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

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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

The Virtues of Pomegranate

NYBC’s buyers’ co-op stocks Pomegranate Juice Concentrate (Jarrow) Each bottle, 12 oz (355 ml) of 100% pomegranate juice concentrate. This concentrate is really thick, so you are getting a lot of the pomegranate in a bottle!

Pomegranate is one of Nature’s most powerful sources of antioxidants, with an antioxidant power greater than that of blueberries and strawberries. Various studies suggest that pomegranate’s antioxidants may help to improve the level of glutathione in cells. (Glutathione is sometimes called the “master antioxidant” for its role in controlling many damaging inflammatory responses in the body.) Specifically, pomegranate may support blood vessel health and counteract the oxidative processes of atherosclerosis (“hardening of the arteries”)

A related product: Cardio-Edge (Douglas Labs). This combination supplement was devised by Douglas Labs following recent research attention to “plant sterols” and other botanical substances that can support healthy cholesterol levels. Cardio-Edge also includes pomegranate (for support of cardiovascular health, as mentioned above), and Sytrinol (a proprietary extract obtained from citrus and palm fruits).

Reference: Aviram M, Rosenblat M, Gaitini D, et al. Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation. Clinical Nutrition 2004; 23:423-233.

Healthy cholesterol levels the botanical way

We’ve long known about certain supplements like niacin, pantethine, omega-3 fatty acids that can have an effect on cholesterol levels. In recent years, research attention has also focused on “plant sterols” and other botanical substances that can provide help in supporting healthy cholesterol levels.

Responding to this emerging science, supplement suppliers have devised some combination supplements. Among them is Douglas Lab’s Cardio-Edge, which includes: plant sterols (phytosterols) from soy; Sytrinol (a proprietary extract obtained from citrus and palm fruits); and pomegranate extract.

Here’s a little more detail on the product:

Cardio-Edge is designed to help maintain cardiovascular health and support healthy cholesterol levels. Sytrinol is intended to have the following effects, some of which you can monitor with routine bloodwork to assess its effect for you. These include:
1) Decrease apoprotein B, needed for LDL synthesis
2) Decrease action of an enzyme in the liver that makes triglycerides
3) Inhibit HMG-CoA reductase in the liver

Patented combination of citrus PMFs and alpha, delta and gamma tocotrienols derived from palm fruit (U.S. patents #6,251,400, and #6,239,114). Palm tocotrienols have been shown to inhibit HMG CoA reductase, the enzyme responsible for regulating cholesterol synthesis in the liver. Clinical studies in both animals and humans support Sytrinol’s role in reducing total and LDL-cholesterol as well as triglycerides.

Plant Sterols
Blood cholesterol is derived from the diet and synthesized in the liver. Sterols work by reducing the absorption of both forms of cholesterol – Sterols compete with cholesterol for absorption. Sterols and sterol esters can now be found in many foods including orange juice, rice drink, and margarine.

Pomegranate
Recent science has been focusing on the cardioprotective aspects of pomegranate. These brightly colored fruits contains numerous cornpounds known for their antioxidant capabilities, induding anthocyanidins, catechins, tannis, and gallic and ellagic acids. Research has shown that supplementation with pomegranate juice can decrease macrophage lipid accumulation, and cellular cholesterol accumulation in mice. Recently, research in humans has confirmed a beneficial effect of consuming pomegranate juice on parameters such as LDL oxidation, blood pressure, and blood vessel health.

In human clinical studies involving hypercholesterolemic subjects, no side effects were observed and four weeks of supplementing with a daily dose of 300 mg of Sytrinol.

See further information on recommended dosing on the NYBC website:

http://nybcsecure.org/product_info.php?products_id=284

Jon Kaiser presentation: a nutritional supplement combination therapy to lower cholesterol

We had the opportunity to hear Dr. Jon Kaiser speak in New York last night, in one of his regular information sessions for people wanting to know about holistic/integrative approaches to treating HIV. (It was a double bill, since he had invited his colleague Dr. Ricky Hsu to open the evening with a review of HIV pharmaceuticals, including those just approved.)

While Dr. Kaiser ranged over several topics, including his long-standing interest in micronutrient support for people with HIV and the benefits it can provide, we took the most notes on his approach to reducing cholesterol with nutritional supplements. The need for cholesterol reduction strategies is widespread among people with HIV, since cardiovascular disease is a major concern, especially among those who have been on treatment for a number of years. Yes, as Dr. Kaiser stressed, there are obvious things to start with in order to reduce cardiovascular disease risk: you’ve got to quit smoking, and if you have high blood pressure, you have to work out the (relatively simple) treatment to control it.

But many people with HIV are prescribed statin drugs like Lipitor to reduce cholesterol, and unfortunately the statins come with a handful of potential side effects. So, Dr. Kaiser has recently been offering some of his patients the alternative of a nutritional supplement combination therapy. It consists of low-dose Niacin (to minimize flushing), fish oil (helpful in lowering triglycerides), plant sterols (available now in spreads, by the way), and pantethine. Although he’s only followed a few cases to date, he’s quite encouraged by results, and believes that many people with HIV could achieve good results (comparable to those offered by statins) with this kind of combination therapy.

Of course all of these components have been widely studied for cholesterol control before (you’ll find more information on them on the NYBC website at http://www.newyorkbuyerslcub.org). But it’s another very valuable contribution from Jon Kaiser the integrative health specialist to refine a combination of supplements to serve the particular purpose of reducing cholesterol and cardiovascular risk for people with HIV. We’ll watch for further updates from him on the clinical experience with this combination therapy.

Recommendations for Cardiovascular Health: from “Supplement Your Prescription,” by Hyla Cass, M.D.

We return to this excellent guide published in 2007 by Hyla Cass, a practicing physician and expert on integrative medicine.

In Chapter 4 of the book, Dr. Cass reviews recent findings that call into question the idea that dietary cholesterol causes cardiovascular disease. In line with the current scientific thinking on this subject, she suggests looking at underlying inflammation as essential to any understanding of risks to heart and circulatory system health. As a consequence, she says, people who want to reduce risk of cardiovascular disease should consider dietary changes that are anti-inflammatory (that is, a diet high in antioxidants, anti-inflammatory herbs, and antioxidant-rich foods–that’s colorful fruits and vegetables, curry, turmeric, rosemary, ginger, green tea, dark chocolate, low-toxin fish like salmon or sardines).

Statin drugs, though they come with some side effects, have proven of benefit to certain groups of people with cardiovascular complications, including diabetics, those who have had a heart attack, and those diagnosed with cardiovascular disease. Like many others, Dr. Cass recommends supplementing with CoQ 10 if you’re taking statins. She also supports use of omega-3 fatty acids (from fish oil), niacin (though not recommended for diabetics), plant sterols, tocotrienols (a form of the antioxidant vitamin E), and D-ribose for controlling cholesterol and otherwise countering cardiovascular disease. In addition, the B vitamins are recommended to help lower homocysteine, high levels of which are associated with artery damage and increased risk of heart disease.

Citation: Hyla Cass, M.D., Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition (Basic Health Publications, 2007).

New England Journal of Medicine Editorial: Vytorin and Zetia may not work, and should only be prescribed as a last resort

Here’s the latest news on Vytorin and Zetia, two drugs that are widely prescribed as cholesterol-lowering agents.

We repeat some of the suggestions we made when the failings of these two drugs were first revealed: consider such alternatives as statins plus niacin*; or a supplement based on plant sterols and other components, Cardio Edge from Douglas Labs.

* See NYBC entries for Niacin 100mg (recommended as initial dose to minimize “flushing”) and Niacin Timed-Release / Niatab 500mg, the full-strength dose.
 —- 
Journal Issues Warning on Two Cholesterol Drugs
New YorK Times
By ALEX BERENSON
Published: March 30, 2008

CHICAGO — Two widely prescribed cholesterol-lowering drugs, Vytorin and Zetia, may not work and should be used only as a last resort, The New England Journal of Medicine said in an editorial published on Sunday.

The journal’s conclusion came as doctors at a major cardiology conference in Chicago saw for the first time the full results of a two-year clinical trial that showed that the drugs failed to slow, and might have even sped up, the growth of fatty plaques in the arteries. Growth of those plaques is closely correlated with heart attacks and strokes.

We accessed the full story at http://www.nytimes.com on 3/30/2008.