Bisnis Internet Pemula ~ Tutorial(Panduan) Cara Bisnis Online Internet untuk Pemula
Tutorial(Panduan) Cara Bisnis Online Internet untuk Pemula – Anda seorang pemula dan bingung bagaimana harus memulai bisnis online atau bagaimanakah sebenarnya cara bisnis online itu.? Well, Belajar cara Bisnis online tidak harus rumit.
Memulai bisnis online baru atau mengambil bisnis online yang ada mungkin tampak menakutkan atau luar biasa. Tapi seperti segala sesuatu yang lain, jika Anda membuat rencana dan mengambil langkah demi langkah, Anda akan bangun dan berjalan dalam waktu singkat.Seri artikel ini akan membantu Anda melalui langkah-langkah dari memilih bisnis Anda untuk membangun kehadiran online anda sendiri dan seterusnya.
Memilih Bisnis Online
Mari kita menyederhanakan proses memilih bisnis online dan mengatakan pada dasarnya ada empat cara untuk memulai bisnis online – dan benar-benar, tidak ada alasan Anda tidak bisa melakukan semua tiga.
Namun, Anda mungkin ingin memilih salah satu dan fokus pada yang pertama.
1. Memulai Bisnis Online denga Menjual Produk/Jasa Anda sendiri:
Anda dapat “mulai dari awal” dan mengembangkan sendiri produk atau jasa untuk dijual. Sebagai contoh, jika Anda seorang seniman atau perajin Anda mungkin bisa membuat produk Anda sendiri dan menawarkan mereka untuk dijual atau Anda dapat menawarkan layanan seperti konseling karir atau jodoh.
Anda bahkan bisa masuk ke pasar menguntungkan untuk menciptakan produk informasi. ide bisnis online yang tidak terbatas.
2. Memulai Bisnis Online dengan Affiliate Program:
Jika Anda tidak memiliki produk atau jasa Anda sendiri untuk menjual, Anda dapat memasarkan produk orang lain melalui program afiliasi. Dengan program afiliasi, Anda dibayar persentase dari penjualan yang dibuat ketika Anda mereferensikan seseorang untuk website perusahaan.
Biasanya pembeli harus mengklik link afiliasi Anda dan melakukan pembelian segera. Beberapa program afiliasi akan melacak pengunjung dari link anda dan membayar komisi untuk dalam jangka waktu, seperti dalam waktu 3 bulan kunjungan.
3. Memulai Bisnis Online dengan Penjualan Langsung:
Akhirnya, jika Anda merasa membutuhkan struktur lebih lanjut dan dukungan, Anda dapat bergabung dengan Perusahaan Penjualan Langsung dan memasarkan produk mereka. Ada ratusan perusahaan penjualan langsung segala sesuatu yang tersedia dari kosmetik dan perawatan kulit ke dapur, dekorasi rumah, produk kerajinan, dan suplemen diet.
Biasanya wakil independen tanda di bawah wakil lain atau sponsor yang akan memberikan informasi dan dukungan untuk Anda mulai.
4. Memulai Bisnis Online dengan Menjual Kembali(Reseller) Produk yang Anda Beli di Grosir:
Jika Anda tidak ingin memulai bisnis online dengan mengembangkan produk Anda sendiri, Anda dapat menjual produk orang lain. Anda dapat membelinya di grosir dan kapal mereka keluar dari rumah Anda. Atau Anda dapat memilih kemudahan dropship seseorang memiliki produk-produk untuk Anda.
Hal ini berarti perusahaan dari yang anda beli grosir melakukan semua pengiriman untuk Anda. Anda hanya mengambil perintah.
Btw, Bisnis online ini sebagai pekerjaan atau bisnis? Banyak orang, terutama ibu, mulai mencari pekerjaan yang online. Ibu ingin bekerja dari rumah sehingga mereka bisa merawat anak-anak mereka sambil terus memberikan kontribusi pada keuangan rumah tangga.
Mereka cepat belajar bahwa pekerjaan online sedikit dan jauh antara dan terlalu sering membayar uang untuk janji pekerjaan yang tidak pernah terwujud.
Seringkali, orang yang memiliki pekerjaan besar di pekerjaan rumah yang dibawa mereka pulang pekerjaan dari kantor.
Mereka mulai keluar digunakan dalam pekerjaan di luar dan kemudian majikan mereka yakin bahwa itu bermanfaat bagi perusahaan untuk memungkinkan mereka untuk bekerja dari rumah.
Ada beberapa peluang kontrak secara online tersedia jika Anda memiliki spesifik, keterampilan yang sangat berharga. Jika Anda mencari peluang tersebut, lihatlah pekerjaan kami pada bagian rumah.
Anda tidak perlu membayar biaya untuk mendapatkan pekerjaan (sama seperti Anda tidak akan membayar toko bahan makanan lokal biaya untuk dipekerjakan), tetapi kebanyakan cara bisnis online memerlukan beberapa jenis investasi untuk memulai.
Artikel direkomendasikan untuk belajar bisnis online untuk pemula : Bisnis online pemula
source : http://www.investasi10milyar.com/bisnisonline/tutorialpanduan-cara-bisnis-online-internet-untuk-pemula/
Latar Belakang
Free-living amebae yang paling dikenal adalah Naegleria fowleri dan Accanthamoeba spp. Kedua amebae ini hidup bebas ditanah yang lembab dan air, menjadi parasit fakultatif pada manusia. Naegleria fowleri adalah penyebab primery amebic meningoencephalitis (PAM), dan Accanthamoeba spp berhubungan dengan kelainan yang lebih kronis di sistem saraf, yakni granulomatous amebic encephalitis (GAE), amebic keratitis, serta ulkus di kulit. Tipikal kasus PAM terjadi pada musim panas, dimana Naegleria fowleri berproliferasi dengan cepat seiring dengan bertambahnya temperatur. Penderita PAM biasanya memiliki riwayat kontak dengan air seperti berenang di danau, sungai, atau kolam renang yang dapat terinfeksi oleh organisme ini beberapa hari sebelumnya timbul gejala. Selama periode kering dan meningkatnya temperatur ini, konsentrasi Naegleria fowleri akan meningkat. Pada beberapa kasus, ada indikasi bahwa organisme ini juga dapat ditularkan melalui inhalasi dari debu yang terkontaminasi. Pada tahun 1965, Fowler dan Carter mempublikasikan sebuah laporan kasus yang terjadi pada 4 orang penderita di Australia. Laporan ini pertamaa kali menghubungkan antara Naegleria fowleri dan penyakit yang menyerang susunan saraf pusat. Pada awalnya peneliti tersebut beranggapan bahwa ameba penyebab dari penyakit tersebut adalah genus accanthameba, tetapi setelahpenelitian lebih lanjut ameba penyebabnya cenderung mengacu kepada Naegleria fowleri.
PEMBAHASAN
NAEGLERIA FOWLWRI
A. Morfologi Naegleria Fowleri
Naegleria fowleri dikenal dengan karakteristik yang disebut amebaflagellata, yaitu memiliki bentuk ameboiddan flagellata dalam hidupnya. Siklus hidupnya terdiri atas stadium trophozoit (ameboid dan flagellata) yang motile dan bentuk kista yang non-motile dan resisten. Trophozoit bentuk ameboid adalah bentuk satu-satunya yang dijumpai pada manusia.
Trophozoit dapat hidup di air, atau tanah yang lembab dan kultur jaringan atau media lainnya. Trophozoit bentuk ameboid ketika bergerak berbentuk memanjang, lebih lebar pada bagian anterior, yang dapat dengan jelas dibedakan dari bagian posterior yang menyempit, dan membentuk sebuah pseudopoida yang lebar. Memiliki satu inti dengan karyosom sentral yang besar dan dikelilingi oleh sebuah halo, tanpa kromatin perifer. Terdapat vakuola makanan yang biasanya terdiri dari bakteri pada saat berada dalam bentuk free-living, atau berisi debris sel pada saat menginfeksi manusia.
Bentuk ameba dapat berubah dengan cepat menjadi bentuk flagellata dengan 2 buah flagella ketika berada didalam air, yang apabila dilakukan di laboratorium dapat diinduksi dengan menggunakan air suling untuk membantu diagnosa, dan dipertahankan pada suhu antara 27-37 derajat celcius. Bentuk ameba biflagellata ini biasanya berbentuk seperti pir, dengan 2 buah flagella pada ujung bagian posterior yang melebar. Bentuk flagella ini besifat sementara dan akan berubah kembali pada bentuk ameboid. Perubahan ini terjadi paling lama 20 jam, dan biasanya beberapa dari bentuk flagella dapat bertahan selama 2 hari atau lebih.
Dalam kondisi lingkungan yang tidak menyenangkan, trophozoit akan berubah menjadi bentuk kista. Dengan mikroskop elekron struktur tampak jelas termasuk pori-pori pada dindding kista dan mitokondria, endoplasma retikulum, vesikel dan granul sekretiri. Bentuk kista ditemukan di alam tetapi tidak ditemukan di jaringan SSP.
B. Siklus Hidup Naegleria Fowleri
Naegleria fowleri memiliki 3 stadium dalam siklus hidupnya, yaitu kista trophozoit bentuk ameba dan bentuk flagella. Trophozoit ber-replikasi dengan cara promitosis (membran nukleus tetap utuh). Naegleria fowleri ditemukan di air, tanah, kolam renang air hangat, hidroterapi dan kolam renang untuk pengobatan, akuarium, dan limbah. Trophozoit bentuk ameba dapat berubah menjadi bentuk flagella, dan dapat kembali berubah menjadi bentuk ameba. Menginfeksi manusia dengan cara trophozoit terhirup melalui hidung, yang kemudian akan menginvasi membran nasal, dan masuk ke ruang sinus paranasal. Trophozoit ini akan langsung menembus ciribriform plate ditulang ethmoidalis, dan masuk ke otak melalui nervus olfaktorius. Selanjutnya akan bermultiplikasi di jaringan sistem saraf pusat (SSP) dan menyebabkan Primary Amebic Meningoencephalitis. Dapat diisolasi dari cairan serebro spinal (cerebro spinal fluid/ CSF).
C. Patologi
Gambaran patologi yang dapat ditemukan pada otopsi yaitu hemispher cerebral yang biasanya membengkak dan edema. Karakteristik PAM yaitu nekrotik dan hemorrhagic pada korteks cerebral dan bulbus oktafarius. Secara histopatologi, PAM ditandai dengan eksudat yang purulen, nekrotik, dan edema dengan hemorragic yang difus pada area kortikal dan parenkim otak. Trophozoit dapat ditemukan pada eksudat, walaupun akan sukar membedakannya diantara sel-sel inflamasi. Sel-sel inflamasi yang banyak dijumpai yaitu sel-sel polimorfonuklear (PNM). Trophozoit dapat dijumpai dan dibedakan terutama pada ruang perifascular, dimana sel-sel inflamasi jarang ditemukan. Trophozoit juga dapat ditemukan pada bulbus olfaktorius dan cairan cerebrospinal. Kista tidak ditemukan pada lesi diotak.
Gambaran yang didapati pada PAM sangat dramatis, namun hampir tidak dapat dibedakan dengan meningoencephalitis yang diakibatkan oleh bakteri.
1. Infeksi Naegleria fowleri biasanya terjadi pada dewasa muda dan anak-anak yang sehat dan sebelumnya mempunyai riwayat berenang atau menyelam di air hangat sekitar 7-14 hari sebelumnya. Kebanyakan gejala pertama kali muncul 2-5 hari setelah paparan terakhir yaitu demam, sakit kepala pada area bifrontal atau bitemporal, mual, dan muntah.
2. Dapat timbul beberapa gejala yang berhubungan dengan persepsi olfaktorius yaitu gangguan dalm mengecap.
3. Iritasi meningeal dapat ditandai peningkatan tekanan intra kranial yaitu dengan timbbulnya gejala kejang dan kaku kuduk.
4. Dapat timbul kelumpuhan yang meliputi saraf kranial III, IV, dan V seperti cerebellar ataksia dan penurunan refleks tendon yang mengidentifikasikan adanya edema otak dan herniasi.
5. Status perubahan mental terjadi pada dua pertiga kasus yang pernah dilaporkan dan keadaan penderita akan semakin menurun menjadi koma dan akhirnya akan meninggal dalam waktu sekitar satu minggu setelah munculnya gejala.
6. Kebanyakan kasus PAM berakhir dengan kematian. Penyebab kematian biasanya adalah karena meningkatnya tekanan intra kranial dengan herniasi otak yang akan menyebabkan terhentinya sistem kardiorespiratori.
D. Cara Pencegahan
Temperatur yang hangat, ketersediaan makanan yang mencukupi dan kemungkinan kadar pH yang optimal serta oksigen yang cukup adalah merupakan habitat yang mungkin ameba ini dapat berkembang.
Pencegahan Naegleria fowleri dilakukan dengan pemanasan air sampai di atas 60 derajat celcius dan pemberian chlorine 0,5-1 mg/l. Pemberian chlorine ini terbukti efektif baik untuk air minum maupun air di kolam renang. Namun hal ini tidaklah mungkin dilakukan di daerah reaksi umum lainnya seperti danau dan sungai. Sehingga tindakan pencegahan yang terpenting adalah dengan memberikan peringatan, terutama pada saat musim panas.
E. Pengobatan
Pemeriksaan penunjang yang dapat dilakukan antara lain adalah :
1. Laboratorium
Pemeriksaan cairan serebrospinal
Cairan serebrospinal akan tampak kelabu sampai purulen. Adanya domonasi sel leukosit polimorfonuklear dan tiadak ditemukanya bakteri. Ditemukanya juga adanya eritrosit. Tekanan intra serebral meningkat. Konsentrasi glukosa akan menurun tetapi konsentrasi protein akan meningkat.
Kultur
Teknik kultur dengan menggunakan media yang terdiri dari 1,5% non-nutrient agar plates dengan penambahan Escherichia coli. Media tersebut akan diinkubasi pada suhu 37 derajat celcius dan diamati setiap hari. Ameba ini akan memakan bakteri tersebut dilingkungan aerob seperti habitatnya yang alami.
PCR dan Indirect Immunoflourescent Antibody
Teknik ini dipergunakan untuk mengidentifikasi organisme yang biasanya dilakukan dilaboratorium Center fir Disease Control and Prevention.
Biopsi Otak
Biopsi otak secara potensial dapat dipergunakan untuk mendeteksi tropozoit ini dan gambaran karakteristik histopatologi, namun hingga kini data kasus PAM yang didiagnosa melalui biopsi otak.
2. Pemeriksaan Neuroimaging
Pemeriksaan dengan CT-scan dan MRI diperlukan untuk menilai edema cerebri.
PEMBAHASAN
ACCANTHAMOEBA
A. Morfologi Accanthamoeba
Berbeda dengan spesies sebelumnya, accanthamoeba memiliki bentuk trofozoit dan kista, tidak ada bentuk flagellatanya.
Bentuk trofozoit memiliki ciri khas berupa pseudopodia yang lancip, disebut acanthopodia. Memiliki satu inti dengan karyosom sentral yang besar, tanpa kromatin perifer.
Kistanya bulat, memiliki satu inti. Dindingnya dua lapis, lapisan terluarnya bergerigi dan tidak teratur.
Penularan biasanya tidak berhubungan dengan kolam renang. Infeksi SSP berlangsung secarahematogen setelah inhalasi / aspirasi bentuk trofozoit maupun kista, atau melalui kulit atau mukosa yang luka secara invasi vaskular langsung.
B. Siklus Hidup Accanthamoeba
C. Patologi
Masa inkubasi berlangsung selama beberapa minggu hingga beberapa bulan. Organisme yang terinhalasi akan menimbulkan pneumontis. Invasi melalui kulit akan menstimulasi timbulnya granuloma dalam waktu yang lambat. Granulomatous amebic encephalitis (GAE) yang ditimbulkan oleh acanthamoeba bersifat progresif lambat, dan biasanyatimbul pada penderita yang immunocompromised. Gejalanya mulai dari sakit kepala, demam, kelelahan, hingga kaku kuduk, dan penurunan kesadaran.
Keratitis oleh acanthamoeba biasanya terjadi pada pengguna lensa kontak yang kurang bersih, yang terkontaminasi oleh organisme. Infeksi dapat pula terjadi melalui trauma.
D. Cara Pencegahan
Penularan tidak berhubungan dengan kolam renang. Infeksi SSP berlangsung secarahematogen setelah inhalasi / aspirasi bentuk trofozoit maupun kista, atau melalui kulit atau mukosa yang luka secara invasi vaskular langsung.
Untuk itu pencegahan Accanthamoeba dapat dilakukan dengan menghindari penggunaan kontak lensa.
E. Pengobatan
Walaupun berlangsung lambat, banyank di antara infeksi ini yang terlambat didiagnosis. Pemeriksaan dilakukan dengan menemukan bentuk trofozoit pada spesimen cairan spinal, lesi kulit, atau kornea. Kultur dapat dilakukan pada agar yang sudah ditanami bakteri E. Coli.
Terapi yang digunakan belum ada yang memuaskan, namun penggunaan Amphotericin B dengan sulfadiazin dapat memperlambat perjalanan penyakit dan mengurangi mortalitas
source :http://arwanbj.blogspot.com/2011/03/naegleria-fowleri-dan-accanthamoeba.html
The free-living amoebae that cause human infections include Acanthamoeba, Naegleria, Balamuthia mandrillaris, and Sappinia diploidea. All 4 genera cause CNS infections that are frequently fatal. These amoebae are distinct from other pathogenic protozoa. They all have a free-living existence, have no human carrier state (which is important in disease transmission), have a limited relationship with the spread of infection and poor sanitation, and involve no insect vector.
The pathogenic species of Acanthamoeba include Acanthamoeba castellanii, Acanthamoeba polyphaga, Acanthamoeba culbertsoni, Acanthamoeba palestinensis, Acanthamoeba astronyxis, Acanthamoeba hatchetti, Acanthamoeba rhysodes, Acanthamoeba divionensis, Acanthamoeba quna, Acanthamoeba lugdunensis, and Acanthamoeba griffini. The life cycle consists of 2 stages: a trophozoite (which is 14-40 µm in diameter) and a cyst (which has a double-layered wall with a diameter of 12-16 µm).
Acanthamoeba was first established as a cause of human disease in the 1970s. This genus causes 3 clinical syndromes: granulomatous amebic encephalitis (GAE), disseminated granulomatous amebic disease (eg, skin, sinus, and pulmonary infections), and amebic keratitis. Individuals who develop GAE or disseminated disease are usually immunocompromised, whereas those with amebic keratitis are usually immunocompetent. Disseminated disease and GAE carry a poor prognosis, and treatment strategies are not well defined; Acanthamoeba keratitis is a sight-threatening disease that carries a favorable prognosis when diagnosed and treated early in the disease course
Pathophysiology
Acanthamoeba keratitis occurs in patients who sustain minor corneal trauma; this is usually associated with wearing contact lenses. Amoebae can be introduced through environmental exposures, including swimming while wearing contact lenses or using contaminated contact lens solutions, especially homemade solutions. Rare reports cite radial keratotomy preceding this infection.[1, 2]
GAE usually develops after hematogenous spread of the amoebae from pulmonary or skin lesions to the CNS. Alternatively, amoebae may enter via the olfactory epithelium.
Disseminated disease may begin in the sinuses, skin, or lungs and disseminate from these locations to other sites, including the brain, leading to GAE.
Epidemiology
Acanthamoeba are ubiquitous organisms and have been isolated from soil, water (including natural and treated water), air, and dust. Most persons appear to have been exposed to this organism during their lifetime, as 50-100% of healthy people have serum antibodies directed against Acanthamoeba; studies have also demonstrated that this amoeba can be cultured from the pharynges of healthy persons. Acanthamoeba has caused disease worldwide, including in the United States, Europe, Australia, Africa, and South America.
Acanthamoeba keratitis typically develops in otherwise healthy persons, with over 1,300 cases described in the literature. Most cases occur in people who wear contact lenses. Keratitis has been associated with wearing nondisposable contact lenses, using homemade sodium chloride solution to clean the lenses, and wearing lenses while swimming. The isolation of Acanthamoeba from swimming pool water is not unusual. The bacteriologic quality of the water does not correlate with the presence of Acanthamoeba in swimming pools. Acanthamoeba cysts are very resistant to chlorine. A higher percentage of isolates from swimming pools have been shown to be pathogenic than those isolated from natural fresh water.
Despite the widespread existence of Acanthamoeba, GAE usually occurs among immunocompromised persons, including those with AIDS, transplant recipients (eg, bone marrow transplants), patients with cancer receiving chemotherapy, and those with systemic lupus erythematosus, steroid use, diabetes mellitus, malnutrition, or liver disease. Likewise, persons with disseminated disease without CNS involvement are usually immunocompromised; this condition is most common among patients with AIDS who have low CD4 counts (eg, < 200 cells/µL). In unusual cases, disseminated disease develops in immunocompetent children and adults. The incidence of GAE and disseminated disease appears to be rising, likely mirroring the increased number of persons worldwide who are living with immunocompromising conditions. To date, more than 100 cases of GAE have been described
Frequency
United States
Keratitis cases substantially increased in the 1980s with the introduction of disposable soft contact lenses. Some evidence shows that the rate has subsequently declined, especially with the introduction of multipurpose cleaning solutions. The estimated rate of Acanthamoeba keratitis is 1 per 250,000 people in the United States, although rates vary among studies: from 1.65-2.01 per million population up to 1 per 10,000 people who wear contact lenses.[3]
GAE and disseminated Acanthamoeba disease are very rare, but rates may be increasing given the rising number of persons living with immunocompromising conditions. More than 100 cases of GAE have been described to date.
International
Acanthamoeba can cause keratitis, GAE, and disseminated disease worldwide. Data on the incidence rates of these infections internationally are not available since it is not a reportable disease.
Mortality/Morbidity
- Keratitis is a local infection that does not lead to systemic infection or death but may be complicated by cataracts, hypopyon, and increased intraocular pressure and may threaten sight.
- GAE carries a very high mortality rate (nearly 100%). Survivors of GAE have been described; these patients were treated with combination antimicrobial therapies. Disseminated disease also carries a high mortality rate, but it is lower than GAE if CNS involvement does not occur
Hypercholesterolemia, or high cholesterol, occurs when there is too much cholesterol in the body. Cholesterol is a soft, waxy, fat-like substance that is a natural component of all the cells of the body. Your body makes all the cholesterol it needs. Any added cholesterol, which comes through the foods you eat, can cause harm.
High cholesterol raises your risk for heart disease, heart attack, and stroke. When there is too much cholesterol circulating in the blood, it can create sticky deposits (called plaque) along the artery walls. Plaque can eventually narrow or block the flow of blood to the brain, heart, and other organs. And blood cells that get caught on the plaque form clots, which can break loose and completely block blood flow through an artery, causing heart attack or stroke.
The normal range for total blood cholesterol is between 140 and 200 mg per decilitre (mg/dL) of blood (usually just expressed as a number). However, the total number doesn't tell the whole story: There are two types of cholesterol -- HDL (high density lipoproteins, or "good" cholesterol) and LDL (low density lipoproteins, or "bad" cholesterol). The amount of HDL relative to LDL is considered a more important indicator of your heart disease risk. There is a third kind of fatty material, triglycerides, found in the blood. They also play a role (generally as triglyceride levels rise, "good" HDL cholesterol falls). When you have high cholesterol, it usually means you have high levels of LDL cholesterol, normal or low levels of HDL cholesterol, and normal or high levels of triglycerides.
More Americans are diagnosed with high cholesterol every year. While heredity may be a factor for some people, the main culprits are lack of exercise and diets high in saturated fat. High cholesterol can be prevented, sometimes with lifestyle changes (diet and exercise) alone. If these do not work, your doctor may recommend medications to lower your cholesterol levels.
Signs and Symptoms:
There usually aren't any symptoms of high cholesterol, especially in early stages. The only way to tell if your cholesterol is high is through a blood test.
Causes:
In some cases, high cholesterol levels may be inherited -- your liver may make too much cholesterol, or your body may not remove LDL from your blood as efficiently as normal. High cholesterol or triglycerides can also be associated with other diseases, such as diabetes. But most often high cholesterol is caused by eating foods high in saturated fat and not getting enough exercise. High cholesterol is more common in people who are overweight or obese, a condition that affects almost half of U.S. adults.
Risk Factors:
Some factors increase a person's risk of having high cholesterol. While some of these cannot be changed, many can be. The most important risk factors for high cholesterol are:
- Being overweight or obese
- Eating a diet high in saturated fat and trans fatty acids (found in processed and fried foods)
- Not getting enough exercise
- Family history of heart disease
- High blood pressure
- Smoking
- Diabetes
Diagnosis:
Most people don't have any symptoms of high cholesterol. A blood test is the only way to check levels of cholesterol in your blood. If your levels are above 200 mg/dL or your HDL is below 40, your doctor may do a fasting lipid profile (a test performed after you abstain from food for 12 hours).
Although cholesterol levels above 200 are generally considered high, what's considered safe for each person depends on whether you are at risk for, or have, heart disease.
Total cholesterol levels:
- Desirable: Below 200 mg/dL
- Borderline high: 200 - 239
- High: Above 240
LDL cholesterol levels:
- Optimal for people with heart disease or who are at high risk: Below 70 mg/dL
- Optimal for people at risk of heart disease: Below 100
- Optimal: 100 - 129
- Borderline high: 130 - 159
- High: 160 - 189
HDL cholesterol levels:
- Poor: Below 40 mg/dL
- Acceptable: 40 - 59
- Optimal: 60 or above
Triglyceride levels:
- Optimal: Below 150 mg/dL
- Borderline high: 150 - 199
- High: Above 200
Adults with normal total and HDL cholesterol levels should have their cholesterol checked every 5 years. If you have high cholesterol, you should be checked every 2 - 6 months. You should have liver function tests as well if you are on cholesterol-lowering medication.
Preventive Care:
Most people can lower cholesterol levels by eating a well balanced diet, getting regular exercise, and losing any excess weight.
Diet
A healthy diet can help you lose any extra pounds. Even losing just 5 or 10 pounds may help lower your cholesterol. To eat a healthy diet:
- Cut down on saturated fats and trans fats. No more than 10% of your daily calories should come from saturated fat, and you should avoid trans fats completely. Based on data from 4 studies, it is estimated that a 2% increase in energy intake from trans fats increases the incidence of heart disease by 23%. Choose unsaturated fats, such as olive oil and canola oil, instead.
- Eat whole grains -- whole wheat bread and pasta, oatmeal, oat bran, and brown rice.
- Eat more fruits and vegetables, which are high in fiber and can help lower cholesterol levels. Studies show that plant based diets are associated with decreases in total cholesterol and LDL cholesterol of up to 15%.
- Limit cholesterol in your diet. The highest amounts are found in egg yolks, whole milk products, and organ meats.
- Eat fatty fish. The American Heart Association recommends that people eat at least 2 servings of fatty fish (such as salmon or herring) each week.
- Eat phytosterols and stanols found in nuts, seeds, vegetable oils, and fortified food products, such as orange juice, yogurt, margarine spreads, and salad dressing. Studies show that eating spreads enriched with phytosterols per day reduced total cholesterol by up to 11% and LDL cholesterol by up to 15%.
The American Heart Association (AHA) has developed dietary guidelines that help lower fat and cholesterol intake and reduce the risk of heart disease. The AHA does not recommend very low fat diets, because new research shows that people benefit from unsaturated ("good") fats, such as those found in olive oil, in their diet.
Many fad diets are popular, but they may not help you lose weight and keep it off -- and in some cases, they may not even be healthy. Any healthy diet will include a variety of foods. If a diet bans an entire food group (such as carbohydrates), it's probably not healthy.
For healthy eating, eat a balanced diet that emphasizes fruit and vegetables:
- Grains: 6 - 8 servings per day (half should be whole grains)
- Vegetables: 3 - 5 servings per day
- Fruits: 4 - 5 servings per day
- Fat free or low fat dairy: 2 - 3 servings per day
- Lean meat, poultry, seafood: 3 - 6 oz. per day (about the size of a deck of cards)
- Fats and oils: 2 - 3 tbsp. per day (use unsaturated fats such as olive oil or canola oil)
- Nuts, seeds, legumes: 3 - 5 servings per week
- Sweets, sugars: 5 or fewer servings per week (the fewer, the better)
In addition, the American Heart Association also recommends eating 2 servings of fatty fish (such as salmon, herring, or lake trout) per week; holding sodium (salt, including salt already added to food) to less than 2,400 mg per day; and limiting alcohol intake to 1 drink a day for women and 2 for men. However, moderate alcohol consumption may help lower triglyceride levels and increase HDL levels.
The TLC (therapeutic lifestyle changes) diet is recommended for people who have high cholesterol. With the TLC diet, less than 7% of your daily total calories should come from saturated fat, and only 25% -35% of your daily calories should come from fat, overall. Sodium should be limited to 2,400 mg per day. If these steps don't lower your cholesterol, your doctor may suggest adding more soluble fiber to your diet, along with plant sterols (found in cholesterol lowering margarines and salad dressings).
The Mediterranean style diet concentrates on whole grains, fresh fruits and vegetables, fish, olive oil, and moderate, daily wine consumption. This diet is not low fat. It is low in saturated fat but high in monounsaturated fat. This diet is naturally rich in fiber, antioxidants, and omega-3 fatty acids. It appears to be heart healthy: In a long term study of 423 patients who had a heart attack, those who followed a Mediterranean style diet had a 50 - 70% lower risk of recurrent heart disease compared with people who received no special dietary counseling.
Losing Weight
Being overweight increases risk of high cholesterol and heart disease. Even a 5 - 10 pound weight loss can lower LDL twice as much as diet alone. Weight loss often results in lower triglyceride levels and increased HDL, too. To maintain a healthy diet, you should aim for a gradual, weekly weight loss of 1/2 to 1 pound.
Getting Exercise
Regular exercise both reduces the risk of death from heart disease and helps lower LDL cholesterol levels, especially when combined with a healthy diet. Just 30 minutes of moderate exercise 5 times per week can help you lose weight or maintain a proper weight, reduce LDL and triglyceride levels, and increase levels of HDL. And studies show that for every 10 minute prolongation of exercise per session is associated with a 1.4 mg/dL increase in HDL cholesterol. Exercise may also lower blood pressure. Talk with your doctor before starting a new exercise plan.
Treatment Approach:
Lowering your cholesterol level reduces your risk of heart disease and stroke. Studies have shown that for every 1% reduction in cholesterol levels there is a 2% reduction in the rate of heart disease. People who already have heart disease or are at higher risk benefit most from lowering their cholesterol.
Changes in lifestyle -- improved diet, more exercise -- are the most effective means of both preventing and, in less severe cases, treating high LDL cholesterol levels. In addition to recommending lifestyle changes, physicians often prescribe specific cholesterol lowering medications.
Medications
If your LDL cholesterol remains high, after changing your diet and exercise habits, your doctor may prescribe medications to lower it. If your cholesterol is very high (more than 200 mg/dL), you may start drug therapy at the same time you improve your diet and exercise habits. Drugs commonly used to treat high cholesterol include:
Statins -- These are usually the drugs of choice as they are easy to take and have few interactions with other drugs. Side effects can include myositis (inflammation of the muscles), joint pain, stomach upset, and liver damage. People who are pregnant or have liver disease should not take statins. Statins include:
- Lovastatin (Mevachor)
- Pravastatin (Pravachol)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
- Atorvastatin (Lipitor)
- Fluvastatin (Lescor)
Niacin (nicotinic acid) -- In prescription form, niacin is sometimes used to lower LDL cholesterol. It can be more effective in raising HDL cholesterol than other medications. Side effects may include redness or flushing of the skin (which can be reduced by taking aspirin 30 minutes before the niacin), stomach upset (which usually subsides in a few weeks), headache, dizziness, blurred vision, and liver damage. Dietary supplements of niacin should not be used instead of prescription niacin, as it can cause side effects. Only take niacin for high cholesterol under a doctor's supervision.
Bile acid sequestrants -- These are used to treat high levels of LDL. Common side effects include bloating, constipation, heartburn, and elevated triglycerides. People who have high levels of triglycerides (fats in the blood) should not take bile acid sequestrants. These drugs include:
- Cholestyramine (Prevalite, Questran)
- Colestipol (Colestid)
- Colesevelam (WelChol)
Cholesterol absorption inhibitors -- The medication ezetimibe (Zetia) limits how much LDL cholesterol can be absorbed in the small intestine. Side effects include headaches, nausea, muscle weakness. Ezetimibe is combined with simvastatin in the drug Vytorin.
Fibric acid derivatives -- These medicines are effective at lowering triglyceride levels, and moderately effective at lowering LDL. They are used to treat high triglycerides and low HDL in people who cannot take niacin. Side effects include myositis, stomach upset, sun sensitivity, gallstones, irregular heartbeat, and liver damage.
- Gemfibrozil (Lopid)
- Fenofibrate (Tricor, Lofibra)
If you do not respond to one class of drugs, you doctor may use a combination of drugs from 2 classes.
Nutrition and Dietary Supplements
In addition to eating a healthy diet -- low in saturated fat, with plenty of whole grains, fruits, and vegetables -- some specific foods and supplements may help lower cholesterol.
Fiber -- Several studies have shown that soluble fiber (found in beans, oat bran, barley, apples, psyllium, flaxseed, and glucomannan) lowers LDL cholesterol and triglycerides. Fiber can also help you lose weight because it makes you feel full faster. Your doctor will encourage you to get more fiber in your diet. You may also take a fiber supplement. Men should get 30 - 38 g of fiber per day. Women should get 21 - 25 g.
Beta-glucan -- is a type of soluble fiber found in oat bran and other plants. It slightly reduces LDL cholesterol, which is why oat bran is touted as a cholesterol reducing food.
Soy -- Many studies have shown that eating soy protein (tofu, tempeh, miso), rather than animal meat, helps lower blood cholesterol levels, especially when you eat a diet low in saturated fat. One study found that as little as 20 g of soy protein per day is effective in reducing total cholesterol, and that 40 - 50 g shows faster effects (in 3 weeks instead of 6). Another study showed that soy can help reduce triglyceride levels. The AHA recommends that people with elevated total and LDL cholesterol add soy to their daily diet, and that soy is safe when consumed as part of your regular diet. Before you take soy supplements, however, talk to your doctor. Soy isoflavones may have estrogen like effects on the body, which might lead to an increased risk of breast and other cancers.
Omega-3 fatty acids, found in fish oil -- There is good evidence that omega-3 fatty acids (namely EPA and DHA) found in fish oil can help prevent heart disease, lower blood pressure, and reduce the level of triglycerides (fats) in the blood. However, fish oil can also raise levels of both HDL and LDL slightly. When taken as a supplement, it can also act as a blood thinner, so people who already take blood thinning medication should only take a fish oil supplement under their doctor's supervision. One preliminary study found that people with high cholesterol who took fish oil and red yeast rice lowered cholesterol levels about as much as people who took simvastatin (Zocor). The AHA recommends that people eat at least 2 servings of fatty fish (such as salmon) per week, and that fish is safe when consumed as part of your regular diet. If you have high cholesterol, talk to your doctor before taking a fish oil supplement.
Alpha-linolenic acid (ALA) -- ALA is another omega-3 fatty acid that may protect the heart against heart disease. However, studies have shown conflicting results about its ability to lower LDL, and it does not appear to lower triglyceride levels.
Vitamin C (100 - 200 mg per day) -- Several studies suggest that eating a diet high in vitamin C can help lower cholesterol levels, but there is no evidence that taking extra vitamin C through a supplement will help.
Beta-sitosterol (800 mg to 6 g per day in divided doses about 30 minutes before meals) -- Beta-sitosterol is a plant sterol, a compound that can stop cholesterol from being absorbed by the intestines. Several well designed scientific studies have shown that beta-sitosterol does lower "bad" LDL cholesterol levels in the body. Beta-sitosterol may lower the amount of vitamin E and beta-carotene absorbed by the body, so you may want to ask your doctor if you need to take extra vitamin E or carotene.
Policosanol (5 - 10 mg 2 times per day) -- Policosanol is a mix of waxy alcohols usually derived from sugar cane and yams. Several studies have indicated it may lower "bad" LDL cholesterol and maybe even raise "good" HDL cholesterol. One study found that policosanol was equivalent to fluvastatin (Lescol) and simvastatin (Zocor) in lowering cholesterol levels. It may also inhibit blood clots from forming. However, almost all the studies have been conducted in Cuba or Latin America using a proprietary form of policosanol, so it is hard to evaluate the evidence. Policosanol may increase the risk of bleeding, and should not be taken by people who also take blood thinning medication.
Coenzyme Q10 (CoQ10) -- Researchers believe that CoQ10 may boost levels of antioxidants. One study found that people who received daily CoQ10 supplements within 3 days of a heart attack were much less likely to experience subsequent heart attacks and chest pain. They were also less likely to die of the condition than those who did not receive the supplements. Still, more research is needed to say whether CoQ10 has any role in preventing or treating atherosclerosis. People who take statins may have low levels of CoQ10. If you take statins, you may want to ask your doctor about taking a CoQ10 supplement. CoQ10 can interfere with anticoagulant / antiplatelet drugs.
Polyphenols -- Polyphenols are chemical substances found in plants that have antioxidant properties. Test tube, animal, and some population based studies suggest that the flavonoids quercetin, resveratrol, and catechins (all found in high concentration in red wine, and in grape juice) may help reduce the risk of atherosclerosis by protecting against the damage caused by LDL cholesterol. However, more studies in humans are needed to confirm these findings.
Resveratrol -- A study in mice found that resveratrol protected against age related damage to vital organs, including the heart and liver, even when the mice ate a high fat diet. Although this study is promising, more studies are needed to see whether resveratrol would have the same effect in humans. No one is sure how much resveratrol is needed to see a benefit. In addition, resveratrol may have estrogen-like effects, and researchers don't yet know whether it would pose the same risks as estrogen supplements.
Herbs
The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.
Hawthorn(Crataegus monogyna, 900 - 1,800 mg per day in 2 - 3 divided doses) -- Hawthorn contains the polyphenols rutin and quercetin, and was used traditionally to treat cardiovascular diseases. Animal and laboratory studies show that hawthorn has antioxidant properties that may help lower high cholesterol and high blood pressure. Talk to your doctor before taking hawthorn, as it can interact with other drugs taken for heart disease and high blood pressure.
Garlic(Allium sativum, 900 mg per day of garlic powder, standardized to 0.6% allicin) -- Previous clinical trials have shown that fresh garlic and garlic supplements may lower cholesterol levels, prevent blood clots, and destroy plaque. However, more recent studies show no effect on cholesterol. Garlic can increase the risk of bleeding and should not be taken if you are also taking blood thinning medication.
Olive leaf extract(Olea europaea, 1000 mg per day) -- One study found that people with mild high blood pressure (hypertension) lowered cholesterol and blood pressure by taking olive leaf extract, compared to those who took placebo. More research is needed to confirm this study's findings.
Red yeastor red yeast rice(Monascus purpureus, 1,200 mg 2 times per day with meals) -- Several studies indicate that a proprietary form of red yeast (Cholestin) can lower cholesterol levels, and that the herb acts like prescription statin drugs (See "Medications" section). For that reason, you should not take red yeast without a doctor's supervision, especially if you already take statins to lower cholesterol.
Psyllium(Plantago psyllium, 10 - 30 g per day in divided doses taken 30 - 60 minutes after meals) -- Taking psyllium, a type of fiber, helps lower cholesterol levels, as well as blood sugar levels. If you take medicine for diabetes, talk to your doctor before taking psyllium.
Guggul (Commiphora mukul, 3 - 6 g per day) -- Guggul is used in Ayurvedic medicine to treat high cholesterol levels. Scientific studies have found mixed results -- guggul appears to work in Indian populations, but not in people who eat Western style, high fat diets. Guggul may have estrogen like properties and caution should be taken with people with a history of estrogen sensitive cancers or on hormonal medications; speak with your doctor.
Other Considerations:
Pregnancy
Cholesterol lowering medications should be avoided during pregnancy.
Prognosis and Complications
Several complications may occur if high cholesterol is left untreated. These include:
- Heart disease -- high cholesterol levels more than double the risk of heart attack. Lowering cholesterol by 1% reduces the risk of coronary artery disease by 2%.
- Stroke -- low levels of "good" HDL cholesterol have been associated with an increased risk of stroke.
- Insulin resistance -- 88% of people with low HDL and 84% with high triglycerides also have insulin resistance (which leads to high blood sugar levels). Many people with insulin resistance go on to develop diabetes.
Maintaining a proper weight, eating a diet low in saturated fat, and exercising can lower cholesterol levels and improve long term prognosis.
Alternative Names:
Cholesterol - high; High cholesterol
- Reviewed last on: 12/11/2010
- Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
Supporting Research
Ackermann RT, Mulrow CD, Ramirez G, Gardner CD, Morbidoni L, Lawrence VA. Garlic shows promise for improving some cardiovascular risk factors. Arch Intern Med. 2001;161:813-824.Anderson JW, Davidson MH, Blonde L, et al. Long-term cholesterol-lowering effects on Psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia. Am J Clin Nutr. 2000a;71:1433-1438.
Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr. 2000b;71:472-479.
Becker DJ, Gordon RY, Morris PB, Yorko J, Gordon YJ, Li M, Iqbal N. Simvastatin vs therapeutic lifestyle changes and supplements: randomized primary prevention trial. Mayo Clin Proc. 2008 Jul;83(7):758-64.
Birketvedt GS, Aaseth J, Florholmen JR, Ryttig K. Long-term effect of fibre supplement and reduced energy intake on body weight and blood lipids in overweight subjects. Acta Medica. 2000;43(4):129-132.
Bravo E, Napolitano M, Lopez-Soldado I, Valeri M, Botham KM, Stefanutti C. Hypercholesterolaemia alters the responses of the plasma lipid profile and inflammatory markers to supplementation of the diet with n-3 polyunsaturated fatty acids from fish oil. Eur J Clin Invest. 2006 Nov;36(11):788-95
Read more: http://www.umm.edu/altmed/articles/hypercholesterolemia-000084.htm#ixzz1vthWLovi
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