John A. Patterson MD, MSPH, FAAFP
Strokes and heart attacks can occur when arteries are narrowed by plague buildup.
High levels of LDL (‘bad’) cholesterol and low levels of HDL (‘good’) cholesterol contribute to this buildup. Lowering elevated levels of LDL and raising low levels of HDL can reduce the risk of these major cardiovascular events.
Although drugs are commonly used to lower LDL and raise HDL, physicians and patients are exploring non-drug options before starting drug therapy. Cholesterol can sometimes be managed without drugs by dietary modifications, weight loss, physical activity, restful sleep and stress management. Despite good evidence of effectiveness, many consumers also use dietary supplements to manage cholesterol.
Healthy eating. The Lifestyle Heart Trial combined a very low-fat, vegetarian diet (10% of total calories from fat) with intensive lifestyle changes (exercise, stress management, smoking cessation, group psychosocial support). Participants’ average LDL decreased by 40%. A recent study showed that a primarily plant-based diet, rich in foods known to lower cholesterol, reduced LDL as much as low-dose statin drugs. Foods included plant sterol-enriched margarine, soy protein (soy milk, tofu and soy meat analogues), viscous fibers (oats, barley and psyllium), and nuts (both tree nuts and peanuts). Peas, beans and lentils were encouraged.
Maintaining a healthy weight has been shown to improve cholesterol levels.
Regular physical activity can raise HDL and can help you lose weight, helping lower your LDL. NHLBI recommends 30 minutes of a moderate-intensity physical activity, such as brisk walking, at least 5 days a week, with a goal of at least 150 minutes over the course of the week.
Sleep- Consistently getting less that 6 hours or more than 8 hours of sleep can raise LDL and lower HDL. Here is yet another reason to get 7-8 hours of sleep each night.
Stress– Subjective experiences of stress can also be associated with cholesterol abnormalities. Managing stress skillfully can lead to improvements in cholesterol profiles.
Red yeast rice (RYR) products may contain a substance identical to the active ingredient in the drug lovastatin and may lower blood cholesterol levels but can cause the same side effects as lovastatin (liver damage, muscle pain and weakness). Anyone using RYR should have periodic liver tests just as people using statin drugs. The U.S. Food and Drug Administration considers RYR products that contain more than trace amounts of monacolin K to be illegal unapproved drugs. Consumers have no way of knowing how much monacolin K is actually present in RYR products.
RYR has been associated with congenital malformations in animal studies and should not be used during pregnancy. RYR can be contaminated with citrinin, which has been shown to cause kidney failure in animals and genetic damage in human cells. Side effects include abdominal pain, heartburn, flatulence, headache and dizziness. The risk of liver damage may be increased by combining RYR with other substances with hepatotoxic potential, including alcohol and acetaminophen. Because of concerns for both safety and efficacy, RYR supplements should not be used to manage cholesterol problems.
Flaxseed– A recent review of the scientific research on flaxseed found modest improvements in LDL cholesterol using 40-50 grams of ground flaxseed daily. No research to date has demonstrated benefit from flaxseed oil.
Though flaxseed and flaxseed oil supplements are generally well tolerated, they can cause bloating, flatulence, abdominal pain, diarrhea, constipation, heartburn, nausea and increased risk of bleeding. These are all more likely at doses greater than 45 grams daily. Allergic reactions have been reported. Raw or unripe flaxseed is considered potentially unsafe, as is use during pregnancy.
Due to its fiber content, flaxseed should be taken with plenty of water to avoid worsening constipation or causing intestinal blockage. Flaxseed may lower blood sugar and should be used with caution by those taking drugs for diabetes. Flaxseed’s mild estrogenic effects could interfere with the effectiveness of birth control pills and menopausal hormone replacement as well as complicating hormone sensitive conditions such as breast, uterine and ovarian cancers, endometriosis and uterine fibroids.
Flaxseed should not be taken at the same time as oral medications or dietary supplements, since the fiber in flaxseed may lower the body’s ability to absorb these products. Most nutrition experts suggest using ground flaxseed since whole seeds can pass through the digestive system undigested.
Garlic– Despite prior studies suggesting a cholesterol-lowering benefit for garlic, a study by the National Center for Complementary and Alternative Medicine found no benefit of fresh garlic, dried powdered garlic tablets or aged garlic extract tablets.
Garlic supplements appear to be safe for most adults but can cause side effects, including breath and body odor, heartburn, upset stomach, and rare allergic reactions. These side effects are more common with raw garlic. Garlic may increase the risk of bleeding, which could complicate surgery or dental procedures.
Medicinal amounts are considered unsafe during pregnancy due to an abortifacient effect. Caution is urged during breast feeding as garlic metabolites are detected in breast milk.
Consumers should know that there is wide variation in the amount of the purported active ingredient (allicin) in commercial garlic products. Some have been found to contain none at all.
Cut Stress, Help Your Cholesterol at WebMD.com
Preventive Medicine Research Institute (Ornish Program) at pmri.org
High Cholesterol and Complementary Health Practices at nccam.nih.gov
Could Your Sleep Habits Affect Your Cholesterol? at cholesterol.about.com
An Update on Statin Alternatives and Adjuncts at Medscape.com
About the Author-
Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine, Saybrook University’s School of Mind Body Medicine (San Francisco) and the Center for Mind Body Medicine (Washington, DC). He operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations. He can be reached through his website at www.mindbodystudio.org.