Alternative approaches to improving your cholesterol profile

There are numerous complementary and alternative approaches to achieving healthy cholesterol levels. Some have a strong body of evidence behind them and are well accepted by the medical community, whilst others are little more than old wives tales.

Complementary therapies are defined as those that are used alongside conventional medical treatments whilst alternative therapies are used instead of mainstream interventions.

There is little doubt that evidence-based complementary therapies can have a very positive effect in supporting mainstream interventions as long as they are discussed with - and approved by - your doctor or specialist first.

Alternative therapies, as the sole treatment, carry with them a greater risk of not achieving good management of your cholesterol - or worse, allowing your cholesterol levels to deteriorate further so it's absolutely imperative that you discuss alternative therapies with your doctor or specialist first before you decide on this approach.

Complementary and alternative approaches to cholesterol management

Lifestyle

Regular physical activity and a low-fat diet with plenty of fruit and vegetables, soluble fibre and fresh fish will all have a direct effect on your cholesterol levels as well as help you to maintain a healthy weight, which in turn will further help to reduce your LDL cholesterol level.

A diet called the portfolio diet, based on a variety of plant-based foods with evidence for a cholesterol-lowering effect, was found to reduce LDL cholesterol by almost 30% in the short term (over 3 months) (1). However, the diet is quite restricted and definitely requires dedication. After a year on the diet, the average reduction in LDL cholesterol was 12.8%, with just over 30% of people taking part keeping their LDL cholesterol at least 20% lower than it was before the trial started (2)

The recommended diet comprised:

A low fat diet, with ≤7% of daily energy intake from saturated fat and <200mg dietary cholesterol, as recommended by the NCEP.

  • 5-10 daily servings of fruit and vegetables
  • A vegetarian diet with no meat, egg yolks or milk products.

After 2 months on this diet, the following components were added for one year:

  • About 20g/day of viscous (soluble) fibre
  • 45g/day of soya protein (mainly soya milk and soya meat substitute products in the trial)
  • 2g/day of plant sterols (the trial used plant sterol enriched margarine, equivalent to Flora Pro-Activ in the UK, which provides 1.7g in 1 tablespoon)
  • 46g/day almonds (about 40 whole almonds).

On average, it was estimated that the diet would provide about 2000 kcal/day - although in practice, calorie consumption over the course of the study varied between about 1520 and 1850 kcal/day.

You can also increase your protective HDL level by not smoking and keeping your alcohol intake within the recommended limits of 21 units per week (males) and 14 units per week (females).

Soybeans and soy protein can be very effective at reducing your LDL level, so consider increasing your intake of high-soy foods such as tofu, soy milk and yoghurt, tempeh and soy nuts.

You should certainly avoid trans fats as far as possible (found in hydrogenated oils such as margarines as well as in many processed foods). These deliver a double-whammy to your cholesterol profile by decreasing your HDL level and increasing your LDL level - not good.

Finally, plant sterols and stanols have been found to significantly reduce your total cholesterol and LDL levels. These are natural substances found in whole grains, fruits and vegetables and vegetable oils as well as cholesterol-lowering margarines such as Flora Proactive (sterols) and Benecol (stanols).

Herbal supplements

Garlic was once the 'go-to' supplement for lowering total cholesterol but more recent research casts some doubt over whether it does this as much as once thought. You should also be aware that garlic might prolong bleeding and blood-clotting time, so avoid it prior to surgery or if you take blood-thinning medication.

Guggulipid, a gum resin from the mukul myrrh tree, has been shown in some studies to significantly reduce total and LDL cholesterol levels, although more recent findings have indicated otherwise. More research is required to establish how effective this herb is as a cholesterol-lowering therapy.

Other herbs and spices such as ginger, rosemary, artichoke leaf extract, fenugreek seeds and leaves, holy basil and yarrow may all have some beneficial effects on cholesterol levels and are currently being investigated.

Nutritional supplements

Policosanol is a substance extracted from sugar cane and has been shown in numerous studies to have at least some effect on lowering LDL levels. Another form of policosanol extracted from beeswax has not been shown to have any effect on cholesterol levels so make sure the supplement you're using contains the sugar-cane variety.

Red yeast rice has been found in several studies to lower cholesterol but more research is required into how effective it is. It has proved controversial because early studies, which showed a cholesterol-lowering property, used a version of red yeast rice which contained a naturally-occurring statin called lovastatin. In 1998 the FDA (Food and Drug Administration) in the USA launched an action to ban a product containing red yeast rice extract on the grounds that it was a drug and should be subject to the same regulations and monitoring as statins.

Bergamet - an extract from the flesh of the bergamot orange - has recently become available in the UK. It has been shown in early studies to reduce LDL cholesterol significantly, although as yet no studies have been done to see if this translates into fewer heart attacks

Remember - consultation with your doctor or specialist is imperative. They will not only be able to advise you on how safe and effective the therapies you're considering are but also ensure that they are right for you and integrate effectively with any medical treatment you may be receiving.

References:

1) Jenkins DJ, Kendall CW, Faulkner D et al. A dietary portfolio approach to cholesterol reduction: combined effects of plant sterols, vegetable proteins, and viscous fibers in hypercholesterolemia. Metabolism 2002; 51: 1596-604.

2) Jenkins DJ, Kendall CW, Faulkner D et al. Assessment of longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. Am J Clin Nutr 2006; 83: 582-91.