Download cholesterol - Dr. Falk Pharma GmbH

Lower your
cholesterol
– naturally!
Psyllium
The
informed
patient
Product presentations, compositions and indications as referenced
herein may differ from those in your country. Therefore, please
contact Dr. Falk Pharma GmbH, Freiburg (Germany) or the local
Falk partner.
Publisher
DR. FALK PHARMA GmbH
Leinenweberstr. 5
Postfach 6529
79041 Freiburg
Germany
© 2006 Dr. Falk Pharma GmbH
All rights reserved.
2nd revised edition 2006
The informed patient
Lower your cholesterol
– naturally!
Psyllium
The informed patient
Contents
Foreword
4
What is cholesterol?
6
Why do we need cholesterol?
6
How much cholesterol do our bodies need?
7
How does the body take in cholesterol?
8
Cholesterol – a time bomb
10
What can happen when cholesterol
levels are too high?
11
What can you do about it?
11
LDL and HDL – the mixture is important!
13
How do you reach the goal of
“lowering LDL while raising HDL“?
14
Lowering LDL cholesterol using natural
dietary fiber derived from psyllium
17
– How does psyllium, the active ingredient in
Mucofalk®, reduce the cholesterol level
in the blood?
– When is psyllium recommended for
lowering LDL cholesterol?
– How is psyllium (Mucofalk®) taken?
– Psyllium – a multifaceted natural remedy
3
Foreword
Do you know the role of cholesterol in your body?
Do you know how high your cholesterol level is?
The purpose of this brochure is to provide you with
everything you need to know about this subject, such
as the essential functions of cholesterol in your body,
the negative effects that may occur when your cholesterol level is too high and, of course, your options
for preventing or lowering elevated cholesterol levels
in order to prevent any complications from occurring.
Diseases of the cardiovascular system (heart and
circulation) claim nearly 400,000 lives every year in
Germany and lead the list of causes of death. Many
of these deaths are due to arteriosclerosis (“hardening” or calcification of the arteries). Arteriosclerosis
can also exert a negative effect on other diseases.
Arteriosclerosis, however, is not a disease that happens overnight. Instead, it develops silently over
many years and is too often the payback for a lessthan-healthy lifestyle.
It is crucial to prevent the development of arteriosclerosis or at least avoid its complications. Current
research shows that hardening of the arteries can
to a certain extent be slowed or even reduced as a
result of adopting a healthy lifestyle.
The treatment of disorders of lipid metabolism has
shown extraordinary success over the past few
years. This is the case not only in patients with
markedly elevated cholesterol levels (hypercholes-
4
The informed patient
terolemia) but even in those with moderately
increased levels who at the same time have other
risk factors such as smoking, high blood pressure
(hypertension), overweight, inadequate exercise,
diabetes mellitus or hereditary predisposition for
diseases of the heart and circulation.
Besides increasing physical activity and adopting
healthy dietary practices, elevated cholesterol levels
can be reduced with any of a number of effective
agents. An especially well-tolerated alternative is the
use of natural, water-soluble dietary fiber, such as
that derived from psyllium (Mucofalk®).
5
What is cholesterol?
Cholesterol (Greek cholé = bile and sterós = hard,
solid) is a substance similar to fat that is found in
foods of animal origin such as meat, poultry, giblets,
sausage, whole milk and dairy products, butter and
eggs. Of these foods, giblets and eggs have the
highest amounts of cholesterol. One egg yolk or
120 grams of butter are enough to supply practically
the entire recommended daily allowance of 300 mg.
Cholesterol is essential for life. Thus, the body does
not depend on dietary intake of cholesterol but is also
able to produce it. Cholesterol is a component of cell
membranes and the basic building block in the production of certain hormones and bile acids, the latter
of which are necessary for digestion. The main site of
production and, at the same time, the primary storehouse of cholesterol is the liver.
Why do we need cholesterol?
The body uses cholesterol
As a building block for all the body’s cells
● To produce bile acids essential for the
digestion of fats
● To produce vitamin D, which is required for
building strong bones
● To produce steroid and sex hormones
●
6
The informed patient
How much cholesterol do our
bodies need?
In adults ingesting a diet moderately rich in cholesterol, daily cholesterol production stands at about
11–13 mg per kilogram of body weight. This means
that our body does not require dietary cholesterol
intake, since the liver produces cholesterol and is
able to cover the body’s requirements even when
we consume a diet that is practically cholesterol free.
In the Western industrial nations, the average daily
intake of cholesterol ranges from 500 to 750 mg
per person. Because the small bowel can absorb no
more than 300–500 mg of dietary cholesterol per day,
it is necessary to reduce dietary cholesterol intake
to less than 300 mg per day in order to exert any
significant effect on a person’s cholesterol levels.
7
How does the body take in
cholesterol?
Because of its fat-like chemical structure, cholesterol
is not soluble in water. In order for it to be absorbed
into the blood, it must be surrounded by special proteins known as apoproteins.
This combination of apoproteins and lipids (fats)
results in the formation of lipoproteins. Based on
their physical characteristics, these molecules are
classified according to their respective densities.
The inclusion of cholesterol into different kinds of
lipoproteins is the basis for the distinction between
the so-called “good” HDL cholesterol (High Density
Lipoprotein) and “bad” LDL cholesterol (Low Density
Lipoprotein). Thus, cholesterol itself is always the
same; its transport form is actually responsible for
whether it is primarily useful or dangerous for the
body.
When the cholesterol level in your blood is checked,
testing includes the proportions of HDL and LDL
cholesterol.
8
The informed patient
The pathways of cholesterol
in the human organism
Blood stream
Blood stream
HDL
HDL
Body cells
Deposits
LDL
Deposits
LDL
Cholesterol
biosynthesis
VLDL
Liver
Bile acids
Gallbladder
Portal vein
Feces
Cholesterol
Bile acids
Dietary cholesterol is partially absorbed in the small bowel. It is transported into
the body as chylomicrons and as HDL and LDL. LDL transports cholesterol to the
target organs while HDL transports unused cholesterol from the target organs
back to the liver, where it is used for the production of bile acids or excreted with
the bile into the gut.
HDL = High density lipoprotein
LDL = Low density lipoprotein
VLDL = Very low density lipoprotein
9
Cholesterol – a time bomb
High concentrations of cholesterol in the blood are
sneaky. You do not see them or feel them. Only
by testing the level of cholesterol in the blood and
an evaluation of other risk factors can quantify the
urgency of taking action.
“Too much” in terms of cholesterol usually means
too much LDL - the “bad” cholesterol. Reasons
include heredity, environmental and dietary factors,
as well as metabolic diseases. However, women
may show very high levels of HDL - the so-called
“good” cholesterol. Thus, an elevated total cholesterol level does not automatically point to excessive
LDL.
Other causes of high cholesterol levels include
unbalanced diet, smoking, overweight, diabetes
mellitus and inadequate exercise.
10
The informed patient
What can happen when cholesterol
levels are too high?
As the concentration of LDL in the blood increases,
due, for example, to a high-fat or high-cholesterol
diet, a point comes where the normal capacity of
the body to metabolize and dispose of excess LDL
cholesterol is exceeded. As a result, LDL cholesterol
may be deposited on the inner walls of arteries,
forming a so-called atherosclerotic plaque.
This process, especially in connection with other
risk factors such as smoking, high blood pressure
(over 140/90 mmHg), overweight or diabetes, can
ultimately lead to changes in the lumen (the interior
channel) of the blood vessels. The growth of plaques
by itself rarely blocks a vessel; more commonly, the
plaque ruptures, followed by formation of a blood
clot, which may partially or completely occlude the
vessel. Serious complications include coronary heart
disease, stroke or severely reduced circulation to a
limb or organ.
What can you do about it?
Because the amount of cholesterol in the body is
determined by both the amount of cholesterol in the
diet and the body’s own production, simply reducing
dietary intake of cholesterol is inadequate to produce
a meaningful change. Reducing cholesterol intake
simply causes the body to produce more cholesterol
in the liver and vice-versa.
11
Much more important are measures that influence
the factors responsible for the absorption of
cholesterol from the blood. First and foremost are
saturated fats, which occur almost exclusively in
foods derived from animal sources, including meat,
sausage, cheese, cream, butter, lard, milk, creamfilled pastries and milk chocolate. The consumption
of these foods should be reduced.
Soluble dietary fiber promotes the excretion of bile
acids. An increased intake of soluble fiber results in
reduction in LDL cholesterol and an increase in the
HDL level.
Your goal should be:
Reduce LDL
and
Increase its “opponent” — HDL!
12
The informed patient
LDL and HDL – the mixture is
important!
LDL transports cholesterol to the various organs of
our body. It “docks” at the cell membrane and
“hands over” the cholesterol to the cells. If there
is too much LDL in the blood and the cells are adequately supplied with cholesterol, LDL may deposit
on the inner walls of the blood vessels. The result:
The vessel becomes increasingly narrow and circulation gets progressively poorer. This is known as
arteriosclerosis, or “hardening of the arteries”.
Thus, to a certain degree:
The less LDL, the better!
HDL, on the other hand, possesses the useful ability
to remove cholesterol deposited on vessel walls
and transport it back to the liver. HDL can to some
degree protect against the formation of atherosclerotic deposits in the blood vessels.
Thus:
The more HDL, the better!
13
How do you reach the goal of
“lowering LDL while raising HDL“?
Reducing overweight
Calculating the so-called body-mass index (BMI) or
measuring your waistline (over 88 cm for women
and over 102 cm for men) are simple ways of
determining whether you are overweight. The BMI
is calculated using the following formula:
Body weight in kg
BMI = __________________
(Height in m)2
Normal: 19–25
Overweight: 25–30
Obesity: over 30
In many cases simply normalizing body weight can
return cholesterol levels to normal.
Regular exercise is also very effective because it
increases the HDL concentration. Best results
are obtained from endurance sports such as hiking,
walking, jogging, dancing, cycling or swimming
one-half hour three to four times a week.
14
The informed patient
Adjusting your diet
Changing one’s habits is quite difficult for many
people. However, “changing your diet” does not
necessarily require many changes. Especially effective is the so-called “Mediterranean” diet, consisting
of little meat, fish twice a week, a lot of high fiber
vegetables and fruit. The amount of fat is also low
and consists primarily of high-quality vegetable fats,
such as olive oil, with a high proportion of monounsaturated fatty acids. Finally, don’t forget the fresh
herbs and spices!
Moderate fat intake
Although our diet contains an average 130 grams of
fat per day, the recommended daily fat intake should
not exceed 60–80 grams. Of this, no more than one
to two tablespoons of high-quality margarine (such
as diet margarine) and one to two tablespoons of
high-quality vegetable oil such as olive or rape-seed
oil should be taken.
Dietary intake of high-quality mono- and
polyunsaturated fatty acids
You should limit as far as possible your intake of
animal fats (e.g. meat, sausage, milk, eggs, butter)
and substitute unsaturated vegetable fats (e.g.
mono-unsaturated fatty acids such as olive and
rape-seed oil). Especially favorable for your health
are polyunsaturated fatty acids, especially the eicosanoids or omega-3 fatty acids found in linseed oil,
rape-seed oil, soy products and nuts as well as in
fish high in fat such as salmon, herring and mackerel.
15
Low-cholesterol foods
For many patients, a transition to low-cholesterol
foods will not have much of an effect because their
body answers the change with an increase in the
liver’s own production of cholesterol. Nevertheless,
it is advisable to limit daily cholesterol intake to
300 mg or less. Nearly all high-cholesterol foods are
also high in saturated fats; hence, low-fat foods are
usually also low in cholesterol.
Increase your intake of dietary fiber
Dietary intake of fiber has decreased significantly
over the past 50 years. In earlier times, daily fiber
intake stood at about 100 grams, compared to only
about 20 grams today. Remember that a high-fiber
diet can reduce the LDL level and increase HDL
levels.
What are the benefits of weight reduction and
changes in your diet?
The above-described measure often suffice to reduce
serum LDL cholesterol levels by as much as 15%.
If this is not adequate to normalize cholesterol levels,
there are safe and effective medications that may
help.
16
The informed patient
Lowering LDL cholesterol using
natural dietary fiber derived from
psyllium
(Plantago ovata seed shells)
The seed shells of Plantago ovata, also known
as psyllium, contain large amounts of natural bulking
substances and dietary fiber. Plantago ovata is
native to Iran and India and is also cultivated in those
countries. This plant has been used for centuries
to regulate bowel function. More recently, the cholesterol-lowering properties of psyllium have received
increasing attention.
Plantago ovata
17
How does psyllium, the active ingredient in
Mucofalk®, reduce the cholesterol level in the
blood?
Soluble bulking agents bind a portion of the bile acids
in the small intestine and prevent their re-absorption
into the portal circulation.
As a result, the liver is forced to continuously absorb
cholesterol from the circulating blood as the basic
building block for the production of new bile acids,
thus reducing the serum concentration of cholesterol.
Fiber directly binds lipids (fats) and dietary cholesterol
in the gut, prevents its absorption into the blood, and
promotes its excretion with the stool.
Psyllium reaches the colon unchanged.
Soluble bulking agents are metabolized by the intestinal flora to short-chain fatty acids. These substances
are absorbed into the blood and transported to the
liver, where they may reduce cholesterol synthesis.
The intake of Plantago ovata seed shells (psyllium)
can reduce the serum cholesterol level by about
10–15%.
The efficacy of psyllium in reducing LDL cholesterol
has been investigated in over 30 studies.
18
The informed patient
When is psyllium recommended for
lowering LDL cholesterol?
The first step is to attempt to reduce LDL cholesterol
by means of adjusting the patient’s lifestyle and
dietary habits.
Depending on the individual patient’s risk profile, a
typical “target” level for LDL cholesterol lies in the
range of 100–130 mg/dl. In certain high-risk patients
(e.g. those with coronary heart disease or diabetes)
levels under 100 mg/dl may be advisable. Anyone
can estimate their individual risk of heart attack using
a simple computer program, such as the Procam risk
calculator available on the Internet at www.chd-taskforce.de. Your personal risk is calculated using data
such as gender, age, serum lipids, blood pressure
and factors such as number of cigarettes smoked,
diabetes and a family history of cardiovascular disease. The higher your risk, the more urgent the need
to do something about it!
19
Generally recommended levels for serum lipids:
Parameter
Value in mg/dl (mmol/l) Commentary
Total cholesterol
< 200 (< 5.16)
200–239 (5.16–6.16)
_> 240 (>_ 6.19)
Recommended
Borderline elevated
High
LDL cholesterol
< 100 (< 2.58)
HDL cholesterol
< 40 (< 1.03)
_> 40 (>_ 1.55)
In CHD or a ten
year-risk > 20%*
and/or diabetes
mellitus
With two or more
risk factors
No or only one risk
factor
Low
Normal
Triglycerides
< 150 (< 1.69)
150–199 (1.69–2.25)
Normal
Borderline elevated
_> 200 (>_ 2.26)
High
< 130 (< 3.35)
< 160 (< 4.13)
*Procam Risk Calculator (www.chd-taskforce.de)
Risk factors with elevated cholesterol levels:
● Cigarette smoking
● Hypertension (high blood pressure) over
140/90 mmHg
● Diabetes mellitus
● Overweight
● Positive family history for coronary heart disease
(Men under 60 years, women under 70 years)
● Low HDL cholesterol < 40 mg/dl (< 1.1 mmol/l)
● Sex and age: Men > 45 years,
Women > 55 years or early menopause
20
The informed patient
Psyllium, the active substance in Mucofalk®, is
especially suitable in persons with mild to moderately elevated LDL cholesterol levels (about 130–160
mg/dl) for prophylaxis of arteriosclerosis.
With significantly increased cholesterol levels and
additional risk factors a combination therapy is often
a final step toward exhausting all options. Although
this has not yet been proven in studies, the addition
of psyllium in these cases may be useful, especially
when one considers the high tolerability of this natural remedy.
How is psyllium (Mucofalk®) taken?
The daily ingestion of 10–20 grams of Plantago ovata
seed shells (psyllium) with meals is recommended
as a suitable dose for reducing cholesterol.
This corresponds to 1–2 pouches of Mucofalk® three
times daily.
Psyllium – a multifaceted natural remedy
Psyllium is helpful not only in patients with elevated
levels of cholesterol in their blood. The seed shells
of Plantago ovata are a highly effective bulking agent:
In the gut, they absorb water and their soluble bulking substances increase the volume of the stool.
The stool increases in amount, becoming soft and
pliable, which facilitates bowel movement.
In addition, as a “pre-biotic”, psyllium, by serving
as a nutrient, promotes the growth of the normal
intestinal bacterial flora. The bacteria, in turn, provide important nutrients for the intestinal mucosal
membrane. This process also increases the stool
volume and the bowel returns to regular activity.
21
These special properties make Mucofalk® an
especially effective and well-tolerated remedy for
chronic constipation and irritable bowel syndrome,
as well as at times when easier bowel movements
with soft stool are required, such as in patients with
anal fissures (tears of the mucous membrane of the
anus), hemorrhoids or surgical procedures involving
the rectum.
Finally, psyllium serves to absorb excess fluid in
the bowel and is a successful supportive therapy in
patients with diarrhea.
22
Lower your cholesterol
– naturally
®
Mucofalk
Psyllium
Lowering of
cholesterol
-5%
-10%
4
8
12
16
20
24 Weeks
-15%
Mucofalk ®
Mucofalk®. Active ingredient: Indian isphagula husk, ground (Plantago ovata seed shells).
Composition: 5 g of granules (1 sachet) contains: active ingredients: 3.25 g of Indian isphagula husk,
ground. Excipients: dextrin, sodium alginate, sodium chloride, saccharin sodium, sucrose (saccharose), citric acid, sodium citrate 2 H2O, orange flavouring. Indications: chronic constipation; diseases
in which easier bowel movements with soft stools are desirable, e.g. anal fissures, haemorrhoids, following surgery in the rectum area. As supportive treatment in diarrhoea of various causes. Diseases
in which an increase in daily dietary fiber intake is recommended, e.g. in patients with irritable bowel
syndrome, and those with mild to moderately increased serum cholesterol levels in addition to diet.
Contraindications: hypersensitivity to Isphagula or any of the excipients; excessively hard stools;
abdominal complaints and pain, nausea and vomiting prior to assessment by a physician; sudden
changes in bowel habits (persisting over two weeks); after use of a laxative without subsequent bowel
movement; unassessed rectal bleeding; difficulty swallowing and nausea; stenoses of the esophagus,
the gastroesophageal junction or elsewhere in the gastrointestinal tract; threatened or existing intestinal obstruction or megacolon syndrome, disturbances of water and electrolyte metabolism, disorders
associated with a decreased fluid intake; poorly controlled diabetes mellitus. Children under the age
of 12 years. Side effects: during the first few days of treatment, possible increase in bloating and
feelings of fullness; these decrease in the course of treatment.
DR. FALK PHARMA GmbH
Very rarely, hypersensitivity reactions ranging in severity up to
Leinenweberstr. 5
anaphylactoid reactions. Bronchospasm was reported in one
Postfach 6529
79041 Freiburg
patient. In these cases, the patient should stop taking the mediGermany
cine and consult a doctor. Interactions: See patient information
leaflet. Dosage information: See patient information leaflet.
Date of information: 9/2005.
Leinenweberstr. 5
Postfach 6529
79041 Freiburg
Germany
M82e 2-3/2006/3.000 Bu
DR. FALK PHARMA GmbH