Another reason to work with a provider (like a naturopathic physician) that sort of came up yesterday, but will come up even more so today, is this: garlic is not garlic is not garlic. What do I mean by this? I mean that quality and potency of supplements can vary considerably, not to mention that preparation methods of various supplements dictate their effects. As a result, it's important to work with a practitioner who has done his or her homework regarding supplements.
OK, and now on to the meat of the article. (Here’s that cholesterol labs cheat sheet in case you need it)
Garlic – Why not start with garlic, having mentioned it so recently? Garlic has long been promoted as a cholesterol-lowering treatment, but the jury is still out on whether or not it’s effective. Some studies have shown significant cholesterol-lowering effect from certain garlic preparations, (1, 2, 3, 4) and at least one has shown that a preparation of garlic slows coronary artery disease. Other studies and meta-analyses (analyses which collect data from multiple separate studies) have shown no effect on cholesterol (1, 2, 3). As I said earlier, the jury is still out on garlic. One of the confounding issues in this discussion is the fact that there are a wide variety of garlic preparations being used in these studies, some of which appear to work, others of which appear not to do so – thus when taken all together, the data is inconclusive. Garlic still deserves an important place on your table as a ‘functional food’, but don’t rely on it exclusively to lower your cholesterol.
Niacin – Niacin has been used to lower cholesterol since at least the 1950’s, both by mainstream doctors as well as integrative ones. Its true claim to fame is that it has been shown to raise HDL significantly, an effect that statin drugs are not capable of producing. Niacin comes in a variety of forms – in the form of nicotinic acid, its ability to improve blood levels of total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides is formidable to say the least. A therapeutic dose of niacin can reduce LDL by as much as 22%, total cholesterol by as much as 16%, triglycerides by as much as 44%, all while boosting HDL by as much as 35%. But as with many good things in the world, there is a down side, namely the ‘niacin flush’. Doses of niacin high enough to have therapeutic effect inevitably cause flushing of the skin, accompanied by intense itching. On the plus side, many people are able to adapt to the sensation, or are able to time their doses such that they don’t interfere with daily living.
Niacin has lately received a lot of attention from the conventional medical community for a few reasons. One is the development of a prescription form of niacin (Niaspan) with a fairly low incidence of flushing side effects. Second is an increased interest from cardiologists in being able to increase HDL cholesterol because of HDL’s protective effect. Prescription niacin has been shown to reduce LDL cholesterol both alone and in concert with statin medications, though only niacin has the added benefit of raising HDL. At the beginning of the article, I recommended working with a healthcare provider when addressing cholesterol. This is especially important with niacin – it’s effective, but don’t try this at home folks. Make sure you have a doctor on board. And of course, the recently-developed prescription niacin (Niaspan) is only available by prescription.
Red Yeast Rice – Last but not least, red yeast rice. I’m often asked what red yeast rice is made from – red yeast rice is rice that has been fermented with the Monascus purpureus fungus for use in traditional Chinese foods and medicine. More recently, however, it was discovered that this fermented rice contained naturally occurring statins, a class of medication used to lower both total cholesterol and LDL cholesterol. Since this discovery, red yeast rice has gained popularity as a treatment for lowering cholesterol levels, but it’s not been without controversy. Because red yeast rice contains a compound, monacolin K, which is identical to lovastatin, there was an effort by the FDA in the late 1990s to ban red yeast rice in the United States. Most companies voluntarily withdrew the product from store shelves.
Since then, however, red yeast rice has begun reappearing on the market as a dietary supplement. In some cases, red yeast rice is now being embraced by conventional medical doctors, who are now recommending it to a newly defined class of ‘statin-intolerant’ patients, patients with high cholesterol who were started on statin medications, but were unable to follow a full course of medications because they suffered side effects. Recent studies have shown that certain red yeast rice preparations have significant cholesterol-lowering effects, in some cases comparable to statin medications, and are more easily tolerated by patients, even those who were previously unable to tolerate the side effects of statin medications (1, 2). Additionally, data has recently shown that red yeast rice extracts prevent serious cardiovascular events comparably to statins. The quality of commercial preparations of red yeast rice remains mixed, so it’s important to work with a professional who has done his or her homework in finding a high quality product. The take home message is that certain red yeast rice products are as effective as statins in lowering cholesterol and preventing disease, though this shouldn’t be a surprise, as red yeast rice contains naturally-occuring statins.
I hope you’ve enjoyed my review of supplements and cholesterol. As I said at the beginning of the article, lowering your cholesterol isn’t something that you should do alone – work with a practitioner. However, being equipped with information is important to getting the best outcome. As I said in last week’s entry, sometimes medication is the best route to take, but never is it the one and only answer. Through diet and exercise, as well as the use of some supplements, many people can limit their need for or dose of medications.