word” with 11 letters. The immediate
connotation is something bad, a monster out to wreak havoc on the circulatory
system. However, presence alone is not the nightmare, but the proliferation of
certain types of cholesterol can contribute to the progression of heart disease,
the number one killer in America and other parts of the world.
As its name suggests, cholesterol is a sterol, an unsaturated waxy solid.
Considering a sterol is a combination of steroid and alcohol, cholesterol’s
public image could be worse. It is a lipid manufactured in the body and has
important functions relative to cell membrane management. Plus, it is known to
help produce bile to digest fats, and can also assist in metabolizing
fat-soluble vitamins.
The key to why cholesterol can be problematic is the transportation of these
lipids, which occurs in the bloodstream. Many factors contribute to
atherosclerosis (hardening of arteries by build-up and eruption of plaques in
the artery walls), with excessive cholesterol in the blood being only one
culprit.
Cholesterol is made in tissue membranes or derived through the diet. Herein
lies the basis for “good” and “bad” cholesterol. Cholesterol is not very soluble
in water, so it needs a transporter in the blood stream. Cholesterol made in
tissue membranes is transported by high-density lipoprotein (HDL),
which delivers it to the liver. It is hypothesized that HDL also removes
cholesterol from arteries and delivers it back to the liver for processing.
Increased levels of HDL have been deemed protective against heart disease.
On the other side, dietary cholesterol is transported by low-density
lipoprotein (LDL), which carries cholesterol from the liver to the
tissue membranes. This doesn’t make LDL-bound cholesterol inherently bad; the
danger is the amount of cholesterol in the wrong place at the wrong time.
Excessive amounts of cholesterol and LDL in the arteries can contribute to
plaques that damage the arteries over time, leading to heart attack, stroke or
some other manifestation of heart and vascular diseases. There seems to be a
correlation between risk of atherosclerosis and the size of LDL particles, with
the smaller LDL being considered more problematic. Even still, science is
showing oxidized LDL is more likely to end up trapped in the web of matter that
collects in arteries to become a plaque.
For these reasons, cholesterol management for heart and vascular health
focuses on lowering LDL cholesterol, especially small LDL, and limiting LDL
oxidation, often called lipid peroxidation. Often overlooked is the value
of raising HDL cholesterol levels, which can improve removal of cholesterol from
dangerous locations in the arteries. Further still, very low density lipoprotein
(VLDL) contain triglycerides—a compound with three fatty acids—that are
commonly packaged with cholesterol and released for use as energy; however, high
levels of triglycerides have correlated to high total cholesterol and low HDL,
so lowering triglycerides has become part of the cholesterol management spectrum
of goals.
A Natural Approach
The diet greatly influences health, and addressing macro- and micro-nutrients
is a good place to start influencing cholesterol health. Macro-nutrients that
affect cholesterol include fiber, protein and fats. Micro-nutrients include
vitamins and minerals, particularly those with potent antioxidant mechanism that
can affect lipid peroxidation.
Fiber has long been a recommendation of the American Heart Association (AHA),
with the emphasis being on soluble fiber, such as oats and barley. Oats and
whole oat products were approved for a heart health claim by FDA in 1995, due to
the amount of research showing that adding oat bran to the diet can lower total
and LDL cholesterol levels, while raising HDL levels.1,2
Specific oat fiber products on market have turned in positive results. Adding
just 6 g/d oat beta glucans as OatVantage™, a branded ingredient made by GTC
Nutrition and found in cholesterol management finished products, has
significantly lowered total and LDL cholesterol in 75 hypercholesterolemic study
subjects.3 Likewise, the same amount of oat glucans, this time as
Nutrim™, an ingredient from FutureCeuticals, consumed in conjunction with the
AHA’s Step Diet more effectively lowered LDL than did diet alone in men with
mild to moderate hypercholesterolemia.4 In a similar vein, between 3
g/d and 5 g/d of barley beta glucans—as Barliv™, from Cargill—taken for six
weeks decreased LDL by as much as 15 percent.5
For the more adventurous, a fiber from the Opuntia ficus indica cactus
branded as NeoPuntia®, from Bio Serae laboratories, may raise HDL levels and
lower triglycerides, when adding as little as 1.6 g/d of the fiber
ingredient to the diet.6
Fiber can be straightforward, whereas the trick with protein is always in
finding a good source without the saturated fat and cholesterol that can negate
any of the macronutrient’s benefits. Whey protein may be animal-based, but it
has been shown, to lower LDL cholesterol, at least when taken in hydrolyzed
form.7 However, many people have looked to soy to provide
cholesterol-managing protein. In fact, FDA approved a health claim in 1999 for
soy protein and decreased heart disease risk. While this does not specifically
reward soy for its cholesterol lowering actions, studies showing 25 g/d of soy
reduces LDL by as much as 10 percent went a long way to support the FDA claim.
The science on soy and cholesterol is robust, but is still not definitive.
Soy protein can lower triglycerides and both total and LDL cholesterol, while
raising HDL levels.8,9 It may do so via several mechanisms, including
affecting expression of genes involved in fat metabolism.10
Like cholesterol itself, fat gets a bad rep. But, as the world is slowly
learning, there are good fats and bad fats, and it isn’t even that simple. There
is much debate over the ideal ratio of omega-6s to omega-3s, both considered
good fats. The lesson? With cholesterol and fats, it’s not just about the good
and the bad, but how much of each kind is in the body.
As far as cholesterol management via natural products, marine polyunsaturated
fats (PUFAs) appear to be the heroes. Researchers learned eating fish twice or
more per week can lower triglycerides and raise HDL significantly more than
eating fish only once per week or less.11 The primary PUFAs in fish
are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). FDA even
approved a prescription therapeutic dose of 2 to 4 g/d EPA and DHA for
regulating very high triglyceride levels (>500mg/dL).12
Douglas MacKay, N.D., research advisor to Nordic Naturals, stressed fish oil
does not reduce LDL, as all the clinical trials show fish oil reduces
triglycerides—by as much 30 percent. “What fish oil does for cholesterol is it
changes the ratio and quantity of the cholesterol sub-particles,” he explained.
“Fish oil supplementation leads to more large, buoyant cholesterol sub-particles
(reduces the risk for cardiac event), and less small, dense cholesterol
sub-particles that could increase the risk for a cardiac event.”
Newer to the marine omega scene is krill oil, from shrimp-like crustaceans.
In fact, krill oil has compared favorably to fish in lowering cholesterol
levels. A Canadian trial found 1 to 3 g/d krill oil lowered triglycerides, and
both total and LDL cholesterol, in addition to raising HDL, more effectively
than 3 g/d fish oil (3:2 EPA:DHA ratio) or placebo.13
For retailers and consumers searching for a one-two punch, many manufacturers
have combined omega-3s with other heart healthy ingredients, such as fatty
alcohols (from plant waxes) and phytosterols (the plant version of cholesterol).
Of four interventions in a Canadian trial—fish oil, sunflower seed oil,
fish-oil-sterol combo and plant oil-sterol combo—the fish oil, combined with
plant sterols, best increased HDL levels, although both sterol interventions
lowered LDL cholesterol and total:HDL ratio.14 Plant sterols alone
have demonstrated beneficial cholesterol management properties, especially when
incorporated into fatty foods,15,16 although encapsulated plant
sterols have shown similar benefits.17
Omega-3s and omega-6s, combined with policosanol, a fatty alcohol derived
from sugar cane, have shown promise in boosting HDL levels while lowering non-HDL
levels,18 especially in subjects with diabetes, a disease that goes
hand-in-hand with heart disease.19
On the smaller level of dietary approach, micro-nutrients, such as vitamins
and minerals, can be very helpful to natural cholesterol management. Vitamin E
tops many heart doctors’ nutrient interventions, based on study reports that
supplementing with the vitamin can help lower LDL cholesterol and risk of
atherosclerosis, the formation of plaques.20
Sponsored Link
All American Pharmaceutical is a manufacturer of nutritional supplements and
food products for general health, sports nutrition and anti-aging. We specialize
in private label and custom formulations of powder capsules tablets liquids.
Patent holders of Kre-Alkalyn (the world’s only stable creatine) and
Kre-Celazine. Click here to
download the free "Clinical Trial Comparing Kre-Alkalyn to Creatine Monohydrate"
eBook.
www.AllAmericanPharmaceutical.com
Vitamin E can be found as tocotrienol or tocopherol compounds; both have
shown promise against cholesterol. Tocotrienols from annatto, palm and rice have
shown the ability to lower total and LDL cholesterol, in addition to increasing
HDL levels in some trials.21,22,23 Tocopherols might have similar
actions, dependent on the form, either alpha- or gamma-tocopherol. The alpha
form has helped researchers raise HDL levels in statin therapy,24
while gamma-tocopherols have reduced LDL cholesterol and platelet aggregation
(blood cell adhesion leading to clotting).25 Exemplifying a team
mentality, a mixture of tocopherols and tocotrienols from palm oil decreased
overall cholesterol levels more than did tocotrienols or carotenoids alone.26
One of vitamin E’s biggest contributions to cholesterol health is antioxidant
activities, which seem to thrive in combination with vitamin C.27 In
fact, an antioxidant combination of 400 IU/d vitamin E and 500 mg/d vitamin C
for six weeks in youth with hypercholesterolemia or hyperlipidemia (raised
levels of lipids or lipoproteins in the blood) improved endothelial function and
inhibited progression of atherosclerosis.28
B vitamins also play a role in cholesterol management, including protection
against lipid peroxidation. Folate supplementation in vivo has kept homocysteine
in check and guarded LDL and VLDL from oxidation.29
Fellow B vitamin niacin contributes in a non-antioxidant mechanism, lowering
LDL cholesterol and triglycerides; however, it’s most notable for its ability to
significantly raise HDL, an important, if not overlooked, aspect of cholesterol
management.30
Niacin combined with chromium might offer adjunctive benefits, as this
intervention has led to improvements to mechanisms of cholesterol transport
between the tissues and liver.31 Researchers reported the combination
therapy in hyperlipidemic animals reversed increased lipid peroxidation and
increased aortic levels of an important endogenous antioxidant, glutathione.
As for other minerals, copper and selenium have shown promise in fighting
oxidative stress and lipid peroxidation in the cardiovascular system.32,33
Free Radicals, Free Your Health
The theory of limiting oxidative stress and lipid peroxidation in the
arteries is a popular component of cardiovascular disease cholesterol
management. While micro-nutrients provide a good level of protection from
oxidation, a large contingent of the antioxidant cavalry comes from botanicals,
from flavonoids to carotenoids.
Flavonoids and other polyphenols are the roots of cholesterol care for many
botanical-based products, including cocoa, tea and fruit. The flavanols in cocoa
provide its defense against cholesterol, including its ability to decrease LDL
and increase HDL.34 However, chocolate enriched with plant sterols
and stanols more effectively reduced total and LDL concentrations than did
non-enriched chocolate, according to researchers.35
As in cocoa, the main cholesterol oxidation retardants in green tea are its
flavanol catechins. In one cardio trial, subjects in the high-catechin group
experienced greater LDL reduction than those in the low-catechin group.36
Another study has shown less effect by tea catechins on LDL, but marked effects
on raising HDL.37
Citrus bioflavonoids also weigh in on antioxidant cholesterol management.
Combined with the antioxidant vitamin E tocotrienols, citrus bioflavnoids can
reduce total cholesterol by as much as 30 percent, LDL by as much as 27 percent
and triglycerides by as much as 34 percent.38
Fruit is another source of polyphenols for cholesterol monitoring. Grape
polyphenols such as anthocyanins provide those on a high-cholesterol diet a
means of lowering triglycerides and VLDL levels, via alteration of cholesterol
metabolism in the liver.39 And grape seed extract containing between
containing 200 mg or 400 mg of proanthocyanidins can help limit LDL oxidation.40
Pomegranate, another anthocyanin-rich fruit, has also delivered solid
antioxidant results on cholesterol, reducing not only LDL levels but also LDL
oxidation rates, in addition to moderating other characteristics of
atherosclerosis development.41
Beyond flavonoids, botanicals such as garlic contain other antioxidant
constituents, including organosulfur compounds. Aged garlic extract (AGE) has
turned in some startling results on cholesterol, restricting diet-induced high
cholesterol in one trial,42 and safeguard against oxidation of LDL
particles in another trial.43 While many have focused on AGE’s
allicin content, some research has suggested saponins in garlic are to credit
for the herb’s ability to lower total and LDL cholesterol while maintaining HDL
levels.44
French pine bark extract, also known as Pycnogenol, counts bioflavonoids,
catechins, phenolic acids and other compounds for its various benefits,
including the area of cholesterol health. One study confirmed Pycnogenol
supplementation for six weeks significantly increased HDL levels while reducing
LDL levels.45
Plants and certain algae are also home to carotenoids, which provide colorful
pigments as well as antioxidant punch against cholesterol problems. Lycopene,
most known as the tomato carotenoid, has inhibited lipid peroxidation in
hypertensive patients.46 Early in vitro work suggests lycopene
confers its benefits by reducing macrophage foam cell formation (a key step in
formation of plaques) thereby decreasing lipid synthesis.47
From the garden to the pond, astaxanthin is a carotenoid common to microalgae
and may help retard oxidation of cholesterol lipids.48 This
carotenoid has also reduced triglycerides and increased HDL levels in subjects
with metabolic syndrome.49 In proprietary research from Cyanotech,
has shown BioAstin brand astaxanthin can drop total and LDL cholesterol by as
much as 17 percent and triglycerides by 24 percent.50
Guiding Consumers’ Cholesterol Shopping
As with other areas of the typical health food store, the shelves devoted to
cardiovascular health are crowded with all types of heart products, not to
mention formulas tailored specifically for cholesterol. As big a deal as
cholesterol management has become, is there room for a bunch of
single-ingredient formulas, or do multiple-ingredient products make more sense
for both economy of space and maximized benefits for consumers?
“We definitely know that multiple ingredient formulas work much more
effectively,” said Gary Stanton, president, New Health Corp., which makes Heart
Savior—plant sterols, policosanol, guggulipid and red yeast rice and selenium
and coenzyme Q10 (CoQ10). “For example, plant sterols are great at blocking
dietary cholesterol, but do nothing for cholesterol produced by the liver; red
yeast rice, policosanol and niacin have different mechanisms of action that
reduce cholesterol produced by the human body by inhibiting the production of
cholesterol in the liver. We are seeing consumers ... opting for a combination
of ingredients over single ingredient products.”
Similarly, CholestSolve 24/7™ from American Biosciences focuses on plant
sterols—which have been a popular mainstay in cholesterol-lowering
margarines—but also benefits from the researched lipid-control actions of CoQ10
and various flavonoids from wine, grapes and green tea. Ditto for Country Life,
which offers Total Lipid Control formula, a combination of cholesterol modifying
plant sterols with omega-3 EPA and DHA, as CardiaBeat™ branded ingredient from
Enzymotec.
MacKay advised the best combination is exercise, a fiber supplement, fish
oil, and one specific cholesterol lowering ingredient (niacin, red yeast rice or
policosanol). “If the one ingredient does not seem to do the trick, switch to
another,” he said. “I have found that these products work for some but not
others, so switching is key.”
Another concern for consumers is whether the products they are taking for
cholesterol are having the intended health benefit. As with many natural
products, changing the course of cholesterol is not an overnight feat. However,
without regular cholesterol screening/testing, consumers have no idea of any
true changes. Thus, it is good for retailers to be aware of the average
time-to-effect of products in this category, so that they can inform consumers
when to expect changes in their cholesterol test results.
“Most of our customers are expecting to see some benefit within 60 days,”
Stanton said, noting quality ingredients in the proper form and dosage can
absolutely deliver measurable benefits in this time frame. “Within 60 days,
results are clearly evident.”
MacKay confirmed: “You can not feel your cholesterol go up or down;
cholesterol is tested in the blood. Typically you should give any treatment plan
for cholesterol three months and then have your blood re-tested—you will then
know if it is working.”
Retailers, consumers and their health care providers might not associate
creatine with cholesterol, but the research is telling the tale. All American’s
Kre-Alkalyn, a stable, pH-adjusted creatine product has recently been shown in
scientific research to help with cholesterol care. “We sort of stumbled onto
this [benefit],” Archer admitted. “The research is showing some positive results
on cholesterol, namely that Kre-Alkalyn can lower bad cholesterol and raise good
cholesterol.” He noted previously, creatine has shown an ability to help with
good cholesterol, but never with bad cholesterol, until now.
Whether a single- or multiple-ingredient approach, there are many
well-researched ways to help consumers keep cholesterol levels in check,
lowering the bad, while raising the good. Keeping inventory tied to the
vitamins, minerals, herbs and specialty supplements shown by science to affect
cholesterol and triglyceride levels is a way for retailers to send a strong,
well-supported message to consumers about their heart health preventive care.
1. Berg A et al. "Effect of an oat bran enriched diet on
the atherogenic lipid profile in patients with an increased coronary heart
disease risk. A controlled randomized lifestyle intervention study." Ann Nutr
Metab. 2003;47(6):306-11.
2. Robitaille J et al. "Effect of an oat bran-rich
supplement on the metabolic profile of overweight premenopausal women." Ann Nutr
Metab. 2005 May-Jun;49(3):141-8.
3. Queenan KM et al. "Concentrated oat beta-glucan, a
fermentable fiber, lowers serum cholesterol in hypercholesterolemic adults in a
randomized controlled trial." Nutr J. 2007 Mar 26;6:6.
4. Reyna-Villasmil N et al. "Oat-derived beta-glucan
significantly improves HDLC and diminishes LDLC and non-HDL cholesterol in
overweight individuals with mild hypercholesterolemia." Am J Ther. 2007
Mar-Apr;14(2):203-12.
5. Keenan JM et al. "The effects of concentrated barley
beta-glucan on blood lipids in a population of hypercholesterolaemic men and
women." Br J Nutr. 2007 Jun;97(6):1162-8.
6. Linarès E, Thimonier C, Degre M. "The Effect of
NeOpuntia(R) on Blood Lipid Parameters-Risk Factors for the Metabolic Syndrome
(Syndrome X)." Adv Ther. 2007 Sep-Oct;24(5):1115-25.
7. Pins JJ, Keenan JM. "Effects of whey peptides on
cardiovascular disease risk factors." J Clin Hypertens (Greenwich). 2006
Nov;8(11):775-82.
8. Taku K et al. "Soy isoflavones lower serum total and LDL
cholesterol in humans: a meta-analysis of 11 randomized controlled trials." Am J
Clin Nutr. 2007 Apr;85(4):1148-56.
9. Ho SC et al. "Soy isoflavone supplementation and fasting
serum glucose and lipid profile among postmenopausal Chinese women: a
double-blind, randomized, placebo-controlled trial." Menopause. 2007
Sep-Oct;14(5):905-12.
10. Xiao CW, Mei J, Wood CM. "Effect of soy proteins and
isoflavones on lipid metabolism and involved gene expression." Front Biosci.
2008 Jan 1;13:2660-73.
11. Williams MA. “Maternal erythrocyte omega-3 and omega-6
fatty acids, and plasma lipid concentrations, are associated with habitual
dietary fish consumption in early pregnancy.” Clin Biochem. 2006
Nov;39(11):1063-70.
12. McKenney JM, Sica D. “Role of prescription omega-3
fatty acids in the treatment of hypertriglyceridemia.” Pharmacotherapy. 2007
May;27(5):715-28.
13. Bunea R, El Farrah K, Deutsch L. “Evaluation of the
effects of Neptune Krill Oil on the clinical course of hyperlipidemia.” Altern
Med Rev. 2004 Dec;9(4):420-8.
14. Demonty I et al. “Fish-oil esters of plant sterols
improve the lipid profile of dyslipidemic subjects more than do fish-oil or
sunflower oil esters of plant sterols.” Am J Clin Nutr. 2006 Dec;84(6):1534-42.
15. Devaraj S, Autret BC, Jialal I. “Reduced-calorie orange
juice beverage with plant sterols lowers C-reactive protein concentrations and
improves the lipid profile in human volunteers.” Am J Clin Nutr. 2006
Oct;84(4):756-61.
16. Polagruto JA et al. “Cocoa flavanol-enriched snack bars
containing phytosterols effectively lower total and low-density lipoprotein
cholesterol levels.” J Am Diet Assoc. 2006 Nov;106(11):1804-13.
17. Acuff RV et al. “The lipid lowering effect of plant
sterol ester capsules in hypercholesterolemic subjects.” Lipids Health Dis. 2007
Apr 9;6:11.
18. Valensa Intl. “Results of an initial clinical trial
examining the effects of Nanocosanol™ policosanol/omega-3 nanodispersion on
blood lipids and liver function.” 2006.
19. Castaño G et al. “Comparison of the effects of
policosanol and atorvastatin on lipid profile and platelet aggregation in
patients with dyslipidaemia and type 2 diabetes mellitus.” Clin Drug Investig.
2003;23(10):639-50.
20. Das S et al. “Tocotrienols in cardioprotection.” Vitam
Horm. 2007;76:419-33.
21. Beg ZH et al. "Hypolipidemic and antioxidant properties
of tocotrienol rich fraction isolated from rice bran oil in experimentally
induced hyperlipidemic rats." Food Chem Toxicol. 2005 May;43(5):747-53.
22. Tan B. “Appropriate spectrum vitamin E and new
perspectives on desmethyl tocopherols and tocotrienols.” JANA. 2005;8:35-42.
23. Edem DO. "Palm oil: biochemical, physiological,
nutritional, hematological, and toxicological aspects: a review." Plant Foods
Hum Nutr. 2002 Fall;57(3-4):319-41.
24. Leonard SW et al. “Effects of vitamin E on cholesterol
levels of hypercholesterolemic patients receiving statins.” Am J Health Syst
Pharm. 2007 Nov 1;64(21):2257-66.
25. Singh I et al. “Effects of gamma-tocopherol
supplementation on thrombotic risk factors.” Asia Pac J Clin Nutr.
2007;16(3):422-8.
26. Black TM et al. "Palm Tocotrienols Protect ApoE +/-
Mice from Diet-Induced Atheroma Formation." J Nutr. 2000;130:2420-2426.
27. Traber MG. “Heart disease and single-vitamin
supplementation.” Am J Clin Nutr. 2007 Jan;85(1):293S-299S.
28. Engler MM et al. “Antioxidant vitamins C and E improve
endothelial function in children with hyperlipidemia: Endothelial Assessment of
Risk from Lipids in Youth (EARLY) Trial.” Circulation. 2003 Sep
2;108(9):1059-63.
29. Morgan JM et al. "The effects of niacin on lipoprotein
subclass distribution." Prev Cardiol. 2004 Fall;7(4):182-7.
30. Filis K et al. “High-dose ascorbic acid decreases
cholesterolemic factors of an atherogenic diet in guinea pigs.” Int J Vitam Nutr
Res. 2007 Mar;77(2):125-9.
31. Suren-Castillo S et al. "Cholesterol efflux and the
effect of combined treatment with niacin and chromium on aorta of hyperlipidemic
rat." Mol Cell Biochem. 2008 Jan;308(1-2):151-9.
32. Selamoglu TZ et al. "The investigation of the
antioxidative properties of the novel synthetic organoselenium compounds in some
rat tissues." Exp Biol Med (Maywood). 2008 May;233(5):575-9.
33. Klevay LM. "Copper in legumes may lower heart disease
risk." Arch Intern Med. 2002 Aug 12-26;162(15):1780.
34. Ding EL et al. “Chocolate and prevention of
cardiovascular disease: a systematic review.” Nutr Metab (Lond). 2006 Jan 3;3:2.
35. De Graaf J et al. "Consumption of tall oil-derived
phytosterols in a chocolate matrix significantly decreases plasma total and
low-density lipoprotein-cholesterol levels." Br J Nutr. 2002 Nov;88(5):479-88.
36. Nagao T, Hase T, TokimitsuI. “A green tea extract high
in catechins reduces body fat and cardiovascular risks in humans.” Obesity
(Silver Spring). 2007 Jun;15(6):1473-83.
37. Bursill CA, Roach PD. “A green tea catechin extract
upregulates the hepatic low-density lipoprotein receptor in rats.” Lipids. 2007
Jul;42(7):621-7.
38. Roza JM et al. “Effect of citrus flavonoids and
tocotrienols on serum cholesterol levels in hypercholesterolemic subjects.”
Altern Ther Health Med. 2007 Nov-Dec;13(6):44-8.
39. Zern TL, West KL, Fernandez ML. “Grape polyphenols
decrease plasma triglycerides and cholesterol accumulation in the aorta of
ovariectomized guinea pigs.” J Nutr. 2003 Jul;133(7):2268-72.
40. Sano A et al. “Beneficial effects of grape seed extract
on malondialdehyde-modified LDL.” J Nutr Sci Vitaminol (Tokyo). 2007
Apr;53(2):174-82.
41. Aviram M et al. “Pomegranate juice consumption for 3
years by patients with carotid artery stenosis reduces common carotid intima-media
thickness, blood pressure and LDL oxidation.” Clin Nutr. 2004 Jun;23(3):423-33.
42. Slowing K. “Study of garlic extracts and fractions on
cholesterol plasma levels and vascular reactivity in cholesterol-fed rats.” J
Nutr. 2001 Mar;131(3s):994S-9S.
43. Lau BH. “Suppression of LDL oxidation by garlic.” J
Nutr. 2001 Mar;131(3s):985S-8S.
44. Matsuura, H. “Saponins in Garlic as Modifiers of the
Risk of Cardiovascular Disease.” J Nutr. 2001 Mar;131(3s):1000S-5S.
45. Devaraj S et al. “Supplementation with a pine bark
extract rich in polyphenols increases plasma antioxidant capacity and alters the
plasma lipoprotein profile.” Lipids. 2002 Oct;37(10):931-4.
46. Bose KS, Agrawal BK. “Effect of Lycopene from Tomatoes
(Cooked) on Plasma Antioxidant Enzymes, Lipid Peroxidation Rate and Lipid
Profile in Grade-I Hypertension.” Ann Nutr Metab. 2007 Nov 20;51(5):477-481.
47. Napolitano M et al. “The effects of lycopene on the
induction of foam cell formation by modified LDL.” Am J Physiol Endocrinol Metab.
2007 Dec;293(6):E1820-7.
48. Iwamoto T. “Inhibition of low-density lipoprotein
oxidation by astaxanthin.” J Atheroscler Thromb. 2000;7(4):216-22.
49. Hussein G et al. “Astaxanthin ameliorates features of
metabolic syndrome in SHR/NDmcr-cp.” Life Sci. 2007 Jan 16;80(6):522-9.
50. Ikeuchi M et al. "Effects of astaxanthin in obese mice
fed a high-fat diet." Biosci Biotechnol Biochem. 2007 Apr;71(4):893-9.
To take the exam for this course, please make sure you have the course in your
nutrilearn.com profile. If you need to add the course to your profile
click
here and complete the checkout process.
If you already have the course in your profile and are ready to take the test,
click here
or visit your profile once you are logged in to the nutrilearn system. Note: To access the
available courses in your profile, click on the "courses" link at
the top of the page once you are logged in.
