GUGULIPID
GUGULIPID
• MUKUL MYRRH TREE OF INDIA• YELLOWISH RESIN PRODUCED BY
THE STEM OF THE PLANT ON INJURY• OLEORESIN IS USED TO PRODUCE
THE MEDICAL PREPARATION CALLED GUGULIPID
• CONTAINS RESIN, GUM, AND VOLATILE OILS
• THE SOLUABLE FRACTION IS EXTRACTED TO CONCENTRATE AND ISOLATE THE KETONIC STEROID COMPOUNDS CALLED GUGGULSTERONES
EFFECTS OF GUGULIPID
• LOWERS TOTAL CHOLESTEROL• LOWERS TRIGLYCERIDES• LOWERS LDL AND VLDL CHOL• INCREASES HDL CHOLESTEROL• PERHAPS DIRECT INHIBITION OF
CHOLESTEROL SYNTHESIS OR INCREASES HEPATIC BINDING SITES FOR LDL CHOLESTEROL
• INCREASES FECAL EXCRETION OF CHOLESTEROL AND BILE ACIDS
• DECREASES PLATELET AGGREGATION - COMPARABLE TO THE DRUG CLOFIBRATE
STUDIES
• MULTIPLE STUDIES IN INDIA• 500mg (tid)• 245 HYPERLIPIDEMIC PATIENTS• 4-6 WEEKS• 80% RESPONDED• AVERAGE SERUM CHOLESTEROL
AND TRIGLYCERIDE REDUCTION 27%, 22% RESPECTIVELY
STUDY• Nohr, LA et al. Resin from the mukul myrrh tree, guggul, can it be used for treating
hypercholesterolemia? A randomized,controlled study. Complement Ther Med. 2009 Jan;17(1):16-22
• DOUBLE BLIND, RANDOMIZED, PLACEBO CONTROLLED - 34 SUBJECTS, AGE 27-70 MODERATELY RAISED CHOLESTEROL
• 2,160mg GUGGUL (4 pills)/day OR PLACEBO• MEAN TOTAL CHOLESTEROL WAS
SIGNIFICANTLY REDUCED• MEAN LDL, TRIGLYCERIDES AND
CHOLESTEROL/HDL RATIO BETWEEN THE TWO GROUPS DID NOT CHANGE
DOSE
• 25mg GUGGULSTERONES (tid)• CURRENT EXTRACTS CONTAIN
5%-10%• 12-24 WEEKS NECESSARY• SAFE IN ANIMAL STUDIES WITH
RATS, RABBITS, MONKEYS
HUMAN RISKS
• MILD ABDOMINAL DISCOMFORT• USE WITH CAUTION IN PATIENTS
WITH:– HEPATIC DISEASE OR IMPAIRMENT– DIARRHEA– INFLAMMATORY BOWEL CONDITIONS
GARLIC
GARLIC
• MEMBER OF THE LILY FAMILY• NOT FOUND IN THE WILD• THOUSANDS OF YEARS OF
CULTIVATION• CENTRAL CALIFORNIA AND CHINA• USED FOR HYPERLIPIDEMIA,
HYPERTENSION AND INTERMITTENT CLAUDICATION
• GARLIC CLOVES ARE HIGH IN THE ODORLESS SULFUR CONTAINING COMPOUND - ALLIIN
• WITH CRUSHING OR CHEWING ALLIIN COMES IN CONTACT WITH ALLINASE AND IS TRANSFORMED INTO ALLICIN (ODOR)
• ALLICIN IS VERY UNSTABLE
• HEATING AND COOKING CAN DESTROY ALLICIN
• SUPPLEMENTS WORK BEST WHEN THEY APPROXIMATE EATING RAW GARLIC
• HOWEVER - CAREFULLY PREPARED GARLIC POWDER WILL YIELD ONLY 4% LESS ALLICIN THAN RAW GARLIC
FUNCTIONS OF GARLIC
• LOWERS SERUM CHOLESTEROL• LOWERS SERUM TRIGLYCERIDES• INHIBITS PLATELET AGGREGATION• MILD ANTI-HYPERTENSIVE• MILD ANTI-OXIDANT• ANTI-MICROBAL ACTIVITY• ANTI-FUNGAL ACTIVITY
• INTERFERES WITH HEPATIC METABOLISM OF CHOLESTEROL RESULTING IN LESS RELEASE INTO THE SERUM
• EPIDEMIOLOGICAL STUDIES INDICATE THAT INCREASED INTAKE OF GARLIC IS ASSOCIATED WITH DECREASED CARDIOVASCULAR DISEASE
GARLIC
STUDIES: GARLIC
• THERE ARE MANY HUMAN STUDIES THAT DEMONSTRATE LIPID LOWERING EFFECTS
• MAJORITY USED GARLIC POWDER TABLETS STANDARDIZED TO 1.3% ALIIN
• DOSE WAS BETWEEN 600-900mg/day PROVIDING 5,000 mcg OF ALLICIN AT THE HIGH
• STUDIES RANGED FROM 4-16 WEEKS• AVERAGE REDUCTION OF SERUM
CHOLESTEROL 9%-12% (RANGE 6%-21%)
• SERUM TRIGLYCERIDES RANGE OF 8%-27%
• MILD ANTI-HYPERTENSIVE• DECREASES SYSTOLIC PRESSURE 20-
30mmHg AND DIASTOLIC PRESSURE 10-20mmHg
POSSIBLE MECHANISM?• Mohammadi A and Oshaghi EA Effect of garlic on lipid profile and expression of LXR
alpha in intestine and liver of hypercholesterolemic mice. J Diabetes Metab Disord. 2014 Jan 29;13(1):20.
• GARLIC MAY AFFECT LIVER X RECEPTOR ALPHA (LXRalpha)
• LXRalpha - REGULATES CHOLESTEROL, TRIGLYCERIDE AND GLUCOSE HOMEOSTASIS
• FORTY MICE - DECREASE OF VLDL, LDL, TOTAL CHOLESTEROL, TRIGLYCERIDES, ALT, AST, ATHEROGENIC INDEX - HDL NOT CHANGED
• GARLIC REDUCED LXRalpha EXPRESSION IN THE LIVER AND INCREASED ITS EXPRESSION IN THE INTESTINE GIVING A LOWERING EFFECT
DOSE
• CHEW ONE FRESH CLOVE OF GARLIC DAILY OR,
• ODOR CONTROLLED ENTERIC COATED GARLIC POWDER SUPPLEMENTS PROVIDING 5,000mcg ALLICIN/day (2-3 DIVIDED DOSES)
• EVALUATE OVER A 3-6 MONTH TIME
RISKS
• SOME GET HEARTBURN AND FLATULENCE
• IF TAKING ANTI-COAGULANT MEDICATIONS - NEED TO USE CAUTION
• PREGNANCY AND LACTATION - OK
FENUGREEK
FENUGREEK
• A HERB, SEEDS USED AS THE MEDICINE
• ORIGINALLY FROM SOUTHEASTERN EUROPE AND WESTERN ASIA
• A FOOD AND SPICE EATEN IN MANY PARTS OF THE WORLD
• ACTIVE INGREDIENTS - STEROIDAL SAPONINS
EFFECTS: FENUGREEK
• INHIBITS CHOLESTEROL ABSORPTION AND SYNTHESIS
• HAS BEEN SHOWN TO DECREASE LDL, VLDL, TOTAL CHOLESTEROL
• HDL LEVELS NOT CHANGED
FENUGREEK: DOSE
• SEEDS ARE VERY BITTER• TAKE THE DE-BITTERIZED SEEDS OR
CAPSULES• TAKE 4-5 GRAMS THREE TIMES PER
DAY WITH MEALS
FENUGREEK: RISKS
• USE OF > 100 GRAMS OF SEEDS DAILY CAN CAUSE INTESTINAL UPSET AND NAUSEA
• NOT TO BE USED IF PREGNANT• MAY RETARD ABSORPTION OF ORAL
MEDICATIONS BECAUSE OF THE FIBER
COENZYME Q10
• UBIQUINONE - ESSENTIAL PART OF THE MITOCHONDRIA
• MAJOR ROLE IN ENERGY PRODUCTION
• CAN BE SYNTHESIZED WITHIN THE BODY
• LEVELS DECLINE WITH AGE AND MAY CORRELATE TO HEART DISEASE
• A LIPID SOLUBLE ANTI-OXIDANT• FOUND IN PLASMA LDL FRACTIONS • MAY IMPROVE CARDIAC FUNCTION• REDUCES ANGINAL EPISODES• REDUCES BLOOD VISCOSITY
COENZYME Q10
• BIOPSIES OF HEART TISSUE IN PATIENTS WITH HEART DISEASE SHOWED CoQ10 DEFICIENCIES IN 50%-75% OF CASES
COENZYME Q10
COENZYME Q10: DOSE AND RISKS
• 60-90-120mg IN 2-3 DIVIDED DOSES• START WITH 60mg AND IF NO
IMPROVEMENT GO HIGHER• 4-20 WEEK TRIAL NECESSARY• WHEN REDUCING DOSE, DO SO SLOWLY -
COULD CAUSE A HEART ATTACK• MAY INTERACT WITH WARFARIN (DRUG)
CARNITINE
• A WATER SOLUBLE SUBSTANCE THAT IS FOUND PRIMARILY IN MUSCULAR TISSUE– SYNTHESIZED FROM LYSINE IN THE LIVER,
KIDNEY AND BRAIN
• TRANSPORTS FATTY ACIDS INTO THE MITOCHONDRIA– LONG CHAIN FATTY ACIDS ARE THE
PREFERRED ENERGY SOURCE OF THE HEART
• THEREFORE, THIS IS DEPENDENT UPON ADEQUATE CARNITINE BEING PRESENT
• NORMAL HEART STORES MORE CARNITINE THAN IT NEEDS
• WHEN THERE IS A LACK OF OXYGEN TO THE HEART CARNITINE LEVELS ARE QUICKLY DECREASED
CARNITINE
• SUPPLEMENTS NORMALIZE CARNITINE LEVELS AND ALLOW THE HEART TO USE A LIMITED OXYGEN SUPPLY MORE EFFICIENTLY
• LIMITED OXYGEN SUPPLY IS OFTEN FOUND WITH PATIENTS WHO HAVE CARDIOVASCULAR ABNORMALITIES
CARNITINE
• INCREASES ABILITY OF HEART TISSUE TO OXIDIZE FATTY ACIDS
• DECREASES TOTAL CHOLESTEROL AND TRIGLYCERIDES
CARNITINE
• DOES HAVE ERGOGENIC BENEFIT (INCREASES PERFROMANCE) FOR:– PATIENTS WITH HEART DISEASE
WHO COULD NOT EXERCISE • THESE PATIENTS CAN ENJOY AN
EXERCISE PROGRAM AND ACTIVE LIFESTYLE
CARNITINE
• IMPROVES EXERCISE TOLERANCE AND ENHANCES PHYSICAL PERFORMANCE IN PATIENTS WITH HEART DISEASE
• IMPROVES HEART FUNCTION• DEBATABLE BENEFIT FOR NORMAL
PATIENTS USING IT FOR ATHLETIC PURPOSES – MAYBE HELPFUL FOR WEIGHT LOSS?
CARNITINE
DOSE AND FORM• DL 1,500mg (BID)• L 750mg (BID) UPTO 1gram (BID)• 1 MONTH TRIAL• ACETYL-L-CARNITINE• PROPIONYL-L-CARNITINE
BLOOD DONATION• DONATING BLOOD APPEARS TO
DECREASE THE RISK OF HEART ATTACK
• PERHAPS DUE TO REMOVAL OF EXCESS IRON
SUMMARY
CARDIOPROTECTIVE DIET
• HIGH VEGETABLES AND FRUITS• HIGH FIBER• LOW FAT (SATURATED AND TRANS FATS)• LOW CHOLESTEROL• LOW SUGAR• LOW ANIMAL PROTEIN• INCREASE VEGETABLE PROTEINS• AVOID FRIED FOODS
• HIGH POLYUNSATURATED FATTY ACID TO SATURATED FATTY ACID RATIO
• POLYUNSATURATED FATTY ACID AND MONOUNSATURATED FATTY ACIDS
• HIGH IN POTASSIUM• HIGH IN MAGNESIUM• HIGH IN VITAMIN C AND E• USE GARLIC AND ONIONS
CARDIOPROTECTIVE DIET
SUPPLEMENTS
• MULTIVITAMIN AND MINERAL• OMEGA 3 FATTY ACIDS (FISH OILS)• EXTRA VITAMINS C AND E• COENZYME Q10 - 60mg/day• L-CARNITINE 750mg (twice per day)• NIACIN - 500mg-1500mg/day
• INOSITOL HEXANICITINATE -600-800 mg/day
• GUGGULIPID - GUGGULSTERONES -25mg (tid)
• GARLIC - ALLICIN - UP TO 5000 mcg/day
• FENUGREEK - SEEDS - 4-5grams (tid)
LIFESTYLE
• LOW TO MODERATE ALCOHOL• DO NOT SMOKE• AVOID OBESITY• AEROBIC EXERCISE - 5x/week -in
general- moderate intensity - 30min• STRESS REDUCTION AND
RELAXATION
New References - Part 2
• Kim, BJ Plasma homocysteine and coronary artery calcification in Korean men. Eur J Prev Cardiol. 2014 Jan 30
• AHA recommendation – 2012 WEBSITE• AHA GUIDELINES – 2013 WEBSITE
Part 3
• Keenan JM Wax-matrix extended-release niacin vs inositol hexanicotinate: a comparison of wax-matrix, extended-release niacin to inositol hexanicotinate "no-flush" niacin in persons with mild to moderate dyslipidemia. J Clin Lipidol. 2013 Jan-Feb;7(1):14-23
PART 3
• Eleni Kokkou et al. Short Term Flavonoid Administration Improves Vascular Function in Healthy Smokers. Circulation. 2013; 128: A14441(online)
• Sonia Blanco Mejia1. Effect of tree nuts on metabolic syndrome criteria: a systematic review and meta-analysis of randomised controlled trials. BMJ Open Volume 4 issue 7 2014 (online)
Part 3
• Quanhe, Yang et al. Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults. JAMA INTERN MED 2014; 174(4) 516-524
part 4
• Skulas-Ray AC et al Dose-response effects of omega-3 fatty acids on triglycerides, inflammation, and endothelial function in healthy persons with moderate hypertriglyceridemia. Am J Clin Nutr 2011 Feb;93(2):243-52
• Wannamethee SG et al Plasma vitamin C, but not vitamin E, is associated with reduced risk of heart failure in older men Circ Heart Fail. 2013 Jul;6(4):647-54.
part 5
• Nohr, LA et al. Resin from the mukul myrrh tree, guggul, can it be used for treating hypercholesterolemia? A randomized,controlled study. Complement Ther Med. 2009 Jan;17(1):16-22
• Mohammadi A and Oshaghi EA Effect of garlic on lipid profile and expression of LXR alpha in intestine and liver of hypercholesterolemic mice. J Diabetes MetabDisord. 2014 Jan 29;13(1):20.