THE COMPLEXITY OF CHOLESTEROL · they want. “Some of the time the customer asks ... shown to...

A VRM, Inc. Publication October 2010

THE COMPLEXITY OF CHOLESTEROLIn a category where confusion abounds, natural

retailers can become an invaluable resource

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E very day, the HealthyAlternative (Dayton, OH) retailsales staff receives customerswith questions about loweringtheir cholesterol. While grate-ful that awareness is up and

customers are addressing a clear prob-lem for the American population(according to the American HeartAssociation’s latest statistics, an estimat-ed 102.2 million adults in the US havetotal blood cholesterol values of200mg/dL and higher, and of theseabout 35.7 million American adultshave levels of 240 or above), it’sbecome clear to Tony Hause, presidentof the three-store chain, that too oftencustomers are misguided and rightfullyconfused.

Hause breaks down his cholesterolcustomers into three equal groups: thefirst group thinks all cholesterol is badand it just needs to be obliterated; thesecond group knows cholesterol issomething they need to address, butthey’re unclear if nutrition or pharma-

ceuticals are the answer; the final grouphas been taking cholesterol-loweringmedications and is “fed up” with theside effects, such as achy limbs.

“The vast majority of my customershave no idea about what cholesterolreally is and what it means to their bod-ies. They hear their doctors say theyhave to worry about their cholesterol,meaning their LDL, but they don’t tellthem that HDL is actually good,” saidHause, adding that the market hasgrown considerably, especially as themedical community continues to lower

what it considers safe levels, offering anexample of one customer coming insaying his doctor told him he needed toget his levels below 180. “They’re look-ing for some direction and it’s up to usto educate them.”

What Healthy Alternative is facing isn’tuncommon—retailers across the countryhave customers just like Hause’s. While itcan be a challenge, especially as retail-ers have to keep the ordinances of

28 VITAMIN RETAILER WWW.VITAMINRETAILER.COM ! OCTOBER 2010

THE COMPLEXITYOF CHOLESTEROLRetailers are in a prime position to educate,assist and become an invaluable resource toan ever-increasing customer base seekingnatural cholesterol control options. B y K a t e Q u a c k e n b u s h


DSHEA in mind, with properly trainedstaffs and the right supplier productsand support, retailers have the opportu-nity to be a valuable and appreciatedresource for those customers.

Clearing Up MisconceptionsAccording to Mateo B. Dayo III, MD,MBA, cardiovascular, thoracic and vas-cular surgeon at Venice-Ocala HeartInstitute, the top two myths aboutcholesterol are that all cholesterol isbad and that cholesterol only affects“older people.”

“Not all cholesterol is bad. In fact,cholesterol is produced by the body tocell membranes and contributes to theformation of certain hormones, vitaminD and bile acids,” he said. “It is impor-tant to know that there are two types ofcholesterol. HDL is the ‘good’ kind andLDL is the ‘bad.’ The key to healthy lev-els is finding and maintaining that per-fect balance between the two.”

“Oftentimes our customers are onlythinking about the ‘bad cholesterol’ justbecause this is the only side that main-stream media and some doctors portraythat you need to take care of, when infact all cholesterol is needed in the rightamounts,” said Robert Rohder, seniormanager for the, WA-based retail storeSuper Supplements. “There is a miscon-ception that exists and an opportunityto educate our customers on the role allcholesterol plays in our bodies.”

“Some customers may learn aboutLDL and HDL cholesterol and triglyc-erides when they find out they have ele-vated levels,” added John Kenny, SuperSupplements’ product educator, “but ingeneral it is not well understood.”

In regards to Dayo’s second myth thatcholesterol problems only affect olderpeople, “cholesterol can begin affecting

individuals in their childhood,” he said.“Many people don’t realize the impor-tance of a healthy diet during their 20sand 30s especially if the effects do notshow up in the form ofweight gain,” heexplained. “However,consistently eatingunhealthy foods can leadto atherosclerosis, whichoccurs when cholesterolbuilds up in and gradual-ly narrows the arteries,and, in turn, restricts theblood flow.”

While diet, exerciseand pharmaceuticalshave been the primarytreatment for consumers,the supplement industryhas evolved to createspecific options that work in concert,and the public is clearly interested.

“Heart health has become an increas-ingly important topic for health careproviders and their patients. Witharound 50 percent of American adultssuffering from elevated blood choles-terol levels, a key risk factor for heartdisease, sales of such products haveexploded in recent years,” said JayLevy, director of sales with Wakunaga ofAmerica Co., Ltd. (Mission Viejo, CA).“According to market research conduct-ed between 2003 and 2007, cholesterollowering supplement sales increased 37percent in natural foods markets and 20percent in mainstream sales. With grow-ing concern over the safety of statindrugs, an increasing number of con-sumers are looking toward natural sup-plements and lifestyle changes to helpthem control their cholesterol.”

Pharmaceutical Path to NaturalOne reason con-sumers are lookingtoward naturalmethods is the ris-ing news about theside effects ofstatin medications,one of the top-sell-ing prescribedmedications in theworld. JackGrogan, CN, CSOwith Uckele Health

& Nutrition (Blissfield, MI), offered thatreports show statins can deplete Co-Q10, which is shown to be critical inmaintaining normal energy production in

the heart muscle. “This informationencourages interest in more naturalmethods of balancing cholesterol that willnot deplete other necessary cardiovascu-lar support,” he said.

Kenny pointed out that interest in thecardiovascular category has alwaysbeen high, but it began to peek as neg-ative information about pharmaceuticalside effects began to spread. “It is oneof the most asked about categories witha possible increase in awareness overthe last two years,” he said. “Accordingto one of our stores, many customers

will research ontheir own and telltheir doctors to give them three to six months tolower on their ownwith diet and supplements.”

While the majority of SuperSupplements’ customers arelooking for naturalalternative

suggestions for bringing their choles-terol into acceptable levels, in one of itsstores it’s estimated that eight out of 10people come in knowing exactly whatthey want.

“Some of the time the customer asksfor a specific product, with the mostpopular being red yeast rice extract—usually on a doctor’s recommendation,”

THE COMPLEXITYOF CHOLESTEROL

Super Supplements’ stafftakes a hands-on approachto assisting customers.


said Rohder. “Any red yeast rice-con-taining product is the most popular thelast few years in probably most storesdue to the many advertisements andarticles touting its benefits.”

One of the reasons for red yeast rice’spopularity, according to KaoriDadgostar, PhD, technical specialistwith Jarrow Formulas (Los Angeles, CA),is its close approximation to statins.

“Red yeast rice, which containsmonacolins, naturally occurring sub-stances that are known to regulate cho-lesterol synthesis by inhibiting anenzyme called HMG Co-A reductase(HMGR). This mechanism is also used inprescription drugs known as statins, andthe cholesterol-lowering effects of redyeast rice are comparable to statins

even at lowdosages,”explainedDadgostar, addingthat even thoughred yeast rice hasbeen used for morethan 1,200 years inChina as a preserva-tive, spice and foodcoloring as well as atraditional medicineto treat poor circu-

lation, gastrointesti-nal issues and indigestion, recent stud-ies have shown that red yeast rice canprovide additional cardiovascular bene-fits including improved circulation.

Jarrow Formulas provides a high-quality red yeast rice extract that is freeof the undesirable fermentation byprod-uct citrinin, and includes Co Q10, whichcomplements red yeast rice in supportinghealthy cardiovascular function.

Uckele formulated its popular combi-nation product, Lipisterin, for those con-

cerned about cholesterol levels, and inparticular, the negative effects statinscan have on the liver. “This uniqueingredient formulation includes guggulextract, red rice yeast, plant sterolswith naturally ocurring policosanol, andcontains nutrient support factors thatcan directly improve the liver’s abilityto properly metabolize cholesterol,”said Grogan.

Addressing Mechanisms of ActionConsumers who want additional choles-terol health boosts are looking forherbal formulation products with scien-tifically documented ingredients thattarget various cholesterol loweringmechanisms and antioxidative proper-ties. The most popular ingredients,according to Dadgostar, include redyeast rice, artichoke and sesame seedoil and extract (which in addition totocotrienols make up Jarrow’s ChoLessOptimizer) and well-documentedantioxidants including vitamins C and E,resveratrol and alpha lipoic acid.ChoLess Optimizer provides an optimalcombination of powerful antioxidantsand natural ingredients that recent clinical and pre-clinical studies haveshown improve lipid metabolism whilepreventing LDL cholesterol accumula-tion and oxidation.

Tackling Inflammation“The concept that elevated inflammato-ry stress contributes to high cholesterollevels is about 20 years old, but is beingrevisited, and is just as important a fac-tor in supporting cardiovascular healthas the cholesterol values are in and ofthemselves,” explained Uckele’sGrogan. “Recent research linking chron-ic inflammatory stress with elevatedcholesterol is also a major contributingfactor toward consumers seeking outsupplements that support and manageexcessive inflammatory stress.”

A growing number of people arelooking for multi-pathway supplementsthat can enhance lipid and cholesterolmetabolism, which, in turn, decreasesbad cholesterol and increases goodcholesterol. “This can happen by regu-lating underlining cellular functionswhile producing anti oxidative effects toprevent oxidation of bad cholesteroland inflammation in the cardiovascular

system,” said Dadgostar, who pointedout an overwhelmingly popular choicefor addressing inflammation is omega-3fatty acids (e.g. fish oil and krill oil),which comes from its lowering effect ontotal cholesterol and triglycerides, aswell as bad cholesterol, particularly oxi-dized LDL, while it increases the levelsof good cholesterol.

Also addressing inflammation is aproduct from BSP Pharma, Inc.(Marmora, NJ) called FlexNow® with100% SheaFlex70. While better knownas a joint care product, it has beenshown to impact cholesterol, reduceinflammation, build cartilage andreduce pain due primarily toSheaFlex70™, which is exclusive to theproduct. SheaFlex70, a 70 percent con-centrate of shea triterpenes, is consid-ered to be one of the most powerfulinflammation fighters found in anybotanical, according to the company,and is the subject of over 30 clinical tri-als and studies.

Repairing Damage by Balancing ‘Good’ and ‘Bad’The idea that teenagers and 20-some-things can eat whatever they want is apart of the cholesterol problems in theUS. As Dayo pointed out, atherosclero-sis, or the gradual narrowing of the arter-ies restricting blood flow due to a buildup of cholesterol, is often the result ofconsistently eating unhealthy foods.

To that end, consumers, particularlythose at Healthy Alternative, have beenfans of Wakunaga, which began its car-diovascular research in the 1970s andcontinues today. The foundation of itsefforts has been garlic, which has hadconsistent consumer awareness for thebenefit of heart health and specificallycholesterol benefits by addressing both“good” and “bad,” according to Levy.

“Successive clinical trials and researchout of UCLA Medical Center showedthat Kyolic Aged Garlic may have theability to reduce elevated cholesterol,reduce homocysteine and decreasecoronary calcification, or atherosclero-sis,” he said. “Meaning Kyolic not onlyreduces ‘bad’ cholesterol, but alsoincreases ‘good’ cholesterol.”

It’s this focus on research andWakunaga’s willingness to share it withits retailer partners that makes it a



favorite of Hause’s—espe-cially as many suppliershave cut back on thematerials they share.

“We used to receive alot more information frommanufacturers in the past,yet Wakunaga continuesto provide us with any-thing that we need,” saidHause. “It has a team ofPhDs continuing toresearch garlic, and itoffers more information onits products and ingredi-ents than any other company. Its products arevery popular with our customers, and it contin-ues to innovate by addingproven nutrients to createspecific products.”

Acknowledging anothercholesterol-lowering sup-plement that is gainingmomentum among con-sumers—phytosterols,which are known to reducecholesterol absorption inthe intestines—Wakunagacreated Kyolic® Formula 107, a propri-etary blend of Kyolic Aged GarlicExtract and phytosterols for a uniquelysynergistic cholesterol-lowering supple-ment. The company also offersModuChol®, a potent blend of plantsterols in capsule form free of dairy,gluten, animal derivatives, artificial col-ors, preservatives and sugar.

Education Navigation From omegas through herbs and botan-icals, cholesterol is one category inwhich customers are faced with all toooften too many products. To overcome

this challenge, Don Ryan, with QuestProducts Inc. (Libertyville, IL), which co-branded with Cargill’s popularCoroWise™ plant sterols to createCardio Chews™, suggested that retailers create cholesterol sections intheir stores.

“When cholesterol products areplaced in the basic vitamin aisle withover 3,000 other SKUs, it gets hard toidentify great cholesterol items,” hesaid. “Build a heart health section in thestore with direct focus [or subsection]

on cholesterol.” Sometimes that’s easier

said than done, but SuperSupplements has made thisstrategy work. Its overallassortment has a broad levelcardiovascular category thatincludes High BloodPressure, Circulation andCholesterol. Its primary cate-gory is comprised of 240 orso SKUs with about 50 per-cent of those living in a spe-cific “Cholesterol” home.“This excludes items like gar-lic, turmeric and niacin, whichlive in their own respectivecategories,” said Letty Miller,category manager. Thechain’s secondary level itemshave a broader reach andencompass more than 200SKUs within the “cardiovas-cular sections” the fish oilsspecific to cardiovascular fallinto this secondary category,but are not necessarily prima-rily driven by it.

“As with all categories youcan fall into a situation where

the category is too diluted and so canbe confusing in terms of choice for thecustomer. We try to create a cohesivecardiovascular set that includes functional foods like garlic, plant sterols,Sytrinol and nattokinase but alsoinclude the red yeast rice, policosanolsand cholesterol-specific complexes,”explained Miller. “We have an interrelated cardiovascular set toinclude items for circulation and highblood pressure as well.”

Making products easy to find isalmost as important as being able toaddress consumers’ questions. When

faced with confused customers, in par-ticular about cholesterol, HealthyAlternative takes a three-fold approach.

“First, we train our staff every monthin each store about topics like choles-terol. We’ll spend a whole session talk-ing about nothing but cholesterol andthe questions [our staff] is likely to get,”said Hause, adding that they will gothrough every product offered for thespecific condition being discussed andwhat it does.

Super Supplements also puts a strongemphasis on educating its staff throughvender trainings, in-store trainings,trainings on specific topics as well asproduct demonstrations, but Rohderbelieves there can always be more helpon this front.

“Providing the latest science on theirproducts and giving the retailer infor-mation that can be shared with the con-sumer on the sales floor is the mosthelpful,” he said. “If the suppliers/man-ufacturers could continue to invest intraining the sales person in the storethis will create more informed sales thatcreate return customers.”

This leads to the second step atHealthy Alternatives: resources.

“We encourage our staff to familiarizethemselves with and use our researcharea filled with materials we get fromour vendors,” said Hause, “but moreimportantly, with the research we’vecompiled independently on our own.”Hause and his team have labored to cre-ate files on every ailment to which thestaff can refer, pulling from trade publica-tions and numerous other scientific sites.

“At the store level, customers arelooking for scientific evidence whenthey compare products, and the pres-ence of quality scientific data definitelymakes the consumer feel secure andcomfortable about the products,” saidJarrow’s Dadgostar.

Even though Super Supplementsappreciates vendor assistance, Kennyhas observed that in some stores staffsare more interested in vendor-inde-pendent materials. “Some stores preferunbiased material, so they turn to Aisle7 kiosk, trusted resource books orresearch articles in the store library thataren’t product specific,” he said.

These are some of the most valuable


(Continued on page 80)

tools, in Kenny’s eyes, especially as thestore strives to make sure it is DSHEA compliant.

“We are very conscientiousabout the need for DSHEA-compliant information,” hesaid. “As a company, we don’trecommend specific productsfor lowering cholesterol inorder to be DSHEA compliant,but we point out the best sell-ers, get them information fromAisle 7 (formerly Health Notes)or other reading material and

share positive customer feedback, butwe note that doesn’t guarantee they willhave the same result.”

And that’s an important differentiationcustomers need to understand, accord-ing to Richard D. Johnson, presidentand CEO of BSP Pharma. “In general,we all want products that work … forus,” he said. “When considering estab-lished ingredients and products, theproduct experience and recommenda-tions of retail associates as well asword-of-mouth consumer experiencemay be the best and most valued indi-cators of quality and efficacy.”

The last step at Healthy Alternative isone-on-one counseling, according to the

retailer. “Everyone thinks their situation isunique, so it’s comforting for them to goover with our staff what they’re dealingwith and what they’re looking for,” hesaid. “When customers see that we’reconfident and educated, and most impor-tantly looking them in the eye, they’remuch more at ease, and sometimes thatcan make all the difference.” VR



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