Reasons For High Cholesterol

Beat Cholesterol Guide

Beat Cholesterol In 30 Days is the latest program that teaches people how to control their cholesterol levels, and reduce their risk of a heart attack dramatically. The program also provides people with easy and simple exercises to get lean, fit, and healthy. In addition, this program is designed by Scott Davis, an alternative health expert and medical researcher who has over 14 years of experience in the healthcare industry. Davis shows that lowering your cholesterol is a straightforward process: changing your diet according to the guidelines in the guide will reduce your cholesterol to healthy levels. There's nothing relative or interpreted in this book. Certain foods will make your cholesterol levels better. But some will make them worse, and Davis makes it easy to determine and identify the cholesterol-raising culprits in your cupboard. Davis believes so much in the results of this test that he is offering a no-risk guarantee when you buy his e-book. If for any reason you arent satisfied in the first 60 days you can get your money back. At the very worst, even if you dont learn anything new from this e-book you will get your money back. Continue reading...

Natural Cholesterol Guide Summary


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Cost and regulation of mediumchain triglycerides in different countries

Regulations regarding MCT oils and structured lipids vary between countries. Japan was the first to regulate and implement programs for functional foods. MCFA were approved as FOSHU (Foods for Specific Health Use) for health claims in the category of 'neutral fats and body fats'. In the United States, MCTs benefit from the GRAS (Generally Recognized As Safe) label provided for use by the FDA, confirming the safety of MCTs in human nutrition. In Canada, MCTs are allowed for use both as a food and as an ingredient in foods. When sold as a food, the acceptable common name is 'Medium Chain Triglycerides' and the abbreviation 'MCT' is not acceptable (Canadian Food Inspection Agency Food Safety Directorate

Familial Hypercholesterolemia

Synthetic vectors are being evaluated for the treatment of familial hypercholesterolemia (FH) and hyperlipidemias. FH is an autosomal dominant disorder caused by mutations in the low-density lipoprotein (LDL) receptor. Patients have persistently elevated levels of LDL in their serum, which leads to the development of atherosclerosis and coronary artery disease (43). Tomita et al. (44) injected a complex of hemagglutinat-ing virus of Japan (HVJ) liposomes and a plasmid expressing the human LDL receptor into the hepatic portal vein of LDL receptor knockout mice. RNA was detected in the livers that peaked at days 7 to 10 after injection, but became undetectable by day 21. At day 7 there was a modest but statistically significant decrease in total cholesterol levels. Another approach being taken to treat hypercholesterolemia is to express apoli-poprotein E, which is involved in removing excess lipopro-teins and cholesterol from tissues. Rinaldi et al. (45) injected a plasmid that...

Effects of mediumchain triglycerides on appetite control

The effect of dietary MCT versus LCT on short-term food intake has been compared in rats (Maggio and Koopmans, 1982 Furuse et al1992). The satiating effect of these two triglycerides appears to be related to their caloric content rather than to chain length (Feinle et al2001 Westerterp-Plantenga, 2004a). In addition, the ingestion of MCT as a bolus does not stimulate contraction of the gallbladder nor raise the plasma cholecystoki-nin (CCK) level in the manner in which it occurs following LCT ingestion (Hopman et al., 1984). This gastric relaxation by MCT is not sufficient to induce satiation therefore, the nutrient-induced gastric relaxation occurs through other mechanisms than CCK (Furuse et al., 1992 Barbera et al 2000). According to Maas et al. (1998), MCT inhibit gastrin-stimulated gastric acid secretion, but less so than LCT. Overall, it has been determined that the satiating effects of a fat depend on the fatty acid chain length, and moreover that the role of CCK and...

Introduction mediumchain triglycerides and weight control

Lct Mct Digestion

Conventional fats and oils are composed of glycerides of 12- to 18-carbon long-chain fatty acids (LCFA). These compounds are known as long-chain triglycerides (LCT) and are the predominant form of lipids in the diet. Lipids are an essential source of energy and essential fatty acids, and a vital component of body cells. Therefore, it would be beneficial to have a dietary fat with the added benefit of anti-obesity properties. Medium-chain triglycerides (MCT) have a number of unique characteristics relating to energy density, absorption and metabolism, which give them advantages over the more common LCT. Upon hydrolysis, MCT yield medium-chain fatty acids (MCFA) caproic (C6), caprylic (C8), capric (C10), lauric (C12) (Papamandjaris et al., 1997). Naturally occurring sources of MCT are rare, but include milk fat, palm kernel oil, and coconut oil. Human consumption of MCT is currently low but intake should perhaps be greater due to the distinctive properties of MCT, which cause an...

Curcumin Lowers Serum Cholesterol Levels

Numerous studies suggest that curcumin lowers serum cholesterol levels (78-84). Soudamini et al. investigated the effect of oral administration of curcumin on serum cholesterol levels and on lipid peroxidation in the liver, lung, kidney, and brain of mice treated with carbon tetrachloride, paraquat, and cyclophosphamide (81). Oral administration of curcumin significantly lowered the increased peroxidation of lipids in these tissues produced by these chemicals. Administration of curcumin also significantly lowered the serum and tissue cholesterol levels in these animals, indicating that the use of curcumin helps in conditions associated with peroxide-induced injury such as liver damage and arterial diseases. Soni and Kuttan examined the effect of curcumin administration in reducing the serum levels of cholesterol and lipid peroxides in 10 healthy human volunteers receiving 500 mg of curcumin per day for 7 days (82). A significant decrease in the level of serum lipid peroxides (33 ), an...

Cholesterol Reduction

Flavonoids are known to reduce cholesterol. A 30-day study of induced hyperlipidaemia in rats found that baicalein, quercetin, rutin and naringin reduced cholesterol, with baicalein being the most potent. Baicalein was also the most effective flavonoid in reducing triglyceride levels (De Oliveira et al 2002). In another in vivo study, rats were fed a cholesterol-laden diet and half were also given 5. baicalensis radix extract (Regulska-llow et al 2004). The treatment rats displayed a significant reduction in plasma triglycerides and total cholesterol as compared with control animals.

Hypercholesterolemia high blood cholesterol

Tion, sequestration, or excretion from the body is called the cholesterol balance. When cholesterol accumulates, the balance is positive when it declines, the balance is negative. In 1993, the NHLBI National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults issued an updated set of recommendations for monitoring and treatment of blood cholesterol levels. The NCEP guidelines recommended that total cholesterol levels and subfractions of high-density lipoprotein (HDL) cholesterol be measured beginning at age 20 in all adults, with subsequent periodic screenings as needed. Even in the group of patients at lowest risk for coronary heart disease (total cholesterol < 200 mg dL and HDL > 35 mg dL), the NCEP recommended that rescreening take place at least once every 5 years or upon physical examination. Hypertriglyceridemia An excess of triglycerides in the blood that is an autosomal dominant disorder with the...

Hypercholesterolaemia And Hypertriglyceridaemia

Niacin has been used for the treatment of hypercholesterolemia and hypertriglyceridaemia since the 1950s. Large doses of niacin reduce total cholesterol, LDL-cholesterol, triglycerides and lipoprotein (a) levels and also markedly raise HDL-cholesterol C levels (lllingworth et al 1994). Considering these factors are also predictive of cardiovascular events, niacin is used to reduce overall risk of cardiovascular disease (Canner et al 1986). According to a recent meta-analysis effects on LDL- 2007 Elsevier Australia cholesterol and triglycerides appear to be more significant in females especially at doses > 1 500 mg day (Goldberg 2004). Extended-release niacin (nicotinic acid) has been evaluated in at least four randomised, placebo-controlled trials, with the most efficacious results occurring at doses of 1 500-2000 mg day (Goldberg 1998, Grundy 2002, Guyton et al 2000, Morgan et al 2003). Results were dose- and time-dependent, with trials ranging in length from 4 to 16 weeks. At the...

Type II or Familial Hypercholesterolemia

Familial hypercholesterolemia (FH) is an autosomal dominant disorder characterized by elevation of plasma LDL cholesterol levels. Mutations at the LDL receptor gene locus on chromosome 19 are Apo C-II deficiency High Familial hypercholesterolemia Familial combined hyperlipidemia Polygenic hypercholesterolemia High Familial hypercholesterolemia The ranges of LDL cholesterol levels in plasma of FH subjects are 200-400 mgdl1 in heterozygotes and above 450mgdl 1 in homozygotes. The frequency of defects at the LDL receptor locus is about 1 in 500 for the heterozygous state and 1 in a million in the homozygous state. The genetic defect(s) associated with a common form of hypercholesterolemia present in most subjects with cholesterol levels between 250 and 300mgdr1 has not been elucidated. This disorder may be due to a combination of minor gene defects (i.e., presence of apo E-4 allele) that in combination with the environment (i.e., diet, lack of exercise) predispose individuals to...

Reduces Serum Cholesterol Levels

A 2000 meta-analysis of 13 clinical trials concluded that garlic is superior to placebo in reducing total cholesterol levels, exerting a modest effect (Stevinson et al 2001). The mechanism of action involves inhibition of cholesterol synthesis by deactivating HMG-CoA reductase via enhanced phosphorylation, but not changing theamount of the enzyme, according to in vitro research (Liu & Yeh 2002). The compounds containing an allyl-d sulfide or a I lyl-su If hyd ryl group are most likely responsible for the inhibition of cholesterol synthesis by garlic and that this inhibition is likely to be mediated at sterol 4-alpha-methyl oxidase (Singh & Porter 2006). Clinical evidence also suggests it raises HDL levels and reduces triglyceride levels (Bordia et al 1998).

Hypertension And Cholesterol Lowering

CoQ10 has been studied both as stand-alone and adjunctive treatment in hypertension. According to a review of 8 studies, supplemental CoQ10 results in a mean decrease in systolic blood pressure of 16 mmHg and in diastolic blood pressure of 10 mmHg (Rosenfeldt et al 2003). The effect on blood pressure has been reported within 10 weeks of treatment at doses usually starting at 100 mg daily. One small 10-week open study of 26 subjects with essential hypertension study found that an oral dose of 50 mg taken twice daily also reduced total serum cholesterol levels with a modest increase in serum HDL-cholesterol (Digiesi et al 1994).

Dietary Cholesterol Intake Patterns

Dietary cholesterol intakes in the United States have been declining, from an average of 500 mg per day in men and 320 mg per day in women in 1972 to levels in 1990 of 360 mg per day in men and 240 mg per day in women. This decline is due in part to dietary recommendations to the US public to reduce total and saturated fat intake and to reduce dietary cholesterol daily intake to less than 300 mg and in part from the increased availability of products with reduced fat and cholesterol content. Major efforts in the early 1970s by public health agencies and advertising emphasized reducing dietary cholesterol as a means to lower plasma cholesterol levels, leading to a high degree of consumer concern regarding cholesterol-containing foods and demand for low-cholesterol products. Today, practically all foods sold in the United States are labeled for their cholesterol content and their percentage contribution to the daily value of 300 mg for cholesterol.

Dietary Cholesterol and Plasma Cholesterol

The effect of dietary cholesterol on plasma cholesterol levels has been an area of considerable debate. In 1972, the American Heart Association recommended that dietary cholesterol intake should average less than 300mgperday as part of a 'heart-healthy,' plasma cholesterol-lowering diet. Since that initial recommendation, a number of other public health dietary recommendations in the United States have endorsed the 300 mg daily limit. Interestingly, few dietary recommendations from other countries contain a dietary cholesterol limitation. The evidence for a relationship between dietary cholesterol and plasma cholesterol indicates that the effect is relatively small, and that on average a change of 100 mg per day in dietary cholesterol intake results in a 0.057 mmoll-1 (2.2mgdl-1) change in plasma cholesterol concentrations. Studies have also shown that the majority of individuals are resistant to the plasma cholesterol-raising effects of dietary cholesterol 'nonresponders' and have...

High Cholesterol

Probiotics modestly reduce cholesterol levels in healthy subjects and may have stronger effects in people with hyperlipidaemia. In another study, 32 subjects with serum total cholesterol ranging from 5.7 to 7.25 mg dL were randomly assigned to two treatments (1) Intake of a low-fat drinking yoghurt prepared with two ordinary yoghurt starters (Streptococcus thermophilus and Lactobacillus delbrueckii subsp. Bulgaricus placebo group) and (2) intake of a low-fat drinking yoghurt prepared with the two yoghurt starters plus Bifidobacterium longum strain BL1 (probiotic group). After intake for 4 weeks at 3 100 mL day, reduction of serum total cholesterol was observed in approximately half of the probiotic group subjects a particularly significant decrease in serum total cholesterol was found among subjects with moderate hypercholesterolemia (serum total cholesterol > 6.2 mg dL). The serum lipid concentrations in the placebo group subjects were almost stable during the experimental periods...

Better Than Statins

Researchers gave 120 men with high cholesterol either the statin drug, Zocor, or a placebo (sugar pill) and instructed them to eat either their usual diet or a Mediterranean-type diet. After 12 weeks, the diet had cut LDL by 11 percent, Zocor had cut it by 30 percent, and diet plus Zocor cut LDL cholesterol by 41 percent. A bonus the Mediterranean diet wiped out the (unwanted) 13-percent rise in insulin levels caused by the Zocor.29 In our practice, we lower cholesterol up to 40 percent by eliminating sugar and eating beets.

Dietary Cholesterol

All dietary cholesterol is derived from animal products. The major sources of cholesterol in the diet are egg yolks, products containing milk fat, animal fats, and animal meats. Many studies have shown that high intakes of cholesterol will increase the serum cholesterol concentration. Most of this increase occurs in the LDL cholesterol fraction. When cholesterol is ingested, it is incorporated into chylomicrons and makes its way to the liver with chylomicron remnants. There it raises hepatic cholesterol content and suppresses LDL receptor expression. The result is a rise in serum LDL cholesterol concentrations. Excess cholesterol entering the liver is removed from the liver either by direct secretion into bile or by conversion into bile acids also, dietary cholesterol suppresses hepatic cholesterol synthesis. There is considerable variability in each of these steps in hepatic cholesterol metabolism for this reason the quantitative effects of dietary cholesterol on serum LDL...

What This Book Can Do for

If you choose to go to your doctor and get a lipid profile, you will most likely see an improvement in your total cholesterol, HDL (good cholesterol), triglycerides, and glucose. While heredity plays a part in the lipid profile for example, high cholesterol runs in some families studies have shown that people can control approximately 70 percent of hereditary factors through lifestyle. 7. Fifty percent of our children are obese or overweight and a significant number of kids are already experiencing major health problems such as high blood pressure, type 2 diabetes, deformities of the hips and knees, asthma, premature puberty, increased triglycerides, high cholesterol, and decreased levels of HDL. When an airplane is in trouble, parents are told to put on their oxygen mask so that they can help their children. The only way that we are going to save our kids is to put on the mask to take responsibility for developing healthy nutritional and exercise patterns ourselves.

Learn Why Exercising Increases Fat Loss

Fat is stored in cells in the form of triglycerides. You've heard that exercise increases the body's ability to burn fat, but probably you've never really understood why that happens or, for that matter, why you should even bother to exercise if you're already on a good food program. Shouldn't just eating correctly be enough In reality, appropriate exercise greatly enhances your body's ability to burn stored fat. Epinephrine is a fat-mobilizing hormone released by your sympathetic nervous system. Studies have shown that during exercise there is a significantly greater concentration of this hormone in your body. When epinephrine binds to specific receptors on fat cells, it stimulates hormone-sensitive lipase, also known as HSL, to break apart triglycerides within the cells and release them into the bloodstream where they can be used as energy. And that's precisely what you want to happen. You don't want that fat to just sit around in your body you want to get it mobilized. When you...

Evaluate Your Health and Fat Patterns

While I find it important to help my clients establish an accurate perception of their outward appearance, it is also important to help them establish an accurate perception of their internal health. Knowing that you are bulging over the belt of your pants or your skirt does not tell you anything about your cholesterol, triglycerides, or percentage of body fat versus lean muscle.

Are You as Healthy as You Look

Lineman, 6 feet 5 inches, came into my program weighing 328 pounds. He had a BMI greater than 36, a 51.7-inch waist, and a total cholesterol of 227. His HDL was low at 29. Since his triglycerides were 467, we couldn't get an accurate reading on his LDL because, as my doctors tell me, excessively high triglycerides almost always skew the LDL reading. His glucose was 120, just 6 points below the diabetic classification. The real shocker was his blood pressure, which was 190 120. We found out that he had stopped taking his blood pressure medicine and failed to tell either his trainer or the team doctor. If he had not come to us for help, it is highly likely that in the near future he would have had a stroke right there on the field. And this man was considered to be a world-class athlete.

Learn How to Interpret Your Blood Work

Before you begin the Fat-Burning Metabolic Fitness Plan, ask your doctor to draw your blood and do a full metabolic profile. If you decide to take advantage of your higher metabolic rate and fat-burning ability and continue beyond the basic four-week plan into Modules 2 and 3, you might wish to repeat this test at the twelve-week mark so that you can see how dramatically the nutritional and exercise programs have improved your cholesterol, triglycerides, and glucose levels. You can plug the numbers from your lab work into the following profile

Carrie Amazing Changes in Her Lipid Profile

Carrie's lipid profile was actually pretty good. Her total cholesterol was 193, her LDL was 102, her HDL was 70, her triglycerides were 96, and her glucose was 99. But everything is relative. I have noticed several things over the last two decades. People who are approaching middle life and rapidly gaining fat in the abdominal area, especially women, are not going to have a good lipid profile for long. Carrie's high body fat and her low metabolism from poor nutrition and little exercise were about to tip the scales toward higher cholesterol and triglycerides. With the gain in fat around her waist, she was definitely headed for a reverse fat pattern. I have also noticed that people like Carrie who have acceptable cholesterol and triglycerides even though they carry a large amount of body fat should As soon as Carrie began to follow a nutritionally balanced, low-glycemic food plan and my program of resistive exercise and interval training, she began to lose fat dramatically. After four...

Ceiburaiine468 bupivacaine

The extent of tissue distribution of a drug depends on both its lipid solubility and relative tissue-plasma protein binding for example the apparent stereoselective distribution of (S -ibuprofen into synovial fluid may be explained by differences in protein binding. Relatively few examples of stereoselectivity in tissue binding are known, however this may occur by selectivity in tissue uptake and storage mechanisms. For example there is evidence that the active S-enantiomers of the P-blocking drugs propranolol and atenolol undergo selective storage and secretion by adrenergic nerve terminals in cardiac and other tissue. The selective incorporation of the A-enantiomers of some of the 2-arylpropionic acid non-steroidal antiinflammatory agents into lipid has also been observed. The selective distribution of these agents is associated with their metabolism and the formation of hybrid triglycerides, the mechanism of which will be discussed below (Section 4.7.5). This selective deposition...

Fatty Acids And Glycerides

Triglycerides can be abbreviated by using the first letters of the common names of the component fatty acids. SSS indicates tri-stearin, PPP tripalmitin, and SOS a triglyceride with two palmitic acid residues in the 1 and 3 positions and oleic acid in the 2 position. In some cases, glyceride compositions are discussed in terms of saturated and unsaturated component fatty acids. In this case, S and U are used and glycerides would be indicated as SSS for trisaturated glyceride and SUS for a glyceride with an unsaturated fatty acid in the 2 position. In other cases, the total number of carbon atoms in a glyceride is important, and this can be shortened to glycerides with carbon numbers 54, 52, and so on. A glyceride with carbon number 54 could be made up of three fatty acids with 18 carbons, most likely to happen if the glyceride originated from one of the seed oils. A glyceride with carbon number 52 could have two component fatty acids with 18 carbons and one with 16 carbons. The carbon...

DCoronary Heart Disease

Directly related to cardiovascular risk factors, including high levels of total cholesterol, LDL-cholesterol, triglycerides, blood pressure, fibrino-gen and insulin, 86 and low levels of HDL-cho-lesterol. 42 Plasminogen activator inhibitor-1 causing impaired fibrinolytic activity is elevated in persons with abdominal obesity. 763 Overweight, obesity, and abdominal fat are also associated with increased morbidity and mortality from CHD. 1142155-161

Metabolism Of Vitamin E

The absorption of vitamin E is relatively poor - only some 20 to 40 of a test dose is normally absorbed from the small intestine, in mixed lipid micelles with other dietary lipids. This absorption is enhanced by medium-chain triglycerides and inhibited by polyunsaturated fatty acids, possibly because of chemical interactions between tocopherols and polyunsaturated fatty acids or their peroxidation products in the intestinal lumen. Esters are hydrolyzed in the intestinal lumen by pancreatic esterase and also by intracellular esterases in the mucosal cells.

Dietary Fiber and the Etiology of Hormone Dependent Cancers

Direct binding of sex hormones is possible but is subject to the same concerns as were raised for cholesterol reduction. In addition, it is possible that other components in, or associated with, fiber (phytooestrogens or antioxidants) may be responsible for any observed protective effect. Soy phytooestrogens are believed to play a role in lowering the risk of breast cancer in Asian populations. Lycopenes are antioxidant carotenoids from tomatoes, and their intake has been correlated with a lower risk of prostate cancer.

Cardiovascularassociated Effects Of Ginger

At least one group found that administration or consumption of standardized ginger extract reduced aortic atherosclerotic lesion areas, plasma triglycerides and cholesterol, LDL-associated lipid peroxides, and LDL aggregation in mice (87). In rabbits fed a high-cholesterol diet, administration of ginger extract resulted in a significant antihyperlipidemic effect and a lower degree of atherosclerosis compared to the group fed cholesterol alone (88).

Functional Interactions

Reduction in the concentration of bile acids A reduction in the concentration of bile acids will affect the absorption of most fat-soluble compounds. Lower bile-acid concentration may result from increased binding and excretion or from decreased production. For example, the antibiotic neomycin binds to bile acids and increases their faecal excretion, thus reducing their luminal concentration and, in this fashion, decreasing the absorption of fat-soluble vitamins. This interaction, like many others, can be used ther-apeutically to reduce bile-acid turnover in patients with certain liver diseases and to lower cholesterol levels by reducing their reabsorption.

Survey Of The Digestive Process And Components

Protein fragments, and triglycerides. The final breakdown of the ingested food, including disaccharides, occurs at the surface of the columnar cells lining the tube, and is then absorbed into the lining cells. Nearly all the absorption of nutrients occurs in the small intestine. When nutrients leave the digestive tract, they go either to the body's tissues or to the liver. The liver is an accessory organ to the digestive tract that regulates much of what goes out to the body through the bloodstream. A specific description of this part of the process can be found in Chapter 5.

Maternal Alcohol Consumption

Commonly associated with insulin resistance and other metabolic diseases, are also evident in the in utero alcohol-exposed offspring. The accumulation of triglycerides in nonadipocyte tissue, namely the skeletal muscle and the liver, is commonly observed in both insulin-resistant humans and experimental animal models of insulin resistance. Elevated levels of plasma and nonadipocyte tissue triglycerides have now also been documented in low-birth-weight rats that were exposed to maternal alcohol in utero.

Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of death worldwide (123), and anything that can delay or help prevent CVD will make a significant impact in both economic- and health-related terms. Established risk factors for CVD include hypertension, hypercholesterolaemia, diabetes mellitus, smoking, and increased thrombotic index, and there is an ever-increasing list of new CVD risk factors and predictors, such as homocysteine, C-reactive protein, and oxidative stress. Modulating risk factors is the key to primary prevention of CVD (141). no deleterious changes were seen in plasma biomarkers of kidney or liver function. Furthermore, there was a small (around 7 ) but significant decrease in total cholesterol concentration (144). A cholesterol-lowering effect was also seen in a study using an in vitro rat liver homogenate model (145). One triterpene (the oxygenated lanosterol, Compound VI) from G. lucidum was reported to show a marked inhibitory effect on cholesterol synthesis from...

Eat the Right Percentages of Protein Carbohydrates and Fats

The latest research shows that 30 percent lean protein, 40 percent low-glycemic carbohydrates, and 30 percent acceptable fats work best for metabolic efficiency. These percentages have been tremendously effective in my program for athletes who want to lose fat, build more lean muscle, and improve performance, and for people who are overfat and often suffering from either elevated triglycerides or high glucose levels. A recent article in the American Journal of Clinical Nutrition makes a convincing argument for this ratio in people suffering from type 2 diabetes, stating that eating 30 percent dietary protein and 40 percent carbohydrates appears to improve glycemic control without increasing the risk of heart disease. In as little as five weeks, the glucose levels of the study participants dropped an astonishing 40 percent, and blood lipids, especially triglycerides, were significantly lowered.

Serum Plasma Lipids and Lipoproteins

Sixty-five RCT articles were evaluated for the effect of weight loss on serum plasma concentrations of total cholesterol, low-density lipoprotein (LDL)-cholesterol, very low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein (HDL)-cholesterol. Studies were conducted on individuals over a range of overweight and lipid levels. Weight loss in 52 of these trials was induced by various lifestyle modifications, including diet modification (reducing calories, or saturated fat and cholesterol, or both) and increased physical activity.

Cardiovascular Effects

Antihyperlipidaemic Ginsenoside Rb1 has been shown to lower triglyceride and cholesterol levels via cAMP-production in the rat liver (Park et al 2002b). P. ginseng extract (6 g day) for 8 weeks resulted in a reduction in serum total cholesterol, triglyceride, LDL and plasma malondialdehyde levels and an increase in HDL (Kim & Park 2003) in eight males. Ginseng has also been reported to decrease hepatic cholesterol and triglyceride levels in rats, indicating a potential use of ginseng in the treatment of fatty liver (Yamamoto et al 1983).

Applications To Health Promotion And Disease Prevention

The anti-atherogenic properties of n-3 PUFAs are perhaps their ability to modify serum and tissue lipid alterations, while the most consistent finding is a reduction in fasting and postprandial serum triglycerides and free fatty acids (FFA) (Micallef & Garg, 2009). The displayed effects are decreased levels of very low density lipoprotein (VLDL) production by the liver, which occurs mostly through a reduction in the synthesis of triglycerides (Micallef & Garg, 2009), largely resulting from interference with most of the transcription factors that control the expression of enzymes responsible for both triglyceride assembly and FA oxidation. This leads to the decreased availability of FFAs released from adipose stores (Micallef & Garg, 2009). Omega-3 PUFAs have been shown to significantly reduce the expression of the sterol regulatory element-binding proteins (SREBP), which are transcription factors that regulate cholesterol, FA, and triglyceride-synthesizing enzymes (Micallef...

Diabetes Complications

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia state (HHS) are serious diabetic emergencies and the most frequent cause of mortality. Both DKA and HHS result from an insulin deficiency and an increase in counter-regulatory hormones (a.k.a. hyperglycemia). Hyperglycemia leads to glycosuria (glucose in the urine), increased urine output, and dehydration. Because the glucose is excreted in the urine, the body becomes starved for energy. At this point, the body either continues to excrete glucose in the urine making the hyperglycemia worse (HHS), or the body begins to break down triglycerides causing the release of ketones (by-products of fat breakdown) into the urine and bloodstream (DKA). The mortality rate of patients with DKA is less than 5 percent while the mortality rate of HHS patients is about 15 percent. Infection (urinary tract infections and pneumonia account for 30 to 50 percent of cases), omission of insulin, and increased amounts of counter-regulatory hormones...

Fat across the Species Barrier

These claims were based on decades of research. As early as the 1970s, Dhurandhar had observed that a chicken adenovirus, isolated in Bombay, caused chickens to accumulate as much as 50 percent more fat than healthy birds. The virus also lowered the animals' cholesterol and triglyceride levels before it killed them. Normally, obesity in any species is associated with high levels of cholesterol and triglycerides, Dhurandhar noted (Neporent 2005). What interested him at that time though was the odd fact that infected chickens ate no more than uninfected ones. As a result, Dhurandhar and his colleagues identified the infectious agents as Ad-36. This agent was first isolated in humans in 1978 in the fecal matter of a seven-year-old diabetic girl.

Type I or Familial Chylomicronemia

This disorder is characterized by greatly elevated levels of exogenous triacylglycerols and it is the result of impaired lipolysis of chylomicrons due to a deficiency of LPL or its activator, the apo C-II. Several genetic mutations at the structural genes for both LPL and apo C-II have been reported. These are autosomal recessive traits. In the heterozygous state, subjects have normal to slightly elevated plasma triglycerides, whereas homozygotes have triacylgly-cerol levels that may exceed 1000 mgdl-1 in the fasting state. The diagnosis of the homozygous state takes place during the first years of life from the presence of recurrent abdominal pain and pancreatitis. Eruptive xanthomas and lipemia retinalis may also occur. The recommended treatment includes a diet low in simple carbohydrates and with a fat content below 20 of total energy. The use of medium-chain triglycerides (MCT) has also been reported to be efficacious. Body weight should be maintained within the normal limits and...

General Guidelines for the Treatment of Lipoprotein Abnormalities for CHD Prevention

There is a clear benefit from lowering LDL cholesterol with diet or drug therapy in patients with hyperlipidemia or CHD or both. Dietary therapy includes using diets that are restricted in total fat (< 30 of calories), saturated fat (< 7 of calories), and cholesterol (< 200 mg day-1). Pharmacological therapies include anion exchange resins, niacin, and HMG CoA reductase inhibitors. The latter agents have been demonstrated to also lower CHD mortality. It should be noted that dramatic interindividual variations have been demonstrated in response to diet and drug therapies. Consequently the efficacy of hypolipidemic therapies will vary from individual to individual. More information is needed about the benefits of HDL cholesterol raising in patients with low HDL cholesterol levels as well as the benefits of lowering triacylglycerol plasma concentrations, and more specifically the triacylgly-cerol carried in lipoprotein remnants. This is also true regarding the benefits of Lp(a)...

Chemical Components

A Iipid-rich extract, prepared by supercritical fluid (C02) extraction of freeze-dried stabilised NZ green-lipped mussel, is commercially available as Lyprinol. The main lipid classes in this preparation are sterol esters, triglycerides, free fatty acids (mainly EPA and DHA), sterols and phospholipids (Sinclair et al 2000).

Nutritional summary

Flushing (burning and itching of face, arms and chest) and stomach irritation arc the main side effects of moderately high supplemental niacin intake (more than 35 mg d). Liver damage that may culminate in irreversible liver failure is a risk associated with long-term use of very high doses (3000 and more mg dl as a cholesterol-lowering drug. Such high doses must never be used without close monitoring of liver function. High intakes of nicotinic acid may interfere with the effects of sulfinpyrazone (Anturane).

Functional Properties and Tissue Health

In certain circumstances, lycopene can reduce LDL-cholesterol levels, possibly by inhibiting hydroxymethylglutaryl CoA reductase (HMGCoA reductase), the rate-limiting enzyme for cholesterol synthesis (see below). Lycopene was shown to have modest hypocholesterolemic properties in one small clinical trial.

Lycopene and Cardiovascular Disease

The European Multicentre Euramic Study, which reported that risk of developing myocardial infarct was inversely related to lycopene intake, after appropriate adjustment for other cardiovascular risk factors. Some Scandinavian studies have subsequently supported this claim moreover, lycopene is capable of reducing LDL-cholesterol levels, possibly by inhibiting hydroxymethylglutaryl CoA reductase (HMGCoA reductase), the rate-limiting enzyme for cholesterol synthesis.

Specific Dietary Interventions

Increasing evidence has demonstrated that adequate dietary lipids are extremely important not just for their caloric value but also for their immune-modulatory effects. Lipids may prevent allergic sensitization by downregulat-ing inflammatory response (n-3 but not n-6 long-chain fatty acids) whilst protecting the epithelial barrier, regulate immune function and modify the adherence of microbes to the mucosa, thereby contributing to host-microbe interactions. Medium-chain (8-12 carbons) fatty acids (MCT) seem to have more strongly antiviral and antibacterial properties (against Rous sarcoma virus, herpes simplex virus, H. influenzae and group B streptococcus) than long-chain triglycerides 30 . According to a recent Cochrane review, there is no evidence of differences between MCT and long-chain triglycerides in short-term growth, gastrointestinal intolerance, or necrotizing enterocolitis 31 .

Lipid Lowering Effect

Ha et al. (9) investigated the lipid-lowering effect of C. tora ethanol extacts in rats fed a high-cholesterol diet. Rats were fed either normal diets or diets high in cholesterol (10 g kg diet), supplemented with C. tora ethanolic extract (0, 0.25, or 0.5 ) for 4 weeks. Liver triglyceride and cholesterol contents were raised in the high-cholesterol groups and were significantly reduced in the groups fed C. tora. Serum levels of HDL cholesterol were slightly increased by consumption of C. tora. The results showed that ethanol extracts of C. tora may exert a lipid-lowering effect in rats fed high-cholesterol diets. Furthermore, Choi et al. (10) indicated that ethanol-treated rats fed with 200 or 400 mg kg body wt. day Cassia ethanolic extract had a hypolipemic effect compared with rats treated with ethanol alone.

Lipids And Cardiovascular Disease

And lesions and are related to the course of myocardial infarction 116,122 . However, atherosclerotic plaque formation and the mechanisms for the ensuing increased morbidity and mortality are complex processes, which involve, for example, the production of superoxide by monocytes, and the formation of autoantibodies against oxidized LDL and MDA-LDL 123,124 , In aortic muscle or endothelial cells in vitro, oxidized LDL can increase collagen and fibronectin synthesis, apoptosis, intracellular calcium and TBA formation 122,125 , Moreover, concomitant pathologies such as hypertension are additional risk factors for the etiology of atherosclerosis. For example, in hypertension, ATC status as reflected by red blood cell (but not plasma), concentrations is lower than that of normotensive controls 126 , Age-related reductions in the anti-oxidant capacity of plasma, acting against peroxyl radicals, may also contribute to the atherosclerosis 127 , There is also a tentative association between...

Effect of Meal Frequency on Absorption

Meal frequency not only affects insulin and glucose levels but also influences an individual's circulating lipids. An inverse relationship exists between meal frequency and lipid levels, suggesting that infrequent feeding leads to an increased risk of cardiovascular disease due to large fluctuations in circulating lipids. Increased meal frequency, on the other hand, is associated with several benefits, such as decreased serum cholesterol levels, decreased total high-density lipoprotein cholesterol ratio, decreased esterified fatty acids, and decreased enzyme levels in adipose tissue associated with fatty acid storage. Paradoxically, individuals who report that they eat more frequently not only have lower total and low-density lipoprotein cholesterol (LDL-C) but also have a greater intake of energy, total fat, and saturated fatty acids. Considering that some of these results were found in a free-living

Mechanisms Underlying the Metabolic Effect of Meal Frequency

The mechanisms underlying beneficial responses to frequent feeding as opposed to an infrequent meal pattern are not fully understood. Frequent feeding has been shown to elicit lower plasma glucose fluctuations than does a more infrequent eating pattern. The absolute amount of carbohydrate eaten at each episode of ingestion in a frequent feeding pattern is simply not great enough to elevate glucose to the same extent as more infrequent eating. Small elevations in plasma insulin seen with frequent feeding are most likely in response to minimal fluctuations in glucose. The mechanisms responsible for the effect of an increased frequency of meal eating on lipid metabolism are not as clear-cut. The lower serum cholesterol levels observed during frequent feeding may be related to lower serum insulin levels. Insulin appears to have a key role in enhancing the hepatic synthesis of cholesterol through its ability to stimulate hydroxymethylglutaryl-coenzyme A reduc-tase (HMG-CoA), the...

Potential Effects Requiring Further Clinical Work

Cholesterol control The cholesterol-lowering effects of probiotics have been the subject of two recent reviews with contradictory results. The first, which focused on short-term intervention studies with one yogurt type, reported a 4 decrease in total cholesterol and a 5 decrease in LDL. Contrary to this, the second review concluded that no proven effects could be found. In this context, it is clear that long-term studies are required before the establishment of any conclusion.

Nutrient Gene Interactions in Chronic Disease

HDL is thought to be protective against heart disease. However, the association between the A polymorphism and elevated HDL is quite inconsistent. This is explained by considering diet. Women with the A polymorphism who consumed > 6 of energy as polyunsaturated fatty acids (PUFA) had higher HDL cholesterol concentrations than women consuming < 6 dietary PUFA. In women lacking this polymorphism, no such effect of diet was seen. Thus, although women with the A polymorphism would clearly benefit from the standard recommendation for increasing dietary PUFA, those who lack it may not, at least with respect to HDL.

Hazard Identification

Short-term feeding studies (7 to 46 days) in rats have shown growth retardation, hepatomegaly, and hypercholesterolemia at L-histidine levels of approximately 2 to 4 g kg body weight d (Harvey et al., 1981 Hitomi-Ohmura et al., 1992 Ohmura et al., 1986 Solomon and Geison, 1978). Harvey and coworkers (1981) reported significantly reduced concentrations of copper and zinc in the plasma and reduced liver concentrations of copper after feeding diets containing 8 percent L-histidine ( 4 g kg body weight d) for 46 days. Hypercholesterolemia was eliminated by the simultaneous feeding of an L-histidine- and copper-supplemented diet, supporting the hypothesis that the histidine-induced hypercholesterolemia was a result of changes in copper status. Feeding mice 1.3 g L-histidine kg body weight d for 21 days resulted in an increase in the absorption and utiliza-

Preventing Cardiovascular Disease

A double-blind, placebo-controlled study investigating the effects of a quercetin-containing supplement on plasma quercetin status, risk factors for heart disease and serum platelet fatty acid levels was conducted on 27 healthy men and women with cholesterol levels of 4.0-7.2 mmol L (Conquer et al 1998). The subjects consumed a quercetin-containing supplement (1 g quercetin day) or rice flour placebo for 28 days. Quercetin intakes were approximately 50-fold greater than dietary intakes previously associated with lower coronary heart disease mortality in epidemiologic studies. Plasma quercetin concentrations were approximately 23-fold greater in subjects consuming the quercetin capsules than in the placebo group. Quercetin supplementation did not alter serum total, LDL- or HDL-cholesterol or triglyceride levels, or other cardiovascular disease or thrombogenic risk factors such as platelet thromboxane B2 production, blood pressure or resting heart rate. This is in contrast to a previous...

Components of Physical Fitness

The relative proportion of fat-free mass to fat mass in the body. Fat-free mass is composed of muscle, bone, organs, and water, whereas fat is the underlying adipose tissue. Excessive fat is a good predictor of health problems because it is associated with cardiovascular disease, high cholesterol, and high blood pressure. Higher proportions of fat-free mass indicate an increase in muscle, and thus an increased ability to adapt to everyday stress. cholesterol), low-density lipoprotein cholesterol (LDL-C, the bad cho-triglyceride a type of fat lesterol), and triglycerides (TRG, storage form of energy), which reduce

Coronary Artery Disease

It is well documented that high dietary protein in rabbits induces hypercholesterolemia and arteriosclerosis (Czarnecki and Kritchevsky, 1993). However, this effect has not been consistently shown in either swine (Luhman and Beitz, 1993 Pfeuffer et al., 1988) or humans. In humans, analysis of data from the Nurses' Health Study showed an inverse relationship between protein intake and risk of cardiovascular disease (Hu et al., 1999). The association was weak but suggests that high protein intake does not increase the risk of cardiovascular disease. Similar conclusions have been reached in observational studies showing an inverse relationship between protein intake and blood pressure (Obarzanek et al., 1996) and that replacement of carbohydrate with protein resulted in lower very low density cholesterol, low density cholesterol, and triglycerides (Wolfe and Pich , 1999).

Atherosclerotic and Arteriosclerotic Vascular Diseases

Coronary heart disease Longitudinal studies show a positive correlation of BMI with coronary heart disease (CHD), and obesity is an independent predictor of CHD. However, in the presence of other risk factors, such as hypertension, high serum cholesterol and triglycerides levels, low serum HDL cholesterol levels, and insulin resistance, all of which are increased by obesity, the risk of atherosclerotic CHD increases dramatically. Weight loss reduces all of these risk factors associated with cardiovascular disease, but because long-term reductions in body weight have been difficult to achieve, there are few long-term studies of changes in cardiovascular mortality due to weight loss. A very low-fat diet (10 of total calories as fat) has been shown to reduce the size of atherosclerotic plaques in coronary arteries. Such low-fat diets almost invariably produce weight loss.

Effects of Excess Dietary Fat Intake

The effects of this excess intake of dietary fat has some well-established implications for the health of overweight Americans. For instance, the consumption of excess amounts of saturated fats has been recognized as the most important dietary factor to increase levels of cholesterol. A high cholesterol level is detrimental to health and leads to a condition known as atherosclerosis. Atherosclerosis is the build-up of cholesterol on the walls of arteries, which may eventually result in the blocking of blood flow. When this occurs in the arteries of the heart, it is called coronary artery disease. When this process occurs in the heart, a myocardial infarction, or heart attack, may occur.

Micronutrient Deficiency

There is a rising trend toward dietary supplementation with pharmaceutical preparations containing large doses of vitamins and minerals, based on conclusions drawn from the results of several studies. Available evidence derived from human and animal studies indicates that antioxidant micronutrients, mainly vitamins A, C and E, may play a role in boosting immunity, preventing neoplastic disease, and preventing or retarding the progression of several degenerative diseases, such as atherosclerosis. Vitamins E and C have also been shown to reduce low-density lipoprotein (LDL) cholesterol levels and increase high-density lipoprotein (HDL) levels, in addition to lowering fasting plasma insulin levels and improving insulin efficiency. Epidemiological studies have suggested a protective role for antiox-idants such as vitamin C, vitamin E, -carotene, and glutathione in macular degeneration and cataracts. Nevertheless, evidence derived from other epidemio-logical studies suggests that...

Clinical Studies

In one large prospective, double-blind, randomized, placebo-controlled trial of TAO, 75 steroid-dependent asthma patients were randomized to TAO, 250 mg daily, or placebo, with attempted tapering of methylprednisolone as tolerated (77). The study was hampered by a high patient dropout rate (TAO group seven patients at one year, 20 patients at two years placebo group 11 patients at one year, 30 patients at two years.) Those TAO patients continuing on the study did tolerate lower steroid doses at one year (p < 0.03), but they did not have a significant reduction in the number of hospitalizations and emergency department visits, and had more cases of bone loss (p < 0.01) and higher cholesterol levels (p < 0.05) than did placebo subjects. The study concluded that TAO offered no advantage for asthma outcome, and was associated with greater steroid-related side effects. In a Cochrane review of aggregate data from three randomized trials in which 112 patients were recruited, data from...

Microbial Polymerization Activity

The production of glucan and levan from sucrose by Lactobacillus reuteri and the production of a levan-type fructan by L. sanfranciscensis have been described by van Geel-Shutten et al. (1998). As suggested by Di Cagno et al. (2006), the synthesis of the previously mentioned EPS by sourdough LAB could be considered as a useful tool to replace the commercial additives used for improving the texture of baked goods. The fructan from L. sanfranciscensis has been found to positively affect dough rheology and bread texture. Moreover, glucan, fructans, and gluco- and fructooligosaccharides have potential gut health-promoting properties (Poutanen et al, 2009). Fructose oligosaccharides and inulin are increasingly used as prebiotic additives in baked goods. They are not digested by pancreatic enzymes and thus are available for metabolism by intestinal microorganisms, mainly Bifidobacteria (Tieking et al, 2003). In general, EPS are reported to be able to replace hydrocolloids currently used for...

Human and nonhuman primate studies

Apolipoprotein A-I is the most abundant protein in HDL and plays an important role in maintaining the structure of HDL and activating lecithin cholesterol acyltransferase (LCAT), an enzyme involved in converting cholesterol to cholesterol ester. HDL appears to be primarily cardioprotective by transporting cholesterol from the periphery to the liver for export as bile acids. This process is termed reverse cholesterol transport. From epidemiological studies, higher levels of HDL cholesterol are associated with a decrease in cardiovascular disease risk. Similar studies have shown that apolipoprotein A-I levels show a similar inverse relationship with risk for cardiovascular disease 4 , Consumption of moderate amounts of alcohol is associated with an increase in HDL cholesterol and apolipoprotein A-I. The increases occur in a dose-dependent fashion. As little asl5gof alcohol day can increase apolipoprotein A-I levels in humans 5 , Hojnacki et al. 6 examined the dose response of alcohol on...

Mechanisms calcium and the regulation of energy metabolism

This brings up again an idea proposed a longer time ago, according to which the divalent cation calcium prevents the intestinal absorption of part of the dietary fat and increases faecal lipid loss and sterol excretion forming insoluble fatty acid soaps and bile salts (Denke et al., 1993, Drenick, 1961, Vaskonen et al., 2001, 2002, Vaskonen 2003, Welberg et al., 1994). By the same mechanism calcium may enhance a cholesterol-lowering effect of other food components, e.g. plant sterols (Vaskonen et al., 2001). The extent of this effect increased with an increasing proportion of long-chain saturated fatty acids in the diet, whereby, with Western eating habits, the energy excretion with fat is probably around 1 and 3 of the daily energy supply, i.e. around 30 and 90 kcal day. In a study by Shahkhalalili and co-workers (2001) calcium fortification of chocolate doubled calcium ingestion from 950 to 1855 mg day and increased faecal fat excretion by 36 kcal day (4.04 g day). This effect seems...

Why is the risk of blood vessel diseases increased so much in diabetes

There are several reasons why the risk of vascular diseases, such as heart attack, stroke, and diseases of the vessels in the limbs (peripheral vascular disease), is increased in both types of diabetes. The weight gain and lack of exercise common in people with type 2 diabetes lead to other conditions such as abnormal cholesterol levels and high blood pressure, which are potent causes of vascular disease. If all of these risk factors are not treated effectively, the probability of vascular disease remains high. High blood sugar over months and years leads to a chemical reaction of the sugar in the blood vessels, damaging them structurally. Perhaps most importantly, we now know that diabetes and obesity can be described as irritants to the body tissues, meaning that the body becomes generally inflamed. We know that this is so because we can measure high levels of compounds that indicate inflammation in the blood of many people with diabetes. It turns out that this inflammation, when...

Allium Organosulfur Compounds

Allium organosulfur compounds appear to possess a range of potentially cardioprotective effects. In one study, 432 cardiac patients were divided into a control group (210) and a garlic-supplemented group (222), and garlic feeding was found to reduce mortality by 50 in the second year and by approximately 66 in the third year. Furthermore, the rate of reinfarction was reduced by 30 and 60 in the second and third year, respectively. It should be noted that only a small number of patients in both groups experienced the end event of death or myocardial infarction, and a much larger scale study is needed. AGE lowers cholesterol and triglycerides in laboratory animals and can reduce blood clotting tendencies. It has been suggested that garlic supplementation at a level of 10-15 g of cooked garlic daily could lower serum cholesterol by 5-8 in hypercholestro-lemic individuals. However, there may be more important cardioprotective effects of garlic. In animal studies, AGE suppressed the levels...

Apolipoproteins CII and CIII

Apolipoproteins C-II and C-III both play a major role in VLDL metabolism. Apolipoprotein C-II and C-III stimulate and inhibit, respectively, lipoprotein lipase, the enzyme responsible for hydrolyzing the triglycerides in VLDL. In one study comparing apolipoprotein E levels among low (< 20 g alcohol day), moderate (20-50 g day), heavy (> 50 g day) and alcoholic (> 100 g day) drinkers showed a significant increase in serum apolipoprotein C-III levels with increasing alcohol consumption 43 , Incubating human hepatoma cells with alcohol with concentrations up to 50 mM had no effect on apolipoprotein C-II or apolipoprotein C-III secretion 43 ,

Decision making 7 practical steps

The side effects of cancer treatment are never less in the elderly. In addition to the standard side effects, there are significant age-related toxicities to consider. Though most of these are more a function of frailty than chronological age, even the fittest senior cannot avoid the physical effects of aging. In addition to the changes in fat and muscle you see in the mirror, there are age-related changes in your kidney, liver, and digestive (gastrointestinal) function. These changes affect how your body absorbs and metabolizes anticancer drugs and other medicines. The average older woman takes many different medicines (to control, for example, high blood pressure, high cholesterol, osteoporosis, diabetes, arthritis, etc.). This polypharmacy can cause undesirable side effects as the many drugs interact with each other and the anticancer medications.

The Possible Role of Nutrition in the Pathophysiology of Preeclampsia

Nutritional factors other than antioxidants can also contribute to oxidative stress. Hyper-homocysteinemia can occur as a result of dietary deficiencies. Hyper-homocysteinemia as a risk factor for pre-eclampsia is said to be altered, at least in part, by the genesis of oxidative stress. Vitamin B6 and B12 and folic acid are involved at different steps in the metabolic pathway for removing or recycling homocysteine to methionine. Dietary deficiencies of any of these micronutrients can increase circulating homocysteine. Pre-eclampsia is characterized by increased triglycerides that favor the formation of small, dense low-density lipoproteins (LDLs). This lipoprotein variant has increased access to the subendothelial space where it is sequestered from blood-borne antioxidants. The relevant role of triglycerides in the genesis of pre-eclampsia is indicated by the fact that they are increased long before clinically evident disease. Similarly, free fatty acids are increased in pre-eclampsia...

Physiological Function Of Soy Proteins

Approximately 100 years ago, the cholesterol-lowering effects of soy protein compared with animal protein were reported in rabbits (Ignatowsky, 1908). Since then, many studies have reported the effects of soy proteins on serum lipids in humans however, results have been inconsistent, possibly because of different experimental conditions, such as soy protein content in the diet and degree of hypercholesterolemia in the subjects. In a meta-analysis published in 1995, Anderson et al. concluded that soy protein consumption significantly decreased serum levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and TG, corresponding to the degree of hypercholesterolemia. Based on these findings, the U.S. Food and Drug Administration granted the following health claim for soy protein in 1999 25 grams of soy protein a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. Most commercially available SPI products contain significant...

Classical Lipid Based Formulations Used in Oral Drug Delivery

Lipid-based formulations range from simple lipid solutions to more complex systems incorporating triglycerides, partially digested triglycerides, semisynthetic ester glycerides, lipophilic and hydrophilic surfactants and cosolvents 59, 60 . The formulation can influence digestibility, dispersion and solubilization of the lipid vehicle in vivo, in turn influencing drug absorption. Pouton has proposed a lipid classification scheme to provide insight on lipid behavior on oral dosage (Table 15.1) 59 .

Postprandial Plasma Lipid Responses To Different Types Of Breads

High-carbohydrate (HC) diets are recommended for lowering the risk of coronary heart disease because they decrease plasma low-density lipoprotein (LDL) cholesterol concentrations. In the study by Queenan et al. (2007), 75 hypercholesterolemic men and women were randomly assigned to either the 6 g day concentrated oat b-glucan treatment group or the 6 g day dextrose (control) treatment group. After 6 weeks, it was observed that 6 g concentrated oat b-glucan per day during this period significantly reduced the total and LDL cholesterol in subjects with elevated cholesterol, and the LDL cholesterol reduction was greater than the change in the control group. In a study comparing the effects of whole wheat bread and b-glucan supplemented oat bread on the lipid profile, the oat-derived b-glucan was found to significantly improve high-density lipoprotein (HDL) cholesterol while diminishing LDL cholesterol and non-HDL cholesterol in overweight individuals with mild hypercholesterolemia...

Hiv And Tryptophan Depletion

An open, prospective trial has also concluded that extended-release niacin therapy is safe and effective for the treatment of dyslipidaemia associated with antiretroviral therapy 2000 mg day was given to 14 subjects for 14 weeks and resulted in significant reductions in serum levels of triglycerides, total cholesterol, and non-HDL-cholesterol (Gerber et al 2004).

Significant Interactions

The combined use of niacin and statins, including atorvastatin (lipitor), fluvastatin (lescol), lovastatin (mevacor), pravastatin (pravachol), simvastatin (zocor), has been found to provide added therapeutic effects and reduce requirements for statin medications (Gardner et al 1996, 1997, Jacobson et al 1994, Yim & Chong 2003). A review of the combination of once daily, extended-release niacin and lovastatin therapy found that the addition of niacin may enhance or improve the lipid profile of those who require a further decrease of triglycerides, LDL-cholesterol and or increase of HDL-cholesterol, even after stable statin therapy. The combination has been found to be safe with no increase in adverse reactions (Yim & Chong 2003) beneficial interaction possible.

Presentday Cultivation And Usage

The safflower seed (SS) is well suited for organic skin care products, and has been clinically proven to be highly beneficial in lowering serum cholesterol levels. It is also used quite commonly as an alternative to sunflower seeds in birdfeeders. Today, SS the source of OSS is used for meal, birdseed, in the food and industrial products markets, and foots (the residue from oil processing) to manufacture soap, but it is primarily grown for its oil.

Dietary recommendations and therapeutic use

The most important effect of omega-3 PUFAs, and in particular EPA and DHA, is the triglyceride-lowering effect observed in humans (Connor et al., 1993). Lowering circulating triglycerides has been proven to protect against coronary heart disease and the use of fish oil or increased consumption of fish after myocardial infarction reduced reinfarc-tion and mortality (Calder, 2004). The American Heart Association have presented guidelines for dietary fish intake, proposing that patients without documented coronary heart disease should eat a variety of fish, preferably oily fish, twice a week (Kris-Etherton et al., 2002). Patients with documented coronary heart disease should consume dietary supplementation of at least 1 g EPA and DHA per day. Long-chain omega-3 PUFAs derived from fish and fish oils have beneficial effects in people with pre-existing cardiovascular heart disease. One serving of fish per week may decrease the risk of mortality in heart failure by...

Ascorbic Acid in Xenobiotic and Cholesterol Metabolism

There is impairment of drug metabolism in ascorbate-deficient guineapigs, which is normalized on repletion (Zannoni et al., 1972), possibly reflecting the effects of ascorbate on expression of cytochrome P450 (Mori et al., 1997). This may also account for the hypercholesterolemia and impaired synthesis of bile acids that is seen in vitamin C-deficient guinea pigs. Cholesterol 7-hydroxylase, the first enzyme of bile acid synthesis, is cytochrome P450-dependent, and its activity is reduced in deficiency. In general, the effects on collagen synthesis are more marked and more important than those of decreased formation of carnitine (as a result of impaired activity of trimethyllysine and y-butyrobetaine hydroxylases Section 14.1.1), impaired xenobiotic metabolism, or hypercholesterolemia (Section 13.3.8). However, depletion of muscle carnitine may account for the lassitude and fatigue that precede clinical signs of scurvy. Some scorbutic patients develop chest pains, and acute cardiac...

Adverse Effects And Reactions Allergies And Toxicity

Semen ziziphi spinosae is reported to have very low toxicity when taken orally. In laboratory animals (mice and rats), a huge single dose of 50 g kg body weight produced no toxic symptoms, and a daily dose of 20 g kg for 30 days did not produce toxic reactions. Side effects have not been reported. Modern pharmacology evaluation of Semen ziziphi spinosae oil and Semen ziziphi spinosae extract suggests that with prolonged feeding they can reduce serum triglycerides and cholesterol (mainly LDL), and reduce fatty degeneration of the liver. These properties have also been attributed to the triterpenes of ginseng and ganoderma. Despite its strong medicinal effects, this mild-natured herb is relatively safe to use long term, and for children. Reported adverse effects from inappropriate use include fever with aversion to cold, cold sweats, and joint pain. Western herbalists are also considering the Semen ziziphi spinosae as an alternative to kava kava and valerian, due to the latter two...

Biographical Sketches

Peters, Ph.D., is the Associate Director of Food and Beverage Technology and Director of the Nutrition Science Institute at Procter & Gamble Company in Cincinnati. He received his B.S. in biochemistry from the University of California at Davis and his Ph.D. in biochemistry and nutrition from the University of Wisconsin at Madison. Dr. Peters' research has focused on amino acid metabolism and dietary intake, triglycerides and lipid levels in humans, effects of weight cycling on susceptibility to obesity, and effects of fat replacements on energy, fat intake, and micronutrient metabolism. He has served on the scientific advisory board of the Arkansas Children's Hospital Research Institute on the planning committee of the Cincinnati Health Improvement Collaborative as Vice Chair of the scientific advisory board of the ILSI Center for Health Promotion and Treasurer of the public-private Partnership for Healthy Eating and Active Living. Dr. Peters is currently President of the...

Metabolic Effects Of Lupine Kernel Fiber

The blood lipids did not change in normocholesterolemic subjects. In contrast, the 4-week intervention with LKFiber-enriched food, studied in hypercholesterolemic subjects, led to a decrease of total plasma cholesterol by 12 (p < 0.001). The LDL concentration was lowered by 15 (p < 0.001), but high-density lipoprotein (HDL) cholesterol remained unchanged, which resulted in a 12 decline in the LDL HDL ratio (Fechner and Jahreis, 2011). The reduction of total cholesterol and LDL was similar to the effects of soluble viscous fiber such as psyllium (Anderson et al., 2000). The work group of Johnson also showed only a cholesterol-lowering effect of LKFiber in hypercholesterolemic patients (Hall et al., 2005). Normocholesterolemia X 4.9 Hypercholesterolemia X 6.6 No Yes the primary BAs significantly, but the secondary BA excretion was slightly decreased. Presumably, the observed reduction in the pH value (Fechner et al., 2009) is responsible for the rise in the excretion of primary BAs...

Garlic Allium Sativum

Traditionally garlic has been used for a wide range of conditions, e.g., the common cold and other infections. Today, the main indication for garlic is hypercholesterolemia. A recent meta-analysis (9) included 13 placebo-controlled, double-blind RCTs with a total of 806 patients with hypercholesterolemia. The methodological quality of these studies was good (Jadad score 3-5). The results of the meta-analysis demonstrated a weighted mean difference of 15.7 mg dL (95 CI 25.6 to 5.7). For the most rigorous RCTs, the effect size was only 9.4 mg dL and not any longer statistically significant. Our overall conclusion therefore was ''garlic is superior to placebo .but the effect is modest and of debatable clinical relevance'' (9).

Biomarkers of Diseases

Perhaps the most important outcomes in intervention studies are changes in risk factors or biomarkers of disease, especially for cardiovascular disease. Lipoprotein cholesterol (HDL and LDL) concentrations are considered important biomarkers for risk of cardiovascular disease. In a large (N 65) study of men and women consuming six cups of black tea per day, there was no change in plasma LDL-cholesterol, HDL-cholesterol, or triglycerides compared to a control beverage. However, in a controlled diet study of 12 individuals with slightly elevated LDL-cholesterol, consumption of five cups of black tea per day compared to a control, caffeine-containing beverage resulted in a 6.5 decrease in total cholesterol and an 11.1 decrease in LDL-cholesterol after 3 weeks of consumption. There were no concomitant changes in HDL-cholesterol or triglycerides. A cholesterol-lowering effect of a theaflavin-enriched green tea extract has also been observed in a large (N 240), double-blind, randomized...

Vitamin C in Cardiovascular Disease

Scorbutic guinea pigs develop hypercholesterolemia, which may lead to the development of cholesterol-rich gallstones. This is largely the result of impaired activity of cholesterol 7-hydroxylase, which is an ascorbate-dependent enzyme (Section 13.3.8), resulting in reduced oxidation of cholesterol to bile acids. There is no evidence that increased intakes of vitamin C above requirements result in increased cholesterol catabolism.

Vitamin E Bioavailability

Intestinal absorption of vitamin E is dependent upon normal processes of fat absorption. Specifically, both biliary and pancreatic secretions are necessary for solubilization of vitamin E in mixed micelles containing bile acids, fatty acids, and monoglycer-ides (Figure 3). a-Tocopheryl acetates (or other esters) from vitamin E supplements are hydrolyzed by pancreatic esterases to a-tocopherol prior to absorption. Following micellar uptake by entero-cytes, vitamin E is incorporated into chylomicrons and secreted into the lymph. Once in the circulation, chylomicron triglycerides are hydrolyzed by lipopro-tein lipase. During chylomicron catabolism in the circulation, vitamin E is nonspecifically transferred both to tissues and to other circulating lipoproteins. tocopherols or tocotrienols from the liver into the plasma in very low-density lipoproteins (VLDLs). In the circulation, VLDLs are catabolized to low-density lipoproteins (LDL are also known as the 'bad cholesterol' because high...

Sublingual nifedipine

Sublingual nifedipine is used worldwide to lower BP acutely in so-called hypertensive emergencies. Unfortunately, many patients who received sublingual nifedipine needed it about as much as a patient with high cholesterol would need a sublingual statin. Ofnote, there is good evidence that the sublingual application is of no added benefit because what gets into the blood stream is actually what is swallowed. Also, sublingual nifedipine lowers BP in a completely uncontrolled way, and such an abrupt BP drop has been associated with acute MI, stroke and death. Clearly, this is BP cosmetics and should be considered malpractice.

Dual energy Xray absortiometry DEXA A

Dyslipidemia Disorders in the lipoprotein metabolism classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. use of certain drugs (clofibrate, estrogens, and bile acid sequestrants), and presence of gastrointestinal disease. Gallstones sometimes develop during dieting for weight reduction. There is an increased risk for gallstones and acute gallbladder disease during severe caloric restriction.

High Blood Cholesterol

Cholesterol Lowering in the Patient with Coronary Heart Disease Physician Monograph. Reviews the scientific evidence that cholesterol lowering in patients with coronary heart disease produces dramatic benefits. Provides guidance on implementing dietary and drug treatment and improving patient adherence to lowering cholesterol in the patient with coronary heart disease.

Enhance your Patient Education with Nhlbi Materials

Step by Step Eating To Lower Your High Blood Cholesterol. Advises patients on how to make diet and lifestyle changes to lower their high blood cholesterol levels. Explains the Step I and Step II diets and gives practical tips for buying and preparing foods, eating out, increasing physical activity and selecting a weight loss program. Sample menus at two calorie levels and nutrient content tables of a wide variety of foods are included. Live Healthier, Live Longer Lowering Cholesterol for the Person With Heart Disease. Gives the patient with coronary heart disease information on how to lower high blood cholesterol through diet, physical activity and weight control to prevent future heart attacks and improve the quality of life. Practical information included on choosing foods lower in saturated fat, total fat, and cholesterol.

Biosynthesis Of Betanin

Prickly pear has long been known in traditional medicine for treating a number of pathologies from ulcer, fatigue, and dyspnea to glaucoma, liver conditions, and wounds (11,13). Studies with different models and several experimental conditions provided some scientific basis for the popular use of this plant. Various preparations from fleshy stems (cladodes) have been tested for treatment of diabetes symptomatology in animal models (14,15), or in humans (16). The mechanism for this action is still unknown some results, however, preclude a role for dietary fiber (15). Other studies revealed beneficial effects against ethanol-induced ulcer (17), in the treatment of benign prostatic hypertrophy (18,19), and in hypercholesterolemia in humans (20) and guinea pigs (21). Diuretic activity of cladode, flower, and fruit infusions has been shown in rats (22). Obviously, other investigations are required to gain insight into the active agents in this plant and the mechanisms involved in all the...

In the cardiovascular system

Much evidence has accumulated from various lines of inquiry that indicates that the dietary fatty acid intake and lipid acyl composition of tissues is a determinant of many of the chronic diseases prominent in the Western World, notably cardiovascular disease. It has been appreciated since the 1950s that when dietary polyunsaturated fat intake is increased, a decrease in the total serum and lipoprotein cholesterol levels results 1 . Bang and Dyerberg, in their study of the Greenland Eskimos, a group in which CVD had an extremely low incidence, made the ground breaking inference that the high dietary intake of the long chain polyunsaturated fatty acids, eicosapentanoate and docosahexaenoate was responsible for this protection from disease 2 , More recently, several epidemiological studies have reported a relationship between dietary n-3 polyunsaturates and the risk of CVD 3-8 , For example, Dolechek et al. found an inverse relationship between alpha-linolenate and mortality from CVD,...

Macronutrient Composition of the Diet

HDL cholesterol The mechanisms whereby saturated fatty acids raise LDL cholesterol levels are not known, although available data suggest that they suppress the expression of LDL receptors. The predominant saturated fatty acid in most diets is palmitic acid (C16 0) it is cholesterol-raising when compared with cis-monounsaturated fatty acids, specifically oleic acid (C18 cis1 n-9), which is considered to be 'neutral' with respect to serum cholesterol concentrations. In other words, oleic acid is considered by most investigators to have no effect on serum cholesterol or lipoproteins. Another saturated fatty acid, myristic acid (C14 0), apparently raises LDL cholesterol concentrations somewhat more than does palmitic acid, whereas other saturates - lauric (C12 0), caproic (C10 0), and caprylic (C8 0) acids - have a somewhat lesser cholesterol-raising effect. On average, for every 1 of total energy consumed as cholesterol-raising saturated fatty acids, compared with oleic acid, the serum...

Structure Of Streptozotocin

Averrhoa Bilimbi Leaf Cholesterol

Blood-Lipid and Cholesterol-Lowering Effect The daily administration of ABe per orally (125 mg kg twice a day) for 14 days to STZ-diabetic SD rats caused a reduction in the serum triglycerides and an increase in HDL cholesterol. However, ABe did not decrease the serum cholesterol and LDL cholesterol. This leads to an increase in the antiathero-genic index and HDL cholesterol total cholesterol ratio (11). Moreover, the daily administration of ABe (125 mg kg) and metformin (500 mg kg) to STZ-diabetic rats twice a day for 2 weeks caused a reduction in food and water intake and an increase in body weight (11). Since ABe increased HDL cholesterol, it significantly increased the antiatherogenic index and HDL cholesterol total cholesterol ratio. ABe thus has the potential to prevent the formation of atherosclerosis and coronary heart disease, which are the secondary diabetic complications of severe diabetes mellitus (13). In contrast, metformin failed to increase the HDL-cholesterol level...

Novel Medical Treatments


The presence of a lithogenic bile is primarily a result of a sustained hypersecretion of biliary cholesterol, which has 2 key components hepatic and intestinal.31 In principle, drugs influencing hepatic synthesis and or secretion of cholesterol (ie, statins) and or Inhibition of Hepatic Cholesterol Synthesis by Statins Statins are competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, the rate-limiting step in cholesterol biosynthesis. They occupy a portion of the binding site of HMG CoA, blocking access of this substrate to the active site on the enzyme.124 Currently available statins in the United States include lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, and rosuvastatin. Statins seem also to reduce cholesterol secretion and concentration in bile independently of their ability to block hepatic cholesterol synthesis.125-128 Such combined effects of statins on cholesterol homeostasis in the liver and bile might be able to lower the...

Chemical composition

The lipids of sesame seeds are mostly composed of neutral triglycerides with small quantities of phosphatides (0.03-0.13 with lecithin caphalin ratio of 52 46). The phosphatides also contain about 7 of a fraction soluble in hot alcohol but are insoluble when cold. Sesame oil, however, has a relatively high percentage (1.2 ) of unsaponifiable matter (Johnson and Raymond, 1964 Weiss, 1983). The glycerides are mixed in type, principally oleo-dilinoleo, linoleo-dioleo triglycerides and triglycerides with one radical of a saturated fatty acid combined with one radical each of oleic and linoleic acids (Lyon, 1972). The glycerides of sesame oil, therefore, are mostly triunsaturated (58 mol ) and diunsaturated (36 mol ) with small quantities (6 mol ) of monounsaturated glycerides. Trisaturated glycerides are almost absent in sesame oil. The unsaponifiable matters in sesame oil include sterols (principally comprising P-sitosterol, compesterol and sigma sterol), triterpenes (triterpene alcohols...

Oligonucleotide Formulations

The barrier properties of human skin have been an area of multidisciplinary research for a long time. Skin is one of the most difficult biological membrane to penetrate, primarily due to the presence of stratum corneum (SC), which is composed of corneocytes laid in a brick-and-mortar arrangement with layers of lipid. The corneocytes are partially dehydrated, an-uclear, metabolically active cells completely filled with bundles of keratin with a thick and insoluble envelope replacing the cell membrane (179). The primary lipids in the SC are ceramides, free sterols, free fatty acids, and triglycerides

Cant get an erection

Or pituitary gland, or a deficiency of testosterone may cause impotence. Disease of the arteries and veins may cause impotence. Smoking, diabetes, high blood pressure, and high cholesterol promote disease of the arteries. Men with arterial disease may have difficulty in attaining an erection, whereas men with disease of the veins may have difficulty in maintaining an erection. Disease of the veins results in impotence because the veins are unable to constrict. After an erection is attained, blood normally leaks from the penis back into the veins, causing the penis to soften. After an erection is attained, the veins constrict, preventing leakage of blood from the penis maintaining the erection.

Secondary Metabolites

Of thioesters or amides, results in a huge number of possible structures. Polyketide secondary metabolites include orsellinic acid, tetrahydroxynaphthalene (precursor for melanin), statins, fumonisin, and the aflatoxins, which are some of the most toxic compounds on earth. The function of aflatoxins in fungi is unknown however, after consumption of plant material contaminated by Aspergillus spp, toxicosis followed by death can occur in even large animals by almost undetectable quantities. Species' susceptibility varies greatly however, the liver is the primary target, where cytochrome P450 enzymes convert aflatoxins to the reactive 8,9-epoxide form (Mishra and Das 2003). The reactive aflatoxin epoxide then binds to eukary-otic DNA and proteins, specifically the N7 position of guanines. Aflatoxin-DNA adducts can result in GC to TA transversions, and it's carcinogenic potency is highly correlated with the extent of aflatoxin-DNA adducts formed in vivo (Bennett and Klich 2003). While...

Linda A Jacobs Jane Alavi Angela DeMichele Steven Palmer Carrie Stricker and David Vaughn

Angela Demichele

Shortness of breath High cholesterol Forgetfulness Trouble concentration Trouble with calculations Rapid heart rate Chest pain Tightness in your chest Arm swelling side of your surgery Hand swelling side of your surgery Broken bones Bone pain Urinary frequency Burning when urinating Urine leakage when coughing Numbness tingling in hands Numbness tingling in feet Hot flashes Night sweats Vaginal dryness Decreased desire for sex Decreased satisfaction with sex Ringing in your ears Decreased hearing Weight gain (more than 10 lbs) Weight loss (more than 10 lbs)

Polyunsaturated fatty acids on energy metabolism and other factors connected to weight control

The length and the degree of saturation of fatty acids influence the biophysical properties of the lipids. This has, for example, effects on the digestion and absorption of the fatty acids from the intestine (Small, 1991). Different sources of fat are composed of different types of triglycerides. Triglycerides are digested in the intestinal lumen by lipases to produce fatty acids and monoacylglycerol and the absorption of fatty acids from the intestinal lumen is generally an efficient process. After absorption, the fatty acids are taken up by the enterocytes where the triglycerides are reconstructed, packed in chylomicrons and very-low-density lipoproteins (VLDLs) and secreted into the lymph. From the lymph, the triglycerides are transported to various capillary beds where they bind to the capillary surface. Here, they are hydrolysed by lipoprotein lipase and the surrounding adipocytes or muscle cells take up the free fatty acids. However, the triglycerides containing long-chain PUFAs...

Uses Of Laser And Rapeseedoliveoil

Density Ranges Lipoproteins

In energy from saturated fatty acids, serum LDL cholesterol concentration increases by 0.033 mmol L (Mensink and Katan, 1992), 0.036 mmol L (Clarke et al., 1997), or 0.045 mmol L (Hegsted et al., 1993). Although all fats will increase serum high density lipoprotein (HDL) cholesterol concentration relative to carbohydrate, the increase attributable to saturated fats is greater than that observed for monounsaturated and polyunsaturated fatty acids. Serum HDL cholesterol concentration increases by 0.011 to 0.013 mmol L for each 1 percent increase in saturated fat (Clarke et al., 1997 Hegsted et al., 1993 Mensink and Katan, 1992). A report from the Netherlands suggested that a diet enriched with elaidic acid (a subfraction of 18 1 trans) compared to one enriched with oleic acid (18 1 cis) increased total and LDL cholesterol concentrations and decreased HDL cholesterol concentrations, hence resulting in a less favorable total cholesterol HDL cholesterol ratio (Mensink and Katan, 1990)....

Basis For Gene Therapy For

IEM can also be caused by deficiency of protein that is involved in the transport of metabolite (Fig. 2b). Examples include the cystine transporter in cystinosis and the LDL (low-density lipoprotein) receptor in familial hypercholesterolemia. In this class of disorder, a metabolite accumulates in one tissue as result of an enzymatic deficiency (Fig. 3a). This leads to increased metabolite levels in the blood and toxicity in other tissues. The prototype for this type of disorder is phenylketon-uria in which deficiency of hepatic phenylalanine hydroxylase leads to increased blood levels of phenylalanine and toxic effects to the developing brain. Familial hypercholesterolemia is another IEM that fits this model. Deficiency of the LDL receptor in the liver leads to increased levels of LDL and subsequent damage to the coronary arteries.

Type A Personality and Cardiovascular Disease

Cardiovascular disease is one of the most frequent causes of death and disability in the United States. Health professionals have been searching for the factors that put people at risk for this disease. Known risk factors for developing cardiovascular disease include high blood pressure, obesity, smoking, family history of heart disease, inactive lifestyle, and high cholesterol. In the 1970s, physicians began to consider a new risk factor , a specific personality trait. As mentioned in Chapter 13, this grew out of the observation by some physicians that the patients who had had heart attacks often behaved dif fer-ently, and they seemed to have different personalities, compared with other patients. The heart attack patients were often more competitive and aggressive, more active and energetic in their actions and speaking, and more ambitious and driven (Friedman & Rosenman, 1974). They called this collection of behaviors the Type A personality. Early studies of the Type A...

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