LA JOLLA, CALIF. — Several natural supplements are useful for lowering blood lipids, Erminia M. Guarneri, M.D., said at a meeting on natural supplements in evidence-based practice sponsored by the Scripps Clinic. They include:
▸ Soluble fiber. Ingesting 2–10 g/day of soluble fiber has been found to lower total cholesterol levels by 15%-18% (Am. J. Clin. Nutr. 1999;69:30–42). Common sources include oats, psyllium, pectin, and guar gum. GI complaints from ingesting soluble fiber are frequent.
▸ Phytosterols. Produced by plants, these substances impair intestinal absorption of cholesterol. Studies have found that 2–3 g/day of phytosterols can reduce LDL-cholesterol levels by 10%-15%. In one study of 167 patients on stable statin therapy, the 83 patients who received three servings per day of a plant stanol-ester spread showed reduction in LDL cholesterol of more than 16% at 8 weeks, compared with a nearly 7% reduction in the 84 placebo patients. The stanol spread provided the equivalent of 2–3 g/day of phytosterols (Am. J. Cardiol. 2000;86:46–52).
In an unpublished study of 14 Scripps patients who were “maxed out on nutrition and cholesterol-lowering medicines,” adding 2 g/day of phytosterols led to a 14% reduction in total cholesterol, a 16% reduction in LDL cholesterol, an 11% reduction in triglycerides, and a 2% increase in HDL cholesterol.
Although some margarines contain phytosterols, those foods should be avoided, especially if they contain partially hydrogenated oils, said Dr. Guarneri, a cardiologist who is founder and medical director of the Scripps Center for Integrative Medicine in La Jolla, Calif. She recommends getting phytosterols from two products: CholestePure (Emerson Ecologics) and UltraMeal Plus (Metagenics).
▸ B vitamins. Deficiencies of vitamin B6, vitamin B12, and folic acid have been linked to elevated plasma homocysteine levels, which are a strong predictor of mortality in coronary artery disease patients.
In fact, one study of 587 coronary artery disease patients found that the risk of mortality was 3.8% for those with a plasma homocysteine level of less than 9.0 ?mol/L and 24.7% for 15 ?mol/L or greater.
Dr. Guarneri recommends Cardio B (Ortho Molecular Products), a mix of folic acid and vitamins B6 and B12, “in one pill, instead of popping a bunch of pills,” she said at the meeting, which was cosponsored by the University of California, San Diego.
▸ Niacin. Regular use of this supplement has been found to lower LDL cholesterol by 5%-25%, lower triglycerides by 20%-50%, and raise HDL cholesterol by 15%-35%.
“The first treatment [for low HDL] is to get the weight off the midline,” Dr. Guarneri said. “But if I have to reach for a supplement to fix this, I fix it with niacin,” he added. “People often see me and say, 'I'm drinking all this wine to raise my HDL.' A lot of times all that wine gives you more weight on the midline, so that's not necessarily the solution. The niacin is.”
Side effects may include flushing, hyperglycemia, hyperuricemia, upper GI distress, and hepatotoxicity.
Niacin is contraindicated in patients with liver disease and severe gout, and in those with peptic ulcer.
“I like short-acting niacin so people can take it with each meal if they need to, as opposed to the long-acting prescription niacin, which you're really only supposed to take once a day,” she added. “When I use short-acting niacins, I can also use them at higher doses. Start low and go up slowly, [but] you do have to monitor liver function.”
For patients with arrhythmia, Dr. Guarneri called magnesium one of her favorite supplements to use. Magnesium is a front-line treatment for torsades de pointes, and some studies have found it beneficial for mitral valve prolapse patients who have low magnesium levels.
“At least one study demonstrated a decrease in blood pressure with a 1,000-mg dose [of magnesium],” she said. “If someone has normal renal function, and they have arrhythmia or skipped heartbeats, and I get them off caffeine and sugar, I will use chelated magnesium and titrate it and warn them about the potential for soft stool.”
The cardiac benefits of the following supplements are less clear, she noted, and called for more research on them: L-arginine, coenzyme Q 10, hawthorn, ginkgo biloba, red yeast rice, policosanol, and horse chestnut.
Dr. Guarneri said that she has no financial interest in any of the products she recommended.