June 2, 2015
Dr. Virender Sodhi, ND, MD (Ayurved) and Dr. Anuprao Mulakaluri, ND, AWC
Fats and oils in our diet have been subject to a lot of controversy in the past 3 to 4 decades. Doctors, scientists and the media have warned people about the risks of heart disease, stroke, diabetes, cancer and other diseases related to high consumption of dietary fats. However, the judgement on fats as “exclusively unhealthy” was too broad and often exaggerated.
In 1913, Dr. Anitschkov, a Russian scientist found that feeding cholesterol to rabbits induced heart disease. He failed to realize that rabbits, being vegetarians, have no means of dealing with this animal fat. This theory suited very well for pharmaceutical industry; they developed cholesterol-lowering drugs like statins to sell at premium prices.
By 1978, Merck had isolated lovastatin from the fungus Aspergillus terreus—first marketed in 1987 as Mevacor. To market statins effectively, Merck had to, first, convince the public of the dangers of high cholesterol, and second, doctors that statins would extend lives. As a result of public campaigns, people in the U.S. became familiar with their cholesterol numbers and the difference between"good" and "bad"cholesterol.
If statins are effective in lowering cholesterol and thereby heart disease, why are heart attacks so prevalent? Still, 43% of U.S. population is dying with heart disease; the outcome is almost zero.
New science and the wisdom of Ayurveda guide us back to the truth about dietary fats and their health benefits.
The Great Variety of Fats:[1,2]
- Saturated Fat: These are the simplest forms of fatty acid chain, containing only single bond. These fats can be manipulated by the body to make other compounds. Saturated fat forms the structural components of every cell in the body; they are a good source of nutrition for us and the source of food for bacteria in our gut. These fats are solid at room temperature and can be broadly divided into two categories:
- Animal source like meat, butter, lard and cream.
- Plant source like palm oil and coconut oil.
- Unsaturated Fat: These have one or more double bonds. These can be broken by the body to change the shape and function of fatty acids. The body can use unsaturated fats as signaling molecules and structural components.
- Mono-Unsaturated Fatty Acids (MUFA): These fatty acids have one double bond among its carbon atoms. This makes the fatty acid more stable, as well as a source of various physiological compounds.
- Poly-Unsaturated Fatty Acids (PUFA): These have 2 or more double bonds. PUFA come in two major forms:
- Omega-3 fatty acids are important sources that form EPA and DHA. These fatty acids support healthy inflammatory response, normal development and brain function.
- Omega-6 fatty acids produce arachidonic acid and its derivative. These fatty acids support healthy inflammation. We generally get more omega-6 than omega-3 from most of our oils and fats. This natural balance is important.
- Cis and Trans Fatty Acid: These are different configurations of unsaturated fats.
- Trans Fats: There are two main types:
- Naturally occurring trans fats are formed in the gut of animals by gut bacteria from milk and meat.
- Artificial trans-fat or hydrogenated-fats are formed by industrial processing fatty foods, as well as over heating cooking oil during frying or grilling foods.
- Cis Fatty Acids: Found more readily in plant-based foods, Cis Fatty Acids are much less hydrogenated. Thus, sparing the body from the ill effects of this process.
- Trans Fats: There are two main types:
Cholesterol: The most misunderstood amongst fat, cholesterol forms the basis of all our gonadal hormones, like DHEA, testosterone, progesterone, estrogen, cortisol and much more.
- LDL Cholesterol: This is not a single cholesterol molecule; rather, it is a low-density package that carries fatty nutrition that we get from our diet. It circulates and delivers fatty components to various locations in the body. These deliveries are specified by the protein molecules that are located on the LDL surface. LDL is often dubbed the “bad” cholesterol.
- HDL Cholesterol: As the LDL delivers its contents to various parts of the body, it becomes a high-density package of fatty nutrition; this is called HDL-cholesterol. HDL is often called the “good” cholesterol.
The Myth of Good Vs. Bad Fat
The conversation about fat over the past two decades has been confusing to say the least. Fat is one of the three essential macro-nutrients of our diet. Therefore, including healthy sources of fat in our daily diet is important.
However, many of our patients are unaware of the right kinds of fats. Here are some clarifications:
Saturated and Unsaturated Fats:
- Saturated fats can be an incredible source of energy; these fats have easy-to-manipulate hydrogen-carbon bonds. Examples include fats from coconut oil, shea butter, palm oil and butter. However, if these fatty acids are exposed to improper cooking practices, like frying or repeated over-use, it results in artificial manipulation of these bonds; a process called hydrogenation. This processing turns saturated fats into unhealthy fats, which are detrimental to health.
- Mono-unsaturated (MUFA) and poly-unsaturated fats (PUFA) are used by the body for energy production, as well as producing signaling compounds. PUFAs are essential support for brain function, as well as normal growth and development. PUFAs also stimulate skin and hair growth, maintain bone health, regulate metabolism and maintain the reproductive system.
Cis- and Trans-Fat:
Natural cis- and trans-fats are a normal part of our diet. In regular proportions, these serve as incredible sources of energy—averaging 9 calories per gram. However, artificially hydrogenated oils are used in industrial-commercial kitchens like fast food restaurants and bakeries. Hydrogenated oils are converted to trans-fat due to over-heating, over-processing or reuse of oil. Artificial hydrogenation promotes oxidation of fats—resulting in plaques and blockages in arteries—which have detrimental effects on the cardiovascular system.
“Good” and “Bad” Cholesterol:
- Cholesterol is a single molecule (seen in this figure) that differs from “bad or good” cholesterol in general discussions. Cholesterols, other fatty molecules and proteins are important components of the “fatty packages” that are called low-density lipoprotein (LDL cholesterol) and high-density lipoprotein (HDL cholesterol).
- When we eat a fatty meal, the fats are sequestered by our lymph system, then sorted and packaged by the liver. The liver forms very-low-density lipoproteins (vLDL)—fluffy balls of fat that deliver cholesterol, fats and protein signals to various parts of the body. As the vLDL are emptied, they become LDL, which are less fluffy. As the LDL continues to deliver its contents around the body, it is repackaged to form HDL.
- HDL or good cholesterol is born from LDL or bad cholesterol. Now, studies prove that this conversion LDL to HDL can be achieved through a healthy diet and regular exercise. LDL cholesterol is not the real problem. The real problem is under-utilization of the fatty nutrition. When we metabolize the LDL properly, it becomes HDL and protects health.
The terminology of “good” and “bad” fat or cholesterol just adds to the confusion. The effects of fats are relative to the source of the fat, then how our body processes and uses it.
Inflammation: The Real Problem
In the past decade, studies have shed more light on how fatty acids become involved in disease processes. The primary culprit appears to be inflammation and oxidative stress. Inflammation is a normal part of the healthy body’s metabolic activity of destruction, healing and regeneration. Oxidative stress is the main tool of the inflammatory process. In a healthy body, these processes are more controlled. When natural inflammation controls are stressed or break down, the destructive effects become prevalent.
The process of plaque formation is called atherosclerosis; it is the main cause of arterial dysfunction that results in coronary heart disease, strokes and embolism. Studies on fatty plaque in blood vessels demonstrate that development of plaque and inflammation go hand-in-hand. Arterial plaque may occur by:
- Eating excessively fatty meals or meals with excess hydrogenated fats. This triggers the inflammatory process in blood vessels—resulting oxidative stress that generates initial atherosclerotic plaque.
- Excessive low-grade inflammation. This causes “peroxidation” of fatty acids and cholesterol that circulates in blood vessels, resulting in arterial plaque.
Low-grade inflammation has been associated with many diseases from diabetes to cancer. Even mental diseases are due to chronic inflammation of the gut, which is the main warehouse of neurotransmitters. Low-grade inflammation is also associated with elevated blood sugar,[7 ]thyroid dysfunction, cigarette smoking, chronic exposure to pollutants, as well as psycho-social stress.
Studies have also shown that fatty molecules like LDL, saturated fats and trans-fats have a greater susceptibility to peroxidation by the body’s inflammatory processes. Therefore, these fats are associated with greater risk of developing heart disease.[3,12] While it is important to mindfully manage the quality and amount of fats we eat, it is equally essential to monitor and balance inflammation to prevent heart disease.
Statins: False Cure for Fat-Related Diseases
Many people consider fats and cholesterol to be the enemy of heart disease—without really understanding the cause of heart disease. Many believe that lowering cholesterol and dietary fat intake is the way to prevent heart disease. Unfortunately, this is still the prevailing approach of many allopathic doctors. Medical practitioners often prescribe statin drugs, on the assumption that lowering cholesterol will fix heart disease.
It is true that statin drugs can lower cholesterol levels, but there is little proof that they are effective in preventing heart disease. Here are three of the major studies and the results:
|PROSPER study||RCT w/ 5,804 patients||Statin did not reduce total heart attacks and total strokes in primary prevention group.|
|ALLHAT-LLT study||RCT w/ 10,355 patients||Statin did not reduce total heart attacks and strokes; also, it did not reduce rate of deaths in patients.|
|ASCOT-LLA study||RCT w/ 10,305 patients||Statin did not reduce total heart attacks and strokes compared to placebo.|
A review of all the major studies accounted for more than 65,000 patients using statin drugs for primary prevention. Combined data of 11 randomized control trials showed that statins did not reduce the rate of deaths compared placebo. Additionally, there was no relationship between reduction of LDL-cholesterol (so called “bad” cholesterol) and the rate of death among patients. To conclude, the reduction of LDL cholesterol does not protect individuals from heart attacks; in other words, fats are not the enemy.
Furthermore, we must consider the severe side effects of statin drugs. The FDA outlines four major side effects of statin drugs:
- Liver Injury: Taking statins can result in elevated liver enzyme, associated with significant liver tissue damage, abdominal discomfort and fatigue.
- Memory Loss: People may experience mental fog or difficulty recalling—describing their memory function as “fuzzy”. For example, one of my cardiac surgeon friends was put on a statin drug after minor heart attack. He started to forget things while he was performing surgery, which was scary. He immediately got off statins and called me for Ayurvedic and Naturopathic help.
- Type 2 Diabetes: Statins can cause elevations in blood sugar that may lead to the development of diabetes. Studies have outlined the progressive insulin resistance with the use of statin drugs; this can lead to Type II Diabetes in as many as 46% of folks using statin drugs.
- Muscle Damage: Statins can also cause incremental muscle damage. If excessive muscle damage occurs, it can cause severe weakness, pain and damage to the kidneys—and even kidney failure. For the same reasons, the FDA banned the use of Lipitor 80 mg. Yet still, lots of our medical colleagues are using the same high doses.
- Cell Structure: The use of statins can also cause deficiency of Co-Q-10, which is an important structural component of cells and a very useful energy source.
- Vitamin Absorption: Statins may also lower absorption of fat soluble vitamins like A, D, E and K, which can cause vitamin deficiency consequences.
Lipid-Lowering and Cardiovascular Benefits of Oils
Regular and balanced intake of healthy oil sources offer great health benefits from fetal development to old age. These benefits become more pronounced as we understand disease mechanisms and rely on long-term studies to observe the effect of dietary patterns. Here are some benefits outlined in research:
- Mono-Unsaturated Fatty Acids: Balanced intake of MUFA helps improve insulin sensitivity and balance blood sugar. MUFA can also protect against abdominal obesity, high blood pressure and atherosclerosis—reducing the risk of heart disease by 20%.
Sources of MUFA include almond oil, olive oil, avocado oil, hazelnut oil, sunflower oil, pecans, macadamia nuts, hazelnuts, almonds, avocado and ripe olives.
- Poly-Unsaturated Fatty Acids: Linoleic fatty acid is a source of Omega-6 fatty acids. Studies have shown that intake of Linoleic Acid is associated with reduced rates of diabetes, heart disease and cancer. It can also lower body fat, as well as allergic components like Eosinophils and histamine. Omega-3 fatty acids, commonly known as EPA and DHA, are compound sources that balance inflammation and clot-formation. Both functions protect against heart attacks and strokes. The beneficial effect is extended to other inflammatory diseases like psoriasis and arthritis. Additionally, Omega-3 oils are essential for fetal development, as well as normal growth, development and repair throughout life.
Sources of PUFA include flax seeds, chia seeds, hemp seeds, salmon, halibut, cod, trout, walnuts, soy beans, fish oil, flax oil and hemp oil.
- Medium Chain Triglycerides (MCT): These fatty acids are smaller than PUFA and MUFA. They are an efficient source of energy and nutrition for our body, as well as food for good bacteria in our GI tract. MCTs have been shown to reduce body fat weight, waist size and overall body weight. Subjects eating more MCT lost more visceral and subcutaneous body fat.
Sources of MCT include coconut oil, palm kernel oil and ghee.
- Reducing inflammation, which lowers hsCRP and Interleukin-6.
- Balancing cholesterol, which lowers LDL/triglyceride and increases HDL.
- Reducing levels of clotting factors Fibrinogen and Thromboxane, as well as leukotriene B4.
- Providing protection against heart disease by lowering total cholesterol and LDL, while increasing HDL cholesterol.
- Increasing insulin production and insulin sensitivity in those with diabetes. It promotes better blood sugar management.
- Providing nutrition for patients with debilitating diseases like cancer and HIV/AIDS.
- Supplementing a ketogenic diet for patients with brain cancer, skin cancer and other types of cancer.
- Protecting the heart. Conjugated-linoleic fatty acids reduce oxidation of fatty acids and prevent formation of plaque, as demonstrated by animal studies.
- Protecting against cancer-causing agents and carcinogens. In a study, compared to soy oil, ghee induced better detoxification of carcinogens through the liver and breast tissue. Ghee also reduces the enzyme activity that activates carcinogens.
- Reducing LDL-cholesterol, triglycerides and total cholesterol; while providing protection against fatty acid oxidation in blood vessels. Ghee lowers excess fatty acids in the body, while protecting from inflammatory arterial plaque.
Natural Strategies to Protect the Cardiovascular System:
Food is very important for sustaining health. Air and water are also an important part of our nutrition. Breathing is a thermogenic (caloric burning) process; while 60 to 70% of the body is water.
Low-fat, plant-based diets have shown to reduce weight, overall cholesterol, triglycerides and insulin resistance. In another study, researchers looked at the effects of a low caloric diet that is mostly plant-based with moderate amount of fats and proteins. A low-caloric diet activates thyroxine kinase, which promotes thyroid function and helps increase insulin sensitivity, as well as activate the systemic metabolism or digestive process.
Vegetable diets are a rich source of fiber and bioflavonoids, inherently low in calories and carbohydrates, and have a low glycemic-index—all have been shown to improve insulin sensitivity, reduce inflammation and balance lipids. Thus, protecting us from diabetes, heart disease, inflammatory conditions and many more diseases.
Citrus bioflavonoids, found in citrus like oranges, grapefruit, tangerine, lime and lemons, have proven beneficial effects in lowering high cholesterol and triglycerides. Natural antioxidants, phytochemicals and bioflavonoids present in vegetables and fruits help to clear low-grade inflammation. Vegetable and fruit-based diets, high in fiber, bind cholesterol and triglycerides in the GI tract and prevent absorption—helping manage excess lipids or fatty acids.
Exercise is the most beneficial daily activity for stimulating our metabolic activity. Mix of aerobic exercise and weightlifting can help improve insulin resistance significantly in as little as 8 weeks.[35,37 ]Findings have led scientists to postulate that balanced life-style activities like correct time of eating, sleep and exercise can affect the circadian rhythm in a way that helps regulate normal gene expression—preventing many diseases, including cancer.
Unmanaged stress leads to fatigue, lethargy, depression, cravings for carbohydrates and sugars, which further worsens our body composition. Aerobic exercise, walking, yoga and pranayama (breathing exercises) help reduce stress, promote weight loss, as well as improve insulin sensitivity and the health of blood vessels. Relaxing activities like meditation, reading, writing, singing or spending quality time with family can help neutralize stress.
Breathing and Yoga:
Yoga is a form of physical and mental exercise that combines physical movement, breathing and stretching. Regular yoga can help with weight loss, reduce stress and improve our quality of life. Pranayama, the breathing exercises are useful to improve blood oxygen levels to boost metabolism, promote relaxation, clarity of mind and awareness. Among individuals with metabolic syndromes, one-hour of daily practice of pranayama and yoga proved beneficial to promote significant weight loss, reduce triglycerides, cholesterol and blood sugar, as well as HbA1c. Altogether, combined practice of yoga and pranayama improved all aspects of the metabolic syndrome, with the added benefits of stress relief and peace of mind.
A medicinal resin harvested from the bark of the guggul tree, Commiphora mukul or guggul is a classical Ayurvedic medicine that was first described in the text of Atharva Veda in 2000 BC. Another classical text Sushruta Samhita, written it 600 BC, describes the uses of guggul for obesity, liver dysfunction, internal tumors, malignant sores and ulcers, urinary complaints and more. Research has validated traditional uses for chronic inflammatory diseases, metabolic diseases and cardiovascular diseases. Guggul does so through anti-inflammatory, antioxidant activity that enhances cholesterol excretion by blocking absorption in the gut.[41,42] In other words, guggul reduces cholesterol levels, while helping control the real culprit of inflammation. Guggul demonstrates nature’s versatile capacity to address problems holistically.
Garlic has become popular as a household remedy for supporting the immune system and reducing cholesterol. Garlic, onions, chives and leeks are high in sulfur-containing compounds that can help renew antioxidant liver enzymes, improving activity of antioxidant enzymes systemically. In scores of studies, garlic has proven to lower cholesterol, LDL or bad cholesterol and triglyceride, while it improves HDL cholesterol.
Turmeric is a common curry spice that is easily available and controls inflammation within healthy limits. Curcumin, a yellow pigment from turmeric, has been found beneficial for auto-immune conditions, heart disease, cancer development, etc.
Years of research has shown the benefits of combining these herbs. One study looked at diabetic patients with abnormal lipids. The combination of turmeric and garlic helped reduce total blood sugar, HbA1c, total cholesterol, LDL-cholesterol and triglycerides. In another study, this combination of herbs was found to be as effective as statin drug Simvastatin for reducing cholesterol and balancing lipids. These studies and more have shown that the garlic-turmeric combination can help to prevent heart disease and stroke by combining anti-inflammatory and lipid lowering properties, without the severe side effects of statin drugs.
For years, we have been misguided about fats in our diets.
Yes, statins can lower cholesterol effectively. However, do we see a reduction in heart attacks and strokes? No.
Before 1960s, when saturated fats were used in all the cooking and confectionary, heart attacks were lower. With the introduction of modified and hydrogenated fats, sugar and excessive meat consumption, heart attacks went through roof.
In summary, for health benefits, here is how to proceed:
- Eat 4 to 6 variety servings of vegetables, 2 to 3 servings of fruits, 2 handfuls of nuts or seeds, and 1 to 2 tablespoons of healthy non-oxidized oils.
- Drink 8 to 10 glasses of water daily.
- Do breathing exercises, yoga, walking and light weight bearing exercises.
Diets rich in vegetables, fruits, nuts, seeds, healthy oils, whole grains, limited amount of dairy, meat and fish will not only save us from heart attacks, but also almost all major diseases.
-  Indiana.edu “The Kinds of Fats And Why it Matters to You.” Indiana University
-  “Fats and Oils” American Heart Association
-  Williams C. “Dietary fatty acids and human health.” Annales de zootechnie, 2000, Vol 49 (3), Pg. 165-180.
-  UMM.edu “Omega-6 Fatty acids.” University of Maryland, Medical Center.
-  Varady KA and Jones PJH. “Combination Diet and Exercise Interventions for the Treatment of Dyslipidemia: an Effective Preliminary Strategy to Lower Cholesterol Levels?” J. Nutr., August 1, 2005; Vol. 135(8), Pg. 1829-1835.
-  Libby P, et al. “Inflammation and Atherosclerosis” Circulation. 2002; Vol. 105, Pg. 1135-1143.
-  Heilbronn LK and Campbell LV. “Adipose Tissue Macrophages, Low Grade Inflammation and Insulin Resistance in Human Obesity.” Current Pharmaceutical Design, April 2008; Vol. 14(12), pp. 1225-1230.
-  Taddai S, et al. “Low-Grade Systemic Inflammation Causes Endothelial Dysfunction in Patients with Hashimoto’s Thyroiditis.” The Journal of Clinical Endocrinology & Metabolism, 2006; Vol. 91(12).
-  Danesh J, et al. “Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses.” BMJ 2000; Vol. 321, Pg. 199–204.
-  Ruckerl R, et al. “Air Pollution and Markers of Inflammation and Coagulation in Patients with Coronary Heart Disease.” American Journal of Respiratory and Critical Care Medicine, 2006; Vol. 173(4), pp. 432-441.
-  Bunker SJ, et al. “Stress and coronary heart disease: psychosocial risk factors: National Heart Foundation of Australia position statement update.” MJA 2003; Vol. 178, Pg. 272–276.
-  Lands WEM. “Dietary Fat and Health: The Evidence and the Politics of Prevention.” Ann. N.Y. Acad. Sci. 2005; Vol. 1055, pg. 179-192.
-  Shepherd J, et al. PROSPER study group. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomized controlled trial. Lancet, 2002; Vol. 360, Pg. 1623-1630.
-  The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major Outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA 2002; Vol. 288, Pg. 2998-3007.
-  Sever PS, et al. ASCOT investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomized controlled trial. Lancet 2003; Vol. 361, Pg. 1149-1158.
-  Ray KK, et al. Statins and All-Cause Mortality in High-Risk Primary Prevention: A Meta-analysis of 11 Randomized Controlled Trials Involving 65229 Participants. Arch Intern Med. 2010; Vol. 170(12), Pg. 1024-1031.
-  Consumer Health Information. “FDA Expands Advice on Statin Risks.” Food and Drug Administration.
-  Cederberg H, et al. “Increased risk of diabetes with statin treatment is associated with impaired insulin sensitivity and insulin secretion: a 6 year follow-up study of the METSIM cohort.” Diabetologia, Jan. 2015.
-  FDA.gov “FDA: Limit Use of 80 mg Simvastatin.” Food and Drug Administration.
-  Gillingham LG, et al. Dietary Monounsaturated Fatty Acids Are Protective Against Metabolic Syndrome and Cardiovascular Disease Risk Factors. Lipids (2011); Vol. 46, Pg. 209–228.
-  Buleri MA. Dietary Conjugated Linoleic Acid in Health: Physiological Effects and Mechanisms of Action. Annu. Rev. Nutr. 2002; Vol. 22, Pg. 505–31.
-  Simopoulos AP. Omega-3 fatty acids in health and disease and in growth and development. Am J Clin Nutr 1991; Vol. 54, Pg. 438-63.
-  Tsuji H, et al. Dietary Medium-Chain Triacylglycerols Suppress Accumulation of Body Fat in a Double-Blind, Controlled Trial in Healthy Men and Women.
-  Lopez-Miranda J, et al. Olive oil and health: Summary of the II international conference on olive oil and health consensus report, Jaen and Cordoba (Spain) 2008. Nutrition, Metabolism & Cardiovascular Diseases (2010) xx, 1 – 11.
-  Chempro.in “Fatty Acid Analysis of Some Edible Oils” Chempro Edible Oil Refining.
-  Fifee BF. Coconut oil and Health. Proceedings of the International Coconut Forum in Cairns, Australia, Nov. 2005; Pg. 42.
-  Mirghani Z, et al. “Analysis of fatty acids in Ghee and olive oil and their probable causal effect in lipoid pneumonia.” Med J Indones, 2010; Vol. 19, Pg. 252-7.
-  Chinnadurai K, et al. “High conjugated linoleic acid enriched ghee (clarified butter) increases the antioxidant and antiatherogenic potency in female Wistar rats.” Lipids Health Dis. 2013 Aug 7; Vol. 12, Pg. 121.
-  Rani R and Kansal VK. “Effects of cow ghee (clarified butter oil) & soybean oil on carcinogen-metabolizing enzymes in rats.” Indian J Med Res. 2012 Sep;136(3):460-5.
-  Sharma H, et al. “The effect of ghee (clarified butter) on serum lipid levels and microsomal lipid peroxidation.” Ayu. 2010 Apr; Vol. 31(2), Pg. 34-40.
-  Kent L, et al. The Effect of a Low-fat, Plant-based Lifestyle Intervention (CHIP) on Serum HDL Levels and the Implications for Metabolic Syndrome Status. Nutrition and Metabolism, 2013; Vol. 10(58).
-  Ren J, et al. Nutritional intervention in the metabolic syndrome. Asian Pacific Journal of Clinical Nutrition, 2007; Vol.16 (Suppl 1), Pg. 418-421
-  Galleano M, et al. Flavonoids and metabolic syndrome. Annals of New York Academy of Science, 2012; Vol. 1259, Pg. 87–94.
-  Assini JM, et al. Citrus flavonoids and lipid metabolism. Lipidology, 2013; Vol. 24(1), Pg. 34-40.
-  Stuart CA, et al. Insulin Responsiveness in Metabolic Syndrome After Eight Weeks of Cycle Training. Medical and Science in Sports and Exercise, 2013; Vol. 45(11), Pg. 2021-2029.
-  Gallou-Kabani C, et al. Nutritional Epigenomics of Metabolic Syndrome: New Perspective Against the Epidemic. Diabetes, July 2005; Vol. 54, Pg. 1899-1906.
-  Lemmer JT, et al. Effect of strength training on resting metabolic rate and physical activity: age and gender comparisons. Medicine & Science in Sports & Exercise, 2001 Apr;33(4):532-41.
-  Sales ARK, et al. Aerobic exercise acutely prevents the endothelial dysfunction induced by mental stress among subjects with metabolic syndrome: The role of Shear Rate. American Journal of Physiology – Heart – Circulatory Physiology, 2014; e-publication.
-  Anderson JG, et al. The Metabolic Syndrome and Mind-Body Therapies: A Systematic Review. Journal of Nutrition and Metabolism, 2011.
-  Balaji PA, et al. Effects of yoga – pranayama practices on metabolic parameters and anthropometry in type 2 diabetes. International Multidisciplinary Research Journal 2011; Vol. 1(10), Pg. 01-04.
-  Shishodia S, et al. The Guggul for Chronic Diseases: Ancient Medicine, Modern Targets. Anticancer Research, 2008; Vol. 28, Pg. 3647-3664.
-  Urizar NL, et al. Gugulipids: A Natural Cholesterol-Lowering Agent. Annual Reviews in Nutrition, 2003; Vol. 23, Pg. 303–13.
-  Capasso A. Antioxidant Action and Therapeutic Efficacy of Allium sativum L. Molecules 2013; Vol. 18, Pg. 690-700.
-  Ried K, et al. Eﬀect of garlic on serum lipids: an updated meta-analysis. Nutrition Reviews, 2013; Vol. 71(5), Pg. 282–299.
-  Jurenka JS. Anti-inflammatory Properties of Curcumin, a Major Constituent of Curcuma longa: A Review of Preclinical and Clinical Research. Alternative Medicine Review, 2009; Vol. 14(2).
-  E.Y. Sukandar, et al. Clinical Study of Turmeric (Curcuma longa L.) and Garlic (Allium sativum L.) Extracts as Antihyperglycemic and Antihyperlipidemic Agent in Type-2 Diabetes-Dyslipidemia Patients. International Journal of Pharmacology, 2010; Vol. 6, Pg. 456-463.
-  Sukandar EY, et al. Safety of Garlic (Allium Sativum) and Turmeric (Curcuma domestica) Extract in Comparison with Simvastatin on Improving Lipid Profile in Dyslipidemia Patients. Journal of Medical Sciences, 2013; Vol. 13(1), Pg. 10-18.