Reduce Cholesterol Naturally

Beat Cholesterol By Scott Davis

Scott Davis' e-Book Beat Cholesterol in 30 Days is a useful compendium of information about natural methods and foods to avoid to lower LDL (bad) cholesterol. While the book is extremely useful in categorizing what helps and harms people in terms of diet, it's not so much a full-fledged system as opposed to a guidebook on foods that will improve and worsen your cholesterol levels. This program reveals to people 10 foods that they can use to keep their heart strong, and 3 drinks that can lower their cholesterol levels. The program also provides people with 11 dieting tips to prevent a heart attack, and a collection of delicious and easy-to-make recipes to fight cholesterol. In addition, Scott Davis will provide people with an instruction book and some special gifts when they order this program. When you download the e-book you learn how to be in control of your cholesterol and live a longer and more fulfilling life. Youll also learn diet tips, discover supplements that can help you and even learn how to avoid toxins found in most water. However, the most important thing that youll get is a 30 day action plan. More here...

Natural Cholesterol Guide Summary


4.8 stars out of 58 votes

Contents: EBook
Author: Scott Davis
Official Website:
Price: $49.00

Access Now

My Natural Cholesterol Guide Review

Highly Recommended

I've really worked on the chapters in this book and can only say that if you put in the time you will never revert back to your old methods.

Overall my first impression of this book is good. I think it was sincerely written and looks to be very helpful.

Dietary Cholesterol and Plasma Cholesterol

The effect of dietary cholesterol on plasma cholesterol levels has been an area of considerable debate. In 1972, the American Heart Association recommended that dietary cholesterol intake should average less than 300mgperday as part of a 'heart-healthy,' plasma cholesterol-lowering diet. Since that initial recommendation, a number of other public health dietary recommendations in the United States have endorsed the 300 mg daily limit. Interestingly, few dietary recommendations from other countries contain a dietary cholesterol limitation. The evidence for a relationship between dietary cholesterol and plasma cholesterol indicates that the effect is relatively small, and that on average a change of 100 mg per day in dietary cholesterol intake results in a 0.057 mmoll-1 (2.2mgdl-1) change in plasma cholesterol concentrations. Studies have also shown that the majority of individuals are resistant to the plasma cholesterol-raising effects of dietary cholesterol 'nonresponders' and have...

Dietary Cholesterol Intake Patterns

Dietary cholesterol intakes in the United States have been declining, from an average of 500 mg per day in men and 320 mg per day in women in 1972 to levels in 1990 of 360 mg per day in men and 240 mg per day in women. This decline is due in part to dietary recommendations to the US public to reduce total and saturated fat intake and to reduce dietary cholesterol daily intake to less than 300 mg and in part from the increased availability of products with reduced fat and cholesterol content. Major efforts in the early 1970s by public health agencies and advertising emphasized reducing dietary cholesterol as a means to lower plasma cholesterol levels, leading to a high degree of consumer concern regarding cholesterol-containing foods and demand for low-cholesterol products. Today, practically all foods sold in the United States are labeled for their cholesterol content and their percentage contribution to the daily value of 300 mg for cholesterol.

Safety of cholesterol reduction

The uncertainty concerning the excess mortality from hem-orrhagic stroke at low serum cholesterol concentrations is unresolved, as discussed above. This apart, there are no material grounds for concern about hazard. Trials of statin drugs, particularly informative on safety because of the large reduction in serum cholesterol that they achieve, have resolved the issue of safety because they show no excess mortality from non-circulatory causes.1'7-11 The excess mortality from cancer and accidents and suicide at very low serum cholesterol in observational studies is attributable to cancer or depression lowering serum cholesterol, not the reverse.19 Further reassurance on safety is provided by the condition of heterozygous familial hypobetalipoproteinemia, in which serum cholesterol levels are as low as 2-3 mmol l. Life expectancy is prolonged because coronary artery disease is avoided, and no adverse effects from the low cholesterol are recognized24,25 - an important natural experiment....

Statins as potential antiischemic drugs

Statins have made a considerable difference to the mortality of patients with ischemic heart disease in several studies. In the West of Scotland Coronary Prevention Study (WESCOPS), pravastatin was able to reduce hard end points in middle-aged hypercholesterolemic men without prior MI. In this group, the occurrence of angina pectoris was highly correlated (P 0-0001) with the primary end point, which was definite coronary heart disease death or non-fatal MI.73 Therefore, in hypercholesterolemic males with angina, statins are able to reduce hard end points. That they have a direct anti-ischemic effect is shown by reduction of ST segment deviations on 48 hour Holter traces in patients with stable angina pectoris, documented coronary artery disease and pre-existing antianginal therapy, the latter not being specified.74 Grade A Statin therapy can improve endothe-lial function, measured in the brachial artery, within 3 days in high-risk patients (elderly patients).75 Formal prospective...


Serum triglyceride concentration was associated with the risk of ischemic heart disease in many cohort studies, but the association is subject to confounding by serum LDL and HDL cholesterol, diabetes and other factors.4,30 The effect of dietary fat increasing factor VII will also produce an indirect association between triglycerides and heart disease mortality. Whether an independent association exists is double the population average.30 The 5 of men with highest LDL cholesterol (or its carrier protein, apolipoprotein B) experience 17 of the heart disease deaths.30 Grade A Including HDL cholesterol improves this poor detection by only about one percentage point. Lipids cannot identify a small minority of the population in whom the majority of future heart disease deaths will cluster.

Dietary Cholesterol

All dietary cholesterol is derived from animal products. The major sources of cholesterol in the diet are egg yolks, products containing milk fat, animal fats, and animal meats. Many studies have shown that high intakes of cholesterol will increase the serum cholesterol concentration. Most of this increase occurs in the LDL cholesterol fraction. When cholesterol is ingested, it is incorporated into chylomicrons and makes its way to the liver with chylomicron remnants. There it raises hepatic cholesterol content and suppresses LDL receptor expression. The result is a rise in serum LDL cholesterol concentrations. Excess cholesterol entering the liver is removed from the liver either by direct secretion into bile or by conversion into bile acids also, dietary cholesterol suppresses hepatic cholesterol synthesis. There is considerable variability in each of these steps in hepatic cholesterol metabolism for this reason the quantitative effects of dietary cholesterol on serum LDL...

Energy And Nitrogen Requirements

Contain whole protein as a nitrogen source, energy derived from triglycerides and glucose polymers, while electrolytes, trace elements and vitamins are included in recommended amounts. Standard polymeric diets contain approximately 6g nitrogen l with an energy density of lkcal ml. Other energy, nitrogen-dense diets (containing between 8 and 10 g nitrogen l and an energy density of 1-1.5 kcal ml) are used for those with higher requirements.

Oxidation of Fats and Amino Acids

The human body maintains only enough stored glycogen to last about a day. Then it must switch to fats as a fuel. Most fats are stored in the body as triglycerides. Because they are not soluble in water, they must be transported in the blood as lipoproteins. After a fatty meal the concentration in the blood may be sufficient to give it a milky opalescence. Lipase enzymes in the blood or in fatty tissues hydrolyze the lipoproteins to glycerol and to fatty acids bound to blood proteins. The glycerol enters glycolysis after a few steps involving ATP. The fatty acids enter the cell and react with CoA similar to the way pyr-uvate does at the start of the Krebs cycle. The fatty acid-CoA compounds are then transported into the inner compartment of the mitochondria, where a series of reactions split off the last two carbons of the fatty acid, with the CoA, forming acetyl-CoA and a shorter fatty acid-CoA. The process, called beta oxidation, is repeated until the fatty acid has

Xiimelting And Crystallization

Studies by Hernqvist (1984) shed light on the structure of triglycerides in the liquid state and how this affects crystallization. On the basis of x-ray diffraction and Raman spectroscopy studies, he suggested a gradual decrease in size with increasing temperature of the melt (Figure 2.7). The order in the melt is constant even at 40 C above the melting point. The order is related to chain length a long chain is more disordered at the methyl end-group plane than a short one. When the temperature is decreased, the lamellar units increase in size until crystallization occurs (Figure 2.8).

Tissue Cholesterol Synthesis

RCT describes the metabolism, and important antiatherogenic function, of the HDL-mediated efflux of cholesterol from nonhepatic cells and its subsequent delivery to the liver and steroidogenic organs for use in the synthesis of lipoproteins, bile acids, vitamin D, and steroid hormones. A cellular ABC transporter (ABCA1) mediates the first step of RCT involving the transfer of cellular cholesterol and phospholipids to lipid-poor apolipoproteins. Lecithin cholesterol acyltransferase-mediated esterification of cholesterol generates spherical particles that continue to expand with ongoing cholesterol esterification and phospho-lipid transfer protein-mediated particle fusion and surface remnant transfer. Larger HDL2 particles are converted into smaller HDL3 particles when CETP facilitates the transfer of cholesteryl esters from HDL onto apoB-containing lipoproteins. The scavenger receptor B1 (SR-B1) promotes selective uptake of cholesteryl esters into liver and steroidogenic organs,...

Maternofetal Conversion in Primates

To quantitatively estimate the relative contributions of the mother and fetus to supplying fetal brain DHA requirements, we studied the metabolism of LNA* and DHA* in pregnant animals, administering doses to the maternal or fetal bloodstream. Pregnant baboons consumed a LCP-free diet for approximately 8 wk prior to 13C tracer dose, to minimize effects of uncontrolled intake of LCP incidentally included in fishmeal of commercial primate diets. At the beginning of the third trimester (140 d of gestation age dGA , term 182 d), a U-13C -LNA or U-13C -DHA dose as nonesterified fatty acid in a soy oil emulsion was given intravenously to the pregnant animals or the fetuses. When fats are consumed, lipoprotein lipase located at the maternal side of the placenta cleaves LCP esterified in the triglycerides or phospholipids of lipoproteins into free fatty acids (Dutta-Roy, 2000 Stammers, Stephenson, Colley, & Hull, 1995), which can then bind to fetal plasma proteins and be transported to fetal...

Fats And Oils Flavors

Fats and oils comprising the bulk of foods such as shortenings, mayonnaise, and cooking oils often contribute unique flavors to the product. They are chemically referred to as lipids and occur in food mainly in the form of triglycerides. Fats and oils can either increase or decrease the flavor quality of foods, depending on the chemical reactions taking place during processing and storage. Under the right conditions fats and oils can be susceptible to oxida

Carbohydrate Digestion and Absorption

Dietary fats are composed primarily of water-insoluble triglycerides, some phospholipids, sterols, and sterol esters. Fat digestion is initiated in the stomach, where fats are warmed to body temperature, and subjected to intense mixing, agitating, and sieving action of the distal stomach. Fat globules are broken up into droplets and pass into the small intestine for further emulsification and eventual enzymatic hydrolysis. Although fat digestion is mainly dependent on pancreatic enzymes secreted into the duodenum, gastric lipase also plays a major role in the hydrolysis of triglycerides in the stomach of young animals. Digestion of triglycerides in the lumen of the small intestine involves the emulsification of lipid droplets released from the stomach by bile acids and phospho-lipids, the hydrolysis of emulsified particles by the combined action of pancreatic lipase and colipase as well as cholesterol esterase and phospholipase, and the formation of micelles that are small...

Cholesterol and Lipoproteins

The major classes of circulating lipoproteins in human plasma are chylomicrons, very low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). High fasting plasma concentrations of LDL cholesterol and triglycerides predominantly circulating as part of VLDL and low plasma concentrations of HDL cholesterol are associated with increased risk of cardiovascular disease. Dietary fatty acids can influence lipoprotein metabolism and therefore have the potential to influence atherosclerosis and cardiovascular disease risk. Most studies examining the effects of n-6 PUFAs on cholesterol metabolism have focused on LA, the major dietary n-6 fatty acid. It is now established that LDL cholesterol lowering reduces the risk of cardiovascular disease. In the fasting state LDL is the major cholesterol carrying lipoprotein in human plasma. The mechanisms through which raised plasma LDL cholesterol concentrations increase cardiovascular disease risk are not...

Dairy consumption energy intake and body weight

The association between increased dairy product consumption and healthier body weights has been attributed to several milk components, including conjugated linoleic acid (Wang and Jones, 2004), medium-chain triglycerides (St-Onge and Jones, 2003), and particularly calcium (Heaney et al., 2002 Zemel, 2004). Surprisingly, the role of milk proteins has received little attention, despite the fact that protein makes up a major fraction of milk and is the most satiating among the three macronutrients (Anderson and Moore, 2004).

Future Challenges And Opportunities Analytical Issues

Chemical analysis of excipient materials and trace-level impurities is a challenging task for pharmaceutical chemical analysis. The development of hybrid chromatography techniques such as liquid chromatography-mass spectroscopy, and also combination with magnetic resonance spectroscopy have facilitated better understanding of complex profiles of excipients (89). Specific excipients often require chemical profiling. For example, lecithin used in pMDI formulations may contain various proportions of phosphatidyl choline, triglycerides, fatty acids, and carbohydrates (89,90). Similar analytical issues are present for the detection, identification, and quantification of extractable and leachables in inhaled products. Because inhaled products are packaged and administered from plastic, rubber, and metal materials, the components of these may be extracted into the solvents and excipients of the formulation (91). The Food and Drug Administration in the United States has produced a draft...

Potential Applications And Future Developments

One area that is especially promising is the use of immobilized lipases for the chemical modification of fats. In-teresterification with free fatty acids or with other triglycerides using regiospecific lipases allows upgrading of cheap fats into more valuable fats such as cocoa butter substitutes. The immobilized enzyme could also be used to replace conventional chemical catalysts used in random in-teresterification. These processes have been well developed on the pilot scale, but the extent of commercial production is uncertain.

Lipid Secretion Pathway II

May be one of the most lipogenic organs in the body. In a fully lactating woman secreting 800 ml day of milk containing 4 fat, the mammary gland synthesizes approximately 32 g of triglyceride daily or approximately 6g, 10 of the weight of the woman, in a typical 6-month lactation. The fatty acids for triglyceride synthesis are synthesized from glucose or derived from the plasma lipids by the action of lipoprotein lipase. Once available in the mammary alveolar cells, fatty acids are either bound to a fatty acid binding protein or activated by combination with coenzyme A (CoA) and then bound to an acyl-CoA binding protein. Activated fatty acids are joined with glycerol-3-phosphate by transacy-lases located in the endoplasmic reticulum to form triglycerides, which enter the cytoplasm as protein-coated structures called cytoplasmic lipid droplets. These structures are translocated to the apical membrane, where they are enveloped by a novel budding process that leads to their release as...

Interactions Of Responding Systems

Although a hormone may trigger an overall cellular response by affecting some fundamental rate-determining reaction, several cellular processes may be affected simultaneously. Hormonal effects exerted at several locales within a single cell reinforce each other and sum to produce the overall response. Let us consider, for example, just some of the ways insulin acts on the fat cell to promote storage of triglycerides It inhibits breakdown of already formed triglycerides.

Methods of DHA Administration and Dietary Regimen

Docasahexaenoic acid was administered orally either as the ethyl ester or as the triglyceride. The DHA ethyl ester was supplied by the Charleston Laboratory through a grant from the Fish Oil Test Materials Program (NIH ADAMHA DOC). This material is no longer available at this time. The triglyceride preparation is supplied by the Martek Bioscience Corporation, as a product referred to as DHASCO ARASCO. The DHASCO supplies DHA, and the ARASCO provides arachidonic acid. The triglycerides contain 47 DHA and 46 arachidonic acid. They are administered as a microcapsule that can be sprinkled on food. The daily dosage of the ethyl ester varied between 100 and 500 mg, depending on the age and degree of DHA deficiency (Martinez, 2000). The initial dose of DHASCO ARASCO was 100 mg kg. Dosages are adjusted on the basis of plasma DHA and arachidonic acid levels, with the aim of maintaining these levels as close to normal as possible. Martinez does not recommend pharmacological supplementation with...

Definitions Of Lipids

The traditional definition of total fat of foods used by the U.S. Food and Drug Administration (FDA) has been the sum of the components with lipid characteristics that are extracted by Association of Official Analytical Chemists (AOAC) methods or by reliable and appropriate procedures.'' The FDA has changed from a solubility-based definition to total lipid fatty acids expressed as triglycerides'' 4 , with the intent to measure caloric fatty acids. Solubility and size of fatty acids affect their caloric values. This is important for products that take advantage of this, such as Benefat Salatrim, so these products would be examined on a case-by-case basis. Food products containing sucrose polyesters would require special methodology to calculate caloric fatty acids. Foods containing vinegar ( 4.5 acetic acid) present a problem because they will be considered to have 4.5 fat unless the definition is modified to exclude water-soluble fatty acids or the caloric weighting for acetic acid is...

Type I or Familial Chylomicronemia

This disorder is characterized by greatly elevated levels of exogenous triacylglycerols and it is the result of impaired lipolysis of chylomicrons due to a deficiency of LPL or its activator, the apo C-II. Several genetic mutations at the structural genes for both LPL and apo C-II have been reported. These are autosomal recessive traits. In the heterozygous state, subjects have normal to slightly elevated plasma triglycerides, whereas homozygotes have triacylgly-cerol levels that may exceed 1000 mgdl-1 in the fasting state. The diagnosis of the homozygous state takes place during the first years of life from the presence of recurrent abdominal pain and pancreatitis. Eruptive xanthomas and lipemia retinalis may also occur. The recommended treatment includes a diet low in simple carbohydrates and with a fat content below 20 of total energy. The use of medium-chain triglycerides (MCT) has also been reported to be efficacious. Body weight should be maintained within the normal limits and...

The role of plant sterols and stanols in functional dairy products in reduction of cholesterol

Plant sterols and stanols appear to be as effective in dairy products as in spreads with lowering of LDL cholesterol of 5-10 . No significant changes in HDL cholesterol or triglyceride occur with either food carrier. Volpe (2001) was the first to show an effect of low fat yoghurt containing 1 g day of soybean derived sterols (whether free or esterified was not specified) in 30 men and women with elevated LDL cholesterol. LDL cholesterol was lowered by 6.2 after four weeks compared with placebo. Eleven of the volunteers continued for another four weeks on 2 g day of sterols and achieved an LDL cholesterol-lowering of 15.6 but there was no placebo period to compare it with. Given that during the placebo period in the first part of the study LDL cholesterol fell by 4.9 it would appear that 2 g day of sterol in yoghurt lowers LDL cholesterol by about 10 . A 40 butter fat based spread containing 2.4 g day of esterified soybean sterols lowered median LDL cholesterol by 18.7 in a small study...

The present regulatory framework 1221 The US

Although a functional food is not necessarily a novel food, several functional products (mainly products, including dairy products, containing cholesterol-lowering phytosterols or -stanols) have been authorized according to the procedures outlined in the Novel Food Regulation (http comm

Metabolism and Temperature Regulation

Dietary lipids are usually in the form of neutral fats (fatty acids condensed with glycerol to produce an uncharged triglyceride) but may also include phospholipids and cholesterol. Ingested fats are digested by pancreatic lipase to produce free fatty acids, mono- and diglycerides. These are absorbed by simple diffusion, and reconstituted within the mucosal cell. Some lipid crosses the mucosal barrier by uptake as small lipid micelles. Reformed triglycerides, carrier proteins, phospholipids and cholesterol are then combined as chylos. The average intake of fat in the diet is 1-2 g kg although much lower intakes are well tolerated. A small percentage of the lipid intake must consist of essential fatty acids, which cannot be synthesized by the body. These include linoleic, linolenic and arachidonic acids.

Application To Triglyceride Crystallization

Turning at last to foods, the rates at which oils crystallize and undergo polymorphic transitions are important in determining texture and physical stability in a variety of food products (Larsson, 1982). Edible oils consist almost entirely of triglycerides, with small amounts of mono- and di-glycerides and other minor components (Swern, 1979, Chapter 1). Hence attention has been concentrated on crystallization of triglycerides (TG's).

The Presence Of Fatty Acid Ethyl Esters In Vitro And In Vivo

The first description of in vitro enzymatic synthesis of fatty acid ethyl esters came from Margolis in 1962 (Margolis, 1962). In experiments with adipose tissue microsomes, he showed that glycerol, ethanol, and several other alcohols form esters with 14C-palmitate when the alcohol is added in millimolar concentration. The esterification of these alcohols required the presence of CoA and ATP or of 14C-palmityl-CoA. Intrigued by this observation, Goodman and Deykin injected rats with 14C-radiolabeled ethanol and tentatively identified long-chain fatty acid ethyl esters in total-body lipid extract (Goodman, 1963). In 1965, Newsome and Rattray reported that porcine pancreatin contained a source of enzyme activity to esterify ethanol with fatty acids (Newsome, 1965). Patton and McCarthy in 1966 observed that goat milk converted alcohol and fatty acids into ethyl esters in vitro (Patton, 1966). A prominent spot was observed on the thin-layer chromatography autoradiogram between the solvent...

Fatty Acid Ethyl Esters As Fatty Acid Supplements

Supplementation and with the introduction of FAEE capsules for oral intake, there were a number of studies to evaluate ethyl ester absorption from the gastrointestinal (GI) tract. In 1991, Nordoy et al. reported that ethyl esters and triglycerides were equally well absorbed from the GI tract in human subjects (Nordoy, 1991). In 1992, Yamazaki et al. (Yamazaki, 1992) infused emulsions of ethyl eicosapentaenoate (ethyl EPA) into rat veins and demonstrated that the EPA content in the phospholipids of a variety of organs substantially increased. It has also been shown that treatment of normal volunteers with oral n-3 FAEE, with approximately 3 g of ethyl EPA plus ethyl docosahexaenoic acid (ethyl 22 6) per day, results in a marked accumulation of the fatty acids from these ethyl esters in the plasma and in cell lipids within 6 wk (Marangoni, 1993). Harris et al. conducted a randomized, placebo-controlled, double-blind, crossover trial in which 10 mildly hypertriglyceridemic patients were...

Synthetic Emulsifiers

The most commonly used emulsifiers in the food industry are mono- (MG) and diglycerides (DG). These are prepared commercially by direct esterification of edible fats or fatty acids (from vegetable or animal origin) with glycerol at elevated temperatures, or by interesterification of an oil with glycerol.483 During transesterifica-tion, triglycerides are heated with glycerol and a catalyst, usually sodium hydroxide, under vacuum at 200 C. As the fatty acids are hydrolyzed from the triglycerides, some re-esterify at other free hydroxyl positions to form mono- and diglycerides.84 The yield of MG depends on the proportion of triglyceride to glycerol used. Such methods were demonstrated by reacting the oils of coconut, peanut, sesame, linseed, and sardine and direct esterification of fatty acids with glycerol.85 Feuge and Bailey86 demonstrated that the proportions of glycerol, mono-, di-, and triglycerides can be calculated statistically based on two assumptions The reaction between...

Application Of Molecular Mechanics Calculations To Food Systems

Proteins, of course, are not the only molecules to which molecular modeling calculations can be applied. Simulations of food lipids have in the past been rare, but there have been a number of molecular dynamics studies of membranelike phospholipid bilayers (40), and of a few milkfat triglycerides (41,42). The example of the sweet proteins mentioned in the previous paragraph serves to introduce another broad area of potential application of theoretical techniques to food molecules, which is the development of sweeteners. Theoretical studies might help not only to elucidate what makes these proteins sweet but also to identify the important functional characteristics of other sweeteners (or any other flavorant) as well. In general, the interaction of a flavorant molecule with its receptor is the same problem as in drug binding. Currently such studies are hampered by a nearly complete lack of information about the receptor proteins. This situation also exists for many medical problems,...

Considerations For Future Intervention Trials

The long history of clinical studies in cardiovascular diseases, infant nutrition, and other illnesses have yielded valuable lessons that can help to form the design of future studies of psychiatric disorders. Baseline measurements are essential, as some subjects may enter the study with high tissue concentrations of EPA and DHA and supplementation may produce little additional effect. Biological markers are the most accurate measure of fatty acid status, but a simple dietary questionnaire may be able to screen out subjects with a high omega-3 intake. The baseline diet should be standardized at a low seafood and omega-3 intake. If subjects in the placebo group begin to eat more fish because of their excitement in being part of the study, then treatment effects may be difficult to detect. Consideration should be given to the course of their illness and number of failed treatments. For example, it may be difficult to detect treatment differences among subjects who are treatment...

Oilseeds And Vegetable Oils

A vegetable oil is made up of monoglycerides, diglycer-ides and triglycerides with the latter predominating. A triglyceride is composed of a glycerol molecule backbone with three fatty acid groups branched off it. Technically the term fatty acid applies to the series of compounds referred to as Cn n', where n is the number of carbon atoms and n' is the number of double bonds. The simplest fatty acid is formic acid (C1 0). However, fatty acids that occur in vegetable oils start with caproic (C6 0) and go up to behenic (C22 0) and erucic (C22 l). A saturated fatty acid has no double bonds between any of the carbon atoms. An unsaturated fatty acid has one (monounsaturated) or more (polyunsaturated) double bonds between the carbons. Oils having a higher percentage of saturated fatty acids have higher melting points. For example, shortening and margarine have a higher proportion of saturated fatty acids than salad or cooking oils. Occasionally the terms fat and oil are used...

Allium Organosulfur Compounds

Allium organosulfur compounds appear to possess a range of potentially cardioprotective effects. In one study, 432 cardiac patients were divided into a control group (210) and a garlic-supplemented group (222), and garlic feeding was found to reduce mortality by 50 in the second year and by approximately 66 in the third year. Furthermore, the rate of reinfarction was reduced by 30 and 60 in the second and third year, respectively. It should be noted that only a small number of patients in both groups experienced the end event of death or myocardial infarction, and a much larger scale study is needed. AGE lowers cholesterol and triglycerides in laboratory animals and can reduce blood clotting tendencies. It has been suggested that garlic supplementation at a level of 10-15 g of cooked garlic daily could lower serum cholesterol by 5-8 in hypercholestro-lemic individuals. However, there may be more important cardioprotective effects of garlic. In animal studies, AGE suppressed the levels...

Issues related to study design

A related issue is the use of experimental animals. Although these are often referred to as animal models their validity in predicting outcomes in humans is unclear. Lipid metabolism especially is species-specific, as exemplified by the lack of efficacy of cholesterol lowering statin drugs in many animal species, including monkeys.4 Experiments in animals are therefore best reserved for elucidating mechanisms, and cannot be used to argue that a particular food will have a particular effect on cardiovascular disease in humans.

Issues involving outcome variables

Intermediate variables have been frequently utilized in studies evaluating the association of dietary constituents or dietary patterns to cardiovascular diseases (CVD). Most often, these are risk factors like blood pressure or plasma lipids. However, it must be recognized that similar changes in total plasma cholesterol may be associated with variable effects on levels of LDL cholesterol and HDL cholesterol and on the ratio of total to HDL cholesterol. The impact on risk of atherosclerotic CVD may thus vary. The 25 year follow up experience of the Seven Countries Study revealed that while the increase in relative risk of CHD for comparable levels of plasma cholesterol elevation was similar across diverse populations, the absolute risk of CHD varied widely at the same level of plasma cholesterol, possibly due to other dietary and non-dietary influences.6 Dietary changes may also influence LDL particle size differentially, as also the level of plasma triglycerides, with variable net...

Nutritional And Health Aspects Of Palm

Recent years have seen a considerable amount of anti-palm-oil publicity, claiming that palm oil is unhealthy because of its saturated fat content. The allegation, however, has been challenged by recent animal and human feeding experiments (15). New findings now indicate that not only has palm oil little effect on raising blood cholesterol levels, but, in many instances, its consumption has led to a reduction in blood cholesterol levels (Table 3). The rationale for palm oil's lack of a cholesterol-raising effect despite the fact that it is classified as a saturated fat may be attributed to the following Moderate abundance of the cholesterol-lowering monounsaturated 18 1 oleic acid plus adequate amounts of the essential 18 2 linoleic acid.

Biologically Active Peptides

Serum cholesterol-lowering peptide was isolated from an enzymatic digest of soybean protein (20). Hydrophobic core peptides remaining after the digestion of the protein adsorb bile salt and destabilizes lipid emulsion (21). Consequently, intestinal reabsorption of bile salt and absorption of cholesterol are

The Possible Role of Nutrition in the Pathophysiology of Preeclampsia

Nutritional factors other than antioxidants can also contribute to oxidative stress. Hyper-homocysteinemia can occur as a result of dietary deficiencies. Hyper-homocysteinemia as a risk factor for pre-eclampsia is said to be altered, at least in part, by the genesis of oxidative stress. Vitamin B6 and B12 and folic acid are involved at different steps in the metabolic pathway for removing or recycling homocysteine to methionine. Dietary deficiencies of any of these micronutrients can increase circulating homocysteine. Pre-eclampsia is characterized by increased triglycerides that favor the formation of small, dense low-density lipoproteins (LDLs). This lipoprotein variant has increased access to the subendothelial space where it is sequestered from blood-borne antioxidants. The relevant role of triglycerides in the genesis of pre-eclampsia is indicated by the fact that they are increased long before clinically evident disease. Similarly, free fatty acids are increased in pre-eclampsia...

Regulation Of Vascular Smooth Muscle Cell Apoptosis

The bcl-2 family members are critical in regulating VSMC apoptosis, both in vitro and in vivo. Human VSMCs express low levels of Bcl-2, but Bax is expressed in atherosclerotic plaques reduced levels of VSMC apoptosis seen after cholesterol lowering in rabbit models of atherosclerosis is accompanied by a loss of Bax immunoreactivity. In vivo, rat VSMCs express minimal Bcl-2, but high levels of Bcl-X can be found after injury. Indeed, inhibition of Bcl-X dramatically induces apoptosis of VSMCs after balloon injury19 and differences in expression of Bcl-X may account for differences in apoptosis sensitivity of intimal versus medial VSMCs. Regulation of sensitivity to apoptosis in VSMCs is also mediated by expression of IAP proteins and individual caspases.

In vitroin vivo scaling of drug interactions

O.N., a 40-year-old white male with hypercholesterolemia, has had appropriate low-density lipoprotein levels by taking 40 mg pravastatin daily along with a controlled diet. His normal dietary routine includes a breakfast of cereal, low-fat milk, decaffeinated coffee, and orange juice each morning salad for lunch a sensible dinner and an evening snack of grapefruit juice and graham crackers. With the turning of the year, O.N.'s health maintenance organization sends a letter stating that pravastatin will no longer be covered by his prescription plan however, atorvastatin and simvastatin will be covered. O.N.'s physician switches him to 20 mg daily of simvastatin.

Physicochemical interactions

Aroma-matrices interactions (proteins, lipids, polysaccharides) The chemical composition of the matrix, and consequently its structure, influences release and perception of flavour. The main components of food matrix are primarily lipids, proteins, carbohydrate and water. In food, lipids are mainly triglycerides that increase solubility of aroma substances (Allaneau 1979). The volatility of most compounds is lower in lipids than in water (Le Thanh et al. 1992) and, consequently, flavour threshold concentrations determined in oil are generally higher than in water (Jo and Ahn 1999). A decrease of the concentration of volatile compounds in the vapour phase was observed when

Do individual trials actually change practice

Findings from the Coronary Drug Project indicated that the lipid-lowering agents clofibrate and niacin had no beneficial effect on mortality in survivors of myocardial infarction. During the years following the 1975 publication of these results, the number of patient visits involving prescription of lipid-lowering drugs dropped by more than half.2 Interestingly, a 3-fold increase in such visits was observed almost a decade later following a publication reporting that cholestyramine reduced the incidence of fatal and non-fatal coronary heart disease.2

The Composition of the Waste

The initial problem was to decolorize the complex wastewater from an industrial site. The waste originated in a pigment plant and advice indicated that it contained low molecular weight alkyd (sic) polyester resins derived from the reaction of triglycerides and anhydrides like phthalic anhydride along with epoxide resins, derived from bisphenol, and epichlorohydrin and amine resins from melamine and formaldehyde. Lesser quantities of higher molecular weight materials, from polymerization of vinyl, acrylate, or methacrylate monomers were also present. The effluent had a total organic carbon content (TOC) of 2770 mg l and a total suspended content (TSC) of 7429 mg l.

Bacterial Overgrowth Syndrome

Bacterial overgrowth occurs due to stasis of luminal contents resulting from strictures, fistulas, jejunal diverticula, blind loops, pouches, or motility disorders. The intestine becomes excessively colonized with both anaerobic and aerobic organisms. The latter use vitamin B12 and other nutrients for their own metabolism they deconjugate bile salts and in so doing prevent their use in fat absorption. Normal dietary fat should be substituted by medium-chain triglycerides. Hypoalbuminemia (low blood albumin concentration) may develop and cause oedema. Antibiotics should be given to eradicate the bacteria surgery is sometimes required.

How Changes In Surrogate Markers Predict Clinical Outcomes

A valid surrogate marker is one whose response to an intervention closely mimics that of the real (clinical) outcome it is supposed to represent. Unfortunately, this requirement is seldom met. The Veterans Affairs high density lipoprotein intervention trial6 reported that gemfibrozil reduced the risk of major coronary events in coronary patients with normal LDL cholesterol, but low HDL cholesterol. The assumption was that benefit was mediated through gemfibrozil induced increases in HDL cholesterol. When the investigators analysed the trial data to determine how much of the health benefit could be explained by individual changes in the surrogate marker (HDL cholesterol), they came up with the surprising finding that only 22 of the benefit could be attributed to gemfibrozil induced increases in HDL cholesterol. Similar observations have been reported for raised blood pressure (CD Furberg, unpublished data).

Byproducts of irradiation

Result from the breakdown of triglycerides amino acids that make up proteins and compounds (hydrocarbons) commonly found in the waxy coverings of fruits such as apples, pears, and berries. Others are fatty compounds identical to those found from cooking meat by common methods such as grilling. The other 10 of radiolytic compounds are chemically very similar to natural components in food. The chemistry of irradiation is very predictable, and the products of an individual component such as proteins are not affected by the type of food or other food components present. Radiolytic products have been critically tested for toxicity and no evidence of hazards has been found.

Influence of Omega3 PUFAs on Body Fluid and Sodium Homeostasis

The above-described homeostatic functions are, in large part, dependent on proper neural functioning and the n-3 PUFAs are crucial to neural function. Receptor-driven processes are also crucial to these homeostatic functions. n-3 PUFAs can influence mechanisms known to be involved in body fluid homeostasis. Vaskonen (1996) showed that supplementation of a high-sodium (6 ) diet with n-3 PUFA-rich fish oil increased the ability of stroke-prone-spontaneously hypertensive rats to excrete sodium and prevented the increase in blood pressure and water intake normally caused by the ingestion of 6 NaCl. Fish oil has also been shown to attenuate the increase in blood pressure caused by subcutaneous infusion of ANG II in normoten-sive rats (Hui, St.-Louis, & Falardeau, 1989). In normotensive humans (Kenny et al., 1992), ingestion of n-3 PUFAs (including 1200 mg d DHA and EPA) for 7 days decreased plasma triglycerides and attenuated the increase in vascular resistance caused by ANG II. The n-3...

Programming of the Adipoinsular Axis and Altered Adipogenesis

It is important to note that very few animal studies have addressed interactions between pre and postnatal nutrition. However, other studies that have investigated diet-induced obesity point to a link between peripheral leptin resistance and insulin resistance in the development of obesity. The physiological role of hyperleptinemia associated with caloric excess has been proposed to relate to the protection of nonadipocytes from lipid oversupply that would lead to steatosis and lipotoxicity.68 Elevated leptin production as a result of short-term caloric excess prevents the up-regulation of lipogenesis and increases fatty acid oxidation, thus reducing lipid supply to peripheral tissue during caloric excess.68 In diet-induced obesity, peripheral leptin function is at first normal. However, prolonged caloric excess results in dysregulation of post-receptor leptin signalling. This causes accumulation of triglycerides and lipid metabolites, providing fatty acid substrate for the damaging...

One Enantiomer with All or Most Activity

The antiinflammatory and analgesic effects of NSAIDs are attributed almost exclusively to the S enantiomer (13). * The R enantiomer, therefore, may be considered a useless and potentially harmful ingredient. However, for some NSAIDs with a 2-arylpropionic structure (profens), the inactive ii enantiomer acts as a prodrug because it is biotransformed to the active antipode. Hence, administration of the inactive enantiomer results in in vivo formation of the active antipode, thereby eliciting both antiinflammatory and analgesic effects. In such cases, then, there would seem to be little justification for the use of the single enantiomer. The prodrug nature of the R enantiomers of profens, however, has been overgeneralized based on data generated from laboratory animals (13). Indeed, in humans, among the available profens, the metabolic chirai inversion is known to be therapeutically significant only for fenoprofen and ibuprofen, for which 100 and 60 , respectively, of the R enantiomer is...

Biomarkers of Diseases

Perhaps the most important outcomes in intervention studies are changes in risk factors or biomarkers of disease, especially for cardiovascular disease. Lipoprotein cholesterol (HDL and LDL) concentrations are considered important biomarkers for risk of cardiovascular disease. In a large (N 65) study of men and women consuming six cups of black tea per day, there was no change in plasma LDL-cholesterol, HDL-cholesterol, or triglycerides compared to a control beverage. However, in a controlled diet study of 12 individuals with slightly elevated LDL-cholesterol, consumption of five cups of black tea per day compared to a control, caffeine-containing beverage resulted in a 6.5 decrease in total cholesterol and an 11.1 decrease in LDL-cholesterol after 3 weeks of consumption. There were no concomitant changes in HDL-cholesterol or triglycerides. A cholesterol-lowering effect of a theaflavin-enriched green tea extract has also been observed in a large (N 240), double-blind, randomized...

Compliance And Outcomes

The relation between compliance with lipid lowering drugs and cardiovascular risk was demonstrated in the Lipid Research Clinic's coronary primary prevention trial.10 The more doses taken, the lower the cardiovascular risk, with the greatest benefit achieved for patients who took full doses of cholestyramine daily. These data are included in the medication label to explain the value of full compliance. The Helsinki heart study demonstrated that lipid reductions were linearly related to gemfibrozil compliance.11 Effectiveness was greatly reduced among patients who took less than 70 of prescribed doses. Other studies have shown that patients readmitted to the hospital because of uncontrolled blood pressure had used significantly less medication than patients who were not readmitted (26 v 9 of days without medications).12 A small study with electronic monitoring showed a significant correlation between ambulatory diastolic blood pressure and mean compliance.13

Clinical Significance

Like the adverse effects of thiazides on glucose metabolism, their effect on plasma lipids is reversible. Therefore, discontinuation of thiazides and use of alternative agents which either lower (e.g., ACE inhibitors, calcium channel blockers) or do not change plasma cholesterol should probably be used for treatment of hypertension in patients with preexisting hypercholesterolemia or combinations of other risk factors such as diabetes, left ventricular hypertrophy, and cigarette smoking.

Vitamin E Bioavailability

Intestinal absorption of vitamin E is dependent upon normal processes of fat absorption. Specifically, both biliary and pancreatic secretions are necessary for solubilization of vitamin E in mixed micelles containing bile acids, fatty acids, and monoglycer-ides (Figure 3). a-Tocopheryl acetates (or other esters) from vitamin E supplements are hydrolyzed by pancreatic esterases to a-tocopherol prior to absorption. Following micellar uptake by entero-cytes, vitamin E is incorporated into chylomicrons and secreted into the lymph. Once in the circulation, chylomicron triglycerides are hydrolyzed by lipopro-tein lipase. During chylomicron catabolism in the circulation, vitamin E is nonspecifically transferred both to tissues and to other circulating lipoproteins. tocopherols or tocotrienols from the liver into the plasma in very low-density lipoproteins (VLDLs). In the circulation, VLDLs are catabolized to low-density lipoproteins (LDL are also known as the 'bad cholesterol' because high...

Rationale for the trial

It is also important that trials test the particular treatment on a background of usual accepted practice. Indeed when usual care of study patients does not include general advances in treatment, the trial results must be interpreted with a degree of caution. The management of patients with coronary artery disease is an important example. Many large scale trials of different therapeutic approaches do not embrace the contemporary approach which might include more complete use of arterial conduits during bypass surgery, stent deployment during percutaneous coronary intervention, and an aggressive approach to cholesterol lowering treatment as part of medical management.

Components of Parenteral Nutrition

Maximum lipid clearance occurs when lipids are infused over 24 h. Starting recommendations vary but it is generally accepted to start with 0.5-1gkg-1 day-1 between 1-3 days of life. Lipids should be advanced to an optimum of 3 gkg-1 day-1. Studies have shown that preterm infants have optimal protein retention when approximately 30-40 of calories are provided as lipids. Plasma triglycerides can be used to monitor lipid clearance. It is generally accepted that levels below 150-200 mgdl-1 indicate adequate clearance. Lipoprotein lipase and hepatic lipase are the major enzymes for clearance of intravenous lipid. These activities are inducible by low-dose heparin, which is usually present in central PN solutions. Administration of heparin should be considered in those infants receiving peripheral PN showing poor lipid clearance. In infants with hypertriglyceridemia the provision of 0.5-1 g kg-1 day-1 of lipid is adequate to prevent essential fatty acid deficiency and is a...

Mechanisms of CLA production in lactating ruminants and starter bacteria

Mechanism Lactation

The presence of CLA in the milk of lactating ruminants is a direct result of the action of the ruminal microbiota on dietary linoleic and linolenic acids. These fatty acids are primarily delivered in the form of glycolipids, phospholipids, and triglycerides from forages and seed oils (Bauman et al., 1999), which are released by indigenous and endogenously produced lipases following ingestion (Bauman et al., 1999 Dawson et al., 1977 Dawson and Kemp, 1970 Keeney, 1970) and subsequently undergo microbial biohydrogenation in the rumen by various ruminant bacteria of which Butyrivibrio fibrisolvens is the foremost (Fujimoto et al., 1993 Harfoot and Hazlewood, 1988 Kepler et al., 1966). The biohydrogenation process, which results in the conversion of linoleic and linolenic acids to stearic acid, consists of several steps (see Fig. 21.1). Rumenic acid is formed as the first intermediary in the biohydrogenation of linoleic acid via the activity of the microbial enzyme, linoleic acid...

Nonthiazide Hypocalciuric Diuretics

Indapamide (Lozol) is the first of a new class of oral antihypertensive diuretics, the indolines. In a randomized, prospective study, 75 patients with calcium nephrolithiasis and hypercalciuria were randomly assigned to three different therapies diet and fluid, diet and fluid + indapamide 2.5 mg day, and diet and fluid + indapamide 2.5 mg day + allopurinol 300 mg day 3 , During 3 years of treatment, indapamide caused a 50 drop in urinary Ca excretion. Thus, its hypocalciuric effect was as potent as that of the thiazide diuretics. Relative supersaturations of Ca oxalate and Ca phosphate also decreased by 50 . During the treatment period, the stone rate decreased by 95 in the indapamide group (significantly better than the 64 drop in the diet and fluid group). During indapamide treatment, there were no significant changes in serum glucose, total cholesterol or triglycerides. Serum uric acid increased by 1.0 mg dl and serum K decreased by 0.4 mEq liter after 3 years of treatment with...

Bile acid sequestering agents resins

This class of agents was first developed for the treatment of cholestasis-related pruritus by Carey and Williams in 1960. Hashim and Van Itallie subsequently demonstrated that cholestyramine lowered plasma cholesterol and it has been Resins are associated with significant reductions in plasma total and LDL-C and with small increases in plasma HDL-C levels.51 Plasma triglycerides are inconsistently affected, but substantial increases may occur, if used in those with already elevated plasma triglyceride levels.52 In familial dysbeta-lipoproteinemia (type III or remnant removal disease) plasma triglyceride levels may increase by more than threefold. The newest agent in the resin class is colesevelam, available for use in the US since 2000. It is a polymeric, high-potency, water-absorbing hydrogel with a non-systemic mechanism of action.55 Based on data from approximately 1400 subjects, colesevelam reduced LDL-C by a median of 20 the reduction is dose-dependent. When combined with...

Mechanisms Of Vascular Toxicity

Thesis and metabolism of dimethylarginines are not completely understood however, they are probably formed from the degradation of methylated proteins (58). Endothelial cells are capable of synthesizing small amounts of ADMA (59), and this synthesis is upregulated in the presence of methionine or homocysteine (60). The production of ADMA by human endothelial cells is regulated by S-adenosylmethionine-dependent methyltransferases, and production is upregulated by native or oxidized low-density lipoprotein. This provides a mechanism by which homocysteine can impair endothelial function, particularly in the presence of hypercholesterolemia. The hypothesis that ADMA is an important mediator of homocysteine-induced dysfunction is further supported by data showing that, in monkeys, diet-induced hyperhomocysteinaemia produced twofold to threefold increases in both tHcy and ADMA. However, supplementation with B-group vitamins decreased the plasma level of tHcy but did not affect the plasma...

Fibric acid derivatives Table 132

The fibrates currently marketed in the US are clofibrate, gemfibrozil, and fenofibrate. Fibrates available in other countries include bezafibrate, fenofibrate, ciprofibrate, becla-fibrate, etiofibrate and clinofibrate. In a WHO study clofibrate was shown to reduce modestly (P 0-05) all cardiovascular events. However, increases in non-cardiovascular morbidity and mortality and total mortality occurred.58 In the Helsinki Heart Study, gemfibrozil was associated with a 35 reduction in MIs, particularly in those with elevated levels of plasma LDL-C and triglycerides and low levels of plasma HDL-C. Increases in non-cardiovascular deaths and no reduction in total mortality was observed,59 leading to concerns about the use of fibrates. No fibrate trial has yet shown a significant decrease in total mortality. These agents are approved for use primarily in those with hypertri-glyceridemia. Clofibrate can be toxic in some early studies there was a high mortality rate from malignancy and...

The atherosclerotic plaque

Since the discovery of endothelium dependent relaxation, and its biochemical entity, nitric oxide (NO), it has been recognised that the endothelium plays an important role in vascular biology. Several roles have been ascribed to vascular NO including modulation of tone, inhibition of platelet aggregation, inhibition of VSMC proliferation, and production of potentially destructive free radicals, in particular peroxynitrite. The earliest detectable physiological manifestation of atherosclerosis is reduced production of NO in response to pharmacological or haemodynamic stimuli. This phenomenon is present even in children with hypercholesterolemia,1 and is consistent with the hypothesis that high circulating concentrations of atherogenic lipoproteins lead to endothelial dysfunction and (by unknown mechanisms) subendothelial lipid accumulation. Importantly, however, it remains unclear whether this manifestation of endothelial dysfunction is a cause or a consequence oflipid accumulation,...

Recognizing Causative Factors of Undernutrition

A wide variety of prescribed drugs can cause anorexia, nausea, and other symptoms of gastrointestinal distress in older persons, rendering medication review an important component of nutritional management. Digoxin, theophylline, and nonstero-idal anti-inflammatory agents are frequent culprits in this regard. Enquiry must also be made into the use and tolerance of self-prescribed medication. Offending drugs, once identified, must be discontinued. Iatrogenesis also contributes to undernutrition by way of therapeutic diets. Low-cholesterol and low-salt diets are often prescribed to older persons on the basis of data extrapolated from younger persons. There is currently little evidence to suggest that these diets are of any benefit to older persons when used as primary prevention strategies. Available data actually indicate increased mortality in older adults with low-cholesterol levels. Evidence suggests that hypocholesterolemia may reflect increased cytokine expression in acutely ill...

Degenerative valve disease

Standing Seam Panels

Another study found an association between atherosclerotic risk factors and mitral annulus calcification, and stenotic and non-stenotic aortic valve calcification.8 The analysis was done from a prospective database of 8160 consecutive patients and showed that age (odds ratio (OR) varying from 5.78 to 10.4, depending on age class), hypertension (OR 2.38), diabetes mellitus (OR 2.85), and hypercholes-terolaemia (OR 2.95) were strongly and significantly associated with aortic valve calcification, as were age (OR varying from 8.82 to 67, depending on age class), hypertension (OR 2.72), diabetes mellitus (OR 2.49), and hypercholesterolemia (OR 2.86) with mitral annu

Enterohepatic Bile Acid Transporters In Liver Disease

Mutations in the SLC10A2 gene encoding ASBT have been identified that can cause primary bile acid malabsorption, a rare disorder of the intestine characterized by congenital diarrhoea, steatorrhea and reduced plasma cholesterol levels.38 The ASBT variants carrying these mutations exhibit severely reduced bile acid transport activity in vitro.

Shelf Life Butea Monosperma

Other potential sources of lecithin include canola rapeseed, sunflower seed, peanut, palm kernel, xenophytic curcurbit seed, cereal grains including wheat, barley, and rice, and olive, mango, and avocado fruit. Nonconventional sources include palash (Butea monosperma), papaya (Caricapapaya), jangli bodani (Sterculia factida), coriander (Coriandrum sativum), and carrot (Daucus carota) seed. Phosphatidyl-choline, phosphatidylethanolamine, and phosphatidylinositol have been identified as major components in all of these sources.48,49,61,65-74 Minor components include lysophosphatidylcholine, lysophosphatidylethanolamine, phosphatidic acid, phos-phatidylglycerol, glycolipids, and triglycerides. Differences were noted among minor phospholipids which could alter the functionality of lecithin derived from these seed sources. Canola lecithin has been shown to contain a greater amount of glycolipids than sunflower and soybean lecithin.

In Vivo Applications Liver Transduction

The potential of liver-directed, HDAd-mediated gene therapy was investigated for the phenotypic correction of hypercholesterolemia in the apolipoprotein E-deficient (apoE_ _) mouse model. 6 Apolipoprotein E, a 34-kDa plasma glycoprotein, is a component of all plasma lipoproteins except low-density lipoprotein (LDL) and plays a major role in lipoprotein catabolism by acting as a ligand for the LDL-receptor (LDLR) and the LDLR-related protein for transport of excess cholesterol from the peripheral tissues to the liver for excretion. The apoE_ _ mouse is an excellent model for cardiovascular disease because they develop severe hypercholesterolemia and atherosclerotic lesions similar to those found in humans. Chan and coworkers investigated correction of hypercholesterolemia in apoE_ _ mice with either a FGAd or a HDAd expressing apoE. 6 Injection of apoE_ _ mice with FGAd resulted in an immediate rise in plasma apoE levels and a concomitant drop in plasma cholesterol levels to within...

Brain Lipids during Development

The lipid content and composition of the brain at early stages of growth are very similar to those of other tissues. However, due to a rapid synthesis of lipids in the brain during development, lipid content as well as composition of the mature nervous tissue become markedly different from those of tissues in the rest of the body. The brain also differs from other tissues in that it is rich in more complex and polar lipids. On the other hand, the adult brain contains negligible quantities of esterified cholesterol and almost none of the triglycerides that are abundant in almost all other tissues.

Three Mechanical Characteristics Of Muscle

Fast Twitch Slow Twitch Muscles

Another area where the Force-Velocity Relationship shows dramatic differences in muscle performance is related to muscle fiber types. Skeletal muscle fibers fall on a continuum between slow twitch (Type I) and fast twitch (Type II). Type I are also called Slow-Oxidative (SO) because of their high oxidative glycolysis capacity (considerable mitochrondion, myoglobin, triglycerides, and capillary density). Type II fibers are also called Fast-Glycolytic (FG) because of their greater anaerobic energy capacity (considerable intramuscular ATP and gly-colytic enzymes). Muscle fibers with intermediate levels are usually called FOG (Fast-

Prevention and Treatment of Diuretic Induced Hypokalemia

The first approach to preventing diuretic-induced hypokalemia is to use the lowest dose possible (Table 1). With regard to thiazide diuretics, the majority of the blood pressure lowering effect is seen at doses of 12.5-25 mg day. At higher doses, further blood pressure lowering is minimal, but rather, metabolic side-effects such as hypokalemia, hyperglycemia, and hypercholesterolemia become more prevalent.

Increasing consumption what is being done

In several programmes, emphasis is placed on the education and involvement of children, because many of the processes linked to the development of chronic disease begin in childhood. Evidence from the Bogalusa Heart Study, tracking early risk of heart disease among American children, suggests that eating habits in childhood have a potential lifelong effect on cholesterol levels and on adult coronary heart disease.32 A study of British schoolchildren found that children who ate fruit more than once per day had better lung function compared with those who did not. The difference was evident even after controlling for possible confounding factors such as social class and passive smoking.33 A further study in Italy found that even low intakes of fruit can reduce wheezing and asthma with effects being most noticeable in children with a history of respiratory problems.34 Continued attention to increasing fruit and vegetable consumption in children is viewed as a practical and important way...

Biological programming a new theoretical model about the aetiology of heart disease

The dawn of modern epidemiology came after the second world war, first with ecological studies comparing CVD incidence and mortality, and subsequently multicentre cross sectional and follow up studies on CVD.w3 The studies showed that populations with high CVD mortality have high cholesterol and high blood pressure, and that smoking and obesity are common among these populations. 4 This led to the lifestyle model in understanding the aetiology of chronic diseases, where the key issues are health behaviour and the interaction between genes and an adverse environment in adult life. This was consequently followed by intervention programmes, which have significantly improved heart disease risk status in many countries.w3 However, lifestyle factors only explain part of the heart disease risk, which is why other reasons have been sought. For example, in the mid 1980s Rose pointed out that the well established risk factors for coronary heart disease (CHD) cigarette smoking, high serum...

Costs and cost effectiveness of lipid alterations for CHD prevention

True benefits for individuals and the public health have only been demonstrated for alteration of plasma LDL-C. One method for comparing the costs of cholesterol lowering is shown in Table 13.5 where the cost of the various statins is given in terms of the number of dollars per per cent of LDL-C lowering per year. Table 13.5 Comparative cost, dose and LDL-C lowering of statins Table 13.5 Comparative cost, dose and LDL-C lowering of statins

Procedures For Msms Screening

Long-term therapies for most diseases include low-protein and or low-fat diets. Depending on the respective diseases, carnitine supplementation, coenzyme administration, avoidance of fasting, and treatment of acute episodes with intravenous infusion of glucose may be required. Medium-chain triglycerides are used for some fatty acid oxidation disorders, and sodium benzoate or alternatives are for hyperammonemia of urea cycle disorders.

Thoracic Duct Injuries

Keeping the patient from eating and providing adequate drainage of the pleural cavity with a chest tube for several days usually results in spontaneous closure of the fistula. If the fistula persists and is large, nasogastric suction can help reduce the amount of chyle draining, and intravenous hyperalimentation can help prevent the protein malnutrition that can rapidly develop in these patients. If the patient is allowed to eat, a strict no-fat diet or a diet in which fat is given only as medium-chain triglycerides is preferred. If the drainage is greater than 1500 mL day and leads to metabolic and nutritional problems or persists for more than 14 days, surgery to ligate the duct is generally indicated.

Integrated Actions Of Metabolic Hormones

Although reesterification of fatty acids can regulate FFA output from fat cells, regulation of lipolysis and hence the rate at which the cycle spins provides a wider range of control. It has been estimated that under basal conditions 20 of the fatty acids released in lipolysis are reesterified to triglycerides, and that reesterification may decrease to 9-10 during active fuel consumption. Under the same conditions,

Bile Secretion And Gall Bladder Function

Bile Acids

Converted into the other lipoproteins. The lipoproteins transport cholesterol and triglycerides throughout the body. Loss of excessive bile acids into the colon produces diarrhea. Bile acids or their degradation products inhibit colonic absorption of sodium and H2O. This results in diarrhea without loss of fat in the stool, if the resynthesis of bile acids can keep up with the loss. In cases of extreme loss, such as after ileal resection, the digestion and absorption of long-chain triglycerides is also impaired and steatorrhea results as well. The steatorrhea can be cured by substituting medium-chain triglycerides for long-chain triglycerides in the diet. Medium-chain triglycerides do not require micelle formation for absorption.

Dairy components and food intakesatiety

Medium-chain triglycerides triglycerides (LCT). Whereas LCT are packaged into chylomicrons and transported through the lymphatic circulation to peripheral organs, MCT are absorbed directly into the portal circulation and transported to the liver for rapid oxidation (St-Onge and Jones, 2002). It has been suggested that increased consumption of MCT might be an effective strategy to prevent obesity through combined action of increased energy expenditure, decreased fat deposition and increased satiety (St-Onge and Jones, 2002). However, this discussion will focus exclusively on the effects of MCT on food intake and satiety and their mechanisms of action.

Classes of Carbohydrates

These are organic compounds that usually contain a fatty acid or a fatty acid derivative. Lipids are a highly diverse and varied class of compounds soluble in organic solvents. Fat is obtained in the diet from either animal or vegetable sources as triglycerides. Triglycerides are composed of molecules of glycerol and three fatty acids. The fatty acids may be saturated, unsaturated, or contain multiple unsatura-tions (polyunsaturated fatty acids, PUFAs). In addition, lipids contain sterols, ste

Chylomicron Exocytosis Mechanism

Chylomicron Formation

The major component of dietary fat consists of triglycerides, three fatty acids esterified to glycerol. The principal saturated fatty acids are palmitic (C16) and stearic (C18). The unsaturated ones are oleic (CIS, one double bond) and linoleic (C18, two double bonds). All fatty acids contain an even number of carbon atoms. Phospholipids are present in the diet in small amounts and consist of glycerol esterified to two fatty acids and to either choline or inositol at the 3 position of glycerol. Cholesterol is ingested in the form of cholesterol esters with the fatty acid esterified to the 3-OH group of the sterol nucleus. These three types of compounds are shown in Fig. 8. The churning and mixing that occur in the distal portion of the stomach break lipids into small droplets, greatly increasing the total surface area available to digestive enzymes. These droplets are kept apart by emulsifying agents. The latter are amphipathic compounds (see Chapter 34) such as bile salts,...

Effects on Particular Organs or Organ Systems

Mechanisms that impair the release of triglycerides to the blood. Carbon tetrachloride and ethanol are among the substances that can cause this. Necrosis is caused by carbon tetrachloride, which forms free radicals in the liver, as well as by other halogenated hydrocarbons. Cirrhosis is the formation of scar tissue in the liver. It is also caused by carbon tetrachloride, although ethanol is most commonly associated with this condition. Although there is evidence to the contrary, the effect of ethanol may be related to nutritional deficiency associated with alcoholism. Cholestasis is an inflammation of the ducts carrying bile or a decrease in bile flow by other mechanisms. There are many types of liver cancer, and many chemicals are known to cause cancer in laboratory animals. The role of chemicals in human liver cancer is less clear, except for the notable case of vinyl chloride, which is known as a potent cause of angiosarcoma.

Edible Plants and Phytochemicals

Soy protein extracts have been found to lower cholesterol in humans, an effect that appears to be related to amino acid composition. Soy protein extracts frequently contain nonprotein isoflavones, which have received considerable attention because of their structural similarity to estrogen. Soy isofla-vones are weak estrogen agonists and partial estrogen antagonists. Epidemiologic and experimental data indicate that isoflavone exposure during adolescence may diminish the incidence of adult breast

Dietary Sources High Intakes and Antimetabolites

The greatest interest, in pharmacological terms, has been centered around nicotinic acid, which has been shown to have marked antihyperlipidemic properties at daily doses of 2-6 g. Nicotinamide does not share this particular pharmacological activity. Large doses of nicotinic acid reduce the mobilization of fatty acids from adipose tissue by inhibiting the breakdown of triacylglycerols through lipolysis. They also inhibit hepatic triacylglycerol synthesis, thus limiting the assembly and secretion of very low-density lipoproteins from the liver and reducing serum cholesterol levels. Large doses of nicotinic acid ameliorate certain risk factors for cardiovascular disease for instance they increase circulating high-density lipoprotein levels. The ratio of HDL2 to HDL3 is increased by nicotinic acid there is a reduced rate of synthesis of apolipoprotein A-II and a transfer of some apolipoprotein A-I from HDL3 to HDL2. These changes are all considered potentially beneficial in reducing the...

Health benefits of CLA

Comprised of 85-90 rumenic acid (Lock and Bauman, 2004). Some studies do however focus on rumenic acid primarily, and in this regard rumenic acid has been associated with improving cardiovascular health, anti-carcinogenic properties and improved immune function. Studies in hamsters showed that dietary rumenic acid improved the ratio of non-high density lipoprotein (HDL) cholesterol to HDL cholesterol (Valeille et al., 2005), improved HDL cholesterol and the ratio of HDL cholesterol to LDL cholesterol (Valeille et al., 2004) and significantly reduced plasma triglyceride concentrations (Wilson et al., 2006). The anti-atherogenic effects of the ingestion of high CLA milkfat (2.59 rumenic acid, which also contained a low concentration of saturated fat (67 )) versus a low CLA milkfat (0.39 rumenic acid, which contained a high concentration of saturated fat (72 )) were compared in hamsters (Valeille et al., 2006). It was found that hamsters on the high CLA milkfat diet had 25 less aortic...

Calcium antagonists and p blockers in effort angina

The combined message emerging from APSIS, TIBET, ASIST, and PREVENT is this the real problem is that the incidence of hard end points, such as mortality, infarction, or unstable angina, is so low in chronic stable effort angina that vast trials would be needed to show beyond doubt that calcium antagonists or p blockers do more than relieve symptoms. For example, it can be estimated that a study of 600 total deaths in effort angina, even with a risk reduction of one quarter, would need about 30 000 patients in a long-term trial (60 000 if the end point is cardiac mortality) to show any differences between calcium antagonists and p blockers. Trials of this size are, in the view of the present author, unlikely ever to be undertaken. Rather, it makes much more sense to select high-risk patients (see section on nicorandil) with clusters of risk factors, such as age, male gender, hypertension, smoking, and hypercholesterolemia. Alternatively, trials carefully designed to establish whether...

Effects of Diet on Chylomicron Metabolism

Diets very high in saturated fat have been associated with increased postprandial chylomicrons and chylomicron remnants compared with diets rich in n-6 polyunsaturated fats however, human experiments carried out using moderate to high fat intake have not shown significant effects of different types of dietary fat or dietary cholesterol on postprandial lipoproteins.

Maillard Reaction And Formation Of Heterocyclic Flavor Compounds In Food

Maillard Reaction Food

Aldehydes containing less than five carbon atoms usually are associated with the development of off-flavors. However, unsaturated alkenals containing 5 to 10 carbon atoms impart desirable flavor attributes to fresh vegetables cis- and iran.s-2-hexenals are both potent aroma compounds of green leaf' character. The melonlike odor of cucumbers are due to eis-2-nonenal (Fig. 18). Aliphatic aldehydes may arise and accumulate in vegetables from precursors such as esters, amino acids, and free fatty acids. Esters can be hydrolyzed by esterases and followed by enzymatic oxidation (NADP-dependent dehydrogenases) to produce aldehydes. Amino acids can be converted into a-keto acids by the action of transaminases, followed by enzymatic decarboxylation to produce flavor aldehydes. Triglycerides in plant tissue can be hydrolyzed by lipases to produce free fatty acids, which in turn can produce long-chain aldehydes by the action of lipoxygenases and lyases.

Nutrients in the soil in the absence of permanently cultivated fields hotcold health systems See humoral medicine human

The phrase hunter-gatherers minimizes sometimes heavy dependence on fishing. Also referred to as foragers. hydropathy. The treatment of diseases with the copious and frequent use of pure water. hypotheses. Predictions, which may be derived from theories, about how variables are related. hypercholesterolemia. One of the genetic forms of coronary heart disease that manifests in the 4th or 5th decade of life. Genetically deficient low-density lipoprotein (LDL) protein receptors (LDLRs) in the liver cause LDL cholesterol to accumulate in the blood, resulting in high blood cholesterol, atherosclerosis and heart disease. hyperglycemia. Too high a level of glucose in the blood. hypertriglyceridemia. Elevation of triglycerides in the bloodstream. hypoxia. A condition of oxygen deficiency that often occurs at high altitudes.

Fat Distribution and Disease Risk

Researchers have found positive correlations between fasting glucose, insulin, blood pressure, total cholesterol, LDL cholesterol, and triaclyglycer-ols using imaging techniques, sagittal diameter, waist circumference, and WHR in most, but not all, studies. Visceral fat and HDL cholesterol are inversely associated. The strength of the associations varies but tends to be largest for triaclyglycerols. Associations are reduced after controlling for BMI and age. disease risk factors, including abdominal obesity, cluster in individuals. This cluster of risk factors is referred to as metabolic syndrome. The other risk factors in metabolic syndrome are insulin resistance glucose intolerance, dyslipidemia (high triaclygly-cerols and low HDL cholesterol), and high blood pressure.

Increased standard of living leading to deleterious health behaviors

A third reason to arouse concern is that, if population levels of CVD risk factors rise as a consequence of adverse lifestyle changes accompanying industrialization and urbanization, the rates of CVD mortality and morbidity could rise even higher than the rates predicted solely by demographic changes. Both the degree and the duration of exposure to CVD risk factors would increase as a result of higher risk factor levels, coupled with a longer life expectancy. The increase in body weight (adjusted for height), blood pressure and cholesterol levels in Chinese population samples aged 35-64 years between the two phases of the Sino-MONICA

Serum cholesterol and ischemic heart disease

Evidence from genetics, animal studies, experimental pathology, epidemiologic studies and clinical trials indicates conclusively that increasing serum cholesterol is an important cause of ischemic heart disease and that lowering serum cholesterol reduces the risk,5,6 and the results of six large randomized trials of statins have ensured that this is now widely accepted.1,7-11 Three important practical questions arise the nature of the dose-response relationship, the size of the effect, and the speed of the reversal of risk. To answer these questions data from both observational epidemiology (cohort studies) and randomized controlled trials are necessary. The two are complementary examining trial data alone is misleading. Table 12.1 summarizes the advantages of each. In cohort (or prospective) studies serum cholesterol is measured in a large number of individuals and subsequent heart disease mortality (or incidence of myocardial infarction) is recorded. Cohort studies are easier to...

Fortifying the Bile Acid Binding Ability

It is well known that soybean proteins have a cholesterol lowering effect in human serum (65,66). Several mechanisms for the regulation of serum cholesterol have been proposed. As a major one, an undigested insoluble fraction of soybean protein interacts with cholesterols and bile acids in the intestine, and they are excreted into an easing (67,68). Most probably, hydrophobic interactions play an important role in these interactions. Makino et al. found that the 114-161 residues in A1aB1b, one of the peptides generated by trypsin digestion of glycinin, have a bile acid binding ability (69). On the other hand, Iwami et al. confirmed that peptides generated by hydrolysis of mild acids contain residues having highly hydrophobic properties derived from -conglycinin, and these peptides actually bind bile acids (70).

Ethnic and Racial Issues

The epidemiology of stroke among Hispanic Americans is quite different from that of African Americans. Overall, Hispanic Americans are less likely than non-Hispanic whites to have a stroke. Death from stroke is more likely among younger Hispanic Americans, and less likely among the elderly Hispanics, in comparison to non-Hispanic whites. Hemorrhages are more common among young Hispanics than among non-Hispanic whites or Native Americans. The presence of hypertension as a stroke risk factor is higher (79 ) among Hispanics than among non-Hispanic whites (63 ), according to the Northern Manhattan Stroke Study, after controlling for the influence of socioeconomic status. Diabetes is more prevalent among Hispanic Americans (41 ) than among non-Hispanic whites (26 ), but cardiac disease was nearly twice as common (61 vs 32 ) among non-Hispanic whites. Cholesterol levels are generally lower for Hispanic Americans, but alcohol consumption was more prevalent (37 vs 23 ). Since alcohol...

Glycogen Storage Disorders

Glycogen storage disease (GSD) type I (GSD I) (Figure 6), the most common disorder, is due to a deficiency of glucose-1-phosphatase in the liver, kidney, and intestinal mucosa. Symptoms typically occur in infancy when the frequency of feeding decreases. Profound hypoglycemia can occur progressive hepatomegaly and liver dysfunction are due to storage of glycogen. Other metabolic derangements include lactic acidaemia, which is due to increased pyruvate production increased fatty-acid synthesis causes hypertriglyceridemia and hypercholesterolemia (causing xanthomas) hyperuricemia (causing gout and renal calculi) is due to decreased renal excretion (lactate is preferentially excreted) and increased uric-acid production owing to phosphate depletion. Other long-term complications include progressive renal disease (proteinuria) and hepatocellular carcinoma. Treatment involves frequent meals and continuous nocturnal feeding (in infants) supplemental uncooked cornstarch provides exogenous...

Exogenous Cholesterol Transport

Cholesterol is absorbed in the unesterified state, whereas the cholesterol secreted into the lymph is 70-80 esterified. This esterification process generates a concentration gradient of free cholesterol within the mucosal cell that may facilitate absorption rates. Cholesterol is esterified in intestinal mucosal cells by acyl-coenzyme A cholesterol acyl-transferase-2 to form cholesteryl esters, which are secreted from the basolateral surface of the entero-cyte as part of the chylomicrons. At this stage, it is assumed that cholesterol molecules from exogenous and endogenous sources are indistinguishable and have similar effects on endogenous cholesterol and lipoprotein metabolism. Chylomicrons are large particles ( 70 nm in diameter) composed mainly of triacylglycerols (95 by weight) and contain 37 cholesterol by weight, with the esterified cholesterol localized in the hydrophobic core and the free cholesterol primarily in the hydrophilic outer layer. The data indicate that the amount...

Phenotypic expression of a single gene

Familial hypercholesterolemia is an autosomal dominant trait that is characterized by elevated low-density lipoprotein (LDL), cholesterol, tendon xanthomas (cholesterol-containing tumors), and premature coronary heart disease. The molecular basis of this disease is mutations in the gene coding for the LDL receptor. The LDL receptor protein, located on the surface of most body cells, plays a pivotal role in the removal of LDL cholesterol from the blood circulation. Due to mutations in the LDL receptor genes, the production and function of LDL receptors are drastically altered leading to the accumulation of LDL cholesterol in the circulation. In heterozygotes, with a frequency of about 1 in 500 in most populations, the number of receptors is reduced to almost a half. In rare homozygous cases (1 1 000 000), the number of LDL receptors is reduced drastically and

Health Effects of Carbohydrates

Certain NSP (for example fi glycans) have been shown to reduce low-density lipoprotein (LDL) and total cholesterol levels on a short-term basis. Therefore, a protective effect for CVD has been shown with consumption of foods high in NSP. This High-GI diets have been shown to slightly increase hemoglobin A1c, total serum cholesterol and triacylglycerols, and decrease HDL cholesterol and urinary C-peptide in diabetic and hyperlipi-demic individuals. In addition, low-GI diets have been shown to decrease cholesterol and triacylgly-cerol levels in dyslipidemic individuals. There are insufficient studies performed on healthy individuals and further research on the role of GI in lipid profile and CVD risk factors is warranted.

Other Major Risk Factors

Major risk factors other than LDL cholesterol and diabetes are listed in table 3.1. Age, blood pressure, and high density lipoprotein (HDL) cholesterol, as well as total cholesterol, are used as continuous variables to calculate CHD risk in the current Joint British Societies' guidelines, together with cigarette smoking and diabetes as categorical variables.5 Alternatively age, hypertension, low HDL cholesterol, and family history of premature CHD can all be used as categorical variables to calculate risk.4 A family history of death from CHD in either parent before age 55 conferred a relative risk of 1.3 in their progeny in the Framingham study,6 whereas in the US nurses health study

Micronutrient Deficiency

There is a rising trend toward dietary supplementation with pharmaceutical preparations containing large doses of vitamins and minerals, based on conclusions drawn from the results of several studies. Available evidence derived from human and animal studies indicates that antioxidant micronutrients, mainly vitamins A, C and E, may play a role in boosting immunity, preventing neoplastic disease, and preventing or retarding the progression of several degenerative diseases, such as atherosclerosis. Vitamins E and C have also been shown to reduce low-density lipoprotein (LDL) cholesterol levels and increase high-density lipoprotein (HDL) levels, in addition to lowering fasting plasma insulin levels and improving insulin efficiency. Epidemiological studies have suggested a protective role for antiox-idants such as vitamin C, vitamin E, -carotene, and glutathione in macular degeneration and cataracts. Nevertheless, evidence derived from other epidemiological studies suggests that...

Nonhuman Primate Models For Metabolic Diseases And Drug Discovery

Despite the progress made in creating more humanized rodents to produce more predictive disease models, the differences in physiology and metabolism in particular have raised concern about the relevancy of data obtained from some rodent models. Noticeably, the metabolic regulatory pathways governing the biosynthesis of cholesterol and bile acids in the liver are not entirely conserved between primates and rodents. In humans, one of the major risk factors for the development of atherosclerosis is an elevated circulating level of cholesterol that correlates with high dietary cholesterol and fat intake (Goldstein and Brown, 1990). However, mice and rats on a high-cholesterol diet are resistant to hypercholesterolemia (Horton et al., 1995). Liver conversion of cholesterol into bile acids is through the rate-limiting step enzyme cytochrome P450 (CYP) 7A1 in which expression is governed by a network of nuclear hormone receptors in response to their respective ligands (Goodwin et al., 2000...

Liver in Specific Hepatobiliary Disorders Hepatocellular Diseases

In alcoholics, utilization of lipids and carbohydrates is markedly compromised due to an excess of reductive equivalents and impaired oxidation of triglycerides. Alcoholics are often resistant to insulin and exhibit impaired uptake of glucose into muscle cells. Insulin-dependent diabetes is common. Heavy alcohol consumption is frequently associated with deficiencies of a wide variety of micronutrients, including the fat- and water-soluble vitamins, particularly folate, pyridoxal-5'-phosphate, thiamine, and vitamin A. A variety of international associations have made nutritional recommendations for patients with various types of alcoholic liver disease. The primary recommendation is of course abstinence, which may be all that is needed in patients with fatty liver. Patients with alcoholic hepatitis should take 40kcal kg, 1.5-2.0 g protein kg, 4-5g kg of carbohydrates, and 1-2g kg of lipids per day. Those with cirrhosis without malnutrition should take 35kcal kg, 1.3-1.5 g protein kg,...

More Products

Natural Secrets For High Cholesterol
Lower Your Cholesterol In Just 33 Days

Lower Your Cholesterol In Just 33 Days

Discover secrets, myths, truths, lies and strategies for dealing effectively with cholesterol, now and forever! Uncover techniques, remedies and alternative for lowering your cholesterol quickly and significantly in just ONE MONTH! Find insights into the screenings, meanings and numbers involved in lowering cholesterol and the implications, consideration it has for your lifestyle and future!

Get My Free Ebook