Cholesterol Lowering Supplements

A number of supplements are currently being used for the purpose of cholesterol lowering but for the most part their effect, if any, is modest and significant documentation is lacking.

Only for two of these commonly used supplements does there exist ample justification for use based upon carefully controlled research: niacin and stanol esters. For the remainder including: Policosanol - the pure extract of sugar cane wax; Guggulipid Extract - an ancient herb from India; Green Tea Extract; Garlic; Psyllium and Beta Glucan, either the evidence is not there or the results are too minimal to satisfy most people.

Niacin: High doses of niacin (available by prescription) have been shown to prevent and / or improve both high LDL cholesterol and low HDL cholesterol. Because the common side effects of niacin can be prevented or minimized by starting with low dose therapy and slowly raising the dose as tolerated, many people try the low dose OTC pills for this purpose. Consult with your health professional as to reliability of the product before starting. If any doubt exists, the prescription form should be considered. In either case starting with a small dose with slow increase is the usually suggested path.

Niacin is available in several different supplement forms: niacinamide, nicotinic acid, and inositol hexaniacinate. The form of niacin that is generally best tolerated with the fewest adverse effects is inositol hexaniacinate. Niacin is available as a tablet or capsule in both regular and timed-release forms. The timed-release tablets and capsules may have fewer side effects than the regular niacin; however, the timed-release are more likely to cause liver damage and are therefore not generally suggested for long-term treatment. Regardless of the form of niacin being used, periodic checking of liver function tests is standard when high-dose ( 2 - 6 gm per day ) of niacin is used.

High doses of niacin can cause side effects. The most common side effect is called "niacin flush," which is a burning, tingling sensation in the face and chest, and red or "flushed" skin. Taking an aspirin 30 minutes prior to the niacin may help reduce this symptom but check with your primary physician first.

At the high doses frequently required to lower cholesterol, liver damage and stomach ulcers can occur. When taking pharmacologic doses of niacin, your doctor or other healthcare practitioner may wish to provide periodic testing. People with a history of liver disease or stomach ulcers should probably avoid niacin supplements. The possibility of side effects when taking other medication must always be considered. Again, consult with your primary care physician.

Stanol Esters: Plant sterols and stanols are substances that occur naturally in small amounts in many grains, vegetables, fruits, legumes, nuts, and seeds. Since they have powerful cholesterol-lowering properties, manufacturers have started adding them to foods. You can now get stanols or sterols in margarine spreads, orange juice, cereals, and even granola bars.

On a molecular level, sterols and stanols look a lot like cholesterol. So when they travel through your digestive tract, they get in the way. They can prevent some of the real cholesterol from being absorbed into your bloodstream which just goes out with the waste.

Experts have been studying the effects of food fortified with plant sterols for decades. One important study from 1995 of people with high cholesterol found that less than an ounce of stanol-fortified margarine a day could lower "bad" LDL cholesterol by 14%. The results were published in The New England Journal of Medicine.

A more recent study from the University of California Davis Medical Center looked at the effects of sterol-fortified orange juice. Of 72 adults, half received regular orange juice and half the fortified OJ. After just two weeks, the people who drank the stanol-fortified juice had a 12.4% drop in their LDL cholesterol levels. The results were published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology in 2004.

NASA is sufficiently convinced of the usefulness of this product that it is routinely recommended when indicated during astronaut physicals. Stanol ester supplements are available but not reliable as to amount.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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