First, let's attempt to understand the important role
cholesterol plays in the body. Cholesterol is a fat that
is manufactured in the liver and plays a vital role in the
health of every cell in the body. It is necessary for the
brain and nervous system to function properly and for
the manufacture of sex hormones. However, when
cholesterol levels go over 5.4, it can become
dangerous and can lead to heart problems. There is a
lot of confusion about cholesterol and fats. Many
people believe that margarine is good for them and
that butter is bad. This is far from the truth! Chemicals
that harden margarine can also harden the arteries. A
little real butter is better for you. Butter contains
Vitamin A, which is great for the eyes. It also contains
some protein. Butter will melt easily in the sunshine,
while margarine will not. Stay away from margarine
and avoid hydrogenated oils and polyunsaturated oils
as well. Read labels! Avoid foods cooked in fat or lard.
All of these are bad fats and clog up the arteries. Add
some good fats to your diet such as raw organic cold
pressed flax seed oil, borage oil, pumpkin seed oil,
sunflower seed oil, safflower oil, evening primrose oil,
black currant seed oil and olive oil also foods like
Avocado, cream, crayfish, oysters. Believe it or not
good fats help to lower cholesterol. They increase
immunity and help protect the body from certain types
of cancer. They keep the hair shiny, the nails healthy
and the skin moist. Good oils and good cholesterol
also are needed for the nervous system and the
hormomes. You can have your cholesterol and lipids
tested through a blood test. If your cholesterol and
your triglicerides are high, often the good oil (HDL) is
low, this indicates a "good oil" deficiency. If this is true
for your blood profile then Good fats should be an
important part of your diet. Avocados are a good fat.
Eat nuts and seeds sparingly unless they have been
soaked. Soaking them for 12 hours takes out half the
fat and helps them to digest much easier. Cook only
with cold pressed olive oil, grape seed oil or coconut
oil. These oils can be heated safely. Do not cook with
any other oil. Heating oils to high temperatures can
change their chemical structure and cause them to
become harmful to the body. To lower cholesterol, eat
foods high in fiber such as whole grains including
oats, barley, millet and quinoa, beans, steamed
vegetables and salads. Oat bran and rice bran are
particularly good in helping to lower cholesterol levels.
Use these high fiber brans in muffins, whole grain
breads or whole grain pancakes. Use apple pectin or
citrus pectin (we can order this for you - known as
biopectin) that binds to plaque and fat and pulls it out
of the body. Stir a tablespoon up in apple juice and
water and drink each day. Eat lots of garlic or take
garlic capsules.  Eat beets or take beet tablets. Beets
help to cleanse the liver and gallbladder. Eat raw
grated beets, steamed beets (I love mine baked like
potato - yum) and drink raw vegetable juices that
contain beet such as carrot, celery, beet juice. Juice
Plus is the easiest way to bring your daily intake of fruit
& veg up to 9 serves per day.  Carrots and carrot juice
also flush fat from the bile in the liver and help control
cholesterol. Add some bitter greens to your diet as
well such as parsley, cilantro, arugala, kale, chard,
collards and mustard greens. Bitter greens are great
cleansers for the liver. Ginger and Cayenne help to
improve circulation and also help lower cholesterol.
Ginger is great in raw vegetable juice or have it as a
herb tea with a little honey. Cayenne is good sprinkled
on soups, steamed vegetables and salads. Use
lemon juice and olive oil or raw apple cider vinegar
and olive oil as salad dressings.  Another nice salad
dressing is half balsamic vinegar & half first press
olive oil. These combinations help to cleanse the liver
and lower cholesterol. Drink lemon juice in water with
a bit of cayenne sprinkled in. Drink raw apple cider
vinegar 20 mL and a little honey. Raw apple cider
vinegar aides digestion, assists weight reduction and
lowers cholesterol.

LECITHIN is a powerful emulsifier that helps to break
up and dissolve plaque in the arteries and lower
cholesterol. It helps to keep the arteries from
hardening, and prevent heart disease. Lecithin helps
repair damage to the liver and keeps it working well. In
addition to lowering cholesterol, lecithin is essential to
the functioning of the brain and nervous system.
Lecithin is a natural constituent of every cell
membrane which helps to emulsify cholesterol. 
Lecithin unites with iron, iodine and calcium to give
vigor to the brain, nerves and digestive organs. 
Lecithin granules have a delicious nutty flavor and can
be stirred up in juices, sprinkled over cereals and
salads and added to soups. (Be sure to add the
lecithin to all foods after cooking to preserve the
nutritional value.) Lecithin can also be taken in
capsule form.
Foods High in Lecithin are egg yolk, soy beans, corn
Vitamin D is a fat soluble vitamin.  Ultra-violet rays
activate cholesterol activity.  Helps to stimulate enzyme
action, stabilizes nerve, spleen, hearing, blood clotting
factors, and utilization of calcium and phosphorus. 
Vitamin D is found in sunshine (recommended 20
minutes of early morning or late afternoon sun daily.) 
Foods High in Vitamin D are salmon, sardines,
herring, egg yolk, organ meats, whole milk.
Vitamin E protect the arterial walls from the effects of
pollution, cigarette smoke and other forms of arterial
stress
Foods with a good amount of cholesterol
Butter, cream, cream cheese, camembert cheese,
cheddar cheese, Colby cheese, edam cheese,
mozzarella, swiss cheese, crab meat, crayfish,
oysters, beef, brains, lamb, liver, pork, turkey, veal,
caviar, kidneys.  Personally I don't eat organs.
AFALFA has great cholesterol lowering benefits. For
anyone with high cholesterol or constipation, alfalfa
works wonders. Alfalfa is loaded with fiber that works
like brooms sweeping the arteries and colon clean. As
it cleanses, it pulls plaque, cholesterol and mucus out
of the body. Alfalfa is high in chlorophyll and minerals
so it is a wonderful blood builder. It helps to relieve
gout, arthritis, hemorrhoids, diverticulitis, ulcers, bad
breath, body odors and bleeding gums. Alfalfa also
balances blood sugar so it is beneficial for both the
diabetic and the hypoglycemic. It even helps those
who are dieting not to crave sweets or be hungry.
For those people who do not like vegetables or do not
eat enough salads, Juice Plus is a must

Juice Plus+ and oil Metabolism

Abbreviations and Acronyms
BART _ brachial artery reactivity test
FMV _ flow-mediated vasodilation
JP _ Juice Plus
LDL _ low-density lipoprotein
NAD(P)H _ nicotinamide adenine dinucleotide
phosphate (reduced)
NO _ nitric oxide
V _ Vineyard

Table 1. Assayed Vitamin and Nitrate Content of Juice
Plus
and Vineyard
Juice Plus (4 capsules) Vineyard (4 capsules)
Beta-carotene (i.u.) 9,275 7,188
Vitamin C (mg) 20.4 51
Vitamin E (mg) 24.7 30.4
Thiamin HCL (mg) 0.75 0.17
Riboflavin (mg) trace 0.03
Niacin (mg) 0.37 1.3
Pyridoxine (mg) 0.07 0.35
Nitrate (mg) 5.7 0.76
JACC Vol. 41, No. 10, 2003 Plotnick et al. 1745
May 21, 2003:1744-9 Phytonutrients and Vascular
Function
Follow-up studies. Subjects were studied at three
weeks (taking the morning dose) and at four weeks
(omitting the morning dose). All fasting blood studies
performed at baseline were repeated at four weeks.
Brachial artery studies were performed similarly to
those performed before randomization.
Statistical analysis. Group values are expressed as
mean _SD. Two-tailed paired t test was used to
compare changes in individual subjects, and two-
tailed non-paired t tests were used to compare values
between groups. A p value _0.05 was considered
significant.
RESULTS
Preprandial diameter at baseline (before
randomization) was 2.7 _ 0.2, 3.1 _ 0.5 mm, and 3.1 _
0.6 mm, and blood pressure was 113 _ 6/71 _ 7 mm
Hg, 116 _ 6/73 _ 6 mm Hg, and 116 _ 9/73 _ 7 mm Hg
in subjects randomized to placebo, JP, or combined
JP-V, respectively. These values did not change
significantly over the four weeks of the study.
Preprandial and postprandial FMV determinations at
baseline (before randomization) and at three and four
weeks in the three groups are shown in Table 2. The
postprandial percent of FMV compared with the
preprandial value (mean _ SD) decreased _40.9 _
17.9% in the placebo group, _45.1 _ 19.7% in the JP
group, and _47.5 _ 23.4% in the combined JP-V
group. Differences among the groups at baseline
were not statistically significant. There was a trend
for the pre-meal FMV to decrease over time, but this
did not reach statistical significance. Figure 1 shows
the percent of decrease in vasoactivity from
preprandial to postprandial for each of the three
groups.
In the placebo group, the percent of decrease in
vasoactivity with the high-fat meal remained high at
three and four weeks (_37.1 _ 19.7% and _37.6 _
23.4%, respectively).
In the JP and JP-V group at both three and four weeks,
the percent of decrease in postprandial vasodilation
was significantly less than the decrease found before
supplementation. The percent of decrease in the JP
group after the high-fat meal was _22.3 _ 12.6% at
three weeks and _16.6 _ 10.3% at four weeks (p _
0.05 compared with the baseline values). The percent
of decrease in the JP-V group after the high-fat meal
was _13.7 _ 10.2% at three weeks (p _ 0.05) and only
_1.7 _ 9.7% at four weeks (p _ 0.02 compared with
baseline values). Thus, JP and JP-V at three and four
weeks significantly decreased the detrimental effect
of the high-fat meal on endothelial function. 
Lipoprotein, homocysteine, and serum nitrate/nitrite
determinations at baseline and at four weeks are
shown in Table 3. Total cholesterol and LDL
cholesterol decreased significantly (p _ 0.05) in the
group that received JP over the four-week study period,
but they did not change in the groups taking JP-V or
placebo. There were no changes in other lipoproteins
or homocysteine in any group. There was
a trend for serum nitrate/nitrite levels to increase in
each of the active-treatment groups. When these two
groups were combined, serum nitrate/nitrite levels
rose from 78 _ 39 _m/l to 114 _ 62 _m/l (p _ 0.02).
There was no significant correlation between the
increase in these levels and the change in
vasodilation.
DISCUSSION
This study found that the daily use for four weeks of a
fruit/vegetable juice concentrate, rich in antioxidant
phytochemicals, blunted the detrimental impact of a
single high-fat meal on the endothelial function of
healthy subjects; similar results were seen with a
more complex supple- Table 2. Percent Change in
Diameter Before and After High-Fat Meal
Baseline 3 Weeks 4 Weeks
Fasting 3 h Postprandial Fasting 3 h Postprandial
Fasting 3 h Postprandial
Placebo (n _ 10) 20.2 _ 4.2 11.7 _ 5.4  15.7 _ 5.2 9.9 _
4.9  15.3 _ 5.3 10.2 _ 4.7
Juice Plus (n _ 14) 13.2 _ 4.2 7.63 _ 3.7  9.4 _ 4.6 6.4
_ 4.8   9.7 _ 5.7 7.4 _ 4.0 
Juice Plus and Vineyard
(n _ 12)
15.8 _ 6.7 8.0 _ 4.5  15.8 _ 7.1 12.4 _ 4.8   12.8 _ 6.2
11.2 _ 4.7 
 p _ 0.05 versus fasting;   not significant versus fasting
level.
Figure 1. Postprandial decreases on brachial artery
vasoactivity at 0, 21,
and 28 days after a single high-fat meal in patients
randomized to placebo,
JP, or JP-V supplementation.  p _ 0.05,   p _ 0.02
compared with baseline
(day 0). Solid bars _ day 0; shaded bars _ day 21;
open bars _ day 28.
JP _ Juice Plus; V _ Vineyard.
1746 Plotnick et al. JACC Vol. 41, No. 10, 2003
Phytonutrients and Vascular Function May 21,
2003:1744-9
mentation regimen incorporating various nutrients and
herbal extracts in addition to the fruit/vegetable  juice
concentrate. This extends our previous observation
that pretreatment with a single dose of antioxidant
vitamins is effective when taken immediately before a
high-fat meal (7).  The present design enables us to
conclude that prolonged antioxidant phytochemical
supplementation can exert a long-term effect such that
endothelial function is protected from the adverse
impact of a fatty meal even if antioxidants are not
administered with that meal. It is interesting to note
that, whereas the supplementation provided in this
study provided only modest doses of any one
antioxidant, the cumulative effect of these antioxidants
appeared at least comparable to the protection
afforded by large doses of two supplemental
antioxidants in our previous study.
Although many previous studies have demonstrated
thatsupplemental intakes of vitamins C and E can
benefit impaired endothelium-dependent vasodilation
(6-11), relatively few reports are available evaluating
the potential of food phytochemicals in this regard. We
previously have reported that incorporation of a dark
green salad into an olive oil-rich meal offsets the
adverse impact of the olive oil on endothelial function
(26). Another report indicates that long-term ingestion
of a 40% fat diet impairs brachial artery
FMV but that daily ingestion of red wine-known to be
rich in antioxidant polyphenols-prevents this effect
(33).
In patients with coronary disease, ingestion of purple
grape juice for 14 days likewise has a favorable
impact on FMV (34). In these studies with wine and
grape juice, endothelium function was assessed in
the morning under fasting conditions, without
immediate pre-administration of the protective food;
thus, their findings are concordant with ours. 
Endothelial dysfunction is often associated with, and
at least in part mediated by, increased endothelial
superoxide generation (11,35). The demonstrable
utility of antioxidant
vitamins for blunting the adverse impact of fatty meals
on endothelial function suggests that enhanced
endothelial superoxide production may mediate the
concurrent impairment of FMV. The fact that
superoxide production by stimulated leukocytes
increases sharply after such meals (30,31) is
seemingly consistent with this view, inasmuch as the
membrane-bound NAD(P)H oxidase system appears
to
be primarily responsible for superoxide generation in
both leukocytes and endothelium (24,35-39).
Furthermore, exposure of endothelial cells to free fatty
acids has been shown to stimulate superoxide
production (40,41). Oxidation of LDL particles renders
them more detrimental to endothelial
function (42). Thus, there is reason to suspect that an
ample dietary intake of antioxidants may promote
endothelial health and, more specifically, limit the
adverse influence of fatty meals on endothelial
function. The results of this study appear consistent
with this view.
Owing to the fact that NO has an extremely short half-
life, its production is most conveniently estimated by
measuring serum or urinary levels of its chief
metabolic products, namely nitrate and nitrite. It is
interesting to note that serum levels of nitrate-plus-
nitrite increased significantly in subjects receiving the
active supplements in this study. This tells us nothing
about the impact of such supplementation on
endothelial superoxide production, but it suggests that
endothelial NO synthase activity may be enhanced in
healthy subjects by an increased intake of
phytochemical antioxidants. Because green leafy
vegetables contain nitrates, it's conceivable that the JP
supplement may have contributed modestly to dietary
nitrate intake, but this is unlikely to account for the
magnitude of the observed increase in serum levels of
NO metabolites. Because protein intake was not
specifically controlled for several days before
measurement, serum nitrite/nitrate levels have limited
reliability.  Nitric oxide is known to be the primary
mediator of
flow-induced brachial vasodilation (43); therefore, the
favorable impact of phytochemical supplementation
on endothelial function in this study seems likely to
reflect preservation of NO bioactivity.
Although antioxidant protection can be provided by
high supplemental intakes of specific antioxidant
vitamins- vitamins C and E have received the most
attention in this regard-there may be limitations to
the efficacy of this approach. In prospective cohort
studies, high intakes of vitamin E have been linked to
a notable reduction in coronary risk (44-46).
Nonetheless, except for the small CHAOS trial (47),
randomized primary and secondary prevention trials
evaluating supplemental vitamin E have
demonstrated a lack of beneficial effect of this
antioxidant on cardiovascular events (48-50), in
contrast to the notably
Table 3. Lipoprotein, Homocysteine, and Combined
Nitrite/Nitrite Levels in 38 Normal
Subjects Before and After 28 Days of Placebo or
Supplemental Phytonutrient Supplementation
Placebo
n _ 10
Juice Plus
n _ 14
Juice Plus and Vineyard
n _ 12
Baseline 4 Weeks Baseline 4 Weeks Baseline 4
Weeks
Total cholesterol (mg/dl) 195 _ 36 191 _ 31 184 _ 30
172 _ 22  185 _ 31 182 _ 24
LDL cholesterol (mg/dl) 123 _ 36 123 _ 25 110 _ 25
100 _ 26  113 _ 27 113 _ 22
HDL cholesterol (mg/dl) 56 _ 13 53 _ 14 53 _ 16 51 _
14 54 _ 16 52 _ 13
Triglycerides (mg/dl) 77 _ 32 77 _ 36 104 _ 45 101 _
73 85 _ 29 84 _ 34
Homocysteine (_m/l) 6.2 _ 1.1 5.9 _ 0.7 6.8 _ 0.9 6.8 _
1.3 8.1 _ 2.1 7.8 _ 2.3
NO (_m/l) 63 _ 39 68 _ 31 77 _ 43 110 _ 64   84 _ 45
115 _ 59 
 p _ 0.05 versus baseline;   p _ 0.1 versus baseline. All
values are mean _ SD.
HDL _ high-density lipoprotein; LDL _ low-density
lipoprotein; NO _ nitrate/nitrite serum level.
JACC Vol. 41, No. 10, 2003 Plotnick et al. 1747
May 21, 2003:1744-9 Phytonutrients and Vascular
Function
favorable impact of statin therapy over the same time
span. Conceivably, this reflects the fact that vitamin E,
as a lipid-soluble antioxidant, can only indirectly
influence the oxidation of water-soluble targets such
as tetrahydrobiopterin and dimethylarginine
dimethylaminohydrolase. Vitamin C, on the other
hand, is a versatile water-soluble antioxidant, and a
sharp increase in plasma vitamin C levels has often
been shown to improve endothelium-dependent
vasodilation. Nonetheless, the membrane transporter
primarily
responsible for carrying ascorbic acid into endothelial
cells appears to be saturated by plasma ascorbate
concentrations-50 to 100 micromolar (51)-that can
be achieved and maintained with a daily intake of
about 200 mg (52), this suggests that the protection
achievable with vitamin C, while worthwhile, may be
limited in scope. These considerations suggest that
ingestion of a wide range of both water-soluble and
lipid-soluble antioxidants, including but not limited to
vitamins C and E, may represent the most
effective strategy for achieving comprehensive
antioxidant protection of vascular endothelium, and a
high intake of fruits and vegetables is a very practical
means of attaining this goal. The clear evidence from
prospective epidemiological studies linking high fruit
and vegetable intake- independent of other dietary
factors-with reduced coronary risk may in large
measure reflect a beneficial impact of phytochemical
antioxidants on endothelial health.
Despite strong clues from epidemiology, the thesis
that a high intake of fruits and vegetables diminishes
coronary risk still requires validation in prospective
controlled trials. The encouraging results of this study
suggest that it might be feasible to use encapsulated
fruit and vegetable concentrates, analogous to the JP
product evaluated here, in such a trial.  The merit of
this approach is that the study could be conducted in a
double-blind fashion without influencing the intake of
other foods. Of course, further small studies
validating the utility of products such as JP would be
required before it would be prudent to use those
products in massive long-term prospective trials.
The Vineyard product incorporated in one arm of this
study contains a diverse assortment of 
phytochemicals, herbs, and nutrients that potentially
could influence endothelial function, including 1 g daily
of arginine hydrochloride.
The mechanism by which the administered
supplements abrogate the adverse impact of fatty
meals on
endothelial function has not been determined. We
speculate that the active supplements lessened the
impact of oxidative stress in vascular endothelium and
thereby counteracted the ability of chylomicron
remnants and/or free fatty acids to suppress NO
synthase activity and NO bioactivity.
CONCLUSIONS
In conclusion, a high-fat meal causes a temporary
decrease in flow-mediated brachial artery
vasodilatation, likely owing to an induced increase in
endothelial oxidative stress. In healthy volunteers, four
weeks of daily supplementation with a fruit-and-
vegetable juice concentrate, with or without an
adjunctive complex phytochemical supplement, blunts
the detrimental effect of a high-fat meal on
flowmediated brachial artery vasodilation-even when
the supplement is not administered with the meal-
and increases the combined serum nitrite/nitrate
concentration. However, whether preservation of NO
bioactivity mediates the observed
benefit is still speculative.
Acknowledgments
We thank Dr. Tom Balon for the nitric oxide assay, and
Mark McCarty and Kristee Emens-Hesslink for their
editorial
input.
Reprint requests and correspondence: Dr. Gary D.
Plotnick,
Cardiology Division, University of Maryland Medical
Center, 22
South Greene Street, Baltimore, Maryland 21201. E-
mail:
gplotnic@medicine.umaryland.edu.
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JACC Vol. 41, No. 10, 2003 Plotnick et al. 1749
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