“The Role of Nutraceutical Supplements in the Treatment of Dyslipidemia”; Mark Houston, MD; The Journal of Clinical Hypertension; Volume 14; No. 2; February 2012.
“New treatment approaches that combine weight loss, reduction in visceral and total body fat, increases in lean muscle mass, optimal aerobic and resistance exercise, scientifically proven nutrition, and use of nutraceutical supplements offer not only improvement in serum lipids but also reductions in inflammation, oxidative stress, immune dysfunction, endothelial, and vascular smooth muscle dysfunction.”
Nutritional Supplement Effects on Various Mechanisms of Dyslipidemia-Induced Vascular Disease:
- Niacin: Has a dose-related effect (1-4 gram/day) in reducing Total Cholesterol, LDL, Apo B, LDL particle number, Triglycerides, VLDL, and increasing LDL size from small type B to large type A and HDL, especially the protective and larger HDL 2b particle and Apo A1. These changes vary from 10% to 30% for each of these lipid levels.
Dr. Houston then lists multiple randomized controlled studies that all showed benefit from the use of niacin: HATS, ARBI-TER 2, FATS, CLAS I and II, AFRS have all shown reductions in coronary events, coronary plaque, and carotid intima-media thickness.
- Dose should be gradually increased (500mg—4000mg)
- Take with a meal
- Pre-treat with aspirin 81mg and apple pectin to reduce flushing
- Only vitamin B3 niacin is effective in Dyslipidemia (non-flush niacin is NOT recommended)
Side Effects of Niacin: hyperglycemia, gout, hepatitis, flushing, rash, pruritus, hyperpigmentation, hyperhomocysteinemia, gastritis, ulcers, bruising, tachycardia or palpitations.
- Green Tea Extract and Green Tea: Catechins can improve lipids by interfering with micellar solubilization of cholesterol in the GI tract and reduce absorption. It also reduces fatty acid gene expression, inhibits HMG-CoA reductase, increases mitochondrial energy expenditure, reduces oxidized LDL, upregulates the LDL receptor, decreases Apo B lipoprotein secretion from cells, mimics action of insulin, improves endothelial dysfunction and decreases body fat.
Meta-analysis of 14 trials showed that (EGCG) at 224mg to 674mg per day or 60 oz of green tea per day reduced total cholesterol by 7.2mg/dL and LDL by 2.19mg/dL.
Recommended dose of standardized EGCG extract= 500mg—700mg daily.
- Pantethine: A disulfide derivative of pantothenic acid and is metabolized to cystamine-SH which is the active form in treating Dyslipidemia. More than 28 clinical trials have shown consistent improvement in serum lipids. Total cholesterol is decreased by 15%, LDL by 20%, Apo B by 27.6%, and TG by 36.5%. HDL and Apo A1 are increased by 8%. The caveat to this is that the process is slow and can take up to 9 months to see the improvements.
Recommended dose= 300mg 3 times daily or 450mg twice daily with or without food.
- Resveratrol: Reduces oxidation of LDL, inhibits acyl-CoA, increases bile acid excretion, reduces Total cholesterol, Triglycerides, and LDL. Increases HDL and PON1, inhibits nicotinamide adenine dinucleotide phosphate-oxidase in macrophages, and blocks the uptake of modified LDL by CD36 SRs. N-acetyl cysteine (NAC) has this same effect on CD36 SR and should be taken in conjunction with Resveratrol.
Recommended dose= trans-resveratrol 250mg daily + NAC 1000mg twice daily.
Next week I will continue to review neutraceuticals that improve dyslipidemia.