Heart and blood vessel (cardiovascular) disease is the No. 1 killer of Americans, and study after study points to elevated cholesterol as a major contributor to the problem. Some authorities have indicated that for every one percentage point reduction of cholesterol levels, the risk for cardiovascular disease is reduced by two points.
The current conventional medical treatment is cholesterol-lowering prescription drugs along with low saturated fat diets. Although these drugs do lower serum cholesterol, they also have potential side effects. Consequently, it makes sense to work with a health care professional in trying one or more of the following relatively risk-free dietary supplement approaches before taking drugs.
One of the first possible nutritional supplements is policosanol, a mixture of long-chain alcohols (waxes), including octacosanol, extracted from natural sources. Test tube and animal studies indicate that policosanol is capable of inhibiting cholesterol production by the liver.1,2
Extensive preliminary and double-blind research in Cuba and other Latin American-countries has demonstrated that taking 10 mg/d to 20 mg/d of policosanol extracted from sugar cane results in significant changes in blood cholesterol levels, including total cholesterol (17 to 21 percent lower on average), LDL cholesterol (21 to 29 percent lower), and HDL cholesterol (7 to 29 percent higher).3,4,5,6,7,8 Policosanol may also have some effect on lowering serum triglycerides. However, the studies have been inconsistent, ranging from no effect up to as much as a 19-percent reduction.9,10,11
Another beneficial nutrient is chromium. Chromium supplementation has reduced total cholesterol,12 LDL cholesterol13 and increased HDL cholesterol14 in double blind and other controlled trials. However, not all trials have found an effect.15 One double blind trial found high amounts of chromium (500 mcg/d) in combination with daily exercise was highly effective, producing nearly a 20-percent decrease in total cholesterol levels in just 13 weeks.16 Not surprisingly, people with higher blood levels of chromium appear to be at lower risk for heart disease.17
High amounts (several grams per day) of niacin lower cholesterol, an effect recognized in the approval of niacin as a prescription medication for high cholesterol.18 At such intakes, however, acute symptoms (flushing, headache, stomach ache) may be severe. In an attempt to avoid the side effects of niacin, alternative health practitioners increasingly use inositol hexaniacinate, recommending 500 mg to 1,000 mg, taken three times per day, instead of niacin.19,20
From the botanical kingdom comes guggul, which is an approved treatment for elevated cholesterol in India and has been a mainstay of the Ayurvedic approach to preventing atherosclerosis. One double blind trial studying the effects of guggul reported serum cholesterol dropped by 17.5 percent.21 In another double blind trial comparing guggul to the drug clofibrate, the average fall in serum cholesterol was slightly greater in the guggul group; moreover, HDL cholesterol rose in 60 percent of people responding to guggul, while clofibrate did not elevate HDL.22 A third double blind trial found significant changes in total and LDL cholesterol levels, but not in HDL.23
Another important herb is garlic for its significant lipid-lowering effects. Thirteen trials involving a total of 795 participants demonstrated a positive correlation between garlic supplementation and lipid-lowering effects. Six randomized, double-blind, placebocontrolled, as well as two double-blind, multi-center studies supported the use of garlic in treating elevated lipid conditions including hyperlipidemia and hypercholesterolemia.24 Two meta-analyses on the effect of garlic on total cholesterol found a statistically significant reduction in total cholesterol levels.25,26
Beta-sitosterol alone, and in combination with similar plant sterols, has been shown to reduce blood levels of cholesterol in preliminary27 and controlled28 trials. This effect may occur because beta-sitosterol blocks absorption of cholesterol.29 In studying the effects of 0.8, 1.6, and 3.2 g/d of plant sterols, one double blind trial found higher intake of sterols tended to result in greater reduction in cholesterol, although the differences between the effects of these three amounts were not statistically significant.30 In another controlled trial, supplementation with 1.7 g/d of phytosterols plus dietary changes led to a 24-percent drop in LDL (“bad”) cholesterol compared with only a 9-percent decrease in the diet-only part of the trial.31
Green tea
has also been shown to lower total cholesterol levels and improve people’s cholesterol profile, decreasing LDL cholesterol and increasing HDL cholesterol in most studies,32,33,34,35 but not all.36 It seems to be the naturally occurring catechin polyphenols of green tea, particularly epigallocatechin gallate (EGCG), that provide these benefits. The mechanism by which green tea works appears to be that EGCG inhibits the absorption of dietary cholesterol and promotes its fecal excretion. EGCG may also act as an antioxidant, inhibiting the oxidation of LDL cholesterol.While suggesting dietary supplements to consumers for addressing cardiovascular health, don’t forget to help them put the situation in context. It is possible to lower serum cholesterol levels by altering the diet. The recommended dietary alterations would include reducing fat intake to less than 30 percent of total calories, with saturated fat at less than 10 percent and cholesterol at less than 300 mg/d. If this strategy does not yield satisfactory results, saturated fat should be restricted to less than 7 percent and cholesterol to less than 200 mg/d. Furthermore, the carbohydrate content of the diet should be no more than 60 percent of total calories with protein no more than 20 percent.
Most people are aware that eating a diet with significant amounts of animal foods—which contain saturated fat and cholesterol—is linked to high serum cholesterol and heart disease. Grains and legumes can provide a quality source of both complex carbohydrates and protein. In fact, a largely low-fat, vegetarian diet may yield the best results.
Gene Bruno and Art Presser are on the administrative staff and faculty of Huntington College of Health Sciences (HCHS). HCHS is an accredited distance learning institution offering undergraduate and graduate degrees, as well as a diploma program in nutrition. To learn more, visit www.hchs.edu or call (800) 290-4226.
September 2005 Health Supplement Retailer
"Reducing Cholesterol Levels Naturally" References
1. Menendez R et al. "Cholesterol-lowering effect of policosanol on rabbits with hypercholesterolaemia induced by a wheat starch-casein diet." Br J Nutr. 77:923-32, 1997.
2. Gouni-Berthold I, Berthold HK. "Policosanol: clinical pharmacology and therapeutic significance of a new lipid-lowering agent." Am Heart J. 143:356-65, 2002.
3. Mirkin A et al. "Efficacy and tolerability of policosanol in hypercholesterolemic postmenopausal women." Int J Clin Pharmacol Res. 21:31-41, 2001.
4. Castano G et al. "Effects of policosanol in older patients with type II hypercholesterolemia and high coronary risk." J Gerontol A Biol Sci Med Sci. 56:M186-92, 2001.
5. Castano G et al. "Effects of policosanol 20 versus 40 mg/day in the treatment of patients with type II hypercholesterolemia: A 6-month double-blind study." Int J Clin Pharmacol Res. 21:43-57, 2001.
6. Castano G et al. "Efficacy and tolerability of policosanol in elderly patients with type II hypercholesterolemia: a 12-month study." Curr Ther Res. 56:819-23, 1995.
7. Castano G et al. "Effects of policosanol in hypertensive patients with type II hypercholesterolemia." Curr Ther Res. 57:691-5, 1996.
8. Mas R et al. "Effects of policosanol in patients with type II hypercholesterolemia and additional coronary risk factors." Clin Pharmacol Ther. 65:439-47, 1999.
9. Torres O et al. "Treatment of hypercholesterolemia in NIDDM with policosanol." Diabetes Care. 18:393-7, 1995
10. Canetti M et al. "A two-year study on the efficacy and tolerability of policosanol in patients with type II hyperlipoproteinaemia." Int J Clin Pharmacol Res. 15:159-65, 1995.
11. Pons P et al. "One-year efficacy and safety of policosanol in patients with type II hypercholesterolemia." Curr Ther Res. 55:1084-92, 1994
12. Anderson RA et al. "Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes." Diabetes. 46:1786-91, 1997.
13. Hermann J et al. "Effects of chromium or copper supplementation on plasma lipids, plasma glucose and serum insulin in adults over age fifty." J Nutr Elderly. 18:27-45, 1998.
14. Roeback JR et al. "Effects of chromium supplementation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers." Ann Intern Med. 115:917-24, 1991.
15. Uusitupa MI et al. "Chromium supplementation in impaired glucose tolerance of elderly: effects on blood glucose, plasma insulin, C-peptide and lipid levels." Br J Nutr. 68:209-16, 1992.
16. Boyd SG et al. "Combined dietary chromium picolinate supplementation and an exercise program leads to a reduction of serum cholesterol and insulin in college-aged subjects." J Nutr Biochem. 9:471-5, 1998.
17. Newman HA et al. "Serum chromium and angiographically determined coronary artery disease." Clin Chem. 541-4, 1978.
18. Guyton JR et al. "Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group." Arch Intern Med. 160:1177–84, 2000.
19. Head KA. "Inositol hexaniacinate: a safer alternative to niacin." Alt Med Rev. 1:176-84, 1996.
20. Murray M. "Lipid-lowering drugs vs. Inositol hexaniacinate." Am J Natural Med. 2:9-12, 1995.
21. Agarwal RC et al. "Clinical trial of gugulipid new hypolipidemic agent of plant origin in primary hyperlipidemia." Indian J Med Res. 84:626-34, 1986.
22. Nityanand S, Srivastava JS, Asthana OP. "Clinical trials with Gugulipid--a new hypolipidemic agent." J Assoc Phys India. 37:323-8, 1989.
23. Singh RB, Niaz MA, Ghosh S. "Hypolipidemic and antioxidant effects of Commiphora mukul as an adjunct to dietary therapy in patients with hypercholesterolemia." Cardiovasc Drugs Ther. 8:659-64, 1994.
24. Blumenthal M (ed) et al. The ABC Clinical Guide to Herbs. Austin, Texas: American Botanical Council. Page 161, 2003.
25. Silagy CA, Neil HA. "A meta-analysis of the effect of garlic on blood pressure." J Hypertens. 12, 4:463.8, 1994.
26. Warshafsky S, Kamer RS, Sivak S. "Effect of garlic on total serum cholesterol---a meta-analysis." Ann Intern Med. 119, 7 Pt 1:599-605, 1993.
27. Lees AM et al. "Plant sterols as cholesterol-lowering agents: Clinical trials in patients with hypercholesterolemia and studies of sterol balance." Atheroscler. 28:325-38, 1977.
28. Pelletier X et al. "A diet moderately enriched in phytosterols lowers plasma cholesterol concentrations in normocholesterolemic humans." Ann Nutr Metab. 39:291-5, 1995.
29. Grundy SM, Ahrens EH Jr, Davignon J. "The interaction of cholesterol absorption and cholesterol synthesis in man." J Lipid Res. 10:304-15, 1969.
30. Hendriks HF et al. "Spreads enriched with three different levels of vegetable oil sterols and the degree of cholesterol lowering in normocholesterolaemic and mildly hypercholesterolaemic subjects." Eur J Clin Nutr. 53:319-27, 1999.
31. Jones PJ et al. "Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men." Am J Clin Nutr. 69:1144-50, 1999. www.ajcn.org
32. Kono S et al. "Green tea consumption and serum lipid profiles: a cross-sectional study in Northern Kyushu, Japan." Prev Med. 21:526-31, 1992.
33. Yamaguchi Y et al. "Preventive effects of green tea extract on lipid abnormalities in serum, liver and aorta of mice fed an atherogenic diet." Nip Yak Zas. 97. 6:329-37, 1991.
34. Sagesaka-Mitane Y, Milwa M, Okada S. "Platelet aggregation inhibitors in hot water extract of green tea." Chem Pharm Bull. 38, 3:790-3, 1990.
35. Stensvold I et al. "Tea consumption. Relationship to cholesterol, blood pressure, and coronary and total mortality." Prev Med. 21:546-53, 1992.
36. Tsubono Y, Tsugane S. "Green tea intake in relation to serum lipid levels in middle-aged Japanese men and women." Ann Epidemiol. 7:280-4, 1997.