Five plant-based supplements for managing cholesterol levels

Heart attack – a silent killer.

A friend lost her father recently in his sleep. A sudden heart attack was the determined cause of death. A silent killer indeed. However, this is not uncommon. Sixteen people die from heart disease or stroke every day. Nearly 1 in every 3 deaths in Singapore is due to heart disease or stroke according to the statistics from Ministry of Heath [1].

Heart attack-NIH

Formation of blood clot leading to a heart attack.

One of the major risk factors for heart disease and stroke is high total cholesterol levels in the blood. Research has shown that cholesterol, particularly the low-density lipoprotein (LDL, nickname as the bad cholesterol), can infiltrate and retain in the wall of the arteries causing inflammation and forming of plaques. Unstable arterial plaques may loosen and rupture. Pieces of these ruptured plaques can travel in the blood to the heart or brain, forming a blood clot that block the blood flow, and leads to heart attack or stroke [2,3]. Therefore, to prevent heart attack or stroke, it is essential to keep your blood cholesterol levels low.  

Doctors often prescribe statins as the standard treatment for high cholesterol levels. Although statins can save lives, it is not without adverse effects. Most notably, statins can increase the risk of diabetes mellitus and cause muscle-related symptoms, such as muscle weakness, cramp or pain [4]. Hence, for individuals who are on borderline of being diagnosed with high cholesterol levels, lifestyle modifications that include diet, exercise, weight loss, and plant-based dietary supplements can be used to manage the blood cholesterol levels [5]. Here are five plant-based dietary supplements that can help to reduce cholesterol levels.

Garlic

Garlic – a wonder food

Garlic (Allium sativum) has long been used as a herb for treating heart disease in ancient India for two thousand years [6]. Many clinical trials have studied the effect of garlic on blood cholesterol levels. A meta-analysis study that analysed results from 39 clinical trials found garlic to be effective in reducing total cholesterol level by 11-23 mg/dL (0.61 – 1.28 mmol/L) and lower LDL level by 3-15 mg/dL (0.17 – 0.83 mmol/L), provided garlic is taken for more than 2 months [7].This comprehensive study provides a strong evidence to support the use of garlic to bring down cholesterol levels naturally. In addition, taking garlic supplements is also found to reduce blood pressure and platelet aggregation, two other risk factors for cardiovascular disease.  

Red Yeast Rice

Red rice wine hong zhao

Red yeast rice under fermentation


Red yeast rice, or Hong qu (红麴) in Chinese, is white rice fermented with the yeast Monascus purpureus and other related moulds. It has been traditionally used in Chinese medicine as a food as well as herb [8]. Red yeast rice contains Monacolin K, a bioactive compound that is chemically identical to lovastatin (a type of statins). For this reason, red yeast rice has been explored as a natural form of statin for lowering cholesterol levels [8]. A meta-analysis of 13 clinical trials found red yeast rice to be more effective than placebo in lowering total cholesterol, LDL, and triglycerides in the blood. The study considered red yeast rice supplementation to be an effective and relatively safe approach to manage high cholesterol levels [9].

Soy isoflavones

Soy is a rich source of isoflavones

Consumption of soy products is known to reduce the risk of cardiovascular disease as observed in major population-based studies. Isoflavones in soy, including genistein and daidzein, may potentially reduce the rate of plaque formation by LDL [10]. The cholesterol-lowering effects of soy isoflavones have been studied in many clinical studies. A meta-analysis of 11 clinical trials shown that soy isoflavones significantly decreased serum total cholesterol by 0.10 mmol/L (3.9 mg/dL) and LDL cholesterol by 0.13 mmol/L (5.0 mg/dL) [11]. A larger reduction in cholesterol levels was observed in people who have higher cholesterol levels than normal.

Phytosterol esters

Many margarine and spreads are now being fortified with phytosterol esters

Phytosterol esters are plant sterols and stanols. Plant sterols are naturally occurring compounds in vegetable oils; plant stanols are the hydrogenated form of plant sterols.  Plant sterols and stanols only present in very small quantity naturally. Due to their ability to inhibit the absorption of cholesterol from food to achieve reduction of blood cholesterol level, oil and margarine products are now being fortified with phytosterol esters [12]. A meta-analysis of 124 studies on phytosterol esters effects on LDL levels revealed that intakes of 0·6–3·3 g/d of phytosterol esters could gradually reduce LDL-cholesterol concentrations by, on average, 6–12 % [13]. For patients currently taking statins, supplementing with phytosterol esters can assist in a further reduction in total cholesterol and LDL levels by 0.30 mmol/L each according to another meta-analysis of 15 trials[14].

Artichoke

Artichoke leaf extract can effectively lower cholesterol levels

Artichoke (Cynara scolymus) is used extensively in the Mediterranean diet, which is renown for its protective effects on heart health. The extract from artichoke leaves has been long used as a remedy for many liver and gallbladder conditions [15]. It contains many antioxidant components that are also beneficial in lowering cholesterol levels. A meta-analysis of 9 clinical trials found artichoke leaf extract to be effective in significantly reducing total cholesterol (-17.6 mg/dL or -0.98 mmol/L), LDL (-14.9 mg/dL or -0.83 mmol/L), and triglycerides (-9.2 mg/dL or -0.51 mmol/L) [16].    

Conclusion

Plant-based dietary supplements can be an effective approach to reduce cholesterol levels and prevent heart disease and stroke. Garlic, red yeast rice, soy isoflavones, phytosterol esters, and artichoke extract are among the most well-studied plant-based remedies. They can be safer alternatives to statins in lowering cholesterol levels.  

References

[1]        M.A. Richards, Singapore’s approaching tsunami of cardiovascular disease, in: NMRC Res. Symp., Singapore, 2017. http://www.nmrc.gov.sg/content/dam/nmrc_internet/nmrc2.0/nmrcAwards/2017/Slides/Cardiovascular Diseases – Mark Richards.pdf.

[2]        R.H. Nelson, Hyperlipidemia as a risk factor for cardiovascular disease., Prim. Care. 40 (2013) 195–211. doi:10.1016/j.pop.2012.11.003.

[3]        M.F. Linton, P.G. Yancey, S.S. Davies, W.G. (Jay) Jerome, E.F. Linton, K.C. Vickers, The Role of Lipids and Lipoproteins in Atherosclerosis, MDText.com, Inc., 2000. http://www.ncbi.nlm.nih.gov/pubmed/26844337 (accessed April 23, 2018).

[4]        P.D. Thompson, G. Panza, A. Zaleski, B. Taylor, Statin-Associated Side Effects, J. Am. Coll. Cardiol. 67 (2016) 2395–2410. doi:10.1016/J.JACC.2016.02.071.

[5]        E.T. Carreras, D.M. Polk, Dyslipidemia: Current Therapies and Guidelines for Treatment, US Cardiol. Rev. 11 (2017) 1. doi:10.15420/usc.2016:9:2.

[6]        R.S. Rivlin, Historical Perspective on the Use of Garlic, J. Nutr. 131 (2001) 951S–954S. doi:10.1093/jn/131.3.951S.

[7]        K. Ried, C. Toben, P. Fakler, Effect of garlic on serum lipids: An updated meta-analysis, Nutr. Rev. 71 (2013) 282–299. doi:10.1111/nure.12012.

[8]        T. Nguyen, M. Karl, A. Santini, Red Yeast Rice., Foods (Basel, Switzerland). 6 (2017). doi:10.3390/foods6030019.

[9]        Y. Li, L. Jiang, Z. Jia, W. Xin, S. Yang, Q. Yang, L. Wang, A meta-analysis of red yeast rice: an effective and relatively safe alternative approach for dyslipidemia., PLoS One. 9 (2014) e98611. doi:10.1371/journal.pone.0098611.

[10]      U. Wenzel, D. Fuchs, H. Daniel, Protective effects of soy-isoflavones in cardiovascular disease. Identification of molecular targets., Hamostaseologie. 28 (2008) 85–8. http://www.ncbi.nlm.nih.gov/pubmed/18278168 (accessed April 23, 2018).

[11]      K. Taku, K. Umegaki, Y. Sato, Y. Taki, K. Endoh, S. Watanabe, Soy isoflavones lower serum total and LDL cholesterol in humans : a, Am. J. Clin. Nutr. 85 (2007) 1148–1157. doi:85/4/1148 [pii].

[12]      G.R. Thompson, S.M. Grundy, History and Development of Plant Sterol and Stanol Esters for Cholesterol-Lowering Purposes, Am. J. Cardiol. 96 (2005) 3–9. doi:10.1016/j.amjcard.2005.03.013.

[13]      R.T. Ras, J.M. Geleijnse, E.A. Trautwein, LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies., Br. J. Nutr. 112 (2014) 214–9. doi:10.1017/S0007114514000750.

[14]      S. Han, J. Jiao, J. Xu, D. Zimmermann, L. Actis-Goretta, L. Guan, Y. Zhao, L. Qin, Effects of plant stanol or sterol-enriched diets on lipid profiles in patients treated with statins: systematic review and meta-analysis., Sci. Rep. 6 (2016) 31337. doi:10.1038/srep31337.

[15]      M. Rondanelli, F. Monteferrario, S. Perna, M.A. Faliva, A. Opizzi, Health-promoting properties of artichoke in preventing cardiovascular disease by its lipidic and glycemic-reducing action, Monaldi Arch. Chest Dis. 80 (2015). doi:10.4081/monaldi.2013.87.

[16]      A. Sahebkar, M. Pirro, M. Banach, D.P. Mikhailidis, S.L. Atkin, A.F.G. Cicero, Lipid-lowering activity of artichoke extracts: a systematic review and meta-analysis., Crit. Rev. Food Sci. Nutr. 0 (2017) 0. doi:10.1080/10408398.2017.1332572.

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