Exploring Supplements to Treat High Cholesterol

Doctor: What about Supplements to Treat my High Cholesterol? I Like Natural!

Your doctor says that your cholesterol [ko-LESStuh-roll] or “lipids” are too high and need to come down. Although statins and other drugs are the backbone of lipid-lowering therapy, many people use “natural” treatments today for treating lipid problems. Some natural remedies are thought to have effects similar to statins. But there is much confusion about what can be tried!

Here is information about several popular “natural” treatments:

Garlic is a popular natural medicine that some have tried to treat high cholesterol. But, it is not clear how well garlic lowers cholesterol. Early studies that found a benefit were small and not of very good quality. More recent, larger, higher-quality studies show that garlic does not lower cholesterol much at all. A few studies suggest a small benefit but for only about six months. Also, because garlic interacts with some drugs, you should not take garlic supplements if you also take statins, oral contraceptives, blood thinners, or aspirin. In summary, you should not rely on garlic for controlling cholesterol or reducing your risk for heart attack.

Red yeast rice is popular as a natural choice for lowering cholesterol. These products are produced when red yeast acts on rice to make a chemical that lowers cholesterol. The chemical is a low-dose statin, so red yeast rice is really statin therapy at a low dose. Red yeast rice lowers cholesterol but also could share the same side effects as statins, such as muscle aches or liver problems. It is important to know that some products sold as red yeast rice do not contain the active statin ingredient and will not lower cholesterol. Red yeast rice products do not have consistent ingredients, so the amount of active drug may vary. Some trace elements in the supplement may also be harmful. Because of these reasons, red yeast rice should not be used to lower cholesterol.

Niacin is available usually in low doses (250 mg or less). Prescription niacin is used at much higher doses. Even at the higher doses (1000-2500 mg) the benefit of adding niacin when the cholesterol is well controlled with statin treatment is debated. Niacin may be good for some patients with high levels of triglycerides [try-GLIS-er-ides] and low levels of “good” cholesterol (HDL cholesterol) but there is no evidence that the low doses found in over-the-counter niacin offer any benefit. Some side effects include facial flushing, headache, itching, liver problems, and high blood sugar. “No Flush” niacin is more expensive and less effective and is not recommended. Your doctor will let you know whether prescription niacin is needed and how you can minimize facial flushing.

Plant sterols and stanols are found in several buttery spreads (Promise Activ, Smart Balance, Benecol), orange juice (Minute Maid Premium Heart Wise) and other products. They reduce the amount of cholesterol that the intestine absorbs. Using the spreads twice daily instead of butter or drinking two 8-ounce glasses of the juice that contains sterols can lower your “bad” cholesterol (LDL cholesterol) by up to 17%. If your doctor tells you that you need to lower your cholesterol, plant sterols and stanols can be useful. But, although plant stanols and sterols do lower LDL cholesterol, they probably do not reduce heart attacks or strokes.

Fish oil contains two “fattyacids,” EPA and DHA. These are also known as omega-3 fatty acids. Fish oil is very popular today. Some believe that it reduces the risk for heart disease. Taking 4-6 grams of fish oil can reduce triglycerides up to 50%. But, cholesterol does not decrease. The benefit of using EPA and DHA at 1-2 grams is less clear. The American Heart Association does recommend at least 1 gram of combined EPA and DHA daily by eating fish at least three times a week. Patients at risk for heart disease who do not eat fish three times a week should take 1 gram of EPA/DHA each day (in fish oil supplements). Taking fish oil, though, is not likely to lower the risk for heart attacks or strokes. Omega fish oil is available by prescription (Lovaza) at a high dose (840 mg EPA/DHA per capsule) only for treatment of very high triglycerides. Over-thecounter fish oil has much less EPA and DHA. So, many more capsules are needed per day to lower triglycerides. If you do take fish oil capsules, make sure that it has a United States Pharmacopeia (USP) seal. These are of higher quality and free of pesticides. Use caution if you take blood thinners or aspirin, because high-dose fish oil may increase your tendency to bleed. Keep an eye on bleeding or bruising more than normal.

Fibrous foods can help lower cholesterol. The fiber in whole grain foods (whole wheat, whole oats, corn, barley) may reduce the risk of heart disease by lowering cholesterol. Blond psyllium [SILL-i-um]and oat bran are high in fiber. Blond psyllium (10-12 grams/day) can reduce the “bad” cholesterol (LDL cholesterol) by 5% and oat bran in some patients can lower LDL cholesterol by up to 25%. The ability of fiber to lower cholesterol varies from patient to patient since it also depends on what else you are eating.

In summary, some “natural” methods of lowering cholesterol might have a role. Surely, increasing the fiber in your diet, using plant stanol or plant sterol spreads in place of butter and consuming fish three times a week is sensible and helpful for your health. But, there is no good evidence that garlic, low-dose niacin or low-dose fish oil improves cholesterol or prevents heart attacks. High-dose fish oil is helpful in lowering very high triglycerides (not cholesterol) but is not likely to reduce heart attacks or strokes. Even though it lowers cholesterol, red yeast rice is usually low-dose statin treatment in disguise with the potential for statin side effects. Red yeast rice products vary in what is in them and may even have things in them that could harm you. Some contain no active ingredient. If your doctor says your cholesterol is too high, a prescription statin drug is best, not red yeast rice.

Dr. Paul S. Jellinger is board certified in internal medicine and endocrinology and metabolism. After receiving his medical degree from Wayne State University School of Medicine, Dr. Jellinger completed a first-year medical residency at Beth Israel Hospital and a second-year residency at Mount Sinai Hospital in New York City. He, subsequently, was awarded an NIH fellowship in Endocrinology at Mount Sinai Hospital. Dr. Jellinger is a Professor of Clinical Medicine at the University of Miami and has served as Chief of the Section of Endocrinology at Memorial Regional Hospital in Hollywood, Florida. He is a past president of the American Association of Clinical Endocrinologists and American College of Endocrinology.