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INTRODUCTION AND GENERALITIES

Western societies, and countries whose standard of living is increasing, and which are adopting a « modern » high-calorie diet, rich in fats, meat and simple sugar, low in slow-assimilation carbohydrates (and this while people’s physical activity is decreasing), are seeing the prevalence of obesity increase as well as that of hypercholesterolemia-hyperlipidemia and type 2 diabetes.
Recent epidemiological surveys show that in these societies at least one person in 20 has hypercholesterolemia.

In the majority of cases, herbal medicine combined with an appropriate diet and a healthy lifestyle can control these metabolic disorders, particularly early or moderate hypercholesterolemia.

The most serious consequence of this blood hyperlipidemia is the appearance of « atherosclerosis » (formerly arteriosclerosis), or atheromatous disease, which is characterized by the occurrence of lipid plaques on the internal wall of the arteries, promoting the development of cardiovascular diseases: coronary artery disease (angina pectoris, myocardial infarction), arteritis, kidney disorders, cerebral circulatory insufficiency, high blood pressure, etc.
This hyperlipidemic state is also accompanied, quite often, by a tendency towards blood hypercoagulability, promoting vascular obstructions and the appearance of embolisms, as well as tissue resistance to insulin (type 2 diabetes) which is sometimes difficult to control.
Of course, not all hyperlipidemias are acquired, some are congenital and transmissible from parents to children, others develop on a terrain which favors their appearance.

Specialists differentiate between several profiles of blood hyperlipidemia: to simplify, we can differentiate between simple hypercholesterolemia and that associated with an increase in blood triglycerides.

Blood cholesterol values currently considered normal:

Total cholesterol: 2g/liter
Triglycerides: 1.5 to 2 g/l

Blood cholesterol is coupled to transport proteins that ensure its transfer between the different organs and tissues of the body. Cholesterol is indeed a vital molecule for the body, absolutely necessary for maintaining the integrity of cell membranes and the proper functioning of metabolism: for example, biosynthesis of corticosteroid hormones (e.g. cortisone) and male and female hormones.

Biochemists differentiate several types of lipoproteins associated with plasma cholesterol based on their « density. »

HDL-C: high density lipoprotein
LDL-C: low density lipoprotein
VLDL-C: very low density lipoprotein generally associated with 4/5 triglycerides and 1/5 cholesterol.
It appears that LDL-C and, to a lesser extent VLDL-C, promote the precipitation of cholesterol and other lipids on the arterial walls (atheroma) while HDL-C would be little atherogenic and for some authors even protects against this degeneration.

Values currently considered normal:
For a total cholesterol of approximately 2g/l:

HDL-C: 0.45g/l for men and 0.55g/l for women
LDL-C: 1.30 to 1.60g/l
The total cholesterol/HDL-C ratio or atherogenicity index must be less than 4.5

Main drug treatments:

The current trend for treating increased blood cholesterol is first to modify the diet and then, if this is not enough or if the risk factors for cardiovascular accidents are too high, to use synthetic drugs.

Among the most important:

• Statins which decrease endogenous synthesis (synthesis by the liver) of cholesterol
• Fibrates which appear to increase the catabolism (destruction) of blood lipids while decreasing their hepatic synthesis
• Cholestyramine, which blocks the reabsorption of cholesterol in the digestive tract and indirectly reduces plasma LDL-C.
  The liver is the key organ in regulating cholesterol levels.
  It ensures its synthesis from simple molecules (acetyl coenzyme A) and also its excretion: bile salts (necessary for the proper digestion of fats) are produced by the liver and excreted by the bile ducts into the intestine (duodenum). They contain a lot of cholesterol and are only partially reabsorbed at the intestinal level, a good part of these salts is evacuated in the feces.

MEDICINAL PLANTS AND HYPERCHOLESTEROLEMIA

Medicinal plants are very useful for controlling hypercholesterolemia when combined with an appropriate diet, the most important points of which are:

• First, reduce the amount of food, especially if excess weight is evident,
• especially reduction of foods rich in saturated fatty acids which increase LDL-C (bad cholesterol!): dairy products (butter, cream, cheese), cold meats (except cooked ham), fatty meats, animal fats, hard margarines.
• Reduction of foods rich in “trans fatty acids”: mainly croissants, biscuits, certain breads enriched with margarine ,
• In case of increased triglycerides, avoid sweets and sugary and alcoholic drinks, sweet fruits in abundance

And on the other hand:

• Increase in foods rich in « soluble » or insoluble fibers that are not assimilated, promote good intestinal transit and slightly lower the level of total cholesterol and LDL-C: vegetables, fruits (except in the case of increased triglycerides), cereals (oats)
• Frequent consumption of fish.
• Use in cooking “unsaturated” oil or oil rich in unsaponifiable fraction: e.g. olive, sunflower.
• Increased consumption of phytosterols: these are analogues of cholesterol but present in plants and which seem to block (compete?) the intestinal absorption of cholesterol: certain diet margarines are enriched with them.
• Consumption of « plant antioxidants » whose exact action is not well known but which seem to promote the reduction of LDL-C or prevent its oxidation, an essential step in the atheromatous process: carotenoids (carrot), lycopene (tomato), vitamin E and C, certain plant polyphenols called proanthocyanidols or condensed tannins: example tannins in red wine, tannin in tea (especially green).

Herbal remedies useful for treating high cholesterol :

• act on lipid metabolism: like guggul and garlic,
• act on the synthesis and excretion of bile salts, cholagogue and choleretic plants: artichoke, boldo, combretum, turmeric, fumitory, dandelion, rosemary,
• prevent the deposit or development of atheromatous plaques: green tea, ginseng, red vine

EXAMPLES OF PLANTS THAT CAN BE USED TO TREAT HYPERCHOLESTEROLEMIA

GUGGUL Commiphora mukul BURSERACEAE

Guggul is a small thorny tree that grows in the desert regions of the northern Indian subcontinent (Rajasthan, Gujarat, Baluchistan).
Ayurvedic doctors have long used the resin collected after incision of the branches during the winter. It appears as a white or green substance, with a balsamic odor and has been used for a very long time (600 years BC) in the composition of Ayurvedic medicines to treat obesity: example triphala guggul, sinhanad guggul.
Indian doctors and researchers have studied the chemistry and mode of action of guggul extracts since 1960 and especially after 1980.

The most interesting compounds are phytosterols: Z and E « guggulsterone » which are found in the « guggulipid », that is to say the fraction extracted from the raw resin by a diluent (ethyl acetate).

Several physiological actions have been described by researchers:
-stimulation of the thyroid gland by direct action on the endocrine cells of the thyroid and not by a pituitary-hypothalamic relay,
-activation of the membrane receptors of LDL lipoproteins leading to a decrease in the level of plasma LDL-C (bad cholesterol),
-antagonism with a transcription factor (FXR) which causes a blockage of the negative feedback exerted by bile acids on their synthesis and therefore the excretion of cholesterol.
Guggulsterone therefore promotes an increase in the synthesis of bile acids which contain cholesterol. Normally when the quantity of bile acids increases the activation of the FXR factor leads to the cessation of their synthesis; guggulsterone blocks this control mechanism; The quantity of cholesterol excreted by the bile ducts increases and it is only partially recycled-reabsorbed at the intestinal level, hence the decrease in plasma cholesterol.

Numerous studies and tests in animals and humans have shown the interest of guggulipid and guggulsterones in reducing abnormal levels of blood lipids: total cholesterol, LDL-C and triglycerides. The action of guggulsterones appears to be potentiated by the other components of guggulipid: a 10 to 30% decrease in blood lipid levels and a decrease in the total cholesterol / HDL-C ratio (atherogenicity index) are observed.
The percentage of decrease varies according to the experimental conditions and the subjects tested.

The effective dose would be around 50 mg of guggulsterone per day or 500 mg to 2000 mg of guggulipid depending on their standardization in sterones (10 to 2.5% of guggulsterone).

The side effects seem to be reduced (some nausea, belching, sometimes diarrhea) and less than those observed by taking raw resin which quite often causes diarrhea and itching.
Avoid taking guggulipid during pregnancy, in case of chronic or acute liver disorders and thyroid disorders.
It is quite easy to obtain guggulipid on the international market as well as in France.

In India, Ayurvedic doctors often mix guggul with other plants: example « triphala guggul » with Terminalia belerica and Terminalia chebula (two plants that provide tannins), in this medicine the proportion is 130mg of guggul for 250mg of triphala guggul.
Example: CAPS HT2 (anti-oxidant, anti-inflammatory, anti-diabetic) associating Commiphora mukul (guggul) with Allium sativum (garlic) and 7 other plants. This mixture of antilipidemic-antioxidant plants seems to be a good treatment for atherosclerosis.

Note that guggulipid has other applications:
-to treat acne (nodulocystic) with oily and greasy skin: equivalent to 25 to 50mg of guggulsterone for 3 weeks
-certain inflammatory joint and rheumatisms are sometimes sensitive to it
-one can reduce one’s weight with guggul extracts but the results are irregular.
The anti-oxidant, anti-inflammatory and antiplatelet action is very useful for preventing complications of atheromatous disease.

Garlic Allium sativum LILIACEAE

Garlic is a small perennial plant with linear and sheathing leaves, probably native to Siberia but cultivated since antiquity in the Middle East, Egypt, Greece and China. It adapts to all climates but gives the best harvests in temperate countries. It is a very common food plant (the garlic clove), a condiment marketed throughout the world but which also has very interesting pharmacological and therapeutic properties.
Garlic contains sulfur compounds responsible for the majority of the pharmacological properties.
In fresh garlic, the main sulfur constituent is aliin (odorless) but as soon as the garlic is bruised or crushed, an enzyme (aliinase) is released which degrades aliin; the final product of this transformation is aliicin (with a strong garlic odor) which is itself rapidly oxidized in air and becomes diallyl disulfide (with an equally marked odor) the main constituent of « garlic essence ».
Aliicin can also condense, in which case secondary compounds, ajoenes, are obtained, which are pharmacologically less active. Cooking quickly transforms, in a few minutes, all these sulfur compounds into cyclic condensation products (vinyldithiin) whereas it takes several hours at room temperature.

In animals (studies on rats, chickens, rabbits) garlic consumption significantly reduces cholesterol and triglyceride levels.
In humans, even if the experimental protocols are sometimes criticized, a decrease of 9 to 12% in blood cholesterol levels is generally observed after one month of treatment (600 to 900 mg of garlic powder standardized to 1.3% aliin, per day) and especially after 4 months of regular intake.
An increase in « good » lipoproteins (HDL-C) and a decrease in LDL-C are observed.

At the same time, the atheroma plaques seem to be reduced in surface area (10 to 20%) and thickness (3%). However, this drop in blood cholesterol is only observed in cases of moderate increase in cholesterol levels and not in cases of familial or congenital diseases.
But garlic also helps improve blood circulation.

Several actions are combined; the most important is the reduction of platelet aggregation (up to 30%) when cholesterolemia is normal or slightly increased (10-month study). The plasma effect is rapid: 6 to 8 hours after absorption of 900 mg of garlic powder (standardized to 1.3% aliin) an improvement in plasma viscosity and capillary flow is noted; there is a rapid reduction in platelet aggregation and an increase in fibrinolysis (up to 70%) for about 12 hours. All this is of course very interesting when one has disorders due to arteriosclerosis.

Blood lipid disorders are chronic and therefore require prolonged treatment.
Raw garlic is unfortunately quite indigestible and can cause unpleasant gastric disorders in some people.
For those who tolerate garlic, an average dosage would be the equivalent of 6 to 10 mg of aliin per day, i.e.: 1 clove of fresh garlic.
For a more marked effect, the dose can be increased by spreading it out over the day, i.e.:
1 to 2 cloves of garlic 2 to 3 times per day.

Fresh garlic can be replaced by garlic powder in gastro-resistant capsules.
An average dosage would be 500 mg to 1000 mg of garlic powder per day; for a more marked effect (but shorter) you can go up to 2000 mg of garlic powder per day in several doses spread out over the day.
It is recommended to do a prolonged or even unlimited treatment at a low or medium dose, or at a high dose 1 to 2 months renewed in the year.
Some herbalists recommend garlic tincture at 1/5, 20 to 30 drops per day, but the smell is particularly unpleasant.

Let us remember that garlic is also slightly antidiabetic (effective in type 2 diabetes) as well as hypotensive (but the results of surveys are not always very conclusive)

As we have seen with guggul, all plants that increase bile flow are useful for reducing blood cholesterol levels; some act mainly through a mechanical effect (increased contractions of the gallbladder or easier opening of the sphincter of Oddi which controls the exit of bile into the intestine (duodenum)) others more particularly increase the production of bile by the liver.

Examples of medicinal plants (cholagogues, choleretics or amphocholerics) useful for controlling increased cholesterol levels: artichoke, boldo, combretum, turmeric, fumitory, dandelion, rosemary,

Artichoke Cynara scolymus ASTERACEAE

The artichoke is a large asteraceae, native to the Mediterranean region, perennial (the flowers only appear in the second year of cultivation), with long leaves arranged in a rosette, not thorny but reinforced by visible veins. It has been cultivated since antiquity.
The flowers, more or less blue or purplish, are grouped to form a whole (capitulum) 8 to 16 cm in diameter which is carried by a robust, grooved and hollow stem, often branched. The basal part of the compound flower (the receptacle) as well as the fleshy base of the bracts (small leaves surrounding the flower) are edible after cooking. The artichoke leaf is the medicinal part.
The active compounds appear to be phenolic acids derived from caffeic acid (5-caffeylquinic acid and 1-5-dicaffeylquinic acid).

Experiments in rats have shown:

-in vitro, that phenolic acids (derived from caffeic acid) were hepatoprotective, protecting liver cells (hepatocytes) against the toxicity of carbon tetrachloride,
-in vivo, that the flow rate of bile secretion was increased without a clear increase in gallbladder contractions (choleretic effect).
-For some authors, flavonoids alone would be the active compounds. Other studies, still in rats, revealed a hypocholesterolemic effect of the total extracts as well as an amphocholeric effect (increased secretion and excretion of bile).

In humans, artichoke is considered to be mainly choleretic and slightly hypocholesterolemic (with also a concomitant decrease in triglycerides). This fairly clear effect on plasma cholesterol levels seems to be due to both a decrease in cholesterol synthesis by the liver and an increase in biliary excretion of cholesterol.
In a double-blind placebo-controlled study of 143 people with hypercholesterolemia, total cholesterol levels fell by 18.5% in people taking dry artichoke extract (1800 mg per day), and by 8.6% in the placebo group. LDL-C fell by 23% in the first group and by 6% in the placebo group.
Another study attributes significant antioxidant power to flavonoid fractions, which is useful in the case of cholesterol disorders (delayed oxidation of the LDL-C fraction).

We generally use young artichoke leaves, which can be either:

-pressed to provide a juice which will be purified to give certain galenic preparations,
-dried quickly, fragmented and left to macerate in the classic way (alcoholictincture),
-pulverized after passing through liquid nitrogen (-190°C), this is cryogenic grinding.

Dosage:
You can use

• Cynara alcoholic tincture, 50 to 150 drops per day,
• Cryogenically ground artichoke powder: 600 to 800 mg per day
• Dry extract of artichoke juice: 1g per day
• Commission E recommends 6g of dried leaves or the equivalent, per day, generally in three doses.
  There is a lack of good standardization of the active part.

Dandelion Taraxacum officinalis ASTERACEAE

Dandelion is an old world plant but has been spread very quickly throughout the world.
Perennial and very common in fields, meadows, roadsides, it also adapts to harsher or subtropical climates (where it is much rarer). Its shape is typical, the basal leaves arranged in a rosette are more or less cut into unequal lobes, the flower is yellow and when ripe the seeds (achenes) escape, carried by the wind thanks to very characteristic fine tufts. The taproot is strong and long; the cut plant excretes a whitish latex.

Tradition and ancient experiments (especially carried out on animals and mainly by the Germans and the Chinese) make the dandelion considered as a cholagogue by its root and a choleretic by its leaves. The whole plant combines these two properties, it increases gallbladder contractibility while increasing the quantity of bile discharged into the intestine.
Its choleretic and cholagogue properties make it used in all chronic liver diseases and in certain jaundice but also to relieve constipation and digestive migraines.
It is considered as an anti-arteriosclerotic, (slightly anti-diabetic).
It is particularly used in Germany

It is used in the composition of phytomedicines for hepatobiliary purposes but it can also be prepared by harvesting it yourself.

• 1 to 3 complete dandelion plants (with the root) in a liter of water; boil for 5 minutes and infuse for 10 minutes, drink one to two cups, it is very bitter!,
• 30 to 60 gr of split root cut into small pieces in a liter of water; boil then infuse as above; drink two cups at noon and in the evening, it is still very bitter.

In some countries, ready-made preparations can be found (sometimes standardized in % of taraxasterol), for example: 250mg capsules 2 to 3 times a day.

The homeopathic ethanolic tincture is flexible to use: TARAXACUM TM 50 to 150 drops per day often in combination with ROSMARINUS and CYNARA.

In the case of moderate hyperlipidemia, prolonged treatments can be planned for 2 to 3 months, twice a year or more if the treatment is well tolerated.

Rosemary, Rosmarinus officinalis, LABIATEAE

Rosemary is a typically Mediterranean plant, it is a shrub, very branched, quite bushy, with small and narrow leaves whose upper surface is convex and slightly shiny, the interior concave and white.
The hydroalcoholic extract (mother tincture) is cholagogue and hepatoprotective in vivo in rats (but at high doses) and, in vitro, free radical scavenger and hepatoprotective (antilipoperoxidant action, prevention of necrosis of isolated hepatocytes (liver cells)).
The ethanolic tincture of young rosemary shoots seems, in view of the experiments, more effective than that of the whole adult plant.
Rosemary (hydroalcoholic extract and to a lesser extent aqueous extract) is considered an effective drainer of the bile ducts

We can recommend:

• Ethanolic tincture of young shoots or glycerine maceration of young shoots, 20 to 100 drops per day,
• prolonged infusion of fresh or dried plant: 1 teaspoon of dried leaves or 1 small sprig of rosemary per cup of very hot water, infuse for 10 minutes, 2 to 3 cups per day,
• capsules of cryo-crushed plants or a ready-made mixture of plants for cholagogue purposes in herbal tea, capsules or in the form of a hydroalcoholic extract (there are pharmaceutical specialties put on the market in 1941!)
  Rosemary is only an adjuvant to an appropriate diet, its antioxidant capacities are also interesting for combating complications linked to atheroma.

Other medicinal plants used by herbalists to control increased cholesterol levels:
we will particularly remember turmeric, zedoary and kinkeliba (choleretic cholagogue), ginseng, tea and vine (antioxidants), ispaghul, konjac and psyllium (fibers).
Angelica, Angelica archangelica, APIACEAE
Eggplant, Solanum melongena, SOLANACEAE
Albizzia, Albizzia lebeck, FABACEAE
Boldo, Pneumus boldus, MONIMIACEAE
Celandine, Chelidonium majus, PAPAVERACEAE
Chrysantellum, Chrysantellum indicum, ASTERACEAE
Turmeric, Curcuma longa, ZINGIBERACEAE
Fenugreek, Trigonella foenum graecum, FABACEAE
Fumeterre, Fumaria officinalis, FUMARIACEAE
Ginseng, Panax ginseng, ARALIACEAE
Gymnema, Gymnema sylvestre = Periploca sylvestris, ASCLEPIADACEAE
Ispaghul, Plantago ovata, PLANTAGINACEAE
Kinkeliba, Combretum micranthum, COMBRETACEAE
Konjac, Amorphophallus konjac, ARACEAE
Lespédéza, Lespedeza capitata, FABACEAE
Olivier, Olea europea, OLEACEAE
Evening primrose, Oenothera biennis, ONAGRACEAE
Panama (wood) or Quillaja, Quillaja saponaria, CARIOPHYLLACEAE
Psyllium, Psyllium afra=Psyllium psyllium, Psyllium arenaria=P. indica=P. racemosa, PLANTAGINACEAE
Tea, Camellia sinensis = Thea sinensis = Camellia thea, THEACEAE
Linden, Tillia europaea, Tillia tomentosa, Tillia cordata, Tillia platiphyllos, TILLIACEAE
Red vine, Vitis vinifera, VITACEAE
Zedoaire, Curcuma zedoaria, ZINGIBERACEAE,

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