Lowering Cholesterol: What Works and What Doesn’t (Part 1)

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Is your LDL (or “bad”) cholesterol above 100 mg/dl? Are you taking medicine to lower it? Have you thought about taking a cholesterol-lowering supplement instead?

No, this isn’t an infomercial. The point of this week’s blog entry is to take a look at the world of cholesterol-lowering supplements.

Why? Well, if you take medicine for your cholesterol, chances are you’re taking a statin—for example, Lipitor (atorvastatin), Zocor (simvastatin), or Crestor (rosuvastatin). Statins are powerful medicines that can definitely do the job, but they have side effects (as do all medicines). Some people don’t like taking these drugs, or can’t tolerate them, and have sought out alternative, more “natural” ways to lower cholesterol. Below I’ll discuss four popular supplements that claim to lower cholesterol levels.

Policosanol: Policosanol is a natural, waxy substance that is manufactured in Cuba from sugar cane. However, because of the United States’ trade embargo against Cuba, it’s usually made from beeswax in the U.S. Policosanol has been marketed as a cholesterol-lowering supplement, and more than 80 studies (done mostly by a single research group in Cuba) claim that it’s just as effective as statins. However, a multicenter, double-blind, randomized trial with 143 people who had hyperlipidemia (high blood lipid levels) failed to show that sugar-cane–derived policosanol lowered LDL levels to any significant extent. This supplement can interfere with blood-clotting drugs, can increase the side effects of medicine for Parkinson disease, and can also cause indigestion, skin rash, headaches, and weight loss. Rating: Not recommended.

Garlic: For many years, garlic has been believed to lower cholesterol and fight heart disease, and garlic supplements have sprung onto the market as a result. However, studies with both animals and humans were poorly designed. A recent study published in the Archives of Internal Medicine involving 170 people with moderately high LDL cholesterol levels who were given either raw garlic, powdered garlic, aged garlic extract, or a placebo showed no form of garlic to have significant effects on LDL levels. The researchers admit that garlic may help lower LDL in people with higher LDL levels. And at least there are no harmful side effects from eating garlic (other than bad breath). Garlic supplements could potentially increase bleeding, however. Rating: Don’t count on it. Save garlic for cooking or for warding off vampires.

Guggulipid:This strange-sounding supplement, also known as guggul, is derived from the myrrh tree and has been used in traditional Ayurvedic medicine for centuries. Guggulipid contains substances called guggulsterones, which can block the synthesis of cholesterol in the liver. Although guggulipid is widely used in Asia for lowering high cholesterol levels, recent studies, both in the U.S. and in India, have found that this supplement actually increased LDL, total cholesterol, and triglyceride levels in the study participants. (However, it’s important to note that in the studies done in the U.S., participants were not following a cholesterol-lowering diet.) Possible side effects include nausea, hiccups, headache, and altered thyroid function. Rating: Skip this one.

Red yeast rice: Red yeast rice is made by fermenting a type of red yeast over rice. It’s used in China both as medicine and to color and flavor foods such as Peking duck, fish sauce, and rice wine. Interestingly, red yeast rice contains substances called monacolins, which inhibit an enzyme called HMG-CoA reductase. This enzyme is responsible for making cholesterol in the body. Statin drugs work the same way (they’re known as HMG-CoA reductase inhibitors, by the way). The U.S. Food and Drug Administration classifies red yeast rice as a dietary supplement, although many believe it should be considered a prescription drug. Does it lower cholesterol levels? Yes. Should you take it? Not without your doctor’s supervision. Red yeast rice can cause the same side effects as statins, such as muscle pain and damage, and shouldn’t be used in people with liver or kidney disease. Other side effects include headache, stomach upset, and dizziness. Rating: Use only under medical supervision.

Next week: more on “natural” ways to lower cholesterol.

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