Our Science Behind Heart Health

Our Claims

  1. Diets low in saturated fat and cholesterol that include at least 0.65g per serving of phytosterols, eaten twice a day with meals for a total daily intake of at least 1.3g may reduce the risk of heart disease by lowering total and LDL cholesterol. Zizi Heart Health Reset supplies 2.0g of phytosterols per day. 1
  2. Diets low in saturated fat and cholesterol that include 7 grams of soluble fiber per day from psyllium husks may reduce the risk of heart disease by lowering total and LDL cholesterol. Zizi Heart Health Reset supplies 4.8g of psyllium husk fiber per day. 2
  3. Studies have shown that plant sterols can lower LDL cholesterol by up to 12%, and psyllium fiber can lower LDL cholesterol by up to 24%. 3
  4. Diet changes alone can lower LDL as much as 30%. 4
  5. 10-30 gm fiber can lead to a 10% reduction in LDL cholesterol. 5 vs 6-15 grams of psyllium fiber per day can lower LDL cholesterol by 6–24% and total cholesterol 2–20%. 6

Key Facts

  1. 1.5-3 grams of plant sterols and stanols per day can lower LDL cholesterol by 7.5-12%. 7
  2. 6-15 grams of psyllium fiber per day can lower LDL cholesterol by 6–24% and total cholesterol 2–20%. 8
  3. Diet change alone can lead to an up to 30% improvement in your LDL. 9
  4. There is no significant difference between the LDL cholesterol−lowering action of plant sterols/stanols supplements compared with foods enriched with plant sterols/stanols. 10
  5. Natural Plant sterol intake can range from 250 to 500 mg/day from food sources, where supplements can deliver up to 3000 mg/day. 11
  6. 1.5-3 grams of plant sterols and stanols per day can lower your LDL by 7.5-12%. 12
  7. Consumption of 2 to 3 g/day of plant sterols or stanols by individuals on statin therapy may lower both total cholesterol and LDL cholesterol by an additional 0.30 mmol/L (11.6 mg/dL), compared to statin alone. 13
  8. Functional Fiber supplements have the ability to reduce LDL by up to 14% more than naturally occurring dietary fiber. 14
  9. High fiber intake can reduce the risk of CHD and stroke by 24-38% compared to low fiber intake. 15
  10. Fiber derived from grain rather than from fruit or other sources, is more strongly associated with improved cardiovascular disease. 16
  11. When recommending a fiber supplement, only a soluble nonfermenting, gel-forming fiber has been clinically proven to provide all of the health benefits typically associated with a fiber supplement. 17
  12. 6-15 grams of psyllium fiber per day can lower LDL cholesterol by 6–24% and total cholesterol 2–20%. 18

Summary

Cardiovascular disease (CVD) is the leading cause of death in the United States and worldwide. Roughly 1 in every 4 deaths are from CVD. CVD includes both strokes and heart attacks.

A dominant cause of CVD is atherosclerosis, also called Atherosclerotic Cardiovascular disease (ASCVD). Atherosclerosis is the narrowing of blood vessels from a collection of plaque formed from a buildup of cholesterol. When a blockage from this plaque occurs, it can result in either a stroke or a heart attack. One of the modifiable risk factors for heart disease is having elevated levels of total cholesterol and LDL (Low-Density Lipoprotein) cholesterol. Lowering your total cholesterol and LDL cholesterol levels helps prevent ASCVD, and also helps prevent death from CVD.

Diets high in saturated fats and trans fats can increase your total cholesterol and LDL cholesterol levels. Many Americans with high cholesterol have an unbalanced lifestyle with a diet low in plant based foods, like fruits, vegetables and whole grains, and an excess of full fat dairy, meat and processed sweets. On average, only 10% of American adults eat enough fruit and vegetables, and only 5% meet the recommended intake of fiber, 21-39g per day. 

A plant based diet combined with reducing saturated fats and increasing exercise can result in lower total cholesterol and LDL cholesterol levels. Increasing vegetables, fruits and whole grains increases daily fiber and phytosterol intake. These two plant derivatives contribute to lower LDL and Total Cholesterol (TC) levels. 

Increasing fiber and phytosterols in your diet can lower your risk of CVD, by reducing a variety of cardiovascular risk factors, including by lowering total cholesterol and LDL cholesterol. 

Fiber and phytosterols both occur naturally in plants and are available as plant derived supplements that can both lower total cholesterol and LDL cholesterol levels and lower the risk of CVD.  These two supplements act as cholesterol binders (fiber) and blockers (sterols) in digestion, allowing cholesterol to be cleared through your digestive system. Both Scientific research and the Food and Drug Administration (FDA) support 2 specific fibers: β-glucan and psyllium husk and 5 specific plant sterol and stanol esters, β-Sitosterol, Sitostanol, Campesterol, Campestanol, and Stigmasterol. Research has found that 6-15 grams of psyllium husk per day can lower LDL by 6-24% and lower TC by 2-20%. Research has also shown that 1.5-3 grams of plant sterols and stanols esters per day can lower LDL by 7.5-12%.

Many other supplements are affiliated with heart health but do not have FDA health claims. To be approved by the FDA as an authorized health claim, there must be significant scientific agreement (SSA) among qualified experts that the claim is supported by the totality of publicly available scientific evidence for a substance/disease relationship. Taking the correct derivative of both fiber and plant sterols in sufficient doses can be challenging to navigate to the consumer given unregulated marketing claims in the marketplace. 

Here at Zizi we are making heart health simple by using the most up to date science and published research to provide consumers with supplements that are effective at lowering total and LDL cholesterol.  Zizi offers specific evidence based supplements that target cholesterol.  

Zizi provides 5 gm of Psyllium and 2 gm of Plant Sterols. Zizi strives to meet both FDA guidelines by including 1.3 to 5 gm psyllium provided at incremental monthly doses composed of >95% psyllium husk; and 1.8 gm Plant Sterols, composed of >70% of beta-sitosterol, campesterol, and stigmasterol estered with stearates. The doses provided can reduce the risk of heart disease and lower LDL cholesterol when accompanied by a diet low in saturated fat and cholesterol, and high in fruits, vegetables and whole grains. 

The “Big” Problem – Cholesterol

Cardiovascular disease is a major killer

Cardiovascular Diseases (CVD) include a group of disorders of the heart and blood vessels. A dominant cause of CVD is atherosclerosis, also called Atherosclerotic Cardiovascular disease (ASCVD). Atherosclerosis is the thickening or narrowing of blood vessels from a collection of plaque forms from a buildup of cholesterol. When a severe build up or blockage from the plaque occurs, depending on where in the body, it can result in either a stroke or a heart attack. 18 Heart attacks and strokes are the most prevalent cause of death in the U.S and Worldwide. Risk factors like high cholesterol increase the chances of having a heart attack or a stroke. 19 A heart attack can occur at any age 20, and prevention should begin early.

  • More than 67 percent of all deaths are caused by one or more of these five chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes. 21
  • ~17.9 million or 32 percent of all global deaths each year are due to cardiovascular disease,  85 percent of those are due to heart attack and strokes specifically. 22
  • In the U.S: 23
  1. More than 80 percent of cardiovascular deaths are due to heart attacks and strokes.
  2. Every 36-40 seconds someone has a heart attack or dies from heart disease.
  3. ~30% or 805,000 people per year have a heart attack.
  4. ~25% or 659,000 people die from heart disease each year. About 20% of those deaths happen in adults less than 65 years old.‍

Does high cholesterol increase your risk of having a heart attack?

High cholesterol levels are a major risk factor for heart attacks and strokes or CVD. As your blood cholesterol rises, so does your risk of CHD. 24 Modifiable risk factors for CVD include: elevated blood pressure, elevated blood glucose, elevated blood lipids (including total cholesterol and LDL cholesterol), being overweight and obesity. 25 It is important to detect CVD as early as possible so that management and interventions can begin. Prevention includes looking at risk factors and making a change in those that are modifiable.

  • 6.7% or 18.2 million U.S. adults have CHD. 26
  • Cholesterol is one of the primary causal risk factors for the development of atherosclerosis and CVD. 27
  • High Cholesterol is 1 of 7 (“Simple 7”) modifiable factors the AHA focuses on for CHD prevention. 28
  • CHD rates are significantly higher when young adults have LDL ≥100 (versus <100) mg/dL, independently of later adult exposures. 29
  • High CHD rates occur among people with high total cholesterol levels of 240 mg/dL or above and LDL-cholesterol levels of 160 mg/dL or above; And Borderline high total cholesterol levels range from 200 to 239 mg/dL and 130 to 159 mg/dL of LDL-cholesterol. 30

How Common is High Cholesterol?

High cholesterol is a common problem for Americans. Nearly 94 million U.S. adults age 20 or older have total cholesterol levels higher than 200 mg/dL. 31 Long-term exposure to even modestly elevated cholesterol levels can lead to CHD later in life. 32

Amongst all U.S. Adults greater than 20 years age: (NHANES 2009–2010) 33

  • 46.5% had at least one of three risk factors for CVD and stroke
  • 23% of which had uncontrolled high levels of LDL-C

Amongst all U.S. Adults greater than 20 years age: (National Heart, Lung, and Blood Institute tabulation using National Health and Nutrition Examination Survey (NHANES) (2013–2016 and 2015-2018) 34

  • 49.2% had CVD (compromising of CHD, HF, stroke, and HTN)
  • 38% had “borderline high” total cholesterol (higher than 200 mg/dL)
  • 12% had “high” total cholesterol (higher than 240 mg/dL)
  • 29% had “high” LDL (higher than 130 mg/dL)
  • 17% had “low” HDL cholesterol (lower than 40 mg/dL)
  • Only 54.5%, (or 47 million) who could benefit from cholesterol medicine are currently taking it.
  • Awareness of cholesterol risk is low amongst young adults age 18-39:
  • 56.9% were aware of their “High” total cholesterol (≥240 mg/dL)  
  • 22.5% were aware of their “Borderline high” total cholesterol (200–239 mg/dL)

Primary Prevention to lower ASCVD risk is to lower LDL cholesterol

LDL is one of the risk factors for ASCVD. Management of an elevated LDL cholesterol has been shown to be of clinical benefit for those with and without a diagnosis of CVD. 35 Management of elevated triglycerides or low high density lipoprotein cholesterol has not. LDL is a primary cause of atherosclerosis, other risk factors contribute, as well. 36 U.S. population studies suggest that optimal total cholesterol levels are about 150 mg/dL, which corresponds to an LDL-C level of about 100 mg/dL. Adult populations with cholesterol concentrations in this range manifest low rates of ASCVD. 37

  • Lowering of LDL levels by 1% gives an approximate 1% reduction in the risk of ASCVD. 38

Diet is to blame for much of high LDL cholesterol

Non-controllable risk factors for CVD include age, gender, and genetics. Genetic risk, like familial hypercholesterolemia (FH) is estimated to occur at a rate 0.3-0.5%. 39 The larger proportion of risk factors for CVD are controllable. Cholesterol, blood pressure, diabetes and being overweight 40 are the controllable risk factors for cardiovascular disease. Behaviors like diet choices, exercise, and smoking are modifiable and great tools to reduce these risks. 41 The CDC promotes “Lifestyle modifications, including engaging in regular physical activity, adhering to a heart-healthy diet, and maintaining a healthy weight, as primary and critical components of health promotion and ASCVD risk reduction when implemented before and in combination with cholesterol-lowering medication”. 42

  • 36.4% of US adults had poor diet quality in 2015 to 2016 43 when including factors that relate to high cholesterol (legumes, nuts and seeds; saturated fats, and processed meats)
  • 0.1%–1.6% met ideal criteria for Healthy Diet Score in 2015 to 2016 44
  • Diets high in saturated fats and trans fats can increase cholesterol in the blood. 45
  • Diet change alone can lead to 30% improvement in your LDL. 46
  • Diets high in saturated fat and cholesterol are associated with increased levels of blood total- and LDL- cholesterol and, thus, with increased risk of CHD. 47

Improving diet through plant based diet is shown to improve LDL cholesterol and lower risk of cardiovascular disease

Diets high in saturated fats and trans fats can increase blood cholesterol. Most Americans with high cholesterol have an unbalanced lifestyle with a diet low in plant based foods, like fruits, vegetables and whole grains, and an excess in animal foods like full fat dairy, high meat and processed sweets consumption. Increasing vegetables, fruits and whole grains  maximizes daily fiber and phytosterol consumption 48, compounds uniquely found in plants. A plant based diet combined with reducing saturated fats and increasing exercise can result in an improved lipid panel prior to use of statins. These dietary changes can lead to a near 30% reduction in LDL cholesterol. 49 The benefit is also observed in people with established CVD. Eating a high-fiber diet post-MI was associated with lower cardiovascular and all-cause mortality. 50

Most cardiovascular diseases can be prevented with lifestyle changes like diet (reduction in saturated fat and trans fat with an increase in fiber and total calories if obese and supplementation with plant stanols), smoking cessation, and exercise are often a favorable approach to cholesterol reduction. 51

  • Up to 30% improvement in your LDL can be achieved with diet changes alone. 52 
  • 36.4 million persons eligible for cholesterol treatment, choose lifestyle modifications, such as exercising, dietary changes, or controlling their weight rather than taking cholesterol lowering medication. 53
  • To improve LDL and HDL levels, limit the amount of fat in your eating plan, eat more plant-based foods, and get regular physical activity. 54
  • With a complete diet overhaul, a 10% decrease in LDL can be seen in 3-4 months. 55

Americans don’t eat enough plants

Cholesterol levels are directly impacted by plant consumption. Plants uniquely provide fiber and phytosterols which naturally block and reduce cholesterol absorption in the body. That is why recommendations for lifestyle change and a low cholesterol diet include increasing both of these in the diet. 56

  • On average only 10% of Adults eat enough fruit and veggies 57
  • 5% meet the recommended intake of fiber. 58
  • A diet high in plant based foods (will provide you with adequate phytosterols and 10-30 gm fiber) can lead to a 10% reduction in LDL cholesterol. 59
  • Less than 1 percent of U.S. adults meet the American Heart Association’s definition for “Ideal Healthy Diet.” Essentially no children meet the definition. 60
  • Of the 5 components of a healthy diet, reducing sodium and increasing whole grains are the biggest challenges. 61
  • Americans improved their diet by 7.3% from 2015 to 2016 by increasing consumption of whole grains and nuts, seeds, and legumes and decreasing consumption of sugar sweetened beverages. 62

Eating a Strict Plant Based Diet is Difficult for People to Do

Change is hard and so is compliance. Working with a Registered Dietitian compared to a Physician has a greater chance of success in lowering your LDL. 63 Physicians can coach and guide the patients but the ultimate cross-over to wellness lies in the patients’ hands. 64 The focus on dietary patterns is more likely to improve diet quality and to promote cardiovascular health, rather than focusing on specific nutrients. 65 Example: Make half of each meal vegetables vs consumer 10gm fiber every meal.  Dietary patterns are defined as the quantities, proportions, variety, or combination of different foods, drinks, and nutrients in diets, and the frequency with which they are habitually consumed. 66 The ineffectiveness of diet modification evidenced in the general population is not inherent in the "treatment" itself, but rather due to low “compliance” with diet intervention. 67

  • A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement. 68 Example: Consume 30g of fiber
  • Diet Compliance is based in 3 steps: 69

1) understanding what foods and the desired diet consist of  

2) figuring out exactly how to logistically execute the diet into one's life

3) implementing the plan

  • 30 years of data suggest patient compliance, or lack thereof, is a problem that healthcare providers face daily, not only with diet regimens, but virtually every form of treatment, including medications, vaccinations, exercise regimens and physical therapy. 70

Zizi’s Solution – Science Supported Supplements

Supplements Can Provide Some of the Benefits of A Plant Based Diet

The best sources of fiber and sterols come from food rather than supplements. Supplements are meant to be supplemental, not a replacement in the diet.  However, fiber and phytosterol supplements can contribute to the recommended daily intake in a very meaningful way especially by lowering LDL cholesterol. Plant Sterols/Stanols were amongst the first ingredients which received authorized health claims by regulatory bodies such as the European Food and Safety Authority (EFSA) and the US Food and Drug Administration (FDA). 71 Increased fiber intake is associated with many health benefits, including a decreased risk of coronary heart disease (CHD), cardiovascular and all-cause mortality, colorectal cancer, stroke, and type 2 diabetes. 72

Phytosterols:

  • There is no significant difference between the LDL-cholesterol−lowering action of plant sterols/stanols supplements compared with foods enriched with plant sterols/stanols. 73
  • Natural Plant sterol intake can range from 250 to 500 mg/day from food sources, where supplements can deliver up to 3000 mg/day. 74
  • 1.5-3 grams of plant sterols and stanols per day can lower your LDL by 7.5-12%. 75
  • Consumption of 2 to 3 g/day of plant sterols or stanols by individuals on statin therapy may lower both total cholesterol and LDL-cholesterol by an additional 0.30 mmol/L (11.6 mg/dL), compared to statin alone. 76

Fiber:

  • Functional Fiber supplements have the ability to reduce LDL by up to 14% more than naturally occurring dietary fiber. 77
  • High fiber intake can reduce the risk of CHD and stroke by 24-38% compared to low fiber intake. 78
  • Fiber derived from grain rather than from fruit or other sources, is more strongly associated with improved cardiovascular disease. 79
  • When recommending a fiber supplement, only a soluble nonfermenting, gel-forming fiber has been clinically proven to provide all of the health benefits typically associated with a fiber supplement. 80
  • 6-15 grams of psyllium fiber per day can lower LDL cholesterol by 6–24% and total cholesterol 2–20%. 81

People Are Used To Taking Supplements

  • Almost 58% american adults have taken a dietary supplement in the past 30 days, 82
  • 52% percent of US adults reported using supplements. 83
  • Herbal remedies continue to be a popular choice due to their perceived safety and easy availability. 84

Federal Regulation of Dietary Supplements

Whether a product is classified as a dietary supplement, conventional food, or drug is based on its intended use.  Prescription and over-the-counter drugs must be proved safe and effective prior to marketing. 85 Supplements can be misleading depending on health goals, and can actually cause harm, particularly if used improperly or with other medication. 86

  • Dietary supplements are not required to be standardized in the United States. 87
  • Supplements are not required to have a safe or effective approval by any agency, including the FDA prior to marketing.
  • Some supplements do provide verification on their purity and potency though USP. 88
  • The law does not require the manufacturer or seller to prove to FDA's satisfaction that the claim is accurate or truthful before it appears on the product. 89
  • The FDA does have an approved list of authorized health claims for certain food and supplements, including fiber and plant sterols.
  • To be approved by the FDA as an authorized health claim, there must be significant scientific agreement (SSA) among qualified experts that the claim is supported by the totality of publicly available scientific evidence for a substance/disease relationship. The SSA standard is intended to be a strong standard that provides a high level of confidence in the validity of the substance/disease relationship. 90
  • Psyllium Husk and β-glucan fibers qualify for an FDA approved health claim for lowering LDL cholesterol.
  • Plant sterols and stanols qualify for an FDA approved health claim for lowering LDL cholesterol.
  • Many Supplements are affiliated with heart health but do not have FDA claims.
  • Fish oil (EPA and DHA) has an approved FDA health claim for reducing blood pressure or hypertension, as a risk factor of CHD. There are no claims for lowering LDL cholesterol supported by scientific studies. (it may lower TG) 91
  • Artichoke leaf extract has inconclusive research and has no claims. 92
  • Garlic supplements have conflicting evidence as to whether they lower LDL and TC and by how much. Furthermore, garlic supplements interact with certain drugs and increase risk of bleeding. 93
  • Polyphenols like Resveratrol and those found in Green Tea have not been shown to lower LDL. 94

Only Two Plant Supplements Have authorized FDA health claims for Lowering LDL Cholesterol: Fiber and Plant Sterols

Both of the plant derived supplements that Zizi provides to consumers, psyllium fiber and plant sterols, have FDA authorized health claims for lowering cholesterol. 95

  1. 7 gm Psyllium Husk
  2. 95% derived from Plantago (P.) Ovata, known as blond psyllium or Indian psyllium, P. indica, or P. psyllium.
  3. Must contain 1.7 gm to comply with eligibility to health claim
  1. 1.3gm Plant Sterol Esters
  2. Composed of 80% of the combined weight coming from beta-sitosterol, campesterol, and stigmasterol
  3. Must contain at least  0.65gm to comply with eligibility to health claim  

Apart from FDA endorsement, both Fiber and Plant Sterols Show Meaningful Ability to Lower LDL Cholesterol in Numerous Studies

Taking the correct derivative of both fiber and plant sterols in sufficient doses can significantly lower LDL cholesterol. Scientific research supports 2 specific fibers to lower LDL cholesterol, and they are β-glucan and psyllium husk. Both of these fibers are soluble fibers that are viscous or gel forming. Scientific literature also supports several forms of plant sterols and stanols: β-sitosterol, sitostanol, campestanol, campesterol, and stigmasterol.

  • 3 grams of β-glucan per day can lower LDL by 5-10%. 98
  • 6-15 grams of psyllium husk per day can lower LDL by 6-24% LDL and Total Cholesterol by 2-20%. 99
  • 1.5-3 grams of plant sterols and stanols per day can lower your LDL by 7.5-12%. 100
  • 10 to 30 g of soluble fiber in a diet results in an approximately 10% reduction in LDL cholesterol. 101
  • The physical effects of fiber in the small intestine drive metabolic health effects (e.g., cholesterol lowering, improved glycemic control), and efficacy is a function of the viscosity of gel‐forming fibers (e.g., psyllium, β‐glucan). 102
  • Studies show oat consumption is associated with 5% and 7% reductions in total and LDL cholesterol levels. 103
  • The recommended intake of beta-glucan for reduction of cholesterol is 3 g/day, an amount found in approximately 90 g of oats. 104
  • No significant difference between the LDL-cholesterol−lowering action of plant sterols/stanols supplements compared with foods enriched with plant sterols/stanols. 105

Zizi provides psyllium husk fiber which is preferable to other fiber

Fiber comes in many forms and has many benefits. With overwhelming support for both dietary and functional fiber products, the health claims depend on type and quantity of fiber. It is important to understand which supplements actually have clinical evidence of a beneficial physiologic effect and qualify as functional fibers. 106 There is adequate research supporting only two of the many functional or isolated fibers for lowering LDL cholesterol, psyllium husk and β‐glucan derived from oats and barley.  107 β‐glucan derived from fungi (yeast/mushrooms), seaweed, and algae does not meet this requirement.

We choose psyllium husk  instead of β‐glucan for the following reasons:

  • The FDA only has authorized health claims for a soluble, viscous/gel forming β‐glucan derived from oats and barley to lower LDL cholesterol.
  • However, the majority of β‐glucan supplements are derived from saccharomyces cerevisiae, which is a yeast / single celled fungi.
  • The molecular weight of β‐glucan affects its viscosity. 108
  • Processed β‐glucan, and fungi derivatives can be soluble but low/non-viscous or non-gel forming, and so may not be efficacious in lowering LDL cholesterol.
  • β‐glucan derived from yeast/ fungi is used and marketed to enhance the immune system. 109
  • Insoluble fiber and low‐viscosity/non viscous soluble fiber (e.g., inulin, wheat dextrin, processed β‐glucan) do not provide this viscosity/gel‐dependent beneficial effect. 110 
  • Zizi provided 5 gm of Psyllium husk for fiber
  • Psyllium is better at lowering LDL than other types of fiber. 111
  • Meets both FDA guidelines to lower LDL cholesterol:
  • Contains  >1.7 gm psyllium husk composed of >95% Plantago (P.) ovata, known as blond psyllium or Indian psyllium, P. indica, or P. psyllium.

Zizi provides plant sterols

Phytosterols are not as complicated to navigate as fiber. Phytosterols can also be referred to as plant sterols, plant stanols, sterol esters, and stanol esters. Chemically they all have slight differences based on their chemical bond type and solubility, but as a group they have similar effects on LDL cholesterol.

However, plant sterol and stanol esters are the only ones identified by the FDA for labeling claims.

  • The most frequently occurring natural plant sterols in the diet are the desmethyl sterols;  β-sitosterol, campesterol, and stigmasterol. 112
  • Plant sterol intake can range from 250 to 500mg/day with about 65% of intake as β-sitosterol, 30% as campesterol, and 5% as stigmasterol. 113
  • The most common plant stanols in the human diet are sitostanol and campestanol, which combined make up about 5% of dietary phytosterol. 114
  • Supplements can contain 1) Plant sterol/stanols 2)  Stigmastanol (sitostanol), 115 3) Campesterol, 4) Campestanol, 5) Beta sitosterol, and/or 6) Stigmasterol
  • We chose Beta-Sitosterol, campesterol, and stigmasterol as our phytosterol sources as they are the most common occurring in the diet, to closely mimic the natural form and absorption in the body.
  • Zizi provides 2 gm of Beta-Sitosterol
  • This dose may lower LDL-C by 7.5-12%
  • Meets both FDA and research guidelines to lower LDL cholesterol:
  • And contains >1.3gm Plant Sterols composed of >80% of beta-sitosterol

Zizi Provides sufficient doses of both fiber and plant sterols, which you would not be able to get from a multivitamin

Our supplements are derived from plants and are naturally occurring compounds isolated for beneficial physiological effects. Zizi provides dosages of both psyllium fiber and plant sterols that meet FDA authorized health claims, and these dosages are not achievable in a single pill multivitamin.  Zizi strives to meet both FDA guidelines by including 1.3 to 5 gm psyllium provided at incremental monthly doses composed of >95% psyllium husk; and 1.8 gm Plant Sterols, composed of >70% of beta-sitosterol, campesterol, and stigmasterol estered with stearates.

  • Zizi provides 5 gm of Psyllium fiber composed of >95% psyllium husk
  • Zizi provides 2 gm of phytosterols composed of 1gm Beta-Sitosterol, 300mg Stigmasterol, and 100mg campesterol; 70% combined weight

Zizi regime designed by a former Stanford Cardiology department Registered Dietitian

Vincenta Faulkner is Registered Dietitian whose cardiac nutrition expertise stems from her extensive work in cardiology, and transplant nutrition over the last 12 years. She started her career providing high level nutrition care to complex patients with multiple chronic illnesses in the intensive care setting. Her experience and passion grew with her involvement in the Stanford Cardiology department.

After beginning her own family, Vincenta’s interest shifted from disease management to disease prevention. Vincenta’s dedication to lowering the risk of heart disease starts at home, as she has counseled and guided her husband as well as other family members into a healthier diet and lifestyle in hopes of avoiding and delaying Cardiovascular disease (CVD). All of her grandparents lived into their late 80s and 90s despite having CVD. She has seen first hand the benefits of lifestyle changes for day to day life and longevity, and hopes to be an ongoing model for her children.

 

1 CFR - Code of Federal Regulations Title 21

2 CFR - Code of Federal Regulations Title 21 

3 UpToDate - Management of LDL in Primary Prevention

4 UpToDate - Management of LDL in Primary Prevention

5 Effectiveness of altering serum cholesterol levels without drugs

6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413815/

7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163911/

8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413815/ 

9 UpToDate - Management of LDL in Primary Prevention

10 High Cholesterol and Natural Products: What the Science Says | NCCIH

11 Plant Sterol Analysis in Relation to Functional Foods | Guus SMJED

12 LDL-Cholesterol Lowering of Plant Sterols and Stanols—Which Factors Influence Their Efficacy?

13 Phytosterols | Linus Pauling Institute

14 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

15 https://www.uptodate.com/contents/healthy-diet-in-adults/abstract/14-21

16 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

17 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413815/ 

18 Cardiovascular diseases (CVDs)

19 Diabetes Overview | NIDDK

20 Understand Your Risks to Prevent a Heart Attack | American Heart Association

21 An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach to Public Health

22 Cardiovascular diseases

23 Cardiovascular diseases Heart Disease and Stroke Statistics—2021 Update | Circulation  Heart Disease Facts | cdc.gov

24 Understand Your Risks to Prevent a Heart Attack | American Heart Association

25 Cardiovascular diseases (CVDs)

26 Heart Disease Facts | cdc.gov

27 Heart Disease and Stroke Statistics—2021 Update | Circulation

28 Heart Disease and Stroke Statistics—2021 Update | Circulation

29 Heart Disease and Stroke Statistics—2021 Update | Circulation

30 eCFR :: 21 CFR Part 101 -- Food Labeling ; ​​Cholesterol Numbers: What Do They Mean

31 Heart Disease and Stroke Statistics—2021 Update | Circulation

32 Heart Disease and Stroke Statistics—2021 Update | Circulation

33 Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999–2010

34 Heart Disease and Stroke Statistics—2021 Update | Circulation Prevalence of uncontrolled risk factors for cardiovascular disease 

35 Management of elevated low density lipoprotein-cholesterol (LDL-C) in primary prevention of cardiovascular disease - UpToDate

36 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol

37 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol

38 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol

39 Familial Hypercholesterolemia

40 Understand Your Risks to Prevent a Heart Attack | American Heart Association

41 Understand Your Risks to Prevent a Heart Attack | American Heart Association

42 Prevalence of Cholesterol Treatment Eligibility and Medication Use Among Adults — United States, 2005–2012

43 Heart Disease and Stroke Statistics—2021 Update | Circulation

44 Heart Disease and Stroke Statistics—2021 Update | Circulation

45 Physiology, Cholesterol - StatPearls - NCBI Bookshelf

46 Management of elevated low density lipoprotein-cholesterol (LDL-C) in primary prevention of cardiovascular disease - UpToDate

47 eCFR :: 21 CFR Part 101 -- Food Labeling

48 Physiology, Cholesterol - StatPearls - NCBI Bookshelf

49 Combination Diet and Exercise Interventions for the Treatment of Dyslipidemia: an Effective Preliminary Strategy to Lower Cholesterol Levels? | The Journal of Nutrition | Oxford Academic  Management of elevated low density lipoprotein-cholesterol (LDL-C) in primary prevention of cardiovascular disease - UpToDate

50 Medline ® Abstract for Reference 26 of 'Healthy diet in adults' - UpToDate

51 Cardiovascular diseases (CVDs) Physiology, Cholesterol - StatPearls - NCBI Bookshelf

52 Management of elevated low density lipoprotein-cholesterol (LDL-C) in primary prevention of cardiovascular disease - UpToDate

53 Prevalence of Cholesterol Treatment Eligibility and Medication Use Among Adults — United States, 2005–2012

54 Diabetes, Heart Disease, & Stroke | NIDDK

55 Combination Diet and Exercise Interventions for the Treatment of Dyslipidemia: an Effective Preliminary Strategy to Lower Cholesterol Levels? | The Journal of Nutrition | Oxford Academic

56 Physiology, Cholesterol - StatPearls - NCBI Bookshelf

57 Only 1 in 10 Adults Get Enough Fruits or Vegetables | CDC Online Newsroom

58 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

59 Effectiveness of altering serum cholesterol levels without drugs

60 Heart Disease and Stroke Statistics – At-a-Glance

61 Heart Disease and Stroke Statistics – At-a-Glance

62 Heart Disease and Stroke Statistics—2021 Update | Circulation

63 Medline ® Abstracts for References 27,28 of 'Management of elevated low density lipoprotein-cholesterol (LDL-C) in primary prevention of cardiovascular disease' - UpToDate

64 An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach to Public Health

65 Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association | Circulation

66 Part D. Chapter 8: Dietary Patterns

67 Diet Programs and Compliance: Do Prepared Meal Programs Increase Adherence?

68 Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association | Circulation

69 Diet Programs and Compliance: Do Prepared Meal Programs Increase Adherence?

70 Diet Programs and Compliance: Do Prepared Meal Programs Increase Adherence?

71 LDL-Cholesterol Lowering of Plant Sterols and Stanols—Which Factors Influence Their Efficacy?

72 https://www.uptodate.com/contents/healthy-diet-in-adults/abstract/14-21

73 High Cholesterol and Natural Products: What the Science Says | NCCIH

74 Plant Sterol Analysis in Relation to Functional Foods | Guus SMJED

75 LDL-Cholesterol Lowering of Plant Sterols and Stanols—Which Factors Influence Their Efficacy?

76 Phytosterols | Linus Pauling Institute

77 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

78 https://www.uptodate.com/contents/healthy-diet-in-adults/abstract/14-21

79 https://www.uptodate.com/contents/healthy-diet-in-adults/abstract/14-21

80 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

81 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413815/ 

82 Dietary Supplement Use Among Adults: United States, 2017–2018

83 Heart Disease and Stroke Statistics—2021 Update | Circulation

84 Acute liver failure caused by 'fat burners' and dietary supplements: A case report and literature review

85 Safety Reporting Portal

86 FDA 101: Dietary Supplements

87 Background Information: Dietary Supplements - Consumer

88 Dietary Supplements Compendium | USP

89 FDA 101: Dietary Supplements

90 Authorized Health Claims That Meet the Significant Scientific Agreement (SSA) Standard | FDA

91 Overview of Omega-3 Fatty Acid Therapies  FDA Announces New Qualified Health Claims for EPA and DHA Omega-3 Consumption and the Risk of Hypertension and Coronary Heart Disease | FDA

92 Pharmacological Studies of Artichoke Leaf Extract and Their Health Benefits

93 Garlic | NCCIH

94 The effects of resveratrol on lipid profiles and liver enzymes in patients with metabolic syndrome and related disorders: a systematic review and meta-analysis of randomized controlled trials | Lipids in Health and Disease | Full Text ; Beneficial effects of green tea: A literature review

95 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

96 eCFR :: 21 CFR Part 101 -- Food Labeling

97 https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.83

98 Cholesterol-lowering effects of oat β-glucan

99 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

100 LDL-Cholesterol Lowering of Plant Sterols and Stanols—Which Factors Influence Their Efficacy?  : Plant Sterols and Stanols in Foods and Supplements

101 Effectiveness of altering serum cholesterol levels without drugs

102 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

103 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

104 Oats Uses, Benefits & Dosage - Drugs.com Herbal Database

105 High Cholesterol and Natural Products: What the Science Says | NCCIH

106 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

107 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

108 Beta Glucan - an overview | ScienceDirect Topics

109 Biomedical Issues of Dietary fiber β-Glucan

110 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

111 Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

112 Plant Sterol Analysis in Relation to Functional Foods | Guus SMJED

113 Plant Sterol Analysis in Relation to Functional Foods | Guus SMJED

114 Plant Sterol Analysis in Relation to Functional Foods | Guus SMJED

115 Stigmastanol - Wikipedia