BÜTÜNSEL TIBBIN YÜKSEK KOLLESTROLÜN TEDAVİSİNE GENEL YAKLAŞIMI

SAMPLE PATIENT IS MALE OF 45 YEARS OLD

Condition/Assessment of Patient:

Annual blood test report of the patient has to be evaluated:

High level of Cholesterol (CHOL/C) (246 mg/dl) as to the lab reference range (0-200 pg/mL), high level of LDL-C (183 mg/dl) as to the reference range (50-150 mg/dL), HDL in the ref. range (50 mg/dL) as to the ref range (40-60 mg/dL).

To be sure for pre-test precautions have been taken into consideration, the following items have been confirmed:

1. A 12 hour fast
2. No alcohol, for at least for 24 hours before the test
3. A stable diet for at least 3 weeks
4. If possible no medication for 24 hours before the test
5. A relaxed and sitting position during the test

Family history: Diabetes, hypertension and heart diseases in the family history are the important factors that can increase the cholesterol levels in the blood.

The patient has been educated about what cholesterol and these values out of normal range mean as follows:

1. Cholesterol is useful for the synthesis of progesterone, estrogens, androgens (such as testosterone), glucocorticoids (such as cortisol), and mineralocorticoids (such as aldosterone) and for Vitamin D synthesizes.
2. One of the major uses of cholesterol is the synthesis of bile acids. These are synthesized in the liver from cholesterol and are secreted in the bile. They are essential for the absorption of fat from the contents of the intestine. The most of the bile acids are not lost in the feces but are reabsorbed from the lower intestine and recycled to the liver. There is some loss, however, and to compensate for this and to meet other needs, the liver synthesizes some 1500–2000 mg of new cholesterol each day. It synthesizes cholesterol from the products of fat metabolism.
3. %80 of total cholesterol is manufactured in the liver while 20% driven from diet.
4. There is an unceasing transport of cholesterol in the blood between the liver and all the other tissues. Most of this cholesterol travels with fatty acids and protein in the form of low density lipoproteins (LDSs).
5. Cholesterol bound to low-density lipoprotein (LDL) is often called “bad” cholesterol. LDL cholesterol increases the risk for a heart attack while HDL cholesterol protects against heart disease.
6. Cholesterol can also create problems. Cholesterol in the bile can crystallize to form gall stones that may block the bile ducts. Cholesterol is also strongly implicated in the development of atherosclerosis: fatty deposits (plaques) that form on the inside of blood vessels and predispose to heart attacks. The major culprit seems to be levels of LDLs that are in excess of the body’s needs.
7. In general, some kind of the drugs, such as antibiotics, antihypertensives, anticonvulsants, hormones and antidepressants can lead to a false-positive value. Decreased LDL levels may be associated with certain drugs such as steroids (e g , sex hormones, synthetic hormones) and or drugs used for their anti–inflammatory properties, juice, hormones, vitamins-vitamin A, E and C and other substances often used in cancer treatments. The drugs used by the patient have been checked for this kind of analytical interferences.
8. LDL-C/HDL-C factor, also referred to as the cardiac-risk-factor ratio, determines whether the cholesterol is being deposited into tissues or broken down and excreted. The risk for heart disease can be reduced dramatically by lowering LDL-C while simultaneously raising HDL-C level. For every 1% drop in LDL-C level, the risk for a heart attack drops by 2 % and conversely for every 1 % of HDL levels, this risk drops by 3-4 %. Considering LDL-C/HDL-C factor, which is bigger than 2,5, of the patient, he is in the risk range for a coronary heart disease (CHD).

Increased LDL levels are caused by:

1. Familial type 2 hyperlipidemia, familial hypercholesterolemia- partly because of LDL receptor damage in the liver.
2. Secondary causes include the following
3. Diet high in cholesterol and saturated fat
4. Hyperlipidemia secondary to hypothyroidism
5. Nephrotic syndrome, glomerulonephritis
6. Chronic renal failure
7. Pancreatic and prostatic malignant neoplasms
8. Hypothyroidism
9. Alcoholism
10. Glycogen storage disease (Von Gierke’s disease)
11. Multiple myeloma and other dysglobulinemia
12. Cholestasis
13. Hepatocellular disease, biliary cirrhosis
14. Anorexia nervosa
15. Diabetes mellitus
16. Chronic renal failure
17. Porphyria
18. Premature CHD
19. Hypertension
20. Low HDL
21. Cerebrovascular or peripheral vascular disease
22. Severe obesity
23. Acute stress
24. Major illnesses,
25. Inflammatory diseases
26. Cushing’s syndrome
27. Werner’s syndrome
28. Seasonal variations, Levels are higher in fall and winter
29. Plasma (EDTA) values are 10% lower than serum

The feces and the urine have been checked for discoloration caused by drug interferences, if any.

During a thru physical check, the iris has been checked with an iridoscope for cholesterol symptoms and for other interferences.

6. Therapeutics/Results:

Sample Recommendations:

Considering LDL ˃ 160 mg/dL, CHD and two other risk factors;  drug, dietary and lifestyle change treatments were recommended.

1. A cholesterol-lowering drug- 30 mg/once a day Lipitor OR equivalent

1. Lifestyle changes and healthier diets.

Stress reduction techniques such as breathing exercises, stretching exercises, meditation, imaginary and other relaxation techniques for an hour each day and exercised  at least 3 hours a week.

A diet of approximately 10% fat, 15-20 % protein and 70-75% complex carbohydrate such as whole grains, legumes and vegetables. Drink at least 48 ounces of quality alkaline water. Achieving and maintaining desirable body weight getting regular exercise.

A diet poor in polysaturated fats and animal products.

A diet rich in:

 polyunsaturated fats (omega 3 oils) , whole fish, fruits and green vegetables, whole grain products, garlic, onion, bromelain, capsicum, ginger, gugulipid, soy bean.

Eggs not fried but boiled etc. can be eaten because it contains balancing lecithin against cholesterol.

Keep away from:

Unhealthy diet in the form of food rich in fat and low in fiber content, especially saturated and trans-fat, like that of the meat, butter, cheese, ice-cream, and processed food made with partially hydrogenated oil. Caffeine, cookies, crackers, cakes, muffins, pie crusts, pizza dough, and breads such as hamburger buns. Some stick margarine and vegetable shortening. Pre-mixed cake mixes, pancake mixes, and chocolate drink mixes. Fried foods, including donuts, French fries, chicken nuggets, and hard taco shells. Snack foods, including chips, candy, and packaged or microwave popcorn. Frozen dinners. Too much dietary salt.

No Smoking whereby a chemical called acrolein, found in cigarettes stops the flow of cholesterol from the cells to the liver, which result in narrowing of arteries.

7. Suggested Supplementation/Treatments:

Supplement Intakes:

1. Vitamin C (500 mg/3 times a day), which reduces Lp (a) and its antioxidant activity while increasing HDL levels in the blood.
2. Vitamin A (2,500 IUs per day).
3. Vitamin E (800 IU/ a day) D ( 1,000 IU/day).
4. Niacin (vitamin B3) which reduces lipoprotein a (Lpa) by 33%. (100 mg/3 times a day).
5. Fish oil (10 gr/day).
6. Pantethine, Vitamin B5, an important component of coenzyme A (CoA) which involves in the transport of fats to and from the cells.Vitamin B5 inhibits cholesterol synthesis and accelerating the utilization of fat as an energy source. (300 mg/3 times a day).
7. Magnesium supplementation For a good lower LDL-C/HDL-C factor, the cardiac-risk-factor ratio, also a (400 mg/ a day).
8. Carnitine, responsible for the transport of long-chain fatty acids into the mitochondria, since the carrier molecule for fatty acids, acyl-CoA, cannot penetrate the cell membrane of the mitochondria, a deficiency in carnitine results in decreased fatty acid concentrations in the mitochondria, and as a result, reduction in energy production against a fatty acid increase in the blood. Meat and dairy products are the major sources of the carnitine. The redder the meat, the higher the carnitine content.  A diet rich in lysine, Vitamin C, B6 and niacin and iron is very important for carnitine synthesis. Carnitine dosage: 2 gr/a day.
9. Lecithin with 90% phosphatidylcholine (500 mg/3 times a day).
10. Flaxseed oil (1 table spoon/ a day)
11. Low levels of Vanadium may indicate that a nutritional therapeutic approach to lowering the cholesterol levels would be helpful. Food sources of vanadium includes parsley, soybeans, eggs, sunflower seed oil, corn, green beans, peanut oil, carrot, cabbage, garlic, radish, onion, whole wheat, lobster, beet, apple, plum, lettuce and millet.

8. Notes for further consideration:

1. a) Blood test for every 2 months has been recommended in order to be sure the dosages recommended.
2. b) Seek counsel from a dietitian
3. c) A comprehensive lipoprotein analysis if cholesterol levels are not lowered within 6 months after this therapy