Our students and their success: the experience of Dr. Riccardo Muscatello

High cholesterol? Not just medicines, then. Nutrition is a great way to prevent and control hypercholesterolaemia and type 2 diabetes. Dr. Riccardo Muscatello, nutritional biologist and nutraceutical consultant at the Cube Labs company, as well as a UniCamillus University MSc Human Nutrition Sciences alumnus, explains it best. His dissertation Nutraceutical approaches in the treatment of hypercholesterolaemia, supervised by Prof. Caterina Pipino, was chosen as the most innovative by the UniCamillus Examination Board.
Dr. Muscatello was keen to send us an article containing the results of his extremely successful research study.

Nutraceutical approaches in the treatment of hypercholesterolaemia

By Dr. Riccardo Muscatello

Metabolic syndrome and hypercholesterolaemia

Metabolic syndrome is a widespread clinical condition comprising a series of metabolic abnormalities associated with overweight and obesity. For the diagnosis to be positive, at least three of the following five factors must be present: visceral obesity; atherogenic dyslipidaemia associated with high LDL cholesterol; high blood triglyceride levels; hypertension and chronic hyperglycaemia associated with insulin resistance. 

Metabolic syndrome almost always develops in conjunction with obesity (especially visceral obesity) and type 2 diabetes. These two factors are usually associated with dyslipidaemia, which significantly increases atherosclerotic processes and the risk of death from cardiovascular disease.

Subjects with metabolic syndrome usually manifest high blood triglyceride levels (>150 mg/dL), a total cholesterol value >200 mg/dL and reduced HDL cholesterol values (<40 mg/dL in men and <50mg/dL in women).

Nutraceutical approach

‘Let food be thy medicine and medicine be thy food’: this statement by Hippocrates reflects the importance of proper nutrition and anticipates Eastern philosophy, according to which there is no plant created by God without medicinal properties. Thus, traditional medicine lays its foundation on the extensive use of plants and plant derivatives (which have been considered therapeutic agents for centuries), emphasising the concept that food, thanks to its medicinal active ingredients, can be used as a medication.

The term ‘nutraceutical’, coined in the 1980s by Stephen De Felice, originates from the fusion of the words ‘nutrition’ and ‘pharmaceutical’, and is connected to foods whose active ingredients are able to modulate the body’s physiological functions, especially with regard to the prevention of chronic degenerative diseases. Nowadays, the concept of ‘medicine food homology’ (MFH) is becoming increasingly popular. MFH studies the function of foods and seeks to understand whether these foods can boast bioactive compounds within them that can exert molecular actions overlapping with those found in medications.

Cholesterol-lowering nutraceuticals

In the dissertation I wrote and presented to the Examination Board last July, I successfully analysed two foods and a compound with cholesterol-lowering properties comparable to that of some first-line medications.

Melannurca Campana is a prized apple cultivar typical of the Campania region officially recognised as a PGI product. The Melannurca has unique health and nutraceutical properties due to its high content of vitamins (B1 and B2), minerals (potassium, iron, phosphorus, manganese) and because it is rich in phenolic compounds―in particular procyanidins―present in higher concentrations than any other apple variety. Among the different apple varieties,the Melannurca fruit was recognised to have one of the highest contents of oligomeric procyanidins, peculiar polyphenolic antioxidants, as well as procyanidin B2, compared to more common kinds of apples such as Red Delicious, Granny Smith, Pink Lady, Fuji and Golden Delicious. This is due to its particular ripening process that does not take place on the plant, but rather takes place on straw beds exposed to the sun. This exposes the Melannurca to attacks from pests and fungi so, in order to protect itself from these, the fruit will produce large quantities of procyanidins and natural antioxidants.

A group of researchers from the University Federico II in Naples, Italy, through numerous studies, have attributed procyanidine B2 with a marked ability not only to inhibit the absorption of dietary cholesterol, but also the endogenous synthesis of cholesterol in the body.

For a cholesterol-lowering effect, a continuous daily intake of two Melannurca apples per day or a supplement containing a highly titrated extract is recommended.

Bergamot is a typical fruit native to the Calabria region of Italy. The fruit is rich in vitamins A and C, B complex-vitamins, terpenes and polyphenolic substances with important health benefits. One of the main mechanisms of action attributed to the nutraceutical polyphenols of bergamot appears to be inhibiting the oxidation of blood LDL-cholesterol. This oxidation, mostly caused by the adoption of certain lifestyles and associated with chronic inflammatory events, increases the risk of atherosclerosis. Regarding the cholesterol-lowering activity attributed to the nutraceutical function of bergamot, it seems that certain compounds within the fruit are able to inhibit the action of hydroxymethylglutaryl-CoA (HMG-CoA) reductase. This is an enzyme that controls endogenous cholesterol synthesis and is the ‘target’ of many drugs used in the treatment of dyslipidaemia. Certain molecules within the fruit, in particular brutieridin and melitidin, appear to have an inhibitory effect on the enzyme HMG-CoA reductase, thus reducing cholesterol synthesis and blood values. What is even more surprising is that these two molecules have an action comparable to that of statins, first-line drugs for the treatment of hypercholesterolaemia. A continuous daily intake of a supplement containing 1 gram of highly titrated bergamot extract is recommended for a cholesterol-lowering effect.

Berberine is an alkaloid extracted from various plants, mostly of oriental origin.  As a supplement, in the West, it is mainly used to reduce insulin resistance and to improve biomarkers of type 2 diabetes such as blood glucose and glycated haemoglobin. It also has applications in improving lipid homeostasis. This alkaloid is in fact able to increase the uptake, subsequent ‘breakdown’ and excretion of LDL-cholesterol (commonly referred to as ‘bad cholesterol’) by the liver. In addition, its regular intake induces a reduction in blood sugar, blood triglycerides and atherosclerotic processes. For a cholesterol-lowering effect, a continuous daily intake of a supplement containing 1-1.5 grams of berberine per day is recommended.


Nowadays, the concept of ‘medicine-food homology’ (MFH) in the treatment of hypercholesterolaemia is becoming increasingly popular, representing medicine-like foods in the treatment of dyslipidaemia. From a practical point of view, this concept translates into a link intersecting the worlds of medicine and food.

The cornerstone of this approach is the functional analogy between complex mixtures of plant extracts and the medications usually used to combat certain diseases.

The goal of nutraceuticals is to place themselves before the medication and, above all, beyond the simplistic concept of food. If science, thanks to medication, has succeeded in ‘giving years to life’, with nutraceuticals it is hoped to give ‘life to years’, thus improving the quality of life.