Supplements that Lower Cholesterol 
(February 13, 2018)

We remember from our last little chat that grease is essential to life (or at least essential to making a proper donut), and that cholesterol is a particular type of that grease. It is a type that is so important to proper functioning that your liver packages it up in several different forms and ferries it around to pretty much everywhere in your body via your bloodstream. Unfortunately, when there is too much cholesterol with the "LDL" type of packaging, it irritates your blood vessels to the point where the resulting inflammation increases your risk of cardiovascular disease.
 
(We used to think that excess LDL cholesterol piled up in the arteries and formed blockages, sort of the way that a crazed Amazon drone that has lost its "Delivered" button might create a pile of coffee bean grinders on your porch. But we now think that that model is wrong, and that the medical conditions associated with LDL cholesterol stem from it inflaming the walls of the blood vessels. Science, as well as Amazon.com, marches on.)

A high LDL cholesterol level is far from the only risk factor for cardiovascular disease. It probably is not even the most important one. Yet it is something that should not be ignored. It should be taken very seriously by anyone who has already had a stroke or heart attack, for sure. And even if you haven’t yet had the pleasure, if stroke or heart attack is NOT on your bucket list, and your LDL cholesterol level is too high, you might want to think about lowering it. 

Why not just take a statin? Well, they are only minimally (if at all) helpful in anyone who does not yet have cardiovascular disease. Plus, their possible side effects include muscle pain (and possibly serious muscle damage), liver damage and increased risk of diabetes. They work by inhibiting an enzyme in the liver that produces LDL, but they also inhibit that particular enzyme everywhere else it’s found in the body. (That in a nutshell is why medications have side effects; they do their thing everywhere, not just where you want them to do it.) So statins are fine for the treatment of disease -- but not for the prevention of it.

What would be great, then, would be to get LDL to a healthy level way before it is problematic without using medication. That’s very doable. And what would be even better than doing simply that? If you could lower your LDL AND positively affect other risk factors for cardiovascular disease at the same time!   

The three supplements I chose to discuss today are the ones that currently have the most evidence for their respective abilities to lower LDL cholesterol. Numero uno on that list is:

Plant sterols, stanols, and their esters. Sorry about all those chemical words there. All you need to know about them is that they are very similar to each other AND to cholesterol  itself. (You can tell that from the “sterol” part of the name. Plant sterol – Chole sterol – there.) They are so similar, in fact, that when your body tries to absorb cholesterol from your food, if they are present in your intestines instead they will fool your body into absorbing THEM instead of cholesterol. That’s how they work, by blocking cholesterol absorption from the digestive system. They can lower blood levels of LDL cholesterol by up to 15%.
 
You can get them in capsules or in some of those new-fangled soft-tub margarines. They are a little on the pricey side, but they work and they won't get you into any troube. Here’s a bonus. If you take curcumin for whatever reason, it can strengthen the cholesterol-lowering effect of the plant sterols. 

PLUS. If you are already taking a statin but it is not quite doing the job, you can take sterols along with it and it will lower your LDL even more! Normally you can’t piggyback these things on top of each other. But this one you can.

Niacin. This is one of the B vitamins and before statins came along, niacin is what your doctor would have given you to lower your cholesterol. It not only lowers your LDL cholesterol (up to 25%), but it also lowers your triglycerides and actually raises your HDL cholesterol, which is something that you actually WANT to see a lot of in your blood. And it is so cheap that it will make you weep. Niacin is a real winner, in my book.

Red yeast rice. This is a chinese medicine thing. You take it in capsules. You don’t eat the stuff itself, for which you should be grateful. The kinds of things that Chinese doctors would have you eat – you don’t want to know. Yum, gecko! (And don’t look up ye ming sha, ok?)

Red yeast rice contains natural statins. It contains lovastatin as a normal part of its makeup as a food. Red yeast rice works the same way in the body, then, as do statin drugs -- by inhibiting an enzyme in the liver that produces LDL cholesterol. It will lower LDL cholesterol by about 20%.

If someone wants to take a statin drug but cannot tolerate the side effects, they should check out red yeast rice. (And niacin as well, of course.) It has a lot less of the statin used in the medication, but it also contains a lot of other things similar to statins that may facilitate the cholesterol-lowering effect. As to which one to buy, you really need to do your research on this one; red yeast rice products in the U.S. vary enormously in quality and effectiveness.

*****

Those guys really are the top three, and if you want to take a pill particularly to target high LDL cholesterol levels, they are where I think you should look. I have not given you enough information here for you to take any of them. This was deliberate. You need to do your own research and then think about it quite a bit before you start with any of these.

With niacin and red yeast rice, as with statin medications, you should have your liver activity monitored regularly while taking them. But all three of the supplements that I listed do the job; they are valid alternatives to statin drugs with (mostly) less cost and (definitely) fewer side effects. So there we are.

A couple of honorable mentions also, by the way, would be the following.

Garlic will lower your total cholesterol number 4-5%. But it will also lower your triglycerides and possibly slow down atherosclerosis. And it can be helpful in lowering blood pressure as well. (Everyone took garlic pills for high blood pressure when I was a kid. I am pleased to see that there is actually some evidence for that.)

Probiotics. Some of these may lower LDL cholesterol. (And maybe blood pressure as well.) They might also reduce triglycerides. Those are a lot of “maybes”, though, and so although I think that generally probiotics are a wonderful thing, I wouldn’t take them for just those reasons.

Policosanol. It’s a particular member of that class of sterol-stanol-ester doohickeys I mentioned earlier. A few Cuban studies suggest this might work, but it's still kind of early to put much in the way of dollars or reliance on them. Still, they have future potential.

And there you have it. Genuine alternatives to medications for high LDL cholesterol. Combine these with proper diet and you should be golden.

--dr. diane holmes
  Copyright © 2018