Hypercholesterolemia is a very common condition, affecting possibly 26 percent of all Americans. Elevated cholesterol confers increased risk for artery disease, the cause of heart attack and stroke. While there is renewed controversy regarding cholesterol level and arterial disease, the National Cholesterol Education Program (NCEP) continues to find that pharmaceutically lowering moderately-high cholesterol values reduces illness and death .
High blood cholesterol levels of do not necessarily stem directly from dietary cholesterol intake. Circulating cholesterol comes from several different sources: (1) liver production (some peoples’ livers produce excess cholesterol); (2) dietary saturated fat intake; (3) untreated hypothyroidism, severe kidney/liver disease; and (4) oral steroids (synthetic progestins, anabolic steroids, glucocorticoids) may contribute to elevated cholesterol values.
The NCEP risk factors for coronary (heart) artery disease (CHD) have changed little in the past 2 decades. Risks for coronary artery disease (CHD) include:
- Age: men over 45, or women over 55 years of age
- Family History or Premature CHD: first-degree male relative less than 55, female less than 65 years
- Cigarette Smoking
- Hypertension: blood pressure greater than 140/90 or on medication
- Low HDL (“good cholesterol”): less than 60mg/dL
In general, elevated cholesterol has no symptoms and rare physical findings because it deposits in the blood vessels (arteries), forming a plaque. This plaque impedes blood flow to the organs either slowly with ongoing damage (kidneys for kidney failure), or acutely due to plaque break-off occluding an entire blood vessel (heart attack or stroke). Your doctor reviews your cholesterol and CHD risks with you, and advises treatment based on your individual needs.
Treatment always includes diet and exercise modifications . Often pharmaceutical medications and sometimes supplements (statins, fenofibrate/fibrinate, cholesterol absorption inhibitors, bile acid sequestrants, niacin or fish oil of very specific types/dosages) are recommended to decrease CHD risk. A newer, small study demonstrates red yeast rice plus lifestyle modification decreases LDL (bad cholesterol) levels .
While traditional Eastern Medicines never measured cholesterol per se, Traditional Chinese Medicine (TCM) physiology/ pathophysiology possesses a clear understanding of both hypercholesterolemia and metabolic syndrome. The robust, pattern diagnosis of TCM equates increased cholesterol, as well as hypothyroidism, diabetes, and overweight, with increased “Dampness and Phlegm” in the system. Interestingly, Western Medicine clearly acknowledges the correlation between untreated hypothyroidism and hypercholesterolemia, as well as the associations between diabetes, overweight and increased cholesterol (metabolic syndrome).
In TCM, the increased “Dampness and Phlegm accumulation” results either directly or indirectly from “Spleen Qi/Stomach Yang deficiencies.” “Spleen Qi/Stomach Yang” (digestive ability/strength) decreases with age, starting at age 35 in women and 42 in men. Weak “Spleen Qi/Stomach Yang” fails to “transport fluids”; the “fluids” (loosely correlating to cholesterol) then migrate and accumulate in the body and bloodstream (correlating with plaque formation and excess weight). Later on, weak “Spleen Qi/Stomach Yang” fails to produce “Wei Qi” (defensive energy), which loosely correlates to dysregulated immune function/autoimmune disease formation.
Thus, treating cholesterol in TCM requires “Moving and Draining Dampness” and strengthening “Spleen Qi.” While acupuncture is helpful to start the process, Chinese Herbal Medicine forms the foundation of trying to address this condition. With time and lifestyle modification, cholesterol can be reduced. Ayurveda, medicine from India, can prove invaluable in addressing the diet and exercise modifications needed to address increased cholesterol. Ayurvedic diets are naturally low fat and very satisfying. Yoga exercises can help even the very sedentary start moving toward some cardiovascular conditioning.[2, 3]
These brief overviews of conditions represent distillations of basic and current medical reviews from the following sources:
Conventional Medical Sources
“Harrison’s Principles of Internal Medicine: Volumes 1 and 2, 18th Edition”. Dan Longo Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jameson, Joseph Loscalzo. McGraw-Hill Professional; (July, 2011)
Medscape eMedicine Physician’s online resource. Various review articles accessed March 2014
Elena Citkowitz, MD, PhD, FACP Clinical Professor of Medicine, Yale University School of Medicine; Director, Cholesterol Management Center, Yale-New Haven Hospital, St Raphael Campus
Stanley S Wang, MD, JD, MPH Clinical Cardiologist, Austin Heart South; Director of Legislative Affairs, Austin Heart; Director, Sleep Disorders Center at Heart Hospital of Austin; Assistant Professor of Medicine (Adjunct), University of North Carolina School of Medicine
Type 2 Diabetes, Type 1 Diabetes
Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School
Meena S Madhur, MD, PhD Assistant Professor, Department of Medicine, Divisions of Clinical Pharmacology and Cardiology, Vanderbilt University School of Medicine
- “Acupuncture Energetics: A Clinical Approach for Physicians”. Joseph M. Helms. Medical Acupuncture Publishers; 1st Edition. (1995)
- “Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists”. Giovanni Maciocia. Churchill Livingstone; 2 Edition (July, 2005).
- “Diagnosis in Chinese Medicine: A Comprehensive Guide”. Giovanni Maciocia. Churchill Livingstone; 1st Edition (January, 2004).
4. “Chinese Scalp Acupuncture”. Jason Ji-shun Hao, Linda Ling-zhi Hao and Honora Lee Wolfe. Blue Poppy Press; 1st Edition. (November, 2011)
5. Griffin BP. Statins in aortic stenosis: new data from a prospective clinical trial. J Am Coll Cardiol. Feb 6 2007;49(5):562-4. [Medline].
6. Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. Dec 1 2007;370(9602):1829-39. [Medline].
7. Becker DJ, Gordon RY, Halbert SC, et al. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. Ann Intern Med. Jun 16 2009;150(12):830-9, W147-9. [Medline].
8. Yoneda M, Yamane K, Jitsuiki K, et al. Prevalence of metabolic syndrome compared between native Japanese and Japanese-Americans. Diabetes Res Clin Pract. Mar 2008;79(3):518-22. [Medline].
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10. Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol. Apr 2008;28(4):629-36. [Medline].
11. Tupper T, Gopalakrishnan G. Prevention of diabetes development in those with the metabolic syndrome. Med Clin North Am. Nov 2007;91(6):1091-105, viii-ix. [Medline].
12. Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. Aug 13 2013;62(7):569-76. [Medline].
13. Esposito K, Ciotola M, Giugliano D. Mediterranean diet and the metabolic syndrome. Mol Nutr Food Res. Oct 2007;51(10):1268-74. [Medline].
14. Pan A, Lucas M, Sun Q, van Dam RM, Franco OH, Manson JE, et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch Intern Med. Nov 22 2010;170(21):1884-91. [Medline]. [Full Text].
15. “Decoded Science” website. http://www.decodedscience.com/xiao-ke-wasting-and-thirsting-disease-and-the-tcm-treatment-of-diabetes/10828
Author: Leslie Cohen, M.A. and B.A
18 Chinese herbal formulas for treating hypertension in traditional Chinese medicine: perspective of modern science Xingjiang Xiong1,3, Xiaochen Yang1, Yongmei Liu1, Yun Zhang1, Pengqian Wang2,3 and Jie Wang1 Hypertension Research (2013) 36, 570–579 & 2013 The Japanese Society of Hypertension All rights reserved 0916-9636/13 www.nature.com/hr