Back in July I wrote about the potential of artichoke leaf extract to lower cholesterol levels.  There have been many papers written about natural alternatives to statins, the commonly prescribed drug for the lowering of cholesterol levels.  Many individuals prefer not to take statin medication due to the potential adverse effects and the fact that it is still not entirely known why it seems to be useful in the prevention of heart disease.  There also seems to be some concern that statins, such as simvastatin and ezetimbe, appear to be linked to an increased risk of cancer(1).

The whole cholesterol issue is one that is filled with contention.  A few years ago I was working with Dr Briffa(a fantastic experience!) and I was surprised to find that cholesterol levels were not necessarily something to worry about and that low levels have been linked to all sorts of other problems.  There are so many types and classes of cholesterol, some of which are seen as ‘good’ and others ‘bad’!  Then there is a type of fat found in blood called triglycerides, these really do seem to be linked to an increased risk of heart disease and should be seen, perhaps, as more of a worry than cholesterol.  The slight problem here is that most people looking to reduce their cholesterol levels adopted a very low fat diet, this generally means that they increase their carbohydrate intake – but carbohydrates, especially refined carbohydrates and sugar, are what increase the triglyceride levels in the body!!  Certain fats, especially omega 3 fatty acids (found in oily fish such as salmon, trout and mackerel as well as flaxseeds), are known to reduce these triglyceride levels and are essential for health!  I wrote in some depth about carbohydrates, sugar, triglycerides, omega 3 fatty acids and heart disease in September and I would recommend that you read the post in order to gain a little more understanding of this complex issue.

Personally I think that a low fat diet is certainly not a good idea, especially if it leads to over consumption of refined carbohydrates and sugar.  Certain fats, such as the omega 3 fatty acids mentioned above, are essential to our health.  The body cannot make these essential fats, they must be provided through the diet.  My interest and enthusiasm lies in the promotion of a healthy, balanced diet rich in vegetables and fruits, which are fantastic sources of nutrients and unrefined carbohydrate, healthy fats from fish, nuts and seeds and olives, and protein from unprocessed meat, fish and beans/legumes/nuts.  Exercise is also a crucial part of a healthy lifestyle.  Just 30-40 minutes of accumulated walking in a day would provide some benefit to health.

Anyway, back to the cholesterol issue.  For those wishing to adopt a different strategy to the use of statins I would like to draw your attention to a recent study (2) which looked at natural alternatives.  The researchers involved with this study wanted to compare the LDL-cholesterol (one of the types of cholesterol frequently seen as ‘bad’) lowering effects of a standard statin (simvastatin) to an alternative regimen which involved lifestyle changes in combination with a fish oil supplement and a red yeast rice supplement for 12 weeks.  The statin group also received standard printed materials about diet and exercise recommendations.  The study was small and involved 74 patients, men and women aged 18-80, with high cholesterol levels. 

The lifestyle program involved weekly 3 and a half hour educational meetings led by a cardiologist (specialist heart doctor), dietician, exercise physiologist and several alternative or relaxation practitioners. The dietician encouraged the group to follow a Mediterranean diet (which I have previously written about in relation to asthma and arthritis) which is low in sugars and refined carbohydrates but not specifically low in fat. An exercise physiologist instructed the group to gradually increase their exercise regimen to 5 or 6 times per week, especially encouraging aerobic exercise including walking, swimming, or jogging for 30 to 45 minutes at a time. The alternative practitioners exposed patients to various relaxation methods including yoga and tai chi.

The results of the study were very interesting.  There was a statistically significant reduction in the LDL-cholesterol levels in both groups.  Neither ‘treatment’ showed better results than the other, indicating that the alternative ‘natural’ regiment was as good as the medication.  However, in addition to reducing the cholesterol levels the alternative/natural group ALSO had a significant reduction in their blood triglyceride levels and a significant reduction in their weight – this was NOT seen in the group who received the statin drug.

The authors conclude: “Lifestyle changes combined with ingestion of red yeast rice and fish oil reduced LDL-Cholesterol in proportions similar to standard therapy with simvastatin. Pending confirmation in larger trials, this multifactorial, alternative approach to lipid lowering has promise for a subset of patients unwilling or unable to take statins”

Red yeast rice, also called hong qu, is a Chinese herbal medication first described in 800 AD.  It contains many active substances that may be responsible for its health benefits.  In the study the dose used was 2.4-3.6g a day.  Fish oil is something I often write about.  It has been linked to the reduction of so many health problems and appears to be very beneficial in the prevention of many heart conditions.  The Mediterranean diet is rich in fish, especially oily fish as well as being abundant in vegetables and fruits which provide a whole array of nutrients and fibre.  If oil fish does not figure highly in your diet, at least two portions per week, you may like to consider taking a supplement providing 250-350mg of EPA and the same of DHA.  Vegetarians and vegans may wish to take a flaxseed oil supplement providing 500mg - 1000mg of alpha linolenic acid a day. 

The take home message, in my opinion, is to eat well and move the body.  Hectic lives often mean we neglect health but just a few short walks a day can easily add up to 40mins and a little meal planning can lead to improvements in diet.

(1) Rossebø AB, et al. Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis. NEJM Published on-line 2nd September 2008.
(2) Becker DJ et al.  2008.  Simvastatin vs Therapeutic Lifestyle Changes and Supplements: Randomized Primary Prevention Trial.  Mayo Clin Proc.  83:758-764

Written by Ani Kowal

Last weekend I had the most delicious artichoke and broad bean salad and it spurred me into thinking about the health benefits of artichoke.  More and more people are taking a supplement of artichoke leaf extract for a variety of reasons.  Artichoke leaf extract is made from the thistle-like leaves at the base of the stem of the Globe Artichoke (botanical name Cynara scolymus) and not from the (very tasty!) artichoke heart that we use in cooking.

Quite a lot of recent research into artichoke leaf extract in the UK has come from the University of Reading and has mostly concentrated on the positive effects of the herb on the digestive system.  Studies have indicated that it may alleviate irritable bowel syndrome(1, 2) and indigestion(3,4). 

However, the latest research, published online last month, has found that artichoke leaf extract is also very effective at reducing cholesterol levels(5).  Many people are now taking statins in order to try and reduce their high cholesterol levels.  Taking steps through diet, exercise and perhaps supplements, before cholesterol levels reach a high could help to reduce the need for drugs (it is my personal opinion that prevention is always better than cure).  This piece of research is important because the study involved healthy people who had only moderately raised blood plasma cholesterol levels (not yet needing drugs) and it was found that the artichoke leaf extract was helpful in reducing their blood cholesterol concentrations.

The trial involved 75 individuals with total plasma cholesterol in the range 6.0–8.0 mmol/l and lasted 12 weeks.  The participants took 1280 mg of a standardised artichoke leaf extract (4 capsules), or a placebo each day.  Plasma total cholesterol decreased significantly in the treatment group (compared to the placebo) by an average of 4.2%.  This may seem like a modest change but it is favourable and certainly significant.

Dr Rafe Bundy, the lead study scientist, is quoted as saying “Reducing cholesterol levels can reduce the risk of developing cardiovascular disease. Our research investigated whether ALE [artichoke leaf extract] could be beneficial to otherwise healthy people who had raised levels of cholesterol but were not yet at a stage where they needed standard medical intervention. ALE may provide another option which people could try over and above a healthy diet in order to help lower plasma cholesterol.”

Artichoke leaf extract may be having an effect via antioxidant action, though the exact mechanism is not clear.  The extract contains a variety of polyphenols/flavonoids (bio-active plant chemicals) such as Caffeic Acid, Chlorogenic Acid and a group of compounds collectively called Caffeoylquiinic Acids (e.g. Cynarin), these are probably the active substances responsible for the beneficial health effects.

Artichoke leaf extract is widely available as a supplement and often supplements are standardised to contain around 15% Chlorogenic Acid and 2-5% Cynarin.  Typically around 600mg-900mg per day is recommended (check the recommended dose on the label) for improved digestion and cholesterol lowering.

(1) Walker AF et al.  2001.  Artichoke leaf extract reduces symptoms of irritable bowel syndrome in a post-marketing surveillance study.  Phytotherapy Research.  15(1):58-61.
(2)Bundy R et al.  2004.  Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis.  J Altern Complement Med.  10(4):667-669.
(3)Marakis G et al.  2002.  Artichoke leaf extract reduces mild dyspepsia in an open study.  Phytomedicine.  9(8):694-699.
(4) Holtmann G et al.  2003.  Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-
blind, multicentre trial.  Aliment Pharmacol Ther.  18(11-12):1099-1105.
(5)Bundy R et al.  2008.  Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: a randomised double-blind placebo controlled trial. Phytomedicine [Epub ahead of print DOI: 10.1016/j.phymed.2008.03.001 doi:10.1016/j.phymed.2008.03.001]    

Written by Ani Kowal