Mayo Clinic recommendations: cholesterol-lowering supplements

The Mayo Clinic has a post, updated in 2012, on the topic of “Cholesterol-lowering supplements: Lower your numbers without prescription medication.” As always, we advise you to check with your healthcare provider before starting to use any of these for cholesterol management.

Most of these suggestions have been in the New York Buyers’ Club repertory for quite a while, but we are happy to repeat them here:

Fish oil (omega-3 fatty acids): can lower triglycerides

Green tea: some research on its cholesterol-lowering capacity; epidemiologic evidence suggests that green tea may lower stroke and cardiovascular disease risk. There are several choices for green tea supplements: see Green Tea; Green Tea Decaffeinated; and Green Tea Organic.

Plant sterols: see Cardio Edge for a supplement featuring plant sterols in a formula designed to support healthy cholesterol levels

Garlic extracts: contact NYBC for information on allicin, a garlic extract that has been studied for cardiovascular health

The Mayo Clinic guide also mentions grains, including oat bran and flaxseed, which can lower cholesterol.

Last, the guide discusses red yeast rice, a supplement that can lower LDL cholesterol. Note the caution that some forms of red yeast rice may contain a naturally occurring form of the prescription medication lovastatin. Lovastatin in the supplement may present some dangers to the user, because there is no way to know the quantity or quality of this prescription medication equivalent. For that reason, it is especially important to consult with your healthcare provider and monitor your usage of this supplement.

See the Mayo Clinic guide at

Mayo Clinic: Cholesterol-lowering supplements: Lower your numbers without prescription medication

New FDA warnings on statins; NYBC reviews supplements to support cardiovascular health

In February 2012 the FDA added new safety warnings about statins, the cholesterol-lowering medications that are among the most widely prescribed drugs in the world. The side effects cited by the FDA include memory loss, muscle pain (myopathy), and now a significant diabetes risk as well. Reports of memory loss, confusion, and forgetfulness were found in all types of patients taking statins, according to the new warnings.

In addition, a 2011 review in the Cleveland Clinic Journal of Medicine concluded that statin-related muscle pain was much more common than previously reported. (The main reason: clinical trials of statins often eliminated patients more likely to develop muscle pain as a side effect of the medication.) The same article estimated that muscle pain as a side effect may help explain why up to 25% of adults stop taking statins within six months, and up to 60% stop taking them within two years.

There is good evidence that statins can be valuable in preventing heart disease, and there is widespread consensus that they remain a crucial option for many dealing with cardiovascular disease and risk. However, it’s also more evident than ever that statin side effects are significant. And given the side effects, there is some disagreement among doctors about what cholesterol levels should call for treatment with statins, and what levels can better be dealt with through changes in diet or exercise habits.

It’s a complex subject and of course involves many individual factors including age, family history and blood pressure, so, as you’d expect, NYBC advocates that everyone make decisions about how best to manage cardiovascular risk and disease in consultation with their healthcare provider.

Given the new FDA warnings about statins, NYBC also believes that it’s more important than ever for people to be aware of the potential of dietary supplements in supporting cardiovascular health. Here are some of the supplements we often recommend for consideration:

–Plant products called sterols have been shown to inhibit cholesterol. See, for example, Douglas Labs’ Cardio-Edge.

Fish oil (omega-3 fatty acids). Research has found a strong effect on lowering triglycerides, one measure associated with cardiovascular risk. Recommended to support cardiovascular health by the American Heart Association.

Flaxseed: 40-50 grams per day can have a substantial impact on cholesterol.

Pomegranate concentrate. Needs more study, though recent research found that diabetic patients taking pomegranate concentrate were able to lower their cholesterol significantly.

Finally, if you are taking statins, consider supplementing to lessen the risk of certain side effects. A 2011 research report suggested that Vitamin D deficiency might contribute to muscle pain caused as a side effect of statins, and that supplementing with the sunshine vitamin could reverse that side effect. (Reference: Glueck, C J et al. Curr Med Res Opin. (2011 Sep). “Vitamin D deficiency, myositis-myalgia, and reversible statin intolerance”) Also, a 2007 pilot study suggested that the supplement CoQ10, used to support cardiovascular health in a variety of contexts, could diminish statin-related myopathy and improve a person’s ability to continue normal daily activities. (Reference: Caso, Giuseppe. Am J Cardiol. 2007 May 15. “Effect of coenzyme q10 on myopathic symptoms in patients treated with statins”)

For more on Vitamin D and CoQ10 see the NYBC entries:

CoQ10

Vitamin D3

American Psychiatric Association Task Force on supplements for major depression

The American Psychiatric Association recently commissioned a task force to study the state of “alternative and complementary” therapies for major depression. This follows widespread interest from the scientific community and a considerable accumulation of research to date. The Task Force reported in a 2010 article that focused special attention on these supplements: omega-3 fatty acids (commonly taken as fish oil supplements), St John’s Wort (the botanical Hypericum), Folic acid (a synthetic form of folate, a B vitamin found in leafy green vegetables, citrus fruits, beans, and fortified breads and cereals), and S-adenosyl-L-methionine (SAMe).

We welcome this acknowledgment by the mainstream US medical establishment that supplements have a role to play in treating a disabling condition that affects millions of people per year, and is not always easily treatable. (Only one-third of adult patients newly diagnosed with major depression achieve complete symptom relief when taking one antidepressant, so there is often an extended search for the right combination of drug and other treatment needed for remission.)

Below is a brief recap of some of the latest thinking on these key supplements for depression. Of course NYBC recommends that you use these supplements in consultation with your healthcare provider. More information on these supplements can be found by following the links to the NYBC website.

Omega-3 Fatty Acids (fish oil) recommended as a stand-alone treatment for people concerned about side effects, such as those with multiple medical conditions. It has also been combined with other antidepressants as an adjunct therapy. Fish oil’s blood-thinning property makes it problematic for doses above 3g/day. Added benefit: fish oil supports cardiovascular health.

St. John’s Wort is an herb widely studied and used, especially in Europe, for mild to moderate depression, though it hasn’t proved effective for major depression. Those taking protease inhibitors or certain other drugs should avoid St. John’s Wort because it interferes with their action.

SAMe (S-adenosyl-l-methionine). Supplementing with SAMe increases concentrations of neurotransmitters that influence mood, and multiple studies have confirmed its antidepressant effect. A dose of 400-800mg/day has been studied for mild-to-moderate depression, and 800-1600mg/day for moderate-to-severe. Studied as a stand-alone treatment, or as an adjunct treatment. Added benefit: SAMe supports joint health and liver function.

When combined with an antidepressant, folic acid supplements can improve symptoms, particularly in women. However, folic acid supplements are not a stand-alone treatment for depression. The safe upper limit is 1,000 mcg per day.

Omega-3 fatty acids improve heart function

A study published in Jan, 2011 in the Journal of the American College of Cardiology found that omega-3 fatty acid (fish oil) supplementation improved heart function, exercise function, and peak oxygen uptake in heart failure patients on standard therapies. This study, led by Mihai Gheorghiade, MD, of Northwestern University in Chicago, added detail to a large, long-term investigation demonstrating that omega-3 fatty acids reduce mortality and cardiovascular hospitalizations in patients with chronic heart failure.

The study randomly assigned 133 heart failure patients to receive either a placebo or the omega-3 fatty acids. (Active treatment consisted of 1-gram capsules containing about 850mg of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Patients took five capsules daily for the first month, followed by two capsules daily for the rest of the study). After a year, the patients who took the omega-3 fatty acids had a significant improvement in left ventricular ejection fraction (a measure of heart function), whereas those on placebo showed a decline in this measure. Furthermore, while 30% of the patients on placebo required cardiovascular hospitalization during the year, only 6% of those taking the omega-3 supplements were hospitalized due to cardiovascular condition.

In addition to the high-quality Pro Omega Nordic Naturals fish oils supplements, NYBC now stocks Jarrow’s EPA-DHA Balance, which provides another convenient way to match the omega-3 fatty acid supplementation levels used in research studies:

EPA-DHA Balance (Jarrow)

Pro Omega Nordic Natural (1000mg/60 softgels)

Pro Omega-Nordic Naturals (1000mg/180 softgels)

Can this omega-3 fatty acid make you think better?

We don’t often put up such a “believe it or not” / “popular science” sounding headline on this Blog, but here’s a rather neatly done scientific study from 2010 that seems to confirm those old sayings about fish being “brain food.”

University of Pittsburgh researchers recently reported on an interesting study about the connection between omega-3 fatty acids (such as those found in fish oil) and cognitive function. The research study followed 280 healthy adults, aged 35-54, and looked at how they performed on tests of nonverbal reasoning and working memory. Researchers found that those who registered higher blood levels of the omega-3 fatty acid docosahexaenonic acid (DHA) performed significantly better on these tests. They did not find any association between two other omega-3 fatty acids, a-linolenic acid (ALA) and eicosapentaenoic acid (EPA), and mental performance measures. They conclude that “DHA is associated with major aspects of cognitive performance in nonpatient adults [up to 55 years old]. These findings suggest that DHA is related to brain health throughout the lifespan…”

Our comment: in recent years there have been several studies relating dietary intake of fish or omega-3 fatty acids and better early brain development and lowered risk of cognitive disorders in late life. (Also , higher fish oil/omega-3 fatty acids intake has been linked to lower rates of depression.) This 2010 study adds evidence that it is specifically DHA that delivers cognitive benefit such as improved reasoning and working memory.

Reference: Matthew Muldoon et al, Serum Phospholipid Docosahexaenonic Acid Is Associated with Cognitive Functioning during Middle Adulthood. The Journal of Nutrition – J. Nutr. 140: 848–853, 2010

NYBC stocks this supplement, which, as the tradename suggests, focuses on providing a substantial dose of DHA, the omega-3 fatty acid found to be effective in the Univ. of Pittsburgh study:

DHA Max (Jarrow)

Fish oil linked to lower breast cancer rate

According to a large survey study conducted by researchers at the Fred Hutchinson Cancer Research Center in Seattle, Washington, taking fish oil supplements may have a protective effect against breast cancer for postmenopausal women.

The study used data from a very large survey of women in western Washington, who filled out questionnaires between 2000 and 2002 about their diet, supplement intake, exercise routines and general health. The analysis included more than 35,000 postmenopausal women aged 50 to 76 who didn’t have breast cancer at the start of the survey. By the end of 2007, 880 of these women had developed breast cancer.

Women who reported taking fish oil from the start of the study were about half as likely to develop ductal carcinoma of the breast, the most common form of breast cancer, during the follow-up years. Women taking fish oil showed no reduced risk of the less-common lobular breast cancer.

How fish oil might prevent cancer remains unknown, but inflammation — linked to cancer by many researchers — may play a crucial role. Fish oil contains omega-3 fatty acids, which inhibit a major inflammatory molecule in the body, a compound called nuclear factor kappa-B.

The study was published in the July, 2010 issue of the journal Cancer Epidemiology, Biomarkers and Prevention.

NYBC stocks fish oil supplements as:

DHA Max (Jarrow)

Pro Omega Nordic Natural (1000mg/60 softgels)

Pro Omega-Nordic Naturals (1000mg/180 softgels)

Supplements for the Brain (and Nerves)

“For Your Peace of Mind…”

Recent research on supplements for memory, cognition and other neurological functions
You may remember (we hope you remember!) the Scarecrow’s petition to the Wizard of Oz for a brain. Be advised–we at NYBC do not stock new brains, so don’t come to us with that request.

However, we do follow the sometimes startling new research on supplements, brain function and related neurological issues. In this department, there’s special cause for concern for people with HIV. According to a Canadian study released in 2010, in a group of 1615 people receiving treatment for HIV during the decade 1998-2008, one fourth had neurological problems, including memory loss, cognitive impairment and peripheral neuropathy. Of course being worried about brain function–and neurological function in general–is not unique to people with HIV. As people age, they are more likely to experience memory loss or forms of dementia such as Alzheimer’s. And the nerve condition called peripheral neuropathy (pain, tingling in the feet and hands) is found not just in people with HIV, but also among the growing population with Type 2 diabetes.

Now, on to what we see as some of the most valuable recent findings about supplements and brain or neurological function:

B vitamins can be considered a foundation because they are needed in so many processes essential to the brain’s operation, from energy supply and healthy blood flow, to the formation of neurotransmitters (=chemical messengers of neurologic information from one cell to another). Furthermore, there is evidence that several groups of people, including those over 60 and those with HIV, have a greater risk for Vitamin B deficiencies. So supplementing with a B complex vitamin is a sensible start to cognitive health. More specifically, there is good research linking deficiency of vitamins B12 and B6 to mood disorders like depression—and depression earlier in life is associated with higher risk of dementia in later life. Last, there is also some evidence that B vitamins may reduce stroke risk in older people.

Omega-3 fatty acids (fish oil) support cognitive health in a variety of ways. In 2008, UCLA researchers reported on a lab study showing that the omega-3 fatty acid DHA, together with exercise, improved cognitive function. This caught our attention, because there is wide agreement that regular exercise strongly supports brain function as we age, and here the suggestion is that omega-3 fatty acids multiply that known benefit. A diet rich in omega-3 fatty acids/fish oil has also been linked to lower risk of depression—another plus. And still more: recent research found that omega-3 fatty acids block the development of retinopathy, a chief cause of blindness as we age. (The retina of the eye is actually part of the brain–it is full of nerve cells essential for vision.) All in all, the neurological benefits of omega-3 fatty acids seem both wide-ranging and quite convincing, so it’s high on our recommended list.

The amino acid acetylcarnitine has shown benefit for brain function in a number of studies with humans. In the last decade, acetylcarnitine has also been investigated for peripheral neuropathy in people with HIV. (Some recommend using it with evening primrose oil and Vitamin C.) A 2008 study found that acetylcarnitine influences a chemical process in the brain that triggers Alzheimer’s, so researchers are continuing to puzzle out how this supplement produces its neurological benefits.

Antioxidants. There’s much suggestive research about how antioxidants counter destructive oxidative processes in the brain, thus blocking memory loss and cognitive decline. For example, a 2003 report found that the antioxidant combination alpha lipoic acid and NAC reversed memory loss in aged laboratory mice. And there’s also been a lot of attention to the combination acetylcarnitine and alpha lipoic acid for memory impairment. Furthermore, other antioxidants such as curcumin are under study for their potential to fight the processes that lead to declining brain function.

Acetylcholine. The first neurotransmitter to be identified, acetylcholine is closely associated with memory, with lower levels linked to memory loss. NYBC currently stocks two combination supplements that support acetylcholine levels in the brain, while also providing other nutrients for neurological function: Neuro Optimizer (Jarrow), which includes acetylcholine enhancers, acetylcarnitine, and alpha lipoic acid; and Think Clearly (SuperNutrition), which includes B vitamins, as well as acetylcholine enhancers and a botanical traditionally used for cognitive support, ginkgo biloba.

Resveratrol. In the past decade, there has been intense scientific interest in this compound, most famously found in red wine. While some research ventures have hoped to find in resveratrol a life-extending supplement (a capacity demonstrated in animal studies), others have focused on its therapeutic value for conditions like diabetes or cognitive decline. For example, Cornell researchers reported in 2009 that resveratrol reduced the kind of plaque formation in animal brains that causes Alzheimer’s. And a year later another lab investigation, this one at Johns Hopkins, found that a moderate dose of the compound protected animal brains from stroke damage.

Ginkgo biloba, a botanical derived from Earth’s most ancient tree species, has been widely used for cognitive function. In the late 1990s, two reviews of dozens of ginkgo studies concluded that it could improve symptoms of dementia. However, a long-term trial of ginkgo published in the Journal of the American Medical Association in 2008 found that the supplement did not prevent development of dementia in a group of more than 3000 older people who had normal cognitive function at the start of the research. One possible conclusion: ginkgo may help symptoms of cognitive decline, but doesn’t address underlying causes.

NYBC’s RECOMMENDATIONS: A B complex supplement (like Jarrow’s B-right) and fish oil (like Jarrow’s Max DHA) are foundations for maintaining cognitive health, especially important for people with HIV or people over 60. There is some evidence for acetylcarnitine, alpha lipoic and acetylcholine supplementation for memory impairment and possibly for cognitive decline. Acetylcarnitine and other supplements can be used to address peripheral neuropathy. And stay tuned for emerging research on preserving brain function with compounds like resveratrol, NAC and curcumin.