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Supplements may not lower cholesterol

Heart disease is the No. 1 cause of death in this country, and most heart disease stems from ruptured cholesterol plaques.

In my last column I talked about the danger of elevated cholesterol. Today, I’m talking about how to alter your cholesterol through diet and supplements.

What are our goals when we change diets, take supplements or medicines, or engage in other health-related behavior? Usually, our goals are to increase the quantity and quality of our lives.



Controlling cholesterol levels can do both by preventing heart attacks and strokes. When you think about taking a supplement or drug, ask for good studies (large, randomized, controlled) that demonstrate a clear mortality benefit. If those studies don’t exist, think twice about spending your time and money on them.

Dietary changes can drop cholesterol if a person is willing to make large changes in their eating habits and stick with them.




The main driver of elevated total cholesterol (TC) and LDL cholesterol (the bad cholesterol) is the consumption of saturated fat and trans-fat. You can eat less of these fats by avoiding products like whole milk, cream, butter, animal fats, commercially baked goods and deep-fried foods. One-percent or skim milk should replace whole or two-percent milk.

Reducing cholesterol intake does not have much effect on TC and LDL, though generally, foods high in cholesterol also are high in saturated fat.

A Mediterranean diet may decrease the risk of heart disease. There is no one Mediterranean diet, but they are typically high in fruits, vegetables, whole grains, beans, nuts and seeds. Olive oil as an important source of fat, and protein comes from low to moderate amounts of fish, chicken and dairy products, with very little red meat.

Changing your diet only helps if you truly change it and maintain that change. Continuing to drink whole milk and eating hamburgers on a whole grain bun with French fries doesn’t count as a Mediterranean diet.

Fish oil has been shown to be helpful in several studies. Current recommendations suggest eating baked or broiled fish (not fried and not drowning in butter) twice a week.

Fish oil supplements are available, but probably only effective if three grams or more a day are consumed. These supplements are often limited by gastrointestinal side effects. The long-term consumption of fish oil in supplement form has not been evaluated for safety, and there may be undesirable long-term effects. I would recommend taking fish oil supplements only under the care of your physician.

Products with plant stanol esters and plant sterols, such as Benecol, Take Control and Rice Dream Heart Wise lower TC and LDL. I suggest using these products only if you currently use a similar product and don’t mind paying the extra expense over the product you usually use. Long-term safety data is not available for them.

Soluble fiber such as psyllium, pectin and oat products are useful by themselves. In combination with plant stanols , they also may provide a reasonable lowering effect.

Nuts are probably helpful, though randomized data is relatively scanty. Observational studies (a much less accurate type of study) indicate consumption of nuts decreases cardiovascular risk.

Adding nuts to the diet should include a reduction of something else, as nuts have a lot of calories. It would be easy to gain weight by adding even modest quantities of nuts to the diet.

Red Yeast Rice is a popular supplement and can be effective in reducing cholesterol. One of the main ingredients in Red Yeast Rice is lovastatin (Mevacor), though other compounds are present.

Unfortunately, these compounds show significant variations between brands. As the industry is not regulated, the buyer has no guarantee the product purchased has the ingredients indicated. No long-term safety data is available, and no long-term monitoring of safety is done. Generic lovastatin is available by prescription, which would provide a regulated product that may be less expensive.

Soy protein in and of itself is not helpful, but if it replaces things such as hamburger or whole milk, it can lower cholesterol. Guggulipid raised LDL in the only American study done to date, and cannot be recommended. Policosanol and garlic are ineffective in large studies, and should not be used to lower cholesterol.

I’ll talk about exercise and medications in my next column. Feel free to ask questions and suggest other topics by e-mailing me at nicholas.browningmd@gmail.com.


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