The Great Cholesterol Myth (25 page)

In most of the epidemiologic and clinical trials, a high dietary intake of magnesium (at least 500 to 1,000 mg a day) resulted in reduced blood pressure.
¹⁵
These studies showed an inverse relationship between magnesium intake and blood pressure; people who consumed
more
magnesium had
lowe
r blood pressure. One study of 60 hypertensive subjects who were given magnesium supplementation showed a significant reduction in blood pressure over an eight-week period.
¹⁶

So basically, you can think of magnesium as a “relaxer.” One of the most relaxing things you can do is to bathe in Epsom salts, which is basically a compound of magnesium with a little bit of sulfur and oxygen. If you’ve ever worked with an integrative medicine practitioner who happens to use vitamin drips, you might have found that the most amazing and restful sleep you’ve ever had occurred after getting a magnesium-heavy vitamin push.
*
Just as magnesium has a relaxing effect on your body, it also has a relaxing effect on your arteries. And that’s a very good thing from the perspective of the heart, which instead of having to push blood through a narrow or constricted vessel (dangerously raising blood pressure) now has the much easier task of pumping it through a relaxed, widened vessel that doesn’t put up so much resistance. Your heart doesn’t have to work as hard, your blood pressure goes down, and all is well with the world.

There’s another interesting connection between magnesium and the heart, and if you’ve followed our argument so far, you’ll love the elegance of how it all comes full circle. The connection? Sugar.

You’ll recall from
chapter 4
that sugar is one of the worst things you can eat if you want to have a healthy heart. (To save you the trouble of looking it up, here’s why: Sugar is highly inflammatory. It also
creates dangerous compounds known as advanced glycation end products, or AGEs, which play a pivotal role in atherosclerosis.
¹⁷
) AGEs play a role of particular importance in type 2 diabetes, which, as you know, is a condition in which blood sugar and insulin are essentially at unhealthy levels and have to be brought under control. (And diabetes is one way to fast-track your path to heart disease.)

One of the very best things magnesium does is help manage blood sugar. In several studies of diabetic patients, magnesium supplements of 400 to 1,000 mg per day, given for anywhere from three weeks to three months, improved a number of measures of glycemic (blood sugar) control, including the requirement for insulin.
¹⁸
One study measured serum concentrations of magnesium in 192 people with insulin resistance and found that the prevalence of a low magnesium level was about 65 percent among those with insulin resistance, as opposed to only 5 percent of those in a control group.
¹⁹

Clearly, there’s a strong association between magnesium deficiency and insulin resistance. You’ll recall that people with insulin resistance are at great risk for diabetes, which in turn puts them at great risk for heart disease. Helping to control blood sugar and insulin is just one more important way in which magnesium is critical for heart health.

Magnesium is necessary for more than three hundred biochemical reactions in the body, and many of these are enzymatic reactions, essential for heart health (or what scientists call
myocardial metabolism
).
²⁰
Even borderline deficiencies of magnesium can negatively affect the heart, and not surprisingly, there is a considerable amount of evidence associating low levels of magnesium with cardiovascular disease.
²¹

Bottom line: Magnesium supplements are a must for those who want to protect their hearts. Magnesium lowers blood pressure, helps control blood sugar, and relaxes the lining of the blood vessels. And almost all dietary surveys show that Americans aren’t getting nearly enough.
²²
We recommend supplementing with at least 400 mg per day.

NOTE:
Magnesium supplementation is
not
recommended for anyone with renal insufficiency (kidney disease).

Even if your doctor hasn’t studied nutrition and is skeptical (or worse) when it comes to supplements, chances are he or she will be familiar with the benefits of niacin. It’s been known since 1955 that cholesterol can be effectively lowered with doses of 1,000 to 4,000 mg of niacin daily.
²³
Subsequent studies have shown that niacin will lower triglycerides by 20 to 50 percent and LDL cholesterol by 10 to 25 percent.
²⁴

Niacin is one of two major forms of vitamin B
₃
—the other is nicotinamide. Although both forms can be used for different things in the body, only the niacin form has an effect on your cholesterol, triglycerides, and related compounds. And the effect is not just on overall cholesterol. Studies have shown that when LDL cholesterol is reduced with niacin, there is a preferential reduction of the really nasty LDL molecules,
the hard, small, BB gun pellet–type particles that stick to the artery walls, get oxidized, and cause damage.

Niacin also reduces lipoprotein(a), or Lp(a). Lipoprotein(a) is basically a special kind of LDL, and it’s a really bad one. This, folks, is the
real
cholesterol story! Lp(a) is an independent risk factor for heart disease and for heart attacks, yet it doesn’t get as much attention as cholesterol does because there aren’t effective drug treatments for lowering it, and no one really knows what to do about it. Niacin lowers Lp(a) levels by a remarkable 10 to 30 percent.
²⁵

Equally terrific, if not more so, is the fact that niacin
raises
HDL cholesterol. That alone would be worth shouting from the rooftops, because we consider HDL cholesterol to be a much undervalued player in the heart disease story. (We’ll delve into this topic later on in the book.) Niacin raises HDL levels by 10 to 30 percent.
²⁶
But even better is the fact that it
preferentially
increases HDL-2, which is the most beneficial of the HDL subclasses.
²⁷
(HDL-3 is actually pro-inflammatory, even though it’s a member of the so-called “good” cholesterol family—HDL—once again demonstrating how obsolete and ridiculous the classification of cholesterol into just “good” and “bad” really is!)

The most clinically important side effect of too much niacin is that it can be very taxing on the liver (a condition known as hepatotoxicity), although as Dr. Alan Gaby points out in his exhaustive review of nutritional supplements and disease, this is almost never seen in patients taking 3 g or less per day.
²⁸

Abram Hoffer, M.D., the great pioneer of nutritional and integrative medicine, stated that his thirty years of experience with niacin therapy (usually 3 g a day or more) showed that one out of every two thousand patients will develop hepatitis from large doses of this vitamin. However, Hoffer also pointed out that in all of his patients who developed hepatotoxicity, liver function returned to normal after treatment was discontinued.
²⁹

Sustained-release niacin is actually more hepatotoxic than regular niacin, and liver problems may occur at lower doses.
³⁰
Nausea may be an early warning sign of niacin-induced hepatotoxicity; if nausea occurs, the dose should be reduced, or treatment should be stopped.
³¹
For folks taking therapeutic doses of niacin, it’s a good idea to have your doctor check your liver enzymes periodically using a standard liver function test.

The first time I experienced the “niacin flush” I was working as a personal trainer. It was five o’clock in the morning, and I was getting ready for my six a.m. client. I remember drinking my protein shake, swallowing my vitamins, and then, a very short time later while getting dressed, having the distinct feeling that I was going to die. My skin was flushed, warm to the touch, and my cheeks (and arms) were pinkish red. It wasn’t painful, but it was deeply unpleasant.

My six a.m. client happened to be the president of a high-end makeup company whose husband was an equally well-known Manhattan dermatologist (as well as the only doctor I knew who was likely to be awake at this ungodly hour). I called my client, and she immediately put her husband on the line. I described my symptoms, and he asked me if I’d taken or eaten
anything unusual. “Just my vitamins,” I said, to which he replied without hesitation, “Oh, it’s just the niacin. Nothing to worry about, it’ll pass in a few. I’m going back to bed now.”

So that was my first encounter with the infamous “niacin flush.” It’s basically a temporary flushing of the skin, not at all dangerous (especially if you know it’s coming!), and it’s actually a result of the dilation of the blood vessels in the skin (which is why my skin turned pink). Some people experience itching as well or even a mild burning sensation. It typically goes away within a couple of weeks and can usually be counteracted with a baby aspirin taken beforehand.

NOTE:
If you are diabetic or have a liver ailment, be sure to check with your doctor before supplementing with niacin.

• Look for straight, non-time-release niacin (also known as nicotinic acid). Take after meals at dosages of 500 mg to 3 g daily (see below).

• Start slowly at 100 mg. Work your way up gradually to a higher level, in divided doses.

• If the flush is too uncomfortable, take a baby aspirin before the first meal of the day and then take the niacin after the meal. Use the aspirin only as long as you experience the flush and whenever you increase your niacin dosage, which will trigger a flush.

• You can also try taking an apple pectin supplement with the niacin to reduce a flush.

• Niacin may increase the enzyme levels in liver function tests. This does not necessarily mean that niacin is causing a liver problem, but have your doctor keep an eye on it. He or she may suggest stopping the niacin for five days before your next liver test to avoid possible confusion. Be aware, though, that when you resume the niacin you will develop a flush.

For decades, the nutritional world revered vitamin E as something of a heart savior, a major antioxidant that defended against lipid peroxidation, which was thought to be the cause of cardiovascular disease. (
Lipid
simply means fat, and
peroxidation
is a fancy way of saying oxidative damage from free radicals.) During the 1990s the adulation for vitamin E even extended to mainstream medicine, going as far as the American Heart Association. In 1996, for instance, vitamin E was celebrated in a well-publicized study for significantly reducing cardiovascular events over the course of one year among some 2,000 patients with documented heart disease.

The successes and reputation of vitamin E prompted many to believe that if a little vitamin E was good, then more would be even better! Critical studies that followed, however, began demonstrating that daily doses of vitamin E at 400 IUs and above didn’t necessarily generate beneficial results, and, in fact, might be detrimental to health. (As early as 2003, Dr. Sinatra wrote in his newsletter about his own reluctance to back high-dose vitamin E because the emerging research indicated possible pro-oxidant effects.)

That said, both of us found ourselves puzzled by the negative study results that have popped up since
then. Sure, problems could come from using the synthetic form of vitamin E (designated
dl-alpha-tocopherol
) instead of the “natural” form (designated
d-alpha-tocopherol
). But a
pro
-oxidant effect from natural vitamin E, considered one of the powerhouses in the anti-oxidant armamentarium? How could that be?

Sharp-eyed readers may have noticed that we put quotation marks around the word
natural
when referring to natural vitamin E in the above paragraph. That’s because d-alpha-tocopherol by itself is only one
part
of natural vitamin E. Vitamin E is actually a collection of eight related compounds that are divided into two classes:
tocopherols
and
tocotrienols
. The tocopherols come in four forms:
alpha, delta, beta,
and
gamma
. Of these four forms, the best known is alpha. When you purchase a “natural” vitamin E supplement, most of the time it is 100 percent
alpha
-tocopherol.

And therein lies the problem.

Gamma-tocopherol is turning out to be the most potent of the four tocopherols, and the one most responsible for vitamin E’s positive effects as an anti-oxidant. Thus, people taking high-dose alpha-tocopherol alone and not getting enough gamma-tocopherol in their diets, or in their supplements, could run the risk of experiencing a pro-oxidant effect from vitamin E. Moreover, large doses of alpha-tocopherol could also deplete the body’s existing gamma-tocopherol stores.

A 2011 study provided an even sharper image of the two faces of vitamin E. In laboratory experiments, researchers in Belfast found that vitamin E (alpha-and gamma-tocopherol) protects very low-density lipoprotein (VLDL) and LDL cholesterol against oxidation. That’s a good thing! Yet they found a “surprising” pro-oxidant effect on HDL (high-density lipoprotein), the cholesterol particle that acts like a garbage truck, picking up harmful oxidized LDL and transporting it back to the liver for removal. Anything that can hinder HDL is of real concern.

Worth noting is that the researchers referenced a previous study in which taking a small amount of vitamin C along with your alpha-tocopherol helped
prevent
the negative, pro-oxidant effect of vitamin E on HDL. That wouldn’t be the first time one nutrient helped another one out. We already know that CoQ
₁₀
helps protect vitamin E in the body and gives it a hand by recycling it back to an active form after it’s been oxidized in biochemical reactions. (We are big fans of the synergistic effects of nutrients.)