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Natural Ways to Lower Your Cholesterol
High cholesterol has long been known to raise the risk of heart and blood vessel disease in people with diabetes and without. Unfortunately, it’s very common among Americans generally, including those with diabetes. The good news is that there’s a lot you can do to lower your cholesterol and, consequently, lower your risk of heart disease. Making the effort to lower blood cholesterol is especially important for people with diabetes — Type 1 or Type 2 — who have a higher risk of heart disease than the general public.
The bad guy: LDL
So it makes sense to keep your LDL level low. For most people with diabetes, the goal is an LDL cholesterol level below 100 mg/dl. If you have heart disease already, your doctor may want you to keep it below 70 mg/dl. If you’re not sure what your LDL is or what your target is, ask your health-care provider, and make sure you get your LDL checked every year.
Some of the steps you can take to help lower your LDL cholesterol level include reducing your intake of saturated fat, dietary cholesterol, and trans fat (which is present in foods that contain partially hydrogenated oils), maintaining a healthy weight, and engaging in regular physical activity.
The good guy: HDL
Another player: triglycerides
Lifestyle and dietary measures that can help to lower triglycerides include losing excess weight, exercising regularly, avoiding refined carbohydrates such as white flour, lowering saturated fat intake, and increasing your intake of omega-3 fatty acids and fiber.
However, as with all drugs, side effects can occur, although most are not usually serious. Statins, for example, may cause muscle pain and, of more concern, liver damage. Fibrates can cause gastrointestinal upset and may increase the risk of gallstones. If you experience side effects when taking a cholesterol drug, always call your health-care provider for advice, rather than stopping the medicine on your own.
Nature’s cholesterol reducers
Any number of magazine or online articles and advertisements tout supplements that can lower cholesterol without harmful or unpleasant side effects. Some of them may indeed work, while others remain unproven or appear to be ineffective.
Here are some of the more popular supplements and food items for which cholesterol-lowering claims have been made. Of those that may have a positive effect, some may help to lower LDL cholesterol more, while others may have more of an effect on triglycerides. Keep in mind that any decisions about taking cholesterol-lowering supplements or making significant dietary changes should be made with the knowledge of your health-care team, who can best guide you toward the therapies that are likely to help and caution you about any possible side effects.
Soluble fiber, or viscous fiber, is found in certain foods, including oatmeal, oat bran, and other oat products, dried beans and peas (black beans, chickpeas, lentils), barley, flaxseed, nuts, apples, oranges, prunes, carrots, Brussels sprouts, and psyllium (seed husks found in some fiber supplements and bran cereals). Soluble fiber works a little differently from insoluble fiber: It takes up water in the digestive tract, forming a gummy, gel-like substance. While it, too, may help prevent constipation, a unique feature of soluble fiber is that it can help lower LDL cholesterol by binding to cholesterol in the intestines. The evidence for soluble fiber’s cholesterol-lowering abilities is pretty strong and is supported by fairly extensive research.
How much soluble fiber does one need to lower LDL? Aiming for 7–13 grams of soluble fiber each day helps. And consuming adequate insoluble fiber can help, too: Eating a total of 20–35 grams of fiber (both insoluble and soluble) each day can lower total cholesterol by 2% to 3% and LDL cholesterol by up to 7%. One way to get that much fiber in your meals is to eat at least 5 servings of fruits and vegetables a day, as well as 6 servings of grains.
Taking psyllium-based fiber supplements or beta glucan supplements (beta glucan is found in barley and oats) may also help lower LDL, particularly if you’re unable or unwilling to eat a lot of foods high in soluble fiber. But fiber supplements can cause gassiness, bloating, cramps, and diarrhea and may decrease the absorption of the fat-soluble vitamins A, D, E, and K. Also, some people may be allergic to psyllium, so caution is necessary; the incidence of psyllium allergy appears to be higher among health-care workers. Signs of psyllium allergy may include rash, itching, and shortness of breath.
The evidence for phytosterols is strong enough for the National Cholesterol Education Program to have added the recommendation to consume at least 2 grams per day if one’s cholesterol is high. The Food and Drug Administration (FDA) also allows the following health claim on foods that meet the criteria:
“Foods containing at least 0.65 gram per serving of vegetable oil plant sterol esters, eaten twice a day with meals for a daily total intake of at least 1.3 grams, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.”
Natural sources of plant stanols and sterols include fruits, vegetables, vegetable oils, nuts, legumes, and whole grains. However, it would be difficult to consume much more than 500 milligrams (mg) of phytosterols daily from these food sources.
Food manufacturers have also fortified a number of foods with phytosterols, including certain brands of vegetable oil spread, juice, yogurt, soy milk, rice milk, snack bars, and even chocolate. Over-the-counter phytosterol supplements are also available.
Plant stanols and sterols are quite safe: There are no known harmful side effects of consuming them, and they can be taken or eaten along with a statin or a fibrate for an even greater LDL reduction.
But in 2006, a second look at the research cast doubt on the magnitude of soy’s benefit in this area. The American Heart Association announced that eating soy had much less of an effect on LDL than previously thought, lowering it only by about 3%. The other catch is that most Americans don’t eat that many soy foods on a daily basis, so few are likely to consume 25 grams of soy protein per day. However, the evidence of some benefit is still there, so if you’re willing to eat a few soy-based meals a week, soy may be of some help in lowering your LDL.
Soy protein is found in tofu, tempeh, miso, edamame (green soybeans), soy nuts, soy milk, soy cheese, and soy-based meat substitutes (such as veggie burgers, soy hotdogs, and “bacon” strips).
Soy foods are generally considered to be safe, but another component of soy, called isoflavones, are natural, estrogen-like substances that may reduce thyroid function in some people (although these findings are not consistent). Women who have had estrogen-sensitive breast cancer and are taking either a selective estrogen receptor modulator (such as tamoxifen [brand name Nolvadex], raloxifene [Evista], or toremifene [Fareston]) or an aromatase inhibitor (such as anastrozole [Arimidex], exemestane [Aromasin], or letrozole [Femara]) should probably not eat soy foods until treatment has been completed.
Niacin is also sometimes prescribed in much larger doses — up to 2,000 mg, or 2 grams, taken two to three times a day — to increase HDL cholesterol (by 15% to 35%), with secondary effects of lowering LDL and triglycerides. Prescription niacin can be taken along with a statin or a bile acid resin for further LDL reduction. Some common brand names of prescription niacin are Niacor, Niaspan, and Slo-Niacin.
While consuming the RDA for niacin in foods or vitamin supplements is safe (but will likely have no effect on your HDL cholesterol level), you should never take large doses of niacin on your own without checking first with your doctor. Side effects of prescription-strength niacin can include flushing (redness of the face and neck), stomach upset, itching, high blood glucose, and liver damage.
Red yeast rice
Interest in red yeast rice in the United States has grown in recent years because of its ability to block the production of cholesterol by the liver. This ability is due, in part, to a substance called monacolin K, which is a “natural” form of lovastatin, a prescription drug used to lower LDL cholesterol. Red yeast rice is essentially a lower-dose type of statin. As a result, many people who either cannot tolerate the side effects of prescription statins or who do not want to take them for other reasons have turned to red yeast rice.
A study published in 2009 in the Annals of Internal Medicine showed that people who were unable to tolerate statins because of muscle pain were able to tolerate 1800 mg of red yeast rice twice daily for 24 weeks, with an average drop in LDL of 35 mg/dl. A study done in China showed that red yeast rice lowered heart disease risk by 30% after study subjects took the supplement for about 4 1/2 years.
The catch is that red yeast rice is sold as a dietary supplement in the United States, not as a drug. That means that the FDA does not regulate it for quality, safety, or effectiveness. An analysis of 10 brands of red yeast rice capsules done by ConsumerLab.com in 2008 found that there was wide variation in red yeast rice content from brand to brand. And given the fact that red yeast rice is essentially a low-dose statin, possible side effects are similar to those of statins, including muscle pain or tenderness that can lead to kidney damage, flulike symptoms, dark-colored urine, difficulty with urination, upset stomach, bloating, and headache.
In 2007, the FDA asked the manufacturers of three red yeast rice supplements — Red Yeast Rice, Red Yeast Rice/Policosanol Complex, and Cholestrix — to withdraw their products from the US market, citing them for containing “unauthorized” lovastatin. However, people are still able to obtain this supplement with smaller amounts of the “natural” lovastatin.
As tempting as it can be to take something that’s natural and effective, it’s wise not to take this supplement without first talking with your doctor. People who decide to take red yeast rice should have their liver enzymes checked about six weeks after starting it and then every six months thereafter. If any of the side effects listed above occur, anyone taking red yeast rice should call his doctor.
Side effects of policosanol are mild and consist primarily of rash, fatigue, headache, weight loss, and insomnia. Policosanol may increase the blood-thinning effects of aspirin, warfarin (Coumadin) and clopidogrel (Plavix). It may also increase the effects of levodopa, a drug used for Parkinson disease.
However, in another study, published in The Journal of the American Medical Association in 2003, 85 otherwise healthy men and women were given either a placebo, 1,000 mg of guggulipid three times a day, or 2,000 mg of guggulipid three times a day. At the end of the study, LDL cholesterol actually increased by 5% in the 1,000-mg group and by 7% in the 2,000-mg group. However, triglyceride levels dropped by about 14% in the subjects with the highest LDL levels. Additionally, C-reactive protein (CRP), a marker of inflammation, dropped by 28% in the group receiving the highest dose of guggulipid.
Since the study was published, there has been little enthusiasm to continue researching guggulipid. Side effects include nausea, vomiting, and diarrhea. It is not recommended for people with liver disease, kidney disease, or inflammatory bowel disease.
On the plus side, garlic may offer some benefit in reducing the risk of heart disease by means other than lowering cholesterol. For example, it’s been shown to slightly lower blood pressure. It may also lower the risk of some types of cancer. Fortunately for garlic lovers, side effects are few. However, those who take blood-thinner medicines such as aspirin, warfarin, or clopidogrel are at increased risk for bleeding if they also take garlic.
A small study published in the journal Saudi Medical Journal in 2008 looked at the effects of taking 3,000 mg per day of ginger for 45 days in people with high cholesterol. The results were promising: Total cholesterol dropped by 13 mg/dl, and triglycerides dropped by 9.5 mg/dl. However, the authors of the study point out that this was a small study and that the effects of ginger on blood lipids should be confirmed in a larger study.
Flaxseed is quite safe, although nausea, bloating, and diarrhea are possible side effects. It’s best to take flaxseed separately from any medicines to prevent drug absorption problems: Flaxseed can slow the movement of food (and medicines) from the stomach to the intestines.
Heart-healthy eating overall
(Click here for more information about choosing foods that can help you lower your cholesterol.)
A registered dietitian can help you develop an individualized eating plan that’s good for both your heart and your blood glucose control. If you choose to try dietary supplements to lower your cholesterol — or for any other reason — tell your health-care provider, and keep him updated on your usage from one appointment to the next.
Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.