Hypercholesterolemia

Nutrition and Dietary Supplements

There is considerable evidence that dietary antioxidants, particularly vitamin E, as well as folic acid, fiber, and soy can help to prevent the development of heart disease. Substances that have shown promise in lowering cholesterol specifically or that have demonstrated benefit in preventing heart disease in people with high cholesterol are discussed below.

Fiber and Fiber Sources

The American Heart Association (AHA) recommends increased intake of dietary fiber in the form of whole grains, vegetables, fruits, legumes, and nuts because they have been shown to do the following:

• Reduce total and LDL cholesterol more effectively than a diet low in saturated fat and cholesterol alone

• Help control weight and intake of calories by promoting a sense of fullness

• Improve cholesterol and triglyceride levels as well as blood sugar in people with diabetes

Soluble fibers such as those in psyllium husk, guar gum, and oat bran have a cholesterol-lowering effect when added to a low-fat, cholesterol-lowering diet. Studies have shown psyllium, in particular, to be quite effective in lowering total as well as LDL cholesterol levels. Oat bran (3 g per day) has also been shown to lower total cholesterol.

Soy

Many studies have shown that replacing some animal protein with soy protein in the diet results in lower blood cholesterol levels, especially when soy is consumed as part of a general low-fat diet. One study has shown that as little as 20 g of soy protein per day is effective in reducing total cholesterol, but that 40 to 50 g shows faster effects (in 3 weeks instead of 6). This evidence suggests that soy protein should be included in a healthy diet. In fact, since October of 1999, the FDA has allowed the labels of foods containing 6.25 g or more of soy protein to carry the claim that these foods reduce the risk of heart disease. Moreover, the AHA recommends that people with elevated total and LDL cholesterol add soy to their daily diet. Ethanol-washed soy preparations should be avoided because this procedure causes the soy to lose its isoflavones (the substances likely responsible for its cholesterol-lowering effects) in the process.

Omega-3 fatty Acids

EPA and DHA

Numerous studies have reported the benefits of consuming fish oils, rich in the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), at doses ranging from 850 mg to 4 g per day for those with heart disease. Supplementation with DHA, for example, has been shown to reduce triglycerides and LDL levels and raise HDL levels.

Alpha-Linolenic Acid

Walnuts are one of the best sources of the omega-3 fatty acid alpha-linolenic acid. Replacing a major portion (35%) of the monounsaturated fat in the Mediterranean diet with walnuts appears to significantly improve cholesterol and triglyceride levels in people with high cholesterol. Almonds, although not as well studied as walnuts, appear to have similar effects when used as a substitute for a portion of monounsaturated fats in low-fat diets.

Vitamin E

A number of studies conducted over the last 10 years have reported beneficial results from the use of vitamin E supplements for the treatment and prevention of heart disease including for those with elevated cholesterol levels.

Vitamin C

Preliminary evidence suggests that vitamin C (3 glasses of orange juice per day or up to 3 g per day as a supplement) may help decrease total and LDL cholesterol and triglycerides, and increase HDL levels.

Coenzyme Q10 (CoQ10)

Coenzyme Q10 (CoQ10), also known as ubiquinone, is an antioxidant that is essential for energy production. Levels of CoQ10 have been found to be lower in people with high cholesterol when they were compared to healthy individuals of the same age. Furthermore, when person with high cholesterol take statin drugs, CoQ10 levels appear to decline in direct proportion to the level of decrease in cholesterol. This is particularly important to bear this in mind when statin drugs are used for long periods of time. Taking CoQ10 supplements, however, can correct the deficiency caused by statin medications without affecting the medication's positive effects on cholesterol levels.

Folic Acid (Vitamin B9)

High blood levels of homocysteine (an amino acid produced by the body) have been shown to increase the risk of heart attacks. Evidence suggests that high homocysteine levels are also related to low folate levels. This means that an adequate supply of folate and other B vitamins may be important, particularly for those with heart disease.

Plant Sterols

Plant sterols (fats present in fruits, vegetables, seeds, and nuts) appear to interfere with the absorption of cholesterol, thereby lowering the level of cholesterol in the blood. A daily intake of 1.6 g of margarine containing plant sterols has been shown to reduce total and LDL cholesterol, with larger intakes not necessarily providing any additional benefit. Questions have been raised, however, regarding the possibility that plant sterols interfere with the absorption of certain antioxidants such as alpha- and beta-carotenes, alpha-tocopherol, and lycopene. While the significance of this is still unclear, it warrants further investigation, and these micronutrients must be carefully monitored in the blood of those using plant sterols.

L-Carnitine

L-carnitine is produced in the liver and kidneys from the amino acids lysine and methionine. It is stored in skeletal muscles and the heart and may be beneficial in treating conditions such as chest pain, heart attack, heart failure, diabetes, and abnormal cholesterol. In several human studies, supplementation with 2 to 3 g per day of L-carnitine led to a significant reduction in total cholesterol and triglycerides, and to increases in HDL cholesterol levels.

Red wine

Red wine contains flavonoids, which inhibit LDL oxidation (the process whereby LDL cholesterol adheres to artery walls). Studies have demonstrated a relationship between flavonoid consumption (from food) and reduced risk of death from coronary heart disease.

Although nonalcoholic grape products contain flavonoids, red wine contains much higher concentrations of flavonoids. However, the use of alcohol is not advocated by the AHA and other organizations because of the potential for addiction and the other serious repercussions such as motor vehicle accidents and the development of hypertension, liver disease, breast cancer, weight gain. If red wine is consumed, it is recommended that men have no more than 2 glasses (20 g ethanol) per day and women, no more than 1 glass (15 g ethanol).

Red Yeast Rice

Red yeast rice, the fermented product of rice and red yeast, has been used in China since at least 800 AD to make wine and preserve food, and for its medicinal properties, which are believed to include, among other things, improvement in blood circulation. Recent well-designed studies have shown that red yeast rice significantly reduces total cholesterol, LDL cholesterol, and triglyceride concentrations.

Chromium

Brewer's yeast is an important source of chromium. Ninety percent of Americans are deficient in this important mineral. Chromium has demonstrated the ability to lower LDL levels in the blood and raise HDL levels.

Calcium

Preliminary studies in animals and people suggest that calcium supplements, in the range of 1,500 to 2,000 mg per day, may help to lower cholesterol. The information available thus far suggests that keeping cholesterol levels normal or even low by using calcium supplements (along with many other measures such as changing your diet and exercising) is likely to be more beneficial than trying to treat it by adding calcium once you already have elevated cholesterol. More research in this area is needed.

Vitamin B5 (Pantothenic Acid)

Research has shown that vitamin B5 lowers cholesterol. Studies are currently underway to determine if this vitamin helps prevent heart disease.