Hypercholesterolemia

September is cholesterol awareness month. Last September I discussed the efficacy of red yeast rice for lowering serum cholesterol. This year I will review the evidence regarding other natural cholesterol-lowering agents. **Pantethine** Pantethine is the stable disulfide form of pantetheine, which is a biologically active form of pantothenic acid. As a precursor to coenzyme A, pantethine plays a role in fat metabolism. In addition, pantethine inhibited cholesterol synthesis by fibroblasts in vitro. Pantethine also inhibited HMG-CoA reductase activity in isolated rat hepatocytes, an effect that mirrors that of statin drugs. In most, but not all, uncontrolled and double-blind1 studies of patients with hyperlipidemia, administration of 600-1,200 mg per day of pantethine decreased the mean serum cholesterol concentration by 11-23% and decreased LDL cholesterol by 11-36%. HDL-cholesterol levels increased by 32-38% in some studies, but did not change in other studies. Pantethine has not been reported to cause any serious side effects. **Niacin** Supplementation with 1.5-3.0 g per day of niacin has been found to produce substantial decreases in serum total cholesterol, LDL cholesterol, and triglycerides, and increases in HDL cholesterol.2 3 4 The response to niacin is dose-related. In 969 patients who were followed for a mean of 10 months, niacin at an average dose of 1.67 g per day reduced total cholesterol by 19.1%, LDL cholesterol by 24%, and triglycerides by 32.5%, and increased HDL cholesterol by 5.7%.5 Only minimal changes in serum cholesterol have been seen in patients taking 1,000 mg per day of niacin or less. Niacin is one of the few natural cholesterol-lowering agents that have been tested with regard to long-term clinical outcomes. In men with a previous myocardial infarction, treatment with niacin (1 g 3 times per day) for 6 years significantly decreased recurrences of nonfatal myocardial infarction and nonsignificantly decreased all-cause mortality, compared with placebo. Fifteen years after the start of the study, approximately 9 years after the treatments had been discontinued, mortality was 11% lower in the niacin group than in the placebo group (52.0% vs. 58.2%; p = 0.0004). Mean life span in the niacin group was 2 years longer than in the placebo group. This late benefit of niacin on mortality may have resulted from the decreased incidence of nonfatal myocardial infarctions during the trial.6 7 Side effects occur frequently with niacin, and result in discontinuation of therapy in nearly 50% of cases. The most common side effects are skin flushing, itching, and urticaria; these symptoms typically improve rapidly with continued therapy. Other adverse effects may include an increase in blood glucose or plasma uric acid levels, gastrointestinal distress, activation of peptic ulcer, and hepatotoxicity. Sustained-release niacin preparations are more hepatotoxic than regular niacin. Some side effects of niacin can be minimized by starting with low doses (such as 100 mg twice a day) and increasing gradually as tolerated. Case reports have suggested that the use of niacin and statin drugs in combination increases the risk of adverse events. However, an analysis of adverse events reported to the FDA suggested that there is no clinically significant interaction between niacin and statins.8 Inositol hexanicotinate (so-called "no-flush" niacin) has been promoted as an alternative to niacin, but its effect on serum cholesterol levels appears to be minimal. **Garlic** Garlic has been reported to inhibit hepatic cholesterol synthesis.9 A number of studies have found that ingestion of garlic or use of garlic supplements lowers serum cholesterol, but other studies have found little or no effect. Meta-analyses of up to 16 randomized controlled trials found that garlic significantly reduced the mean serum cholesterol concentration by 16-30 mg/dl.10 11 12 However, many of the studies had methodological weakness. When only the 6 trials with the highest methodological quality were analyzed, the difference between garlic and placebo was only 4.3 mg/dl and was no longer statistically significant. Thus, garlic may be of some value for treating hypercholesterolemia, but the size of the effect remains uncertain. While a number of different garlic preparations have been used in clinical trials, there is no clear evidence that any particular preparation is more effective than others. **Policosanol not effective** Policosanol is a mixture of long-chain primary alcohols, originally isolated from sugar cane wax, and also found in beeswax, rice bran, and wheat germ. Several studies found that policosanol was as effective as statin drugs for lowering total- and LDL-cholesterol levels. However, virtually all of the published research supporting a beneficial effect of policosanol was conducted by a single research group from Cuba or sponsored by a single Cuban company. In contrast, numerous independent studies conducted in the U.S., Canada, Netherlands, Germany, Italy, and South Africa found that policosanol has no effect on cholesterol levels. The bulk of the evidence indicates that policosanol is not effective, so it not recommended as a treatment for hypercholesterolemia.13 
 * < **Natural Treatments for Hypercholesterolemia** ||
 * By Alan R. Gaby, M.D.

1 Gaddi A, Descovich GC, Noseda G, et al. Controlled evaluation of pantethine, a natural hypolipidemic compound, in patients with different forms of hyperlipoproteinemia. Atherosclerosis 1984;50:73-83. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">2 Philipp CS, Cisar LA, Saidi P, Kostis JB. Effect of niacin supplementation on fibrinogen levels in patients with peripheral vascular disease. Am J Cardiol 1998;82:697-699. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">3 Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Arch Intern Med 2000;160:1177-1184. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">4 Lavie CJ, Mailander L, Milani RV. Marked benefit with sustained-release niacin therapy in patients with "isolated" very low levels of high-density lipoprotein cholesterol and coronary artery disease. Am J Cardiol 1992;69:1083-1085. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">5 Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994;121:252-258. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">6 Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol 1986;8:1245-1255. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">7 Horwitz N. Link niacin to longevity after an MI. Med Tribune 1985(April 24):1. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">8 Alsheikh-Ali AA, Karas RH. Safety of lovastatin/extended release niacin compared with lovastatin alone, atorvastatin alone, pravastatin alone, and simvastatin alone (from the United States Food and Drug Administration adverse event reporting system). Am J Cardiol 2007;99:379-381. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">9 Yeh YY, Yeh SM. Garlic reduces plasma lipids by inhibiting hepatic cholesterol and triacylglycerol synthesis. Lipids 1994;29:189-193. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">10 Stevinson C, Pittler MH, Ernst E. Garlic for treating hypercholesterolemia. A meta-analysis of randomized clinical trials. Ann Intern Med 2000;133:420-429. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">11 Warshafsky S, Kamer RS, Sivak SL. Effect of garlic on total serum cholesterol. A meta-analysis. Ann Intern Med 1993;119:599-605. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">12 Silagy C, Neil A. Garlic as a lipid lowering agent - a meta-analysis. J R Coll Physicians London 1994;28:39-45. <span style="font-family: Garamond,'Times New Roman',Times,serif; font-size: 10pt;">13Gaby AR. Nutritional Medicine, 2011, Concord NH, chapter 77. www.doctorgaby.com. ||

Definition:
an excess of cholesterol in the blood; generally defined as greater than 200 mg/dl, although many doctors are now citing 180 mg/dl as the maximum of the reference range

Etiology:
• hyperlipoproteinemias: cholesterol may be slightly increased in types I and IV; moderately increased in type V (up to 250-500 mg/dl); markedly increased in types IIa, IIb and III (up to 300-1000 mg/dl) • idiopathic • biliary obstruction • von Gierke's disease • "sluggish" liver syndrome • hypothyroidism • pregnancy • pancreatic dysfunction • nephrosis • diet: high intake levels of cholesterol, saturated and polyunsaturated fats, fried foods, hydrogenated oils, meat, sugar, coffee, alcohol; low intake of fiber • nutrients: high zinc; low intake of vitamin C, calcium, chromium, copper, magnesium

Cholesterol levels have become the source of much national fear, even though cholesterol is one of the most valuable substances in the human body. Cholesterol is needed for strong cell walls, as a precursor for hormone production, and as a coating around nerves, to name just a few of its very important functions. Cholesterol is made in the liver in amounts up to 2000 mg/day. Cholesterol associated with high density lipoprotein, HDL (and Apolipoprotein A-1), is generally considered to be beneficial to the body, as it works to remove cholesterol from blood vessel walls and the the blood itself, bringing it to the liver for processing and excretion. Cholesterol associated with the low density lipoprotein, LDL (and Apolipoprotein B), is generally thought to be harmful to the body as it carries cholesterol into the bloodstream and can therefore place it into the intima of the arterial walls, promoting atherosclerotic processes. Very low density lipoproteins, VLDLs, become LDLs in the liver and are therefore also generally thought to be harmful.

For many years, this theory placed the effect of high cholesterol as the major etiologic agent in the epidemic of heart attacks and cardiovascular disease experienced in Western nations. However, recent evidence suggests other important factors: see atherosclerosis

Somatic Therapies:
• regular aerobic exercise: Regular exercise contribute to higher levels of HDL cholesterol and reduce the risk of heart disease. Individuals over 40 and those who have not been engaged in vigorous activity on a regular basis should consult with their physician and consider starting with less strenuous activities such as walking. (Duncan JJ, et al. JAMA 1991;266:3295-3299; Pekkanen J, et al. Lancet 1987;1:1473-1477; Reaven PD, et al. J Am Geriatr Soc 1990;38:847-854; Willich SN, et al. N Engl J Med 1993;329:1684-1690.) • qigong • tai qi chuan

Nutrition:
eating principles: • low sugar • low fat diet of unsaturated fats (Burr ML, Sweetnam PM. Am J Clin Nutr 1982;36:873-877; Resnicow K, et al. J Am Dietet Assoc 1991;91:447-453; Thorogood M, et al. Br Med J (Clin Res Ed) 1987;295:351-353; Ornish D, et al. Lancet 1990;336:129-133; Connor SL, Connor WE. Prev Med 1983;12:115-123; Edington JD, et al. Am J Clin Nutr 1989;50:58-62.) • calorie percentages: 70% complex carbohydrates, protein 12-15%, fat 15-18% • high fiber • low cholesterol • low Sodium/ Sodium-restricted diet • vegetarian cleansing diet or short fasts • see Materia Medica: Diet for Lowering Cholesterol, Fasting, General Sample Diet, General Guidelines for Eating, Sample Vegetarian Diet

therapeutic foods: • garlic, wheat germ, liquid chlorophyll, alfalfa sprouts, buckwheat, watercress, rice polishings, apple, celery, cherries (Ni, p. 120) • foods high in water-soluble fiber: flax seed, pectin, guar gum, oat bran (Anderson JW, Chen WJL. 1983; Bierenbaum ML, et al. J Am Coll Nutr 1993;12:501-504; Glore SR, et al. J Am Dietet Assoc 1994;94:425-436; Jenkins DJA, et al. Am J Clin Nutr 1999;69:395-402; Miettinen TA, Tarpila S. Clin Chim Acta 1977;79:471-477; Rimm EB, et al. JAMA 1996;275:447-451; Ripsin CM, et al. JAMA 1992;267:3317-3325.) • onions, beans, legumes, soy, ginger, alfalfa, yogurt (Marz) • increase omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, salmon, herring, mackerel, sardines, walnuts, flaxseed oil, evening primrose oil, black currant oil (Layne KS, et al. J Nutr 1996;126:2130-2140; Mantzioris E, et al. Am J Clin Nutr 1994;59:1304-1309; Harris WS. Am J Clin Nutr 1997;65(5 Suppl):1645S-1654S; Jenkins DJA, et al. Am J Clin Nutr 1999;69:395-402.) • Psyllium seed husks: 5-10 grams of psyllium per day can lower cholesterol levels by 5% and LDL cholesterol by 9%. (Davidson MH, et al. Am J Clin Nutr. 1998; 67(3):367-376; Wolever TM, et al. Am J Med Sci. 1994; 307(4):269-273; Olson BH, et al. J Nutr 1997;127:1973-1980.) • Red wine antioxidants: Ingestion of red wine by human volunteers significantly inhibited LDL oxidation; this effect was not seen after ingestion of grape juice. Research has found that both red wine and grape juice inhibited oxidation of low-density lipoprotein (LDL) in vitro. However, the antioxidant effect of red wine and grape juice appeared to be due to the flavonoids, not to ethanol or nonflavonoid phenolic compounds. (Miyagi Y, et al. Am J Cardiol 1997;80:1627-1631.) • soy: Soy protein reduces both total and LDL cholesterol. (Anderson JW, et al. N Engl J Med 1995;3333:276-282; Potter SM. Curr Opin Lipidol. 1996; 7(4):260-264.)

fresh juices: • carrot and pineapple with honey • liquid chlorophyll (Jensen, p. 51) • parsley, alfalfa, and pineapple (Jensen, p. 51) • carrot, celery, parsley, and spinach (Walker, p. 123) • carrot and spinach (Walker, p. 123) • carrot, beet, and celery (Walker, p. 123) • celery, lettuce, and spinach (Walker, p. 123) • asparagus and honey (Ni, p. 120)

avoid: • trans-fatty acids, hydrogenated oils (margarine, vegetable shortenings, imitation butter spreads, most commercial peanut butters), oxidized fats (deep fried foods, fast food, ghee, barbequed meats) (Willett WC, et al. Lancet 1993;341:581-585; Khosla P, Hayes KC. J Am Coll Nutr 1996;15:235-239.) • refined, simple carbohydrates: sucrose, white flour, processed foods (Yudkin J, et al. Br Med J 1980;281:1396; Liu K, et al. Arteriosclerosis 1982;2:221-227; Reiser S. Nutr Health 1985;3:203-216.) • alcohol, except possibly red wine: Even though two to three drinks per day may raise HDL cholesterol the overall effect on the liver, heart, blood pressure and other aspects of health indicate that alcohol use will increase the risk of heart disease for most people. (Dai WS, et al. Am J Epidemiol 1985;122:620-627; Doll R, et al. Br Med J 1994;309:911-918; Hein HO, et al. Br Med J 1996;736-741; Hendriks HF, et al. Br Med J 1994;304:1003-1006; Marques-Vidal P, et al. Am J Epidemiol 1996;143:1089-1093; Rimm EB, et al. Br Med J 1996;312:731-736.)

lifestyle: • Reduce stress and maintain regular exercise: Stress reduction and regular exercise contribute to higher levels of HDL cholesterol and reduce the risk of heart disease. Individuals over 40 and those who have not been engaged in vigorous activity on a regular basis should consult with their physician and consider starting with less strenuous activities such as walking. (N Engl J Med 1988;318:110-112; Jiang W, Babyak M, Krantz DS, et al. JAMA 1996;275:1651-1656; Lundberg U, et al. Psychosomatic Med 1989;51:113-122; McCann BS, et al. Psychosomatic Med 1990;52:97-108; Kawachi I, et al. Circulation 1996;94:2090-2095; Duncan JJ, et al. JAMA 1991;266:3295-3299; Pekkanen J, et al. Lancet 1987;1:1473-1477; Reaven PD, et al. J Am Geriatr Soc 1990;38:847-854; Willich SN, et al. N Engl J Med 1993;329:1684-1690.)

Botanicals
• Allium cepa (Onion): lowers cholesterol (Sainani GS, et al. Jpn Heart J 1979 May;20(3):351-357. ) • Allium sativum (Garlic): Despite a few, potentially flawed studies to the contrary, a wide range of research has demonstrated garlic's ability to reduce cholesterol levels. Reviews of all such research indicate that a 9-12% reduction of total serum cholesterol can typically be acheved using 600-900 mg of garlic over a periods of one to four months. Chewing one clove of raw garlic daily presents the most direct method of consuming the necessary levels. However, those who prefer an odorless, enteric-coated tablet, standardized for allicin content would need to take a daily total of 900 mg, containing 5000 mcg of allicin, to obtain the same effects. (Silagy C, Neil A. J R Coll Physicians Lond 1994 Jan-Feb;28(1):39-45; Steiner M, et alk. Am J Clin Nutr 1996 Dec;64(6):866-870; Orekhov AN, Grunwald J. Nutrition 1997 Jul-Aug;13(7-8):656-663; Sainani GS, et al. Jpn Heart J 1979 May;20(3):351-357; Yeh YY, Yeh SM. Lipids 1994 Mar;29(3):189-193.) • Commiphora mukul (guggalon gum): lowers LDL and VLDL, while it raises HDL. In a study comparing guggul with the drug clofibrate, researchers found greater reductions in average serum cholesterol (11% vs. 10%) with the guggul, while the gugul alone produced a 60% increase in HDL levels. The therapeutic dosage of guggul is usually based on the guggulsterone content. Clinical studies have found that 25 mg guggulsterone, three times daily, can be an effective therapeutic dose for elevated cholesterol levels, elevated triglycerides, or both. In a commercial preparation containing 5% guggulsterones the recommended dose would typically be 500 mg three times daily, with results to be expected over a period of three to six months. (Mester L, et al. Planta Med 1979 Dec;37(4):367-369; Satyavati GV, et al. Indian J Med Res 1969 Oct;57(10):1950-1962; Singh K, et al. Phytotherapy Research. 1997; 11(4):291-294; Singh RB, et al. Cardiovascular Drugs and Therapy. 1994; 8:659-664; Verma, Indian J Med Res 87: 356-360; Nityanand S, et al. J Assoc Physicians India 1989 May;37(5):323-328.) • Dioscorea villosa (Wild Yam): In one study looking at adrenal hormones, particularly DHEA, researchers found that DHEA and dioscorea significantly reduced serum lipid peroxidation, lowered serum triglycerides, phospholipid and increased HDL levels. For such purposes 2-3 ml of Dioscorea tincture, 3-4 times daily, or 1-2 capsules of dried root, three times per day, would provide the appropriate dose. (Araghiniknam M, et al. Life Sci 1996;59(11):PL147-157.) • Eleutherococcus senticosus (Siberian Ginseng): lowers cholesterol (Pizzorno, Murray V: EleuSe-4; Maslova LV, et al. Biull Eksp Biol Med 1993 Mar;115(3):269-271.) CAUTION regarding possible interaction: There has been an anecdotal report of elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng. (McRae S. CMAJ 1996 Aug 1;155(3):293-295.) • Panax ginseng: in hyperlipidemia: reduces total serum cholesterol, triglycerides and raises serum HDL-cholesterol levels; CAUTION: in Classical Chinese medicine the use of Panax ginseng would often be contraindicated in many cases involving hypertension, esp. with Fire Shih (Excess) and/or Yin Xu (Deficiency) (Lin SG, et al. Chung Kuo Yao Li Hsueh Pao 1993 Jul;14(4):314-316 ; Lei XL, et al. Am J Chin Med 1986;14(3-4):145-152; Pizzorno, Murray V: PanaxG-6; Han KH, et al. Am J Chin Med 1998;26(2):199-209.) • Vaccinium myrtillus: reduces serum cholesterol and triglyceride levels in primary dyslipidemia (Pizzorno, Murray V: VacMyr-3; Detre Z, et al. Clin Physiol Biochem 1986;4(2):143-149.)

Chinese Formulae
• Cir Q (patent) (Fratkin, p. 276) • Tienchi Ginseng Tablet (patent) (Fratkin, p. 131) • Siler and Platycodon F. (Fang Feng Tong Sheng San): Obese constitution with cardiac disorders, habitual constipation, strong pulse, abdominal firmness and fullness, facial reddening (Hsu, 1980, p. 119; Yeung, p. 92; Bensky and Barolet, p. 58) • Salvia Shou Wu (patent) (Dharmananda, 1990, p. 55). Zhi Bi Tai has been equally as efficacious in lowering cholesterol as atorvastatin [Focus on Alternative and Complementary Therapies Vol. 16, Issue 2]

Acupuncture
after assessing the person and palpating, consider these patterns: Dampness; Spleen Xu (Deficiency)

» combinations: • Lv-3 and St-36: together help resolve increased blood lipids - sup (Ambrose)

Homeopathy
• Cholesterolinum: if necessary, with regular lab work every three months; starting with higher potencies and descending (Eizayaga) • Carbo vegetabilis: patient is sluggish, fat and lazy; very debilitated; general venous stasis, bluish skin, limbs cold; the simplest food distresses; digestion slow, food putrefies before it digests; aggravation from rich fatty foods • Ferrum metallicum: obesity, patient looks strong, but is weakly anemic and chlorotic with pseudo-plethora; < after any active effort; muscles flabby and relaxed; irregular distribution of blood; sanguine temperament; distention and pressure in stomach after eating; aggravation from fats, oils; intolerance of eggs • Nitric acid: person dark complexioned and past middle life; hydrogenoid constitution; irritable; vindictive; hopeless despair; love fat and salt; longing for indigestible things; great hunger with sweetish taste • Nux vomica: patient is thin, active, irritable, seeks stimulants, takes preferably rich and stimulating food; indulges in alcohol; has late hours; thick head; dyspepsia and irritable temper; easily chilled and avoids open air • Pulsatilla: mild, gentle, yielding disposition; seeks open air; symptoms ever-changing; averse to fat food, cannot tolerate it; eructations; taste of food remains a long time • Sulphur: great acidity; sour eructation; craving for fats; food tastes too salty; very selfish; averse to business; < standing, < warmth of bed;> dry warm weather; very weak and faint around 11 A.M.

Subtle Support
• notes: A#, B, C, D#, E, G, G#

• chords: diminished 8th, C Major, D# Major, G# Major (Gimbel, p. 116)

cardiovascular: • The Barcarole • The Blue Danube • Chopin's A minor Waltz • Tango music • Humoresque • Cui's Orientale • Song of India • Donna e Mobile • Oley Speak's Sylvia (Heline, p. 18)

Mind/Body
• Stress management training in group of 23 patients showed the following results after 24 days: 20% decrease in plasma cholesterol, 44% increase in duration of exercise, 55% increase in total work performed, a 6% increase in ventricular ejection fraction from rest to maximal exercise, and 91% decrease in anginal episodes. (Locke, 1985, p. 104) • Four year evaluation: 13,000 male patients age 35-57 were assigned to usual care or to intervention designed to reduce smoking, hypertension, and serum cholesterol. The intervention group showed a strong decrease in all three risk factors over the four years, while the control group showed a moderate decrease (indicative of societal changes in health attitudes). (Locke, 1985, p. 143) • Clogging the channels of joy; fear of accepting joy. (Hay, 1984, p. 160)

lifestyle: • Reduce stress and maintain regular exercise: Stress reduction and regular exercise contribute to higher levels of HDL cholesterol and reduce the risk of heart disease. Individuals over 40 and those who have not been engaged in vigorous activity on a regular basis should consult with their physician and consider starting with less strenuous activities such as walking. (Lundberg U, et al. Psychosomatic Med 1989;51:113-122; N Engl J Med 1988;318:110-112; Jiang W, et al. JAMA 1996;275:1651-1656; Kawachi I, et al. Circulation 1996.)

Chinese psychophysiology: • Spleen ~ Pi governs digestion and manifests in the muscle tissues; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel balanced and centered. » Healthy expressions are fairness, openness, deep thinking, and reminiscence; » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; easy bruising; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Unresolved Spleen Xu (Deficiency) predisposes to Spleen Shi (Excess), particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines. » Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise, overexposure to external Dampness, and excess consumption of sweet and/or Cold foods will also deplete the Spleen.

Integrative Therapies
Cholesterol is a fat-related substance that is a normal part of most body tissues. It is produced in the liver.

If you obtain a fasting blood test, it will show the level of total cholesterol. This should be lower than 180. Higher levels than this, mean an increased risk of heart disease and strokes. Two other items measured by the blood test are HDL and LDL. High LDL also means an increase in risk for heart disease, while high HDL is a good sign and lowers the risk.

A PROPER DIET TO HELP REDUCE CHOLESTEROL WILL INCLUDE THE FOLLOWING: 1. If you are overweight, it is important to get on a sensible diet. Obesity greatly contributes to elevated cholesterol levels. For more information, refer to the article on obesity and weight loss. 2. Omega-3 oils, such as flaxseed and fish oils, reduce cholesterol and boost HDL levels. Take at least 1 to 2 tablespoons or 3 capsules per day. 3. Include at least 3 servings or more of fruits and vegetables per day in your diet. 4. Include beans such as pinto, navy, and kidney beans in your diet on a regular basis. 5. A fiber supplement of psyllium seeds, oat bran, or pectin will bind to cholesterol so it can be excreted. This decreases LDL levels while increasing HDL. Take 1 tablespoon of the supplement at night just before bedtime, in a cup of water. 6. Eliminate or greatly reduce animal fat in your diet. This includes fatty meat, organ foods such as liver, eggs, cheese, milk, butter, sour cream, and other dairy products. 7. Alcohol and sugar intake also need to be kept to a minimum or avoided altogether because these turn into fats in the body. 8. Avoid eating large portions of grains.

THE FOLLOWING SUPPLEMENTS CAN BE USED TO HELP REDUCE CHOLESTEROL LEVELS: 1. Vitamin C – 1,000 milligrams twice a day. A low intake of vitamin C is linked to high cholesterol levels. 2. B-complex vitamins – 50 milligrams once a day. 3. Calcium carbonate – 1,000 milligrams once a day. 4. Vitamin E – 400 Units per day. 5. Carnitine – 1,000 milligrams per day. 6. Lecithin – 1to 2 tablespoons per day.

HERBS USED FOR CHOLESTEROL: 1. Onions, Garlic, and Ginger are recommended for their ability to help lower cholesterol levels. Include them – raw as well as cooked – in your diet as often as possible. As a garlic source, raw garlic is most likely best, but odor-controlled, enteric-coated tablets standardized for allicin content also appear to be effective. 2. Combine equal parts of fresh minced or grated garlic with fresh minced parsley. Mix with enough honey to make a syrup. Take 1 tablespoon 3 times per day. 3. Alfalfa leaf tea – 1 to 2 cups per day. To prepare, add 1 teaspoon of the herb per cup of boiling water and steep.

AS PHYSICAL THERAPY MEASURES: 1. Stress should be dealt with effectively through stress management techniques such as visualization and meditation. For more information, refer to the article on stress reduction. 2. It is important to exercise regularly. Vigorous physical exercise will boost HDL levels. At least 30 minutes 5 times per week should be engaged in physical exercise that will get your heart working vigorously. Brisk walking, aerobics, swimming, tennis, and racquetball are all excellent forms of exercise. 3. Since smoking highly increases risk for heart disease, try to quit. For more information on how to quit smoking, refer to the article on that topic.

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Recommended Minerals
-Copper -Iodine

Orthomolecular Treatment
-Arginine -Ornithine -Taurine -Glucomannan -Phosphatidylcholine -Policosanol -Resveratrol -Chondroitin -Squalene

Prescription
2 month cures seperated by 1 month rest periods Morning: Olea Europaea D1, 50-100 drops Evening: Juniperus Communis D1, 50-100 drops