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.