What is Heart Disease and why does it occur?

What it is and why it occurs

Heart disease is the number one killer in United States and is a huge subject for several reasons.  One of these reasons is that there are different schools of thought relating to the reasons why heart disease occurs and more importantly what the proper methods of dealing with it are.

For decades, the American Medical Association insisted that high cholesterol foods were the primary culprit in the development of heart disease. This has been proven to be not necessarily the case. The simple fact is 50% of all fatal heart attacks occur in people who’ve had no previous history of high cholesterol and whose cholesterol was normal at the time of death.

This is not to say that diet does not play a role in the overall health of an individual including cardiovascular health. It has been established that the better the diet and the higher the fruit, legume and vegetable content, the less risk for cardiovascular disease. Nevertheless even vegetarians die from heart attacks although at a much reduced rate.

What exactly is heart disease?

Heart disease occurs when there is a blockage or narrowing in any of the major arteries feeding blood to the heart muscle itself. This results in weakening of the heart and death of heart tissue. When enough of the heart tissue has been damaged, a heart attack can take place creating even further damage due to lack of blood supply to the rest of the heart muscle.

Heart disease affects both men and women but until the age of 50, men have a much greater risk than women.  After the age of menopause though, a woman’s risk of developing heart disease triples. 1

1.       Nelson GJ. Dietary fat, trans fatty acids, and risk of coronary heart disease. Nutr Rev 1998;250–2.

Why does blockage occur?

Why does blockage occur?

This is the $64,000 question. Several theories are prevalent in the medical community and all of which carry weight scientifically.

High blood insulin levels

High blood insulin has the capability of scarring or acting almost as an acid on the inside of blood vessels. This damage to the intima, the inner layer on the inside of all blood vessels, stimulates a repair mechanism whereby circulating blood cholesterol is laid down almost like a bandage on the damaged areas in the blood vessels. Over a period of time this rough area in the affected blood vessels collect more cholesterol effectively narrowing the passage through which blood circulates with an end result of atherosclerosis.

Considering that type II diabetes or syndrome X is increasing in prevalence by double digits every year, this theory very well could be a major reason why heart disease is the number one killer in North America.  In syndrome X, insulin resistance is a normal side effect which in turn forces the body to increase the amount of insulin found in the blood, resulting in high levels of insulin in the blood which in turn can cause damage to the interior layer of the blood vessels. 

Elevated homocysteine levels

High homocysteine levels have been reported to be associated with heart disease but not necessarily to cause heart disease directly. Homocysteine is a normal constituent found in the blood stream; under normal circumstances it is changed into other amino acids for use elsewhere in the body. In order for this change to occur specific B vitamins, folic acid, B 6 and B 12 and enzymes need to be present. High homocysteine levels can cause LDL cholesterol to oxidize therefore forcing this form of cholesterol to fall out of solution, creating the potential for a blockage in the bloodstream, atherosclerosis. In addition it makes the blood stickier than it should be thereby reducing circulation and increasing the potential for stroke and heart attack. Lack of these vital B vitamins in the diet is one possible reason for creation of higher homocysteine levels, however a poorly functioning thyroid, kidney disease or psoriasis and some medicines can also contribute to this issue.

Oxidation of cholesterol

Just as high homocysteine increases the rate of oxidation of cholesterol, a lack of antioxidants in the blood can also create this same problem. Overall high blood cholesterol levels are also associated with heart disease however the ratio between LDL and HDL cholesterol is vital in determining whether you have an increased risk for developing heart disease. Low levels of HDL and high levels of LDL cholesterol are commonly found in patients with heart disease.

High triglyceride levels are also dangerous. 3

The liver creates cholesterol and is used for the formation of various hormones including sex hormones such as testosterone.

1. Cunnane SC, Hamadeh MJ, Liede AC, et al. Nutritional attributes of traditional flaxseed in healthy young adults. Am J Clin Nutr 1994;61:62–8.

Exercise and overall lifestyle

A sedentary lifestyle contributes dramatically to an increase in overall cholesterol levels. Regular exercise, at least two hours a week will reduce your chances of developing heart disease. Change in diet and stopping smoking are also vital. 2

Exercise and overall lifestyle

1. Sebregts EH, Falger PR, Bar FW. Risk factor modification through nonpharmacological interventions in patients with coronary heart disease. J Psychosom Res 2000;48:425–41 [review].

The Importance of Diet

You are what you eat. Being overweight especially if you have a beer belly rather than having fat accumulates on the hips increases the risk of heart disease.  Often the one common factor many patients with heart disease have is poor diet. By this I mean diets that are high in fats sugars and junk food and generally low in fresh fruits, vegetables and fiber including beans.

The average North American diet is excessively high in proteins and trans fatty acids including margarine, fried foods and some vegetable oils.  High trans fatty acid levels are now considered as being a substantial marker for future heart disease. 4

Eating a diet that is high in flaxseed and canola oils, which have higher levels of alpha-linolenic acid (ALA), increases blood levels of Omega 3 fatty acids which recent research has found to be a substantial protection against development of atherosclerosis.  A recent study reported that the so-called Mediterranean diet which is high in olive oil which contains substantial amounts of ALA had a 70% reduced risk of developing or dying from heart disease. 5

This diet contained high levels of beans, brightly colored fruit, vegetables, high fiber breads and cereals, fish and was low in meat, dairy fats and eggs.

Increased dietary fiber in the form of whole grain foods such as legumes, oats, psyllium, pectin found in fruit and beans which include guar gum can reduce the risk of heart disease by about 26%. 6

Insoluble fiber found in fruits and vegetables seem to have a better effect in reduction of arterial sclerosis. 7-9

It has finally been proved that a vegan diet (no poultry or meat, eggs, dairy of any kind) combined with exercise can reduce incidence of arterial sclerosis and atherosclerosis. 10

Drinking red wine at a moderate level, 2 glasses per day has been proven to reduce the incidence of heart disease. The active constituent appears to be resveratrol, the pigment that gives red wine its colour, although in its pure form it is colourless. 11-13  This is the basis for the French paradox, the fact the French have a low incidence of heart disease despite an average diet high in fats and rich foods normally associated with heart disease.

People that react badly to stress or who are aggressive or consistently angry along with type A personality have an increased chance of developing heart disease. 14-17

1. Ascherio A, Willett WC. Health effects of trans fatty acids. Am J Clin Nutr 1997;66(suppl):1006S–10S [review].
2. De Lorgeril M, Salen P, Martin J-L, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction. Final report of the Lyon Diet Heart Study. Circulation 1999;99:779–85.
3. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 1999;69:30–42.
4. Jenkins DJA, Kendall CWC, Ransom TPP. Dietary fiber, the evolution of the human diet and coronary heart disease. Nutr Res 1998;18:633–52 [review].
5. Wolk A, Manson JE, Stampfer MJ, et al. Long-term intake of dietary fiber and decreased risk of coronary hart disease among women. JAMA 1999;281:1998–2004.
6. Knopp RH, Superko HR, Davidson M, et al. Long-term blood cholesterol-lowering effects of a dietary fiber supplement. Am J Prev Med 1999;17:18–23.
7. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336:129–33.
8. Bertelli AA, Giovanninni L, Bernini W, et al. Antiplatelet activity of cis-resveratrol. Drugs Exp Clin Res 1996;22(2):61–3.
9. Chen CK, Pace-Asciak. CR. Vasorelaxing activity of resveratrol and quercetin in isolated rat aorta. Gen Pharm 1996;27(2):363–6.
10. Pace-Asciak CR, Rounova O, Hahn SE, et al. Wines and grape juices as modulators of platelet aggregation in healthy human subjects. Clin Chim Acta 1996;246(1–2):163–82.
11. Miller TQ, Smith TW, Turner CW, et al. A meta-analytic review of research on hostility and physical health. Psychol Bull 1996;119:322–48.
12. Kawachi I, Sparrow D, Spiro A 3rd, et al. A prospective study of anger and coronary heart disease. The Normative Aging Study. Circulation 1996;94:2090–5.
13. Thomas SA, Friedmann E, Wimbush F, Schron E. Psychological factors and survival in the cardiac arrhythmia suppression trial (CAST): a reexamination. Am J Crit Care 1997;6:116–26.
14. Angerer P, Siebert U, Kothny W, et al. Impact of social support, cynical hostility and anger expression on progression of coronary atherosclerosis. J Am Coll Cardiol 2000;36:1781–8.

Medical options

Over the counter aspirin (Bayer Children’s Aspirin®, Ecotrin Adult Low Strength®, Halfprin 81®) might be beneficial for reducing recurrent strokes and for reducing the risk of future heart attacks.

A high intake of carotenoids from dietary sources has been shown to be protective against heart disease in several population-based studies.^{11 12} A diet high in fruits and vegetables,¹³ fiber,¹⁴ and possibly fish¹⁵ appears protective against heart disease, while a high intake of saturated fat (found in meat and dairy fat) and trans fatty acids (in margarine and processed foods containing hydrogenated vegetable oils)¹⁶ may contribute to heart disease. In a preliminary study, the total number of deaths from cardiovascular disease was significantly lower among men with high fruit consumption¹⁷ than among those with low fruit consumption. A large study of male healthcare professionals found that those men eating mostly a “prudent” diet (high in fruits, vegetables, legumes, whole grains, fish, and poultry) had a 30% lower risk of heart attacks compared with men who ate the fewest foods in the “prudent” category.¹⁸ By contrast, men who ate the highest percentage of their foods from the “typical American diet” category (high in red meat, processed meat, refined grains, sweets, and desserts) had a 64% increased risk of heart attack, compared with men who ate the fewest foods in that category. The various risks in this study were derived after controlling for all other beneficial or harmful influencing factors.

A parallel study of female healthcare professionals showed a 15% reduction in cardiovascular risk for those women eating a diet high in fruits and vegetables—compared with those eating a diet low in fruits and vegetables.¹⁹

Lifestyle changes that may be helpful

Both smoking²⁰ and exposure to secondhand smoke²¹ increase cardiovascular disease risk.Moderate exercise protects both lean and obese individuals from cardiovascular disease.²²

Herbs and supplements that work

Much research has occurred in the last 20 years regarding natural methods and products that are effective in treating, reversing or preventing arteriosclerosis and heart disease.

The following is a short list inclusive of research, of some of these products and protocols. 

Vitamins and supplements that may be helpful

Vitamin E

There are eight different vitamin E’s, 4 tocopherols and 4 tocotrienols. It has been suggested that tocotrienols have between 30 and 60 times the antioxidant value of tocopherols. One double blind human study reported a dramatic reduction in cholesterol oxidation over 12 months with the administration of 200 mg per day of tocotrienols. It is reported that there was even a reduction in the size of the atherosclerotic plaque in the carotid artery with the use of this dosage level.

A common dosage would be between 400 and 800 international units per day.

1.       Suarna C, Hood RL, Dean RT, Stocker R. Comparative antioxidant activity of tocotrienols and other natural lipid-soluble antioxidants in a homogeneous system, and in rat and human lipoproteins. Biochim Biophys Acta 1993;1166:163–70.

2.       Tomeo AC, Geller M, Watkins TR, et al. Antioxidant effects of tocotrienols in patients with hyperlipidemia and carotid stenosis. Lipids 1995;30:1179–83.

Fish oils

A diet rich in omega 3 fatty acids is associated with reduction in the occurrence of atherosclerosis and heart disease in many studies. 20- 25   A reduction in the size of the plaque was also noted with the use of up to 6 grams a day for 3 months with the dosage halved to 3 grams a day for 21 months. 

1.       Ando M, Sanaka T, Nihei H. Eicosapentanoic acid reduces plasma levels of remnant lipoproteins and prevents in vivo peroxidation of LDL in dialysis patients. J Am Soc Nephrol 1999;10:2177–84.

2.       Olszewski AJ, McCully KS. Fish oil decreases serum homocysteine in hyperlipemic men. Coron Artery Dis 1993;4:53–60.

3.       Phillipson BE, Rothrock DW, Connor WE, et al. Reduction of plasma lipids, lipoproteins, and apoproteins by dietary fish oils in patients with hypertriglyceridemia. N Engl J Med 1985;312:1210–6.

4.       Haglund O, Wallin R, Luostarinen R, Saldeen T. Effects of a new fluid fish oil concentrate, ESKIMO-3, on triglycerides, cholesterol, fibrinogen and blood pressure. J Intern Med 1990;227:347–53.

5.       Haglund O, Luostarinen R, Wallin W, Saldeen T. Effects of fish oil on triglycerides, lipoprotein(a), atherogenic index and fibrinogen. Influence of the degree of purification of the oil. Nutr Res 1992;12:455–68.

6.       Haglund O, Luostarinen R, Wallin R, et al. The effects of fish oil on triglycerides, cholesterol, fibrinogen and malondialdehyde in humans supplemented with vitamin E. J Nutr 1991;121:165–9.

Vitamin C

Vitamin C prevents oxidation of LDL and also has a favourable effect on levels of homocysteine found in the blood.

Many health professionals suggest a dosage of 1 gram per day despite the fact that research does not support the use of more than 500 mg per day.

1.       Chambers JC, McGregor A, Jean-Marie J, et al. Demonstration of rapid onset vascular endothelial dysfunction after hyperhomocysteinemia. An effect reversible with vitamin C therapy. Circulation 1999;99:1156–60.

2.       Frei B. Ascorbic acid protects lipids in human plasma and low-density lipoprotein against oxidative damage. Am J Clin Nutr 1991;54:1113S–8S.

3.       Balz F. Antioxidant Vitamins and Heart Disease. Presented at the 60th Annual Biology Colloquium, Oregon State University, February 25, 1999.

4.       Salonen JT, Nyyssönen K, Salonen R, et al. Antioxidant supplementation in atherosclerosis prevention (ASAP) study: a randomized trial of the effect of vitamin E and C on 3-year progression of carotid atherosclerosis. J Intern Med 2000;248:177–86.

Vitamins B6, B12 and folic acid

The use of these three B vitamins is associated with the reduction in total homocysteine levels in the blood. 30, 31

Although various studies have used different dosage in the course of their investigations, an effective dose seems to be 50 mg of vitamin B6, 100–300 mcg of vitamin B12, and 500–800 mcg of folic acid.

Changing diet appears not to affect levels of levels of homocysteine in the blood.

1.       Ubbink JB, Hayward WJ, van der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927–33.

2.       Manson JB, Miller JW. The effects of vitamin B12, B6, and folate on blood homocysteine levels. Ann NY Acad Sci 1992;669:197–204 [review].

3.       Ubbink JB, Vermaak WJH, van der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927–33.

Quercetin

The flavonoid quercetin in dosages as low as 35 mg per day has been found in preliminary studies to lower the risk of heart disease however not all research corroborates this result.

1.       Hertog MGL, Feskens EJM, Hollman PCH, et al. Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen Elderly Study. Lancet 1993;342:1007–11.

2.       Hertog MGL, Kromhout D, Aravanis C, et al. Flavonoid intake and long-term risk of coronary heart disease and cancer in the Seven Countries Study. Arch Intern Med 1995;155:381–6.

3.       Knekt P, Jarvinen R, Reunanen A, Maatela J. Flavonoid intake and coronary mortality in Finland: a cohort study. BMJ 1996;312:478–81.

4.       Rimm EB, Katan MB, Ascherio A, et al. Relation between intake of flavonoids and risk for coronary heart disease in male health professionals. Ann Intern Med 1996; 125:384–9.

5.       Hertog MGL, Sweetnam PM, Fehily AM, et al. Antioxidant flavonols and ischemic heart disease in a Welsh population of men: the Caerphilly Study. Am J Clin Nutr 1997;65:1489–94.

Evening primrose oil

Evening Primrose Oil used in low levels such as 2 grams per day appears to not have much affect; however in higher doses such as 3 - 4 grams per day, double blind research has reported a lowering of cholesterol levels which can have a positive effect on formation of atherosclerotic plaquing

1.       Boberg M, Vessby B, Selinus I. Effects of dietary supplementation with n-6 and n-3 long-chain polyunsaturated fatty acids on serum lipoproteins and platelet function in hypertriglcyeridaemic patients. Acta Med Scand 1986;220:153–60.

2.       Horrobin DF, Manku MS. How do polyunsaturated fatty acids lower plasma cholesterol levels? Lipids 1983;558–62.

Chondroitin Sulfate

Recent preliminary animal research suggests that chondroitin sulfate can prevent atherosclerosis and may reduce the effects of or prevent heart attacks in atherosclerotic patients

1.       Morrison LM, Branwood AW, Ershoff BH, et al. The prevention of coronary arteriosclerotic heart disease with chondroitin sulfate A: Preliminary report. Exp Med Surg 1969;27:278–89.

2.       Morrison LM, Enrick NL. Coronary heart disease: Reduction of death rate by chondroitin sulfate A. Angiology 1973;24:269–82.

Grape seed extract

As mentioned before, resveratrol found in red wine due to its antioxidant activity may provide antioxidant protection to various parts of the bloodstream including cholesterol. 

1.       Bertelli AA, Giovanninni L, Bernini W, et al. Antiplatelet activity of cis-resveratrol. Drugs Exp Clin Res 1996;22(2):61–3.

2.       Chen CK, Pace-Asciak. CR. Vasorelaxing activity of resveratrol and quercetin in isolated rat aorta. Gen Pharm 1996;27(2):363–6.

3.       Pace-Asciak CR, Rounova O, Hahn SE, et al. Wines and grape juices as modulators of platelet aggregation in healthy human subjects. Clin Chim Acta 1996;246(1–2):163–82.

Nattokinase

Acting in much the same way as plavix, a pharmaceutical drug used as an anticoagulant, nattokinase is a making a mark as a potential new treatment for poor circulation and heart attack prevention. This extract of soybeans derived from natto, a fermented soybean dish, has been the subject of several recent studies and has shown great promise for increasing overall circulation and reducing the thickness of blood through reduction of platelet aggregation and reducing the thickness of the intima, the innermost layer of blood vessels

1.       Suzuki Y, Kondo K, et al. Dietary supplementation with fermented soybeans suppresses intimal thickening. Nutrition. 2003 Mar;19(3):261-4.

2.       Fugita M, Hong K, et al.Thrombolytic effect of nattokinase on a chemically induced thrombosis model in rat. Biol Pharm Bull. 1995 Oct;18(10):1387-91.

3.       Sumi H, Hamada H, et al. Enhancement of the fibrinolytic activity in plasma by oral administration of nattokinase. Acta Haematol. 1990;84(3):139-43.

Lycopene

This carotenoid found in large amounts in tomatoes may have a protective role in atherosclerosis especially if you’re a smoker.  Although there’s no correlation between this carotenoid blood levels of other carotenoids such as beta carotene as far as atherosclerotic plaque is concerned, research still suggests that lycopene may have benefit. 1

1.       Klipstein-Grobusch K, Launer LJ, Geleijnse JM, et al. Serum carotenoids and atherosclerosis. The Rotterdam Study. Atherosclerosis 2000;148:49–56.

Helpful Herbs

Helpful Herbs

• Garlic
• Ginkgo
• Guggal (Commiphora mukul)

Several other herbs including green tea, ginger, bilberry, peony, turmeric, rosemary, fenugreek and butchers broom have all been the subject of preliminary trials with some good results; however more studies need to be done to authenticate their effectiveness for use as circulation enhancers and cholesterol antioxidants. 1-11

1.       Sharma RD, Raghuram TC, Dayasagar Rao V. Hypolipidaemic effect of fenugreek seeds. A clinical study. Phytother Res 1991;5:145–7.

2.       Serafini M, Ghiselli A, Ferro-Luzzi A. In vivo antioxidant effect of green tea in man. Eur J Clin Nutr 1996;50:28–32.

3.       van het Hof KH, de Boer HS, Wiseman SA, et al. Consumption of green or black tea does not increase resistance of low-density lipoprotein to oxidation in humans. Am J Clin Nutr 1997;66:1125–32.

4.       Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber officinale Rosc) and fenugreek (Trigonella foenumgraceum L) on blood lipids, blood sugar, and platelet aggregation in patients with coronary artery disease. Prostagland Leukotrienes Essential Fatty Acids 1997;56:379–84.

5.       Lumb AB. Effect of dried ginger on human platelet function. Thromb Haemost 1994;7:110–1.

6.       Janssen PL, Meyboom S, van Staveren WA, et al. Consumption of ginger (Zingiber officinale Roscoe) does not affect ex vivo platelet thromboxane production in humans. Eur J Clin Nutr 1996;50:772–4.

7.       Srivastava R, Dikshit M, Srimal RC, Dhawan BN. Anti-thrombotic action of curcumin. Throm Res 1985;404:413–7.

8.       Srivastava KC, Bordia A, Verma SK. Curcumin, a major component of food spice turmeric (Curcuma longa) inhibits aggregation and alters eicosanoid metabolism in human blood platelets. Prost Leuk Essen Fat Acids. 1995;52:223–7.

9.       Pulliero G, Montin S, et al. Ex vivo study of the inhibitory effects of Vaccinium myrtillus (bilberry) anthocyanosides on human platelet aggregation. Fitoterapia 1989;60:69–75.

10.   Liu J. Effect of Paeonia obovata 801 on metabolism of thromboxane B2 and arachidonic acid and on platelet aggregation in patients with coronary heart disease and cerebral thrombosis. Chin Med J 1983;63:477–81 [in Chinese].

11.   Felix W, Schmidt Y, Nieberle J. Protective effect of Ruscus extract against injury of vascular endothelium and vascular smooth muscle caused by ethracrynic acid. Int Angiol 1983;3:77.

Garlic

Garlic is at the top of the list for several good reasons. Studies reported that not only has garlic prevented atherosclerosis, it also lowers cholesterol levels and prevents platelet aggregation. Aged garlic extracts but not raw garlic stops oxidation of LDL cholesterol which is probably the first stage of plaquing. 1-4

1.       Koscienlny J, Klüßendorf D, Latza R, et al. The anti-atherosclerotic effect of Allium sativum. Atherosclerosis 1999;144:237–49.

2.       Neil HAW, Silagy CA, Lancaster T, et al. Garlic powder in the treatment of moderate hyperlipidaemia: A controlled trial and a meta-analysis. J R Coll Phys 1996;30:329–34.

3.       Kiesewetter H, Jung F, Pindur G, et al. Effect of garlic on thrombocyte aggregation, microcirculation and other risk factors. Int J Pharm Ther Toxicol 1991;29(4):151–5.

4.       Srivastava KC, Tyagi OD. Effect of a garlic derived principle (ajoene) on aggregation and arachidonic acid metabolism in human blood platelets. Prostagl Leukotr Ess Fatty Acids 1993;49:587–95.

5.       Munday JS, James KA, Fray LM, et al. Daily supplementation with aged garlic extract, but not raw garlic, protects low density lipoprotein against in vitro oxidation. Atherosclerosis 1999;143:399–404.

Ginkgo

Gingko has been used for millennia to increase circulation to the brain however new research shows it is also good for increasing circulation to the arms and legs and reducing overall atherosclerosis by lowering the levels of PAF, a chemical created by the body which causes blood platelets to stick together which reduces over-activation of coagulation of blood cells. 1-4

1.       Braquet P, Touqui L, Shen TS, Vargaftig BB. Perspectives in platelet activating factor research. Pharmacol Rev 1987;39:97–210.

2.       Brown DJ. Herbal Prescriptions for Better Health. Rocklin, CA: Prima Publishing, 1996, 119–28.

3.       Kiesewetter H, Jung F, Mrowietz C, et al. Effects of garlic on blood fluidity and fibrinolytic activity: A randomised, placebo-controlled, double-blind study. Br J Clin Pract Suppl 1990;69:24–9.

4.       Jung F, Mrowietz C, Kiesewetter H, Wenzel E. Effect of Ginkgo biloba on fluidity of blood and peripheral microcirculation in volunteers. Arzneimittelforschung 1990;40:589–93.

Guggal (Commiphora mukul)

This Ayurvedic herb lowers triglyceride and cholesterol levels and prevents oxidation of LDL. One study reported it works as well as clofibrate, a common prescription drug used to reduce platelet aggregation.

The dose used in these trials was 1500 mg of extract per day however 75 mg per day is a common dose used. ^{58- 63}

Guggal (Commiphora mukul)

1. Satyavati GV. Gum guggul (Commiphora mukul)—The success of an ancient insight leading to a modern discovery. Indian J Med 1988;87:327–35.
2. Nityanand S, Kapoor NK. Hypocholesterolemic effect of Commiphora mukul resin (Guggal). Indian J Exp Biol 1971;9:367–77.
3. Singh K, Chander R, Kapoor NK. Guggulsterone, a potent hypolipidaemic, prevents oxidation of low density lipoprotein. Phytother Res 1997;11:291–4.
4. Mester L, Mester M, Nityanand S. Inhibition of platelet aggregation by guggulu steroids. Planta Med 1979;37:367–9.
5. Malhotra SC, Ahuja MMS, Sundarum KR. Long-term clinical studies on the hypolipidemic effect of Commiphora mukul (guggul) and clofibrate. Ind J Med Res 1977;65:390–5.
6. Nityanand S, Srivastava JS, Asthana OP. Clinical trials with gugulipid—a new hypolipidemic agent. J Assoc Phys India 1989;37:323–8.

Science proves there are safe, natural methods you can use to reduce cholesterol levels and protect your circulatory system. While prescriptions are very effective, they carry a heavy price tag both in side effects and expense. These natural methods do work but only with consistent use along with change in life style; if you don’t care about your health who else will.

Good luck and good health