You Don't Need Drugs to Control Your Cholesterol
Allan Magaziner, DO
Magaziner Center for Wellness and Anti-Aging Medicine
I t's widely known that low cholesterol levels help prevent heart
attack and stroke. But that's only part of the story. Levels of HDL
"good" cholesterol must be high enough to carry harmful forms of
cholesterol to the liver to be excreted.
New finding: Research has shown that decreasing LDL "bad" cholesterol
by 40% and increasing HDL by 30% lowers the risk for heart attack or
stroke by 70% -- a much greater reduction of risk than occurs from
lowering either total cholesterol or LDL levels.
The pharmaceutical industry has worked feverishly to develop a
prescription medication that significantly increases HDL levels, to be
used as a complement to cholesterol-lowering statins that focus
primarily on lowering LDL levels.
Latest development: The new drug torcetrapib was pegged as a
blockbuster that increases HDL levels by 60% -- that is, until last
December, when late-stage clinical trials showed that torcetrapib
actually increased heart problems and death rates.
What you may not know: Therapeutic doses of
niacin (vitamin B-3)
effectively boost HDL levels -- and lower LDL and total cholesterol.
THE "CHOLESTEROL VITAMIN"
Fifty years ago, Canadian scientists discovered that high doses of
nicotinic acid -- a form of niacin -- could lower total cholesterol.
In a 1975 study of men with heart disease, niacin was shown to reduce
the rate of second heart attacks. Later, niacin was found to boost
heart-protective HDL levels.
Although niacin alone cannot help everyone with abnormal cholesterol
levels -- often it is best used in combination with a statin -- the
vitamin is one of the most effective nondrug therapies available.
Ask your doctor about taking niacin if after trying cholesterol-
lowering medication you have suffered side effects or your cholesterol
levels have not improved within three months of getting a cholesterol
test. Or consider trying niacin with the nondrug therapies described
below.
How to use: Start with 100 mg of niacin daily and build up over one
week to 500 mg a day. Every week, increase the dose by 500 mg until
you reach 2,000 mg a day, taken in three divided doses, with meals. Be
certain to use nicotinic acid, not niacinamide, a form of B vitamin
that does not improve cholesterol levels. Consult your doctor before
taking niacin.
The most common side effect of niacin is flushing -- a warm, itchy,
rash-like reddening of the face, neck and chest, which lasts about 10
minutes. Flushing is caused by niacin's ability to trigger
vasodilation (widening of blood vessels).
To lessen this side effect, choose a form of niacin known as inositol
hexanicotinate. It helps prevent the flush without reducing niacin's
effectiveness.
Caution: Niacin should be avoided by people with a history of liver
disease or stomach ulcers and used with caution by patients with
diabetes and/or gallbladder disease. In addition, high-dose niacin
(2,000 mg or more) may interact with certain medications, including
alpha-blockers, such as
doxazosin (Cardura), and the diabetes drug
metformin (Glucophage).
OTHER NONDRUG THERAPIES
A diet that keeps sugar and processed food to an absolute minimum and
emphasizes fruits and vegetables... whole grains... beans... fish...
lean meats... and nuts and seeds can help lower LDL cholesterol and
raise HDL levels. So can regular exercise, such as brisk walking, and
losing excess weight.
Other nondrug approaches can lower total and LDL cholesterol and boost
HDL. Combine the following nondrug therapies with niacin for maximum
effectiveness...
Red yeast rice. This Chinese medicine -- a yeast that is grown on
white rice, then fermented -- contains monacolins, substances that act
as naturally occurring statins. Research in China shows that red yeast
rice can lower total cholesterol by 11% to 30%. Typical use: Take
1,200 to 2,400 mg a day of red yeast rice, in two to four doses, with
meals.
Not recommended: Policosanol -- a supplement derived from cane sugar
that also contains natural statins -- has been widely promoted as
effective for lowering cholesterol. However, several recent studies
show that policosanol has no significant effect on cholesterol.
Fish oil and flaxseed. Fish oil and flaxseed supply omega-3 fatty
acids, which lower total cholesterol and LDL levels and raise HDL
levels. Typical dose: For fish oil, take supplements containing a
total of 3 g daily of eicosapentaenoic acid (EPA) and docosahexaenoic
acid (DHA). If you take a blood-thinning drug, such as
aspirin or
warfarin (Coumadin), check with your doctor before taking this dose of
fish oil. Or use one to three teaspoons of ground flaxseed a day,
sprinkled on food or mixed with water or juice. Flaxseed also can help
relieve constipation and ease arthritis pain.
Soy. Many studies show that soy can help lower total and LDL
cholesterol. Typical use: Try to get 20 g of soy protein a day -- the
equivalent of eight ounces of tofu... or one cup of edamame (soy)
beans. Important: Soy ice cream and other processed soy foods don't
deliver enough soy to help reduce cholesterol.
Caution: If you have been diagnosed with a hormone-dependent cancer,
such as some breast malignancies, or are at risk for such a condition,
check with your doctor before adding soy to your diet.
Plant sterols. These natural substances, which block the absorption of
cholesterol in the intestines, are found in fruits, vegetables, beans,
grains and other plants. Regular intake can reduce total cholesterol
by 10% and LDL by 14%. Products with plant sterols (or a similar form,
plant stanols) include spreads, salad dressings, snack bars and
dietary supplements. Typical use: Aim for 1 g to 2 g daily of plant
sterols.
Walnuts. A recent study published in the medical journal Angiology
showed that people who ate a handful of walnuts daily for eight weeks
had a 9% increase in HDL. Walnuts contain polyphenol antioxidants,
which also inhibit oxidation of LDL cholesterol. Recommended intake:
One ounce of raw walnuts three times daily.
Bottom Line/Health interviewed Allan Magaziner, DO, a clinical
instructor in the department of family practice at the Robert Wood
Johnson University of Medicine and Dentistry in New Brunswick, New
Jersey, and the medical director of the Magaziner Center for Wellness
and Anti-Aging Medicine in Cherry Hill, New Jersey
(
www.drmagaziner.com). A past president of the American College for
Advancement in Medicine, he is the author of The All-Natural Cardio
Cure (Avery).
You Don't Need Drugs to Control Your Cholesterol 
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