“The Role of Nutraceutical Supplements in the Treatment of Dyslipidemia”; Mark Houston, MD; The Journal of Clinical Hypertension; Volume 14; No. 2; February 2012.
Over the last four weeks I have been reviewing Dr. Mark Houston’s articles that discuss the fact that the traditional cholesterol or lipid testing is outdated and that the Vertical Auto Profile or other test that truly measures the subfractions of the different lipids is a much more accurate assessment of a person’s risk for developing vascular disease. Then, I began reviewing the different neutraceutical supplements that can be used in the treatment of Dyslipidemia and in this blog I will continue with the list.
J. Plant Sterols and Stanols: Naturally occurring sterols of plant origin that include B-sitosterol, campesterol, and stigmasterol. The stanols are saturated. The plant sterols are much better absorbed than the plant stanols.
These have a dose dependent reduction in serum lipids. Total cholesterol decreases by 8%, LDL decreases by 10% with no change in triglycerides or HDL on doses of 2 g to 3 g per day in divided doses with meals. A recent meta-analyses of 84 trials showed that an average intake of 2.15 g per day reduced LDL by 8.8% with no improvement with higher doses.
The mechanism of action is to decrease the incorporation of dietary and biliary cholesterol into micelles due to lowered micellar solubility of cholesterol, which reduces cholesterol absorption and increases bile acid secretion. The plant sterols have a higher affinity than cholesterol for the micelles. They are also anti-inflammatory and decrease the levels of proinflammatory cytokines: hs-CRP, interleukin 6, IL-1b, tumor necrosis factor alpha, phospholipase 2, and fibrinogen.
The plant sterols can interfere with absorption of lipid-soluble compounds such as fat-soluble vitamins and carotenoids such as vitamin D, E, K, and alpha carotene.
The daily intake of plant sterols in the U.S. is about 150mg to 400mg per day mostly from soybean oil, various nuts, and tall pine tree oil.
Recommended dose= 2 to 2.5 grams daily
K. Red Rice Yeast: Is a fermented product of rice that contains monocolins that inhibit cholesterol synthesis via HMG-CoA reductase and thus has “statin-like” effects. It also contains sterols, isoflavones and monounsaturated fatty acids.
A recent placebo controlled Chinese study of 5,000 patients over 4.5 years showed that an extract of red rice yeast decreased LDL by 17.6% and increased HDL by 4.2%. Cardiovascular mortality fell by 30% and total mortality fell by 33% in treated patients. The overall primary end point for MI and death was reduced by 45%.
A highly purified and certified red rice yeast must be used to avoid potential renal damage by a mycotoxin, citrinin.
Red Rice Yeast is an excellent alternative for patients with statin induced myopathy.
Recommended Dose= 2400mg to 4800mg of a standardized Red Rice Yeast.
L. Gama/delta Tocotrienols: Tocotrienols are a family of unsaturated forms of vitamin E termed alpha, beta, gamma and delta. The gamma and delta forms lower total cholesterol up to 17%, LDL by 24%, Apo B by 15%, and lipoprotein (a) by 17%, with minimal changes in HDL or Apo A1. The mechanism of action is that the gamma and delta form of tocotrienols suppress HMG-CoA reductase activity and they act as anti-oxidants.
Alpha tocopherol taken in conjunction with gamma and delta tocotrienols reduces absorption and may interfere with lipid lowering effects. The combination of a statin with gamma/delta tocotrienols further reduces LDL by 10%.
Carotid artery stenosis regression has been reported in about 30% of patients given tocotrienols over 18 months and they slow progression of generalized atherosclerosis.
Recommended Dose= 200mg of gamma/delta tocotrienol at night with food.
M. Citrus Bergamot: In several clinical prospective trials in humans this lowers LDL up to 36%, triglycerides by 39%, increased HDL by 40%. It inhibits HMG-CoA reductase, increases cholesterol and bile acid excretion and reduces reactive oxygen species and oxLDL.
Recommended Dose= 1000mg daily.
N. Vitamin C: A meta-analysis of 13 randomized controlled trials in patients given at least 500mg of vitamin C daily for 3 to 24 weeks found a reduction in LDL cholesterol of 7.9mg/dL and triglycerides of 20.1 mg/dL and HDL did not change. The reductions were greatest in patients with the highest initial lipid levels and the lowest serum vitamin C levels.
Recommended Dose= 500mg to 1000mg daily
O. Soy: Numerous studies have shown mild improvements in serum lipids with soy, but the studies are conflicting due to differences in the type and dose of soy used in the studies, as well as nonstandardized methodology.
Soy decreases the micellar content and absorption of lipids through a combination of fiber, isoflavones, and phytoestrogens. The most reduction is seen with soy-enriched isoflavones with soy protein and fermented is preferred.
Recommended Dose= 30 g to 50 g daily.
P. Flax and Alpha Linoleic Acid (ALA): Flax seeds and ALA from walnuts have been shown in several meta-analyses to reduce total cholesterol and LDL by 5% to 15%, lipoprotein (a) by 14%, and triglycerides by up to 36%, with either no change or slight reduction in HDL.
In the Seven Countries Study CHD was reduced with increased consumption of ALA and in the Lyon Diet Trial at 4 years intake of flax reduced CHD and total deaths by 50% to 70%.
Flax seeds and ALA are anti-inflammatory, increase endothelial nitric oxide synthase, improve endothelial dysfunction, contain phytoestrogens and decrease vascular smooth muscle hypertrophy, reduce oxidative stress and retard development of atherosclerosis.
Recommended Dose: 14 g to 40 g daily.