Note that while standard cholesterol/lipid testing is valuable, it only provides information about a small piece of a patient’s overall cardiovascular health. There are other markers for cardiovascular disease that are important and for which you should be tested, including lipoprotein a (a type of LDL cholesterol)…apolipoprotein b (also a subtype of LDL cholesterol)…homocysteine (an amino acid associated with heart disease)…very low-density lipoprotein or VLDL (a type of lipoprotein that transports lipids in the body)…iron (elevated levels of free iron may contribute to oxidation of LDL, which clogs arteries)…insulin…omega-3 fatty acid index (a measure of heart healthy omega-3 fatty acid levels in blood)…and C-reactive protein (a sign of inflammation). Check future issues of Bottom Line Natural Healing for more information about these cardiovascular disease markers and how to treat them naturally when they are out of balance.
If your cholesterol is mildly or moderately elevated (total cholesterol 200 mg/dL to 239 mg/dL…and/or LDL above 130 mg/dL), then try the diet and lifestyle changes (described below) for eight to 12 weeks. Then have your levels retested. If you don’t see at least a 10 percent reduction, add targeted nutritional supplements (also described below).
People who are unable to reduce their cholesterol levels through diet and exercise and/or who have family members with high cholesterol are likely to be genetically predisposed to the condition. Such people should not rely on lifestyle changes alone.
Better: They should combine the healthful practices described here with regular supplement use.
Important: There are times when I recommend statin therapy—immediately after a heart attack to reduce inflammation and when there is extreme elevation in total cholesterol (400 mg/dL or higher) and/or LDL cholesterol (210 mg/dL or higher), usually due to genetics.
My suggestions for improving cholesterol levels…
1. Reduce saturated fat in your diet to less than 7 percent of daily calories. Saturated fat is found mainly in beef, veal, pork and poultry (especially in dark meat and the skin of any meat). Saturated fat is plentiful in most dairy products, except nonfat yogurt, reduced-fat cheese and skimmed milk. Small amounts are found in coconut and palm oils, so consume these sparingly. To monitor your saturated fat intake, keep a daily record based on food label information.
Avoid products that contain trans fatty acids, which often are found in deep-fried foods, commercial bakery products, packaged snack foods, margarines (except those with cholesterol-reducing plant stanols or plant sterols), crackers and vegetable shortening. Avoid foods that “hide” trans fats by using the term “partially hydrogenated” on their labels and claiming 0 grams (g) of trans fat. Common offenders include baked goods, crackers and packaged mixes. Cardiovascular disease is linked to trans fat intake because this unhealthful fat raises levels of LDL cholesterol and harmful blood fats known as triglycerides, while lowering beneficial HDL cholesterol. Cook with organic olive or canola oil. Macadamia nut oil also is healthful.
2. Consume two weekly servings of foods rich in heart-healthy omega-3 fatty acids. Sources include some types of fish—anchovies, Atlantic herring, sardines, tilapia and wild or canned salmon. For a list of fish not contaminated with mercury or polychlorinated biphenyls (PCBs), check www.OceansAlive.org, the Web site of The Environmental Defense Fund, a nonprofit group dedicated to solving environmental problems.
3. Eat five to seven daily servings of fruits and vegetables. Produce contains antioxidants that prevent oxidation (cell damage from negatively charged molecules known as free radicals) of cholesterol, as well as fiber that helps lower cholesterol.
4. Consume foods that contain soluble fiber, such as beans, barley, oats, peas, apples, oranges and pears. Soluble fiber (the kind that dissolves in liquid) reduces the absorption of cholesterol from the intestines into the bloodstream. For example, a daily bowl of oatmeal can reduce total cholesterol by as much as 23 percent. Oatmeal also has been shown to curb LDL cholesterol levels without lowering beneficial HDL cholesterol.
5. Eat nuts, such as walnuts and almonds, which are rich in healthful monounsaturated fatty acids. Walnuts, macadamia nuts, pistachios, almonds, hazelnuts and pecans have been shown to reduce cholesterol levels. Eat a handful of walnuts or any of the nuts listed above daily.
6. Add ground flaxseed (up to one-quarter cup daily, taken in two doses) to protein shakes, cereal and/or salads. Flaxseed has been shown to reduce total and LDL cholesterol. Drink 10 ounces of water for every two tablespoons of flaxseed you consume, to prevent intestinal blockage.
7. Consume 20 g to 30 g of soy protein daily (in food or protein powder form). Some studies suggest that soy protein may lower cholesterol levels in some people with high cholesterol.
8. Reduce daily intake of simple sugars, such as those in crackers, cookies and soda. Found in abundance in processed packaged foods and many baked goods, they have been shown to decrease HDL cholesterol. By cutting back, you also reduce risk for elevated insulin levels, which lead to increased production of cholesterol by the liver.
9. Exercise regularly. Thirty minutes of exercise, such as brisk walking, swimming, biking or tennis, three to five times a week is effective for lowering elevated cholesterol.
10. Lose weight and body fat. Weight loss by people who are overweight reduces cholesterol levels and prevents insulin resistance, a blood sugar problem that can lead to high cholesterol.
11. Don’t smoke. Smokers have lower levels of HDL cholesterol and an increased risk for heart attacks.
12. Adopt stress-reduction techniques, such as deep breathing and biofeedback. Stress has been shown to elevate cholesterol in most individuals.
For some people, healthful dietary and exercise habits are not enough to overcome elevated cholesterol due to genetics (often the case when high cholesterol occurs in more than one member of the same family). Instead of turning to statins, I recommend first trying one of the nutritional supplements that are most effective for controlling cholesterol.
Before starting this protocol, ask your doctor to perform a baseline blood test to check cholesterol. If your results are not within 10 points of the normal levels, you may be at risk for cardiovascular disease.
When total cholesterol is above 400 mg/dL or LDL is above 200 mg/dL, statin drugs may be necessary. However, the vast majority of people can achieve their target levels using one of three “core” cholesterol-lowering supplements—red yeast rice extract, plant sterols and stanols or niacin.
Try one of the natural supplements described below for eight to 12 weeks, then repeat the blood test. If your cholesterol counts reach normal levels, you can lower the supplement dosage, provided that you continue the lifestyle changes I recommended above. If your cholesterol counts have not improved, switch to a different supplement for another eight to 12 weeks, then get retested. Once you’ve found the protocol that works for you, have your cholesterol levels checked annually to ensure that you’re staying in the normal range.
I generally start patients on red yeast rice extract, particularly if high cholesterol (hyperlipidemia) runs in the family. Taken in capsule form, it is an effective treatment for moderately elevated levels of total cholesterol (200 mg/dL to 240 mg/dL)…LDL (150 mg/dL to 190 mg/dL)…and/or triglycerides (160 mg/dL to 200 mg/dL). Studies show that red yeast rice extract significantly lowers these important markers for cardiovascular disease, reducing total cholesterol by 11 to 32 percent…LDL by up to 22 percent…and triglycerides by 12 to 19 percent.
Red yeast rice is a fermented rice product on which red yeast (Monascus purpureus) has been grown. A dietary staple in China and Japan, it is commonly used by Asian-Americans in the US as a natural food preservative for fish and meat. Red yeast rice extract contains an ingredient called monacolin K, which inhibits the action of an enzyme in the liver (HMG-CoA reductase) that is involved in the synthesis of cholesterol. Studies show that red yeast rice extract has an effect similar to that of statins, such as lovastatin, without causing side effects.
The amount of monacolin K in red yeast rice extract is quite small compared with that in lovastatin. Other ingredients in red yeast rice extract, such as additional monacolins, sterols and fatty acids, may contribute to its cholesterol-lowering properties.
From the studies: A variety of studies have shown red yeast rice extract lowers cholesterol, including a landmark double-blind, randomized, placebo-controlled study from the University of California at Los Angeles School of Medicine. This 12-week study involved 83 men and women, ages 34 to 78, with moderately high cholesterol levels. Participants were treated with 2,400 mg of red yeast rice extract or a placebo daily, and instructed to follow an eating plan similar to the American Heart Association Step 1 diet (30 percent of calories from fat, less than 10 percent of calories from saturated fat and less than 300 mg of daily cholesterol from food). Blood lipid levels were measured before the start of the study and again at weeks eight, nine, 11 and 12. Total cholesterol, LDL cholesterol and triglycerides were significantly reduced in the group supplementing with red yeast rice extract compared with the placebo group. There were no differences in HDL “good” cholesterol levels between the two groups. In the group taking red yeast rice extract, there were no side effects and no significant differences in liver enzymes (which can occur with statins) at the beginning and end of the study.
Dosage: The supplements used in the studies contained 10 mg to 13.5 mg of monacolins per day in doses of 1,200 mg to 2,400 mg of red yeast rice extract. I usually start patients at 1,200 mg of red yeast rice extract twice daily and retest their cholesterol levels after eight to 12 weeks. At that point, some patients are able to maintain lower cholesterol levels by taking 1,200 mg just once daily.
Safety: Red yeast rice extract may cause mild heartburn, dizziness and gas for a few days to a week. People who have an existing liver disorder, particularly hepatitis, should not use red yeast rice extract, because it may stress the liver. Pregnant and breast-feeding women should avoid red yeast rice extract, since its safety has not been studied in these groups. I also recommend taking 50 mg to 100 mg of coenzyme Q10 (CoQ10) daily, as red yeast rice extract may deplete this naturally occurring substance that helps produce energy in cells.
In the unlikely event that your cholesterol does not improve with red yeast rice extract, switch to plant sterols (components of plant cell membranes that resemble cholesterol) and stanols (derived from sterols). In 2000, the FDA authorized the use of product labels that make health claims related to plant sterol esters and stanol esters. It now can be said officially what good holistic doctors have been saying for years—that foods or supplements containing these substances reduce the risk for coronary heart disease. Plant sterols and stanols are present in small quantities in many fruits, vegetables, nuts, seeds, cereals, legumes, vegetable oils and other plant sources. Foods that may qualify for claims based on plant stanol ester content include spreads such as Take Control and Benecol…some salad dressings…and certain snack bars. For example, if a person is accustomed to using one to two tablespoons of margarine daily, switching to Take Control or Benecol may reduce LDL levels by up to 10 percent. Scientific studies show that 1.3 g per day of dietary plant sterol esters or 3.4 g per day of plant stanol esters in the diet are needed to produce a significant cholesterol-lowering effect.
From the studies: Supplements of the plant sterol beta-sitosterol may reduce cholesterol absorption by the small bowel by 14 percent. It has little effect on HDL cholesterol. I recommend taking beta-sitosterol by itself or in a plant sterol complex with other sterols, such as campesterol and stigmasterol.
Dosage: In addition to using plant stanols, such as those described earlier, take a daily supplement that contains 2 g to 3 g of plant sterols (or individual beta-sitosterol) in divided doses with food.
Safety: The FDA classifies plant sterols and stanols as “generally recognized as safe” (GRAS) food-grade substances. Studies show no harmful effects from plant sterols or stanols. However, some research indicates that levels of beta-carotene (a nutrient that can be converted into vitamin A) in the body are slightly reduced with the use of sterols or stanols. If you take one of these supplements, eat foods rich in carotenoids (carrots, tomatoes and melons) and take a multivitamin that contains beta-carotene.
Niacin (also known as nicotinic acid, or vitamin B-3) not only reduces harmful LDL and triglycerides but also increases protective HDL. I recommend niacin for people whose HDL is below 40 mg/dL, particularly if they have a history of heart disease. Niacin may reduce production of proteins that transport cholesterol and triglycerides in the blood.
From the studies: A variety of studies show that niacin can reduce LDL cholesterol by 5 to 25 percent…increase HDL cholesterol by 15 to 35 percent…and decrease triglycerides by 20 to 50 percent.
Dosage: 1,500 mg to 3,000 mg daily.
Safety: Niacin can cause stomach upset, gas, bloating, vomiting, diarrhea and nausea, but these side effects may be reduced if the supplement is taken with food. Some people experience a temporary warmth and/or flushing of the neck, ears and face, along with itching, tingling and headache. To prevent “niacin flush,” some doctors suggest taking aspirin or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin) or naproxen (Aleve), 60 minutes before taking niacin. However, in my opinion, it is better to use an over-the-counter flush-free niacin known as inositol hexaniacinate or other nonflush forms. Pregnant and nursing women should avoid niacin supplements. Niaspan, a prescription time-released form of niacin, may slow blood clotting and should be discontinued one week before surgery. It may elevate liver enzymes, so use should be monitored by a doctor.
Source: Mark A. Stengler, NMD, is a naturopathic medical doctor and leading authority on the practice of alternative and integrated medicine. He is editor of Bottom Line’s Natural Healing newsletter, author of The Natural Physician’s Healing Therapies (Bottom Line Books), director of the La Jolla Whole Health Clinic in La Jolla, California and adjunct clinical professor at the National College of Natural Medicine in Portland, Oregon. To learn more about his work, visit www.DrStengler.com and www.LaJollaWholeHealth.com.