High Cholesterol


 What is High Cholesterol?

In some people, cholesterol levels in blood become too high. This is called high cholesterol or hyperlipidemia.
High levels of LDL cholesterol (so-called "bad" cholesterol) are considered a major risk factor for heart disease and stroke.
LDL cholesterol is thought to irritate the lining of blood vessels, stimulating atherosclerosis, commonly known as hardening of the arteries.
Although lowering LDL cholesterol and raising levels of HDL cholesterol ("good" cholesterol) has traditionally been the focus, factors related to free radical damage are drawing increased attention:
  • Lipoprotein A is a relative of LDL cholesterol. It's thought to be formed when there is free radical damage. Lipoprotein A may adhere to damaged blood vessels, eventually forming atherosclerotic plaques.
  • Oxidized cholesterol is found in large amounts in fried and processed foods. Studies have found that oxidized cholesterol may increase the amount of atherosclerotic deposits on blood vessel walls.
High cholesterol is usually treated based on total cholesterol, LDL cholesterol, and HDL cholesterol levels, plus the presence of additional risk factors for heart disease:

Supplements for High Cholesterol

A few tips on using natural products to lower cholesterol:
Talk with your doctor before starting any natural method to lower cholesterol.
Make your doctor knows what supplements you are taking.
Don't discontinue any medication to lower cholesterol. Speak with your doctor if you have questions about your medication.

1) Niacin (Vitamin B3)

Niacin, also called vitamin B3, is used to lower cholesterol. Specifically, it appears to lower LDL cholesterol and increase HDL cholesterol.
Well-designed studies have found that niacin lowers LDL cholesterol by approximately 10%, lowers triglycerides by 25%, and raises "good" HDL cholesterol by 15% to 30%. Niacin also appears to significantly lower levels for another risk factor for atherosclerosis, lipoprotein A.
Niacin is available in prescription form and as a dietary supplement. The American Heart Association cautions patients to only use the prescription form of niacin.
Because of side effects, niacin should not be used to lower cholesterol unless under the supervision of a qualified health practitioner.
Niacin can increase the effect of high blood pressure medication or cause nausea, indigestion, gas, diarrhea, gout, and worsen peptic ulcers, or trigger gout, liver inflammation, and high blood sugar.
The most common side effect of high-dose niacin is skin flushing or hot flashes, which is caused by widening of blood vessels. Most people only notice this when they initially start taking niacin. The flushing may be lessened by taking niacin with meals.
Although high doses of niacin showed promise in combination with drugs to lower cholesterol (called "statins"), there are concerns that combining them could result in a potentially fatal condition called rhabdomyolysis. They shouldn't be combined unless under the close supervision of a physician.

2) Artichoke Leaf

There is some research suggesting that artichoke leaf extract (Cynara scolymnus) may help to lower cholesterol.
Artichoke leaf extract may work by limiting the synthesis of cholesterol in the body.
Artichokes also contain a compound called cynarin, believed to increase bile production in the liver and speed the flow of bile from the gallbladder, both of which may increase cholesterol excretion.
A double-blind, placebo-controlled German study found that 1,800 mg of artichoke extract per day for six weeks significantly lowered total cholesterol by 18.5% compared to 8.6% in the placebo group and lowered LDL cholesterol by 22.9% compared with 6% in the placebo group. The ratio of LDL to HDL decreased by 20% in the artichoke group compared with 7% in the placebo group. There were no adverse effects associated with artichoke use.
A meta-analysis looked at randomized controlled trials for artichoke extract for high cholesterol. Two trials involving a total of 167 people met the quality criteria. One trial found artichoke significantly reduced total cholesterol after 42 days of treatment. The other study found artichoke significantly reduced total cholesterol in a subgroup of patients with total cholesterol levels of more than 230 mg/dl.
Adverse events were mild, transient and infrequent. Larger clinical trials over longer periods are needed. Read more about artichoke

3) Soluble Fiber

Soluble fiber appears to reduce LDL cholesterol by reducing cholesterol absorption in the intestines. Soluble fiber binds with cholesterol so that it is excreted.

Soluble fiber can be found as a dietary supplement, such as psyllium powder, or in foods such as:
  • Oats, barley, rye
  • Legumes (peas, beans)
    Some fruits such as apples, prunes, and berries
  • Some vegetables, such as carrots, brussel sprouts, broccoli, yams
Five to 10 grams a day of soluble fiber has been found to decrease LDL cholesterol by approximately 5%.
The FDA allows soluble fiber products to indicate on the label that they are "heart-healthy".

4) Plant Sterols and Stanols

Plant stanols and sterols (such as beta-sitosterol and sitostanol) are naturally-occuring substances found in certain plants. Stanols are also found as dietary supplements or are added to margarine, orange juice, and dressings.
Research suggests that plant stanols and sterols may help to lower cholesterol. They are similar in structure to cholesterol and may help block the absorption of cholesterol from the intestines.
Studies have found that stanols significantly reduced total cholesterol and LDL cholesterol, but had no significant effect on HDL cholesterol or triglycerides.
Stanols and sterols appear to enhance the effects of other methods to lower cholesterol. In studies, people taking the statin drugs to lower cholesterol had an additional improvement in their cholesterol levels with stanols/sterols.

Other Supplements

Sources:
Alder R, Lookinland S, Berry JA, Williams M. A systematic review of the effectiveness of garlic as an anti-hyperlipidemic agent. J Am Acad Nurse Pract. 15.3 (2003): 120-129. 

Elam MB, Hunninghake DB, Davis KB, et al. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients With diabetes and peripheral arterial disease. The ADMIT Study: a randomized trial. JAMA. 284 (2000): 1263-1270. 

Guyton JR, Goldberg AC, Kreisberg RA, et al. Effectiveness of once-nightly dosing of extended-release niacin alone and in combination for hypercholesterolemia. Am J Cardiol. 82 (1998): 737-743. 

Illingworth DR, Stein EA, Mitchel YB, et al. Comparative effects of lovastatin and niacin in primary hypercholesterolemia. A prospective trial. Arch Intern Med. 154 (1994): 1586-1595. 

Katan MB, Grundy SM, Jones P, et al. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc. 78 (2003): 965-980. 

Lal SM, Hewett JE, Petroski GF, et al. Effects of nicotinic acid and lovastatin in renal transplant patients: a prospective, randomized, open-label crossover trial. Am J Kidney Dis. 25 (1995): 616-622. 

Morgan JM, Capuzzi DM, Baksh RI, Intenzo C, Carey CM, Reese D, Walker K. Effects of extended-release niacin on lipoprotein subclass distribution. Am J Cardiol. 91.12 (2003):1432-6. 

Morgan JM, Capuzzi DM, Guyton JR, et al. Treatment effect of Niaspan, a controlled-release niacin, in patients with hypercholesterolemia: a placebo-controlled trial. J Cardiovasc Pharmacol Ther. 1 (1996):195-202. 

Nies LK, Cymbala AA, Kasten SL, Lamprecht DG, Olson KL. Complementary and alternative therapies for the management of dyslipidemia. Ann Pharmacother. 40.11 (2006): 1984-1992. 

Petrowicz O, Gebhardt R, Donner M, et al. Effects of artichoke leaf extract (ALE) on lipoprotein metabolism in vitro and in vivo. Atherosclerosis. 129 (1997): 147.

Pittler MH, Thompson CO, Ernst E. Artichoke leaf extract for treating hypercholesterolaemia. Cochrane Database Syst Rev. 3 (2002): CD003335. 

Reynolds K, Chin A, Lees KA, Nguyen A, Bujnowski D, He J. A meta-analysis of the effect of soy protein supplementation on serum lipids. Am J Cardiol. 98.5 (2006): 633-640. 

Vega GL, Grundy SM. Lipoprotein responses to treatment with lovastatin, gemfibrozil, and nicotinic acid in normolipidemic patients with hypoalphalipoproteinemia. Arch Intern Med. 154 (1994): 73-82. 

Tammi A, Ronnemaa T, Gylling H, et al. Plant stanol ester margarine lowers serum total and low-density lipoprotein cholesterol concentrations of healthy children: the STRIP project. Special Turku Coronary Risk Factors Intervention Project. J Pediatr. 136 (2000): 503-510. 

Vanstone CA, Raeini-Sarjaz M, Parsons WE, et al. Unesterified plant sterols and stanols lower LDL-cholesterol concentrations equivalently in hypercholesterolemic persons. Am J Clin Nutr. 76 (2002): 1272-1278.
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