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High Cholesterol

High cholesterol isn’t a disease, it’s more like an alarm signal. The state of your cholesterol levels tells you something about your risk of developing the United States’ number one killer, heart disease, or coronary artery disease.

The higher your blood levels of "bad" low-density lipoprotein (LDL) cholesterol, the greater your risk of developing coronary artery disease, the life-threatening condition that occurs when the arteries to your heart become clogged with cholesterol. One form of LDL cholesterol, called lipoprotein (a), or Lp(a), has been found to be even more damaging than ordinary LDL. In fact, the risk of heart disease for people with high levels of Lp(a) is 10 times higher than that of people who simply have elevated levels of LDL cholesterol. That’s because Lp(a) sticks to artery walls much more easily than LDL does.

When doctors look at cholesterol levels for a profile of your risks, they also consider other kinds of fats, or lipids, that affect arterial health. Two of those factors, one bad and one good, are triglycerides and high-density lioprotein (HDL) cholesterol. Triglycerides are simply partners in crime with LDL, and when your blood profile shows high triglycerides, there’s reason for concern. HDL, on the other hand, is a fat that campaigns for free-flowing blood, and it never sticks around to cause trouble in the arteries. For this reason, it’s easiest to think of HDL as the good cholesterol; the higher your HDL levels, the lower your risk of heart disease.

Eating a diet low in fat, especially saturated fat, and high in fiber is always a primary strategy for lowering the bad cholesterol and raising the good. You need to pursue that diet even if your cholesterol is so high that your doctor has prescribed cholesterol-lowering drugs, says Decker Weiss, N.M.D., a naturopathic doctor at the Arizona Heart Institute in Phoenix.

If you know that your LDL cholesterol is high and you’re already on cholesterol-lowering drugs, some vitamin or herbal supplements might come in handy for reducing the side effects of those drugs. Other supplements directly lower cholesterol levels or reduce your risk for atherosclerosis, the notorious hardening of the arteries that results from a buildup of blood-slowing plaque along the arterial walls. Supplements can reinforce your cholesterol-control efforts on a number of different fronts. Here’s how they stack up.

Antioxidants Help Disarm Cholesterol

"Cholesterol doesn’t hurt you when it’s just floating around in your blood," Dr. Weiss says. As soon as the fatty substance clings to your artery walls, however, it becomes a threat, and a serious one at that.

Harmful LDL cholesterol doesn’t go looking for trouble when it’s traveling along in its free-floating form. Before it can stick to your artery walls, it has to be oxidized. To prevent the chain of events that leads to oxidation of cholesterol, you need a good dose of the antioxidant nutrients that can disarm free radicals, the free-roaming, unstable molecules that do the damage. Many antioxidants are found in foods. Others are most available from supplements, particularly when you want vitamin E or large amounts of vitamin C.

Dr. Weiss recommends taking 400 to 800 international units (IU) of vita min E every day. "While it doesn’t actually affect cholesterol levels, vitamin E does help to lessen the potential harmful effects of high cholesterol levels," he says.

In your body, vitamin E helps prevent LDL cholesterol from being oxidized. A study showed that at least 400 IU is needed to significantly reduce LDL oxidation.

C: What It Does

Vitamin C apparently can have a more direct effect on cholesterol levels. Dozens of studies have shown that higher blood levels of vitamin C correspond to lower total cholesterol and triglyceride levels and higher HDL levels. In a study at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, researchers found that people with low blood levels of ascorbic acid (vitamin C) who took 1,000 milligrams a day for eight months had an average 7 percent increase in HDL. Researchers say that eating five servings of fruits and vegetables a day would bring your vitamin C levels into the normal range.

Dr. Weiss recommends taking 1,000 to 3,000 milligrams of vitamin C daily in divided doses.

More on the Antioxidant Front

Additionally, Dr. Weiss recommends lipoic acid, an antioxidant that plays a role in energy production. This antioxidant has a unique property: It is effective against both fat-soluble and water-soluble free radicals. It has been found to raise blood levels of vitamin C and of glutathione, another powerful antioxidant that is made in the body. You can get lipoic acid in either capsules or tablets. A standard dose is 20 to 50 milligrams a day.

Dr. Weiss also recommends bioflavonoids, or proanthocyanidins. These powerful antioxidant compounds are found in many plants and in red wine. The proanthocyanidins used in supplements come from grape seeds and pine bark.

Laboratory studies indicate that, in theory, "proanthocyanidins can trap a variety of free radicals and inhibit the damaging effects of several enzymes, including enzymes that degrade collagen, the body’s main connective tissue," says Dr. Weiss. If you’re using proanthocyanidins to prevent heart disease, a daily dose of 50 milligrams is enough. If you already have heart disease, you should raise the dose to 150 to 400 milligrams a day, he says. Of course, be sure to tell your doctor which supplements you are taking.

Lipotropic Compounds Aid Your Liver

Believe it or not, most of the cholesterol floating around in your bloodstream is made in your liver. In order to make that cholesterol, the liver relies on the fats you eat for raw material. That’s why it deserves attention if you have high cholesterol, Dr. Weiss says.

He recommends a combination supplement of lipotropic compounds that have multiple benefits for the liver. The mixture may include choline, betaine, methionine, vitamin B₆, folic acid, vitamin B₁₂, milk thistle, and dandelion. The combination helps to promote the flow of bile to and from the liver, in effect decongesting it. It helps to promote improved liver function and improve the way your body burns fat.

Take enough lipotropic compounds to get a daily dose of 1,000 milligrams of choline and 1,000 milligrams of either methionine and/or cysteine, recommends Michael Murray, N.D., a naturopathic doctor and co-author of The Encyclopedia of Natural Medicine.

Double Up on Fiber

Along with a lipotropic compound, Dr. Weiss recommends a high-fiber diet. Fiber, especially the soluble kind, can bind up the bile that’s secreted by your liver into the small intestine. Bile is laden with cholesterol. When fiber binds with the bile and escorts it from your body, it means that the fats won’t be reabsorbed, "so the combination of fiber and a lipotropic compound is often an effective way to lower cholesterol," Dr. Weiss says.

You need to get somewhere between 15 and 30 grams of fiber a day in order to see an impact on your cholesterol levels, according to Dr. Weiss. The average intake in the United States is about 12 grams, so he says that you should aim for about twice that amount. Beans, berries, whole grains, and bran, such as oat or wheat bran, can provide good amounts of fiber.

If you need to get more, use a supplement of mixed soluble and insoluble fibers, including pectin, gums, psyllium, and oat bran, Dr. Weiss recommends.

Helping the Heart

Our bodies use both blood sugar (glucose) and fat as fuel. The energy that the heart muscle relies on, however, is supplied mostly by fatty acids. Dr. Weiss recommends cutting back on the fats that can harm and going for the ones that can heal. The harmful kinds are saturated and hydrogenated fats, found in red meat, hydrogenated oils, and many processed foods.

The two essential fatty acids that help to protect your heart are omega-3 and omega-6 fatty acids, found in various proportions in fish oil, flaxseed oil, and borage oil. Moreover, fish oil has additional benefits. Studies show that substituting it for saturated fats or other unsaturated fats can significantly reduce triglycerides.

Dr. Weiss recommends that people with high cholesterol get 1,000 to 3,000 milligrams daily of a combination of fish oil and flaxseed or borage oil. This mixture is available in gel caps, or you can get flaxseed oil separately as a liquid.

Niacin Nixes the Bad Stuff

In large doses, niacin, a B vitamin, is sometimes used to lower LDL cholesterol. Niacin also raises HDL and lowers levels of Lp(a) and triglycerides. It also lowers fibrinogen, a blood protein that causes clot formation. Dr. Weiss cautions, however, that niacin is not universally effective, since there are some inherited forms of high cholesterol that it won’t improve.

Also, niacin is not a supplement that you can automatically substitute for a cholesterol-lowering drug. Some people are better off with one of the "statin" drugs, such as simvastatin (Zocor), says Dr. Weiss. "Either niacin or a statin drug may be an appropriate choice for a particular patient, depending on the patient’s lipid profile."

If triglyceride levels are high, you might get better results from niacin, Dr. Weiss notes. Statin drugs, on the other hand, are more likely to be your doctor’s first choice if you’ve just had a heart attack and have very high LDL levels that need to be reduced quickly.

Even though niacin is available at health food stores, you need to talk to a doctor before you take the high doses—1,000 to 3,000 milligrams a day—that are needed to lower cholesterol. At high doses, niacin can cause liver damage.

Your doctor will want to monitor your liver enzymes while you are taking niacin. If you are taking a cholesterol-lowering drug, never add large amounts of niacin without your doctor’s approval. Such a combination can also cause serious liver damage.

Added Protection: Coenzyme Q₁₀

If you’re taking a statin drug, Dr. Weiss recommends taking coenzyme Q₁₀ (coQ₁₀), a vitamin-like compound that’s made in your body. It acts as an antioxidant and is also essential for the production of energy. "Statin drugs deplete your blood of coQ₁₀, so I have my patients use supplements while they’re taking a statin drug," says Dr. Weiss.

CoQ₁₀ may help your liver cells withstand the toxicity of the statin drugs and reduces side effects such as liver problems and muscle aches. As for how much to take, Dr. Weiss suggests a dose ranging from 30 to 50 milligrams a day.

In studies, it’s been found that people can lower total cholesterol by 10 to 12 percent and LDL and triglycerides by about 15 percent with supplements. HDL levels usually increased by about 10 percent. For these kinds of results, you’ll need a preparation that provides a daily dose of at least 10 milligrams of alliin or a total allicin potential of 4,000 micrograms. You’ll probably need to allow one to three months before you begin seeing a change in your cholesterol levels.