Vitamins, Minerals, and Other Good Stuff: Naming nutrients that fight cholesterol, Discovering the power of niacin, Chewing on some fiber and Planting the anti-cholesterol seed.

Vitamins, Minerals, and Other Good Stuff

In This Chapter

� Naming nutrients that fight cholesterol

� Discovering the power of niacin

� Chewing on some fiber

� Planting the anti-cholesterol seed

One day, vitamins, minerals, and phytochemicals (phyto = plants) are the cat’s meow. The next day, they’re thrown out with the cat’s litter. Although taking vitamin pills and other nutritional supplements is sometimes touted as one way to lower cholesterol, most studies come up a bit short of proclaiming it a certainty. Or worse: At least one study shows that taking extra vitamins may reduce the effectiveness of cholesterol-lowering medications.

As a result, the best advice on supplements may be one that’s tried and true (and a bit boring): A balanced diet beats supplements hands down. In this case, I’m talking about a balanced, low-cholesterol, controlled-fat diet. A few exceptions exist to the advice I just laid on you, and I promise to discuss those exceptions in this chapter, along with all the info you need concerning cholesterol and how it relates to vitamins, minerals, fiber, and other dietary supplements.

For the lowdown on cholesterol-lowering prescription meds, check out Chapter 12; for cholesterol-lowering diets, your best bets are Chapters 4 and 5.

Identifying Supplements

Every year, Americans snap up more than $3 billion worth of nutritional supplements. Some people use them for “nutritional insurance;” others see supplements as a quick and easy way to get vitamins, minerals, and other good stuff without the pesky fat and sugars found in food.

But you’re reading a book about cholesterol, so for you, the most interesting statement about supplements may be that some appear to help lower total cholesterol and low-density lipoproteins (LDLs) while raising high-density lipoproteins (HDLs), the cholesterol particles you can read more about in Chapter 2.

The U.S. government considers dietary supplements to be food products, not drugs. As a result, supplements aren’t regulated as strictly as drugs, and very few serious studies exist to show how these pills affect cholesterol. Every rule, however, has an exception. Which is the point of this chapter, so read on.

Popping a Vitamin and Mineral Pill May Help Lower Cholesterol

Some nutrients play an important role in keeping your heart healthy. For example, calcium enables muscle cells, including heart muscle cells, to send messages back and forth, and selenium protects against Keshan disease, a disorder of the heart muscle whose symptoms include rapid heartbeat, enlarged heart, and (in severe cases) heart failure.

But when it comes to lowering cholesterol, most nutrients are no-shows. The one stellar exception is niacin. The maybes are vitamin E, vitamin C, and calcium.

How niacin helps control cholesterol

Niacin is a B vitamin considered essential for proper growth and develop- ment. It’s intimately involved in the work of enzymes, naturally occurring compounds in your body that power various processes such as digestion.

In fact, niacin is a component of one enzyme that enables oxygen to flow into your body tissues. Like thiamin (vitamin B1), niacin helps you maintain a healthy appetite. It also participates in the digestion of sugars and fat. You get niacin directly from these foods:

� Dairy products: Your body converts the amino acid tryptophan found in milk and dairy foods into niacin.

� Grains: Grains are a source of niacin, but your body can’t absorb them efficiently unless they’ve been treated with lime (the mineral, not the fruit — see the nearby sidebar “Limelicious”).

� Meat, fish, and poultry: No need to explain these three, right?

The niacin you get from food helps your body function in all of these ways, and it also protects you against the niacin-deficiency disease pellagra. The symptoms of pellagra include diarrhea, skin lesions, confusion, and dementia. But the amount of niacin found in food is too small to affect your cholesterol. For that, you need industrial-strength niacin.

Numbering normal niacin needs

In the United States, the recommended dietary allowance of each nutrient is usually abbreviated as RDA, a term comparable to the Canadian RNI (recommended nutrient intake).

The RDA for niacin is described in terms of niacin equivalents (NE), as in milligrams of niacin equivalents (mg/NE). For example, 60 mg of tryptophan (an amino acid in milk) = 1 mg of niacin = 1 niacin equivalent (mg/NE).

The basic adult requirement for niacin is 14 mg/NE per day for women and 16 mg/NE per day for men. The amount of niacin required to lower cholesterol levels is dramatically higher.

Measuring medically-effective levels of niacin

If you take an immediate-release form of niacin, a product that sends the vitamin right into your bloodstream, the starting dose is 100 mg/NE three times a day. The starting dose for an extended-release form of niacin, a product that releases the niacin gradually into your bloodstream, is one 375-mg/NE pill once a day.

So much for the techy details. Now, on to the practical part.

Balancing the benefits and risks of medical-strength niacin

As a medication, large doses of niacin

� Lower your triglycerides (fats in your blood; see Chapter 2)

� Lower your total cholesterol up to 10 percent

� Lower your LDLs by as much as 14 percent

� Raise your HDLs by as much as 25 percent

Limelicious

Treating grain with lime is a common practice in Central American and South American countries. Lime enables the body to absorb the niacin efficiently. In these countries, lime is added to cornmeal used to make tortillas.

In the United States, breads and cereals are routinely fortified with niacin, which makes the use of lime unnecessary.

So far, everything sounds pretty good, but like most medication, a cholesterol- lowering dose of niacin has potential side effects. Like what?

� Like a niacin flush, a feeling of sudden warmth similar to the hot flashes some women experience at menopause, which is kind of weird if you’re not yet in menopause — or if you’re male

� Like making your diabetes or arthritis medication less effective

� Like skin rashes, hives, itching, muscle pain, peptic ulcers, upset stomach, nausea, diarrhea, liver damage, vision problems, dizziness, and fainting Call 911 or go immediately to the closest emergency room if you experience any of these symptoms while taking niacin supplements.

Worse yet (can it really get worse?), if you develop any of these symptoms and decide to stop taking niacin cold turkey, your total cholesterol and your LDLs will rebound, zooming skyward, almost certainly higher than they were before you started taking niacin.

One way to avoid this state of affairs is to taper off niacin, taking a little bit less every day.

If a pill — including a vitamin pill — is powerful enough to alter your cholesterol profile, it’s powerful enough to be troublesome — an example of how something natural may be helpful but not necessarily harmless.

For more info on niacin and other cholesterol-lowering medications, turn to Chapter 12.

Evaluating vitamin E and vitamin C

Vitamin E is a fat-soluble nutrient (a vitamin that dissolves in fat and can be stored in your fatty tissue). Vitamin C is water-soluble (a vitamin that dis- solves in water and is eliminated when you urinate). But the two nutrients have one interesting trait in common: Both are antioxidants.

Antioxidants are substances that prevent fragments of molecules from hook- ing up to form potentially damaging compounds inside your body.

For example, many cured meats contain added vitamin C and vitamin E to prevent fragments of preservatives called nitrates and nitrites from hooking up to form carcinogens called nitrosamines.

Linking antioxidants and cholesterol

Low-density lipoproteins (LDLs) are fat-and-protein particles sometimes called “bad” cholesterol because they ferry cholesterol into arteries. Combining with oxygen makes LDLs more damaging.

So it seems reasonable to assume that anything that prevents LDLs and oxygen from mating should lower your risk of clogged arteries.

One such “anything” may be antioxidant vitamins. In fact, during the 1990s, several major scientific studies at thoroughly reputable scientific institutions suggested that antioxidant vitamins E and C could protect your heart muscle and blood vessels from cholesterol damage.

This led many respected scientists (and some nutritional theorists) to say that taking a lot of E and C would be good medicine. But they may have been off on the wrong path.

More recent studies suggest contrary conclusions: Taking antioxidant vitamins may reduce the effectiveness of cholesterol-lowering statin drugs, and antioxidant vitamins may actually convince your liver to churn out more cholesterol.

Subverting the statins

In August 2001, Atherosclerosis, Thrombosis, and Vascular Biology, a journal of the American Heart Association, published a report from a one-year study at the University of Washington School of Medicine.

The study included 153 volunteers between the ages of 33 and 74 who had arteries narrowed by cholesterol plaque and low levels of HDLs, the “good” cholesterol. Each volunteer was randomly assigned to one of the following “treatment” regimens:

 Regimen #1: The cholesterol-lowering drug Simvastatin (Zocor), plus niacin, and antioxidant vitamins E and C (for a rundown on Simvastatin and other “statins” see Chapter 12)

� Regimen #2: Simvastatin and niacin

� Regimen #3: Antioxidant vitamins alone

� Regimen #4: A placebo (pill with inactive ingredients; basically a sugar pill)

Ordinarily, both Simvastatin and niacin lower total cholesterol and LDLs while boosting HDLs, but volunteers who took Simvastatin, niacin, and antioxidants experienced a smaller increase in HDLs than volunteers who took the drugs alone, and their levels of HDL (2) — a kind of “super good” cholesterol — didn’t budge a bit. Boy, did that surprise the researchers!

As a result, the editorial accompanying the report concluded that doctors should tell their patients that taking antioxidants with a statin drug, such as Simvastatin, or with niacin may not be a good idea.

But the editorial also noted that the study was so small that it couldn’t be considered conclusive, especially since vitamin E — a natural anticoagulant that reduces the risk of blood clots — has been shown to lower the risk of heart disease.

Ticking off tocotrienols

Tocotrienols are phytochemicals similar to vita- min E. One measly study shows that taking tocotrienols lowers LDLs, so some companies are packing tocotrienols in pills and selling them as cholesterol-lowering supplements.

But if you take vitamin E while taking tocotrienols, the former cancels out the effects of the latter. Too complicated for me!

Then, believe it or not, results from another study, this one from Oxford University (England), showed no ill effects from combining antioxidants with a statin drug, leading the Brits to suggest that the problem may lie with the niacin.

Making the body make more cholesterol

In April 2004, a team of researchers at New York University School of Medicine’s Lipid Treatment and Research Center reported that when mice were fed a diet rich in the antioxidant vitamins E, C, and beta-carotene, their livers churned more than normal amounts of VLDLs (very low-density lipoproteins).

VLDLs are one form of LDLs, the fat-and-protein particles that carry cholesterol into arteries. (For more on the various forms of lipoproteins, see Chapter 2.)

Would this also happen in human beings? The researchers couldn’t say for sure; after all, mice aren’t people.

However, the study — plus a raft of others casting doubt on the anti- cholesterol powers of antioxidants — may have been what led the American Heart Association to issue the following statement in 2007:

“The American Heart Association doesn’t recommend using antioxidant vitamin supplements until more complete data are available. We continue to recommend that people eat a variety of nutrient-rich foods daily from all the basic food groups.”

Can calcium supplements counter cholesterol?

Remember when your mother told you to drink your milk because — all together now — “Calcium makes strong bones and teeth.” Would mom say the same thing about calcium’s ability to lower the level of cholesterol circulating in your older body? Maybe.

In May 2003, a team of researchers from the Department of Medicine at the University of Auckland (New Zealand) reported that when 223 postmenopausal women who weren’t being treated for high cholesterol or osteoporosis were given either calcium supplements (1 g/day) or a placebo (a look-alike pill with no calcium) for 12 months, HDL levels rose about 7 percent among those taking the calcium, while LDL and total cholesterol levels went down slightly.

Conclusion? For older women, calcium supplements may protect arteries, as well as bones. Good job, mate.

Fighting Cholesterol with Dietary Fiber

As you can read in Chapter 5, there are two kinds of dietary fiber — insoluble dietary fiber (which doesn’t dissolve in your intestinal tract) and soluble dietary fiber (which does dissolve in your gut).

There’s absolutely no doubt that eating foods like beans, fruits, veggies, and grains, which are all high in soluble dietary fiber, lowers your cholesterol. You can read all about oatmeal and beans, the quintessential soluble-dietary- fiber factories, in Chapter 6.

But suppose you totally loathe high-fiber foods. Suppose just looking at fruits, veggies, grains, and beans makes you go, “Ugh!” Far be it from me to say, “Boy! You’re missing some good stuff.” No, my job here is to answer the question dancing across your lips: “Can I get my fiber from supplements?” Well . . . maybe.

Soluble dietary fiber lowers your cholesterol levels by mopping up cholesterol in your digestive tract before it gets into your bloodstream. To do this job effectively, the fiber must absorb water and form a gel.

To date, more than 50 separate scientific studies (notice the subtle, albeit compelling, alliteration) attest to the ability of some soluble-fiber supplements to lower total cholesterol and LDLs. The soluble dietary fibers most often studied in these tests are

� Guar gum: A sticky, soluble dietary fiber from a plant commonly cultivated in India as cattle feed. Guar gum is also known as guar flour or bentonite.

� Pectin: A soluble fiber found most prominently in apples.

� Psyllium: A sticky soluble fiber also known as plantago seed or plantain seed.

But not all supplements containing these fibers are equally effective. For a soluble-fiber supplement to lower your cholesterol, it must form a strong gel that can attract and hold cholesterol in your gut. Unfortunately, some methods of processing fiber to make supplements break up the strands of carbohydrates that form the gel, thus weakening the whole darned thing.

To be certain that a dietary-fiber supplement will actually lower cholesterol, the manufacturer has to test it, a time-consuming and expensive process. As a result, very few fiber supplements can actually prove they will lower your cholesterol. Sorry about that.

Psyllium alert! Psyllium alert! Some people are allergic to psyllium. If they eat the stuff, they may end up with hives or a rash, respiratory problems, or — worst-case scenario — the potentially lethal, whole-body reaction called anaphylaxis. In other words, something natural may be helpful but not necessarily harmless. If you consume some psyllium and start feeling itchy or have trouble breathing, get to the nearest emergency room or call an ambulance.

Phabulous Phytochemicals

Perhaps the most fascinating nutritional discovery of the past several years has been the identification of phytochemicals, naturally occurring compounds in plants. Some of these compounds actually mimic powerful medicines such as the female sex hormone estrogen and the cholesterol-lowering statin drugs. Who wouldn’t be impressed with these natural wonders?

Sticking with sterols

Plants are great little pretenders. They often manufacture compounds that resemble chemicals found in animal (human) bodies but don’t seem to carry the problems associated with animal (human) chemistry.

One good example is phytosterols, substances that resemble cholesterol so closely that your digestive tract can’t tell what’s a phytosterol and what’s cholesterol.

If you eat phytosterols along with a meal that includes cholesterol, your body is likely to absorb phytosterols (which won’t clog your arteries) in place of cholesterol (which may).

This principle has inspired the creation of special cholesterol-lowering margarines that promise to change your cholesterol profile for the better, although the exact decrease in total cholesterol and LDLs and the increase in HDLs will vary with the dose and the body. For more on the sterol margarines, see Chapter 6.

As with dietary fiber supplements, the question here is whether you can cram enough of the good stuff into a pill to let you take your sterols as a supplement rather than a food. This time, the answer is why bother? The sterol studies say you must wolf down at least 3,000 milligrams (mg) of sterols per day to produce a noticeable change in your cholesterol levels. Each table- spoon of sterol margarine provides 1,700 mg, so two tablespoons per day more than does the trick.

By comparison, the University of California Berkeley Wellness Letter says that the doses of sterols in supplement pills are “too small to have any effect.” How small? Usually in the under-400-mg-per-pill range, which means you’d need about eight pills a day to make a difference. I say, pass up the pills, and “butter” (note the qualifying quote marks) your bread.

The sterols in sterol margarine or cholesterol-lowering supplements aren’t the same as the steroids sometimes used illegally by athletes to bulk up their muscles. Do I need to add that steroids, which can really mess up your body systems, are a definite no-no? Make that, NO-NO. And go ahead and add an exclamation point, as in never, ever use these drugs!

Getting the goods on garlic supplements

As a food, garlic is yummy. As a cholesterol buster, it’s so-so. In the mid-1970s, a number of studies suggested that phytochemicals in garlic, particularly the smelly mustard compounds such as allicin, were useful in lowering cholesterol. Later research is mixed.

Some studies say, yes, garlic and garlic supplements can lower cholesterol. Others say not in this lifetime. In 2007, Christopher Gardner, assistant professor of medicine at Stanford University, ran a trial with 192 adults — in this case, people older than 50 — whose average LDL level was 140. Six days a week for six months, the volunteers were given the equivalent of one clove of garlic (either as a pill or as plain raw garlic mixed into food) or a dummy pill. Monthly blood tests failed to show any change in cholesterol levels, but more than half the people who got garlic reported bad breath and body odor.

Conclusion: Pass this supplement by. Otherwise, people may pass you by.

Waiting for the Next Study

This section may be a good opportunity to remind you that it takes a while to shake down all the data from new medical studies and that this situation sometimes leaves doctors and patients confused.

At one recent medical convention, speakers presented the findings from four large treatment trials whose aim was to determine if taking vitamin E may help prevent heart attack. Three of the trials showed that vitamin E had no beneficial effect on the heart, and one showed that vitamin E caused more heart attacks than the placebo.

At the beginning of the presentations, the doctors in the audience were asked, “How many of you are taking vitamin E for your heart?” and about half of them raised their hands.

After the presentation of the trials, the doctors were asked, “How many of you will be taking vitamin E in the future?” and no one raised his or her hand.

Who’s right? I hate to say this, but who knows? The only conclusive answers about vitamins, minerals, phytochemicals, and cholesterol will come — arrrgh! — with time.