A number of prescription drugs are available to help reduce LDL cholesterol and triglyceride levels. However, many health-conscious people would prefer to improve their lipid levels without resorting to prescription medications.
This article provides information about some of the more commonly used non-prescription methods of lowering cholesterol. But first, there are a few things you should know about cholesterol lowering and its effect on cardiovascular risk.
Why Treatment Is Not Straightforward
While several kinds of prescription medications can substantially improve cholesterol levels, until recently only one class of drugs had been repeatedly shown to also improve cardiovascular risk—the statins.
PCSK9 inhibitor drugs, first approved for use in treating cholesterol in 2015, also show new promise as risk reducers. Two large clinical outcome trials using PCSK9 inhibitors have definitively shown improved cardiovascular outcomes—and thus cardiovascular risk reduction—with the PCKS9 inhibitors evolocumab and alirocumab.
Anyone who already has coronary artery disease, or has had a stroke, diabetes, or other risk factors that place them at very high risk for cardiovascular disease, should be strongly considered for statin therapy. PCSK9 inhibitor therapy may also be an option.
If you are in this category, taking supplements—even if they are effective in improving your lipid levels—is not enough.
When Supplements Make Sense
Not everyone with an elevated cholesterol level needs to take a statin. There are ways to achieve moderate lowering of cholesterol levels without using such drugs.
If you are basically healthy, and a formal assessment of your cardiovascular risk places you in a low-risk group—or at least shows that your risk is not high enough to warrant statin therapy—then non-prescription cholesterol lowering makes good sense.
Let’s review some of the commonly used non-prescription means of lowering cholesterol.
Lifestyle, Lifestyle, Lifestyle
Whoever we are, and whatever our level of cardiovascular risk, the best way to avoid heart disease and stroke is to adopt a healthy lifestyle. A sedentary lifestyle, especially if accompanied by a poor diet, being overweight, and/or smoking, not only causes elevated blood lipid levels, but also produces an extremely toxic overall lipid and glucose metabolism that actively stimulates atherosclerosis.
Getting plenty of exercise, controlling your weight, eating a heart-healthy diet, not smoking, and treating hypertension and diabetes (if present) are essential steps not only in improving your cholesterol levels, but more importantly, in reducing your cardiovascular risk. Anything else you may do—whether it involves prescription medication, supplements, or even invasive therapy—cannot be expected to have very much benefit unless you also get your lifestyle in order.
Supplements for Cholesterol and Triglycerides
Numerous dietary supplements have claimed to improve cholesterol or triglyceride levels. However, relatively few of these claims have actually been evaluated in legitimate scientific studies.
Here’s information about the most commonly used supplements that have been studied.
Fish Oil and Omega-3 Fatty Acids
Concentrates of fish oil containing high levels of omega-3 fatty acids can significantly reduce triglyceride levels and are sometimes prescribed for people whose triglyceride levels are exceedingly high. However, neither fish oil nor omega-3 fatty acids have been shown to substantially improve cholesterol levels.
Plant Sterols
Plant sterols are chemically similar to cholesterol, and when ingested appear to reduce cholesterol absorption from the intestines. However, the absorbed plant sterols themselves may increase the risk of atherosclerosis and other cardiac problems.
The American Heart Association now recommends that plant sterol supplements not be used routinely by the general population.
Soy
In recent studies, soy protein has been shown to reduce LDL cholesterol.
Soluble Fibers
Soluble fibers, found in foods such as whole grain oats, psyllium, and broccoli, can reduce blood cholesterol levels. Foods that contain soluble fibers tend to have other important health benefits as well and ought to be included in your diet, regardless of any effect on blood lipids.
Nuts
A variety of clinical studies have shown that eating nuts can reduce blood cholesterol and triglyceride levels, and can contribute to reduced cardiovascular risk.
Green Tea
Studies have shown that drinking green tea may reduce LDL cholesterol levels. This cholesterol-lowering effect has been difficult to demonstrate with other kinds of tea.
Red Yeast Rice
Red yeast rice is a form of fermented rice that contains statin-like compounds called monacolins. Red yeast rice that has monacolins can, like statins, reduce LDL cholesterol levels.
However, the Food and Drug Administration has ruled that monacolins must be removed from red yeast rice before it can be sold in the United States. Today, it is entirely unclear what you are buying when you purchase red yeast rice from supplement makers.
Policosanol
Policosanol, a product made from sugar cane, was once popular as a cholesterol-lowering agent. But a large, well-designed randomized clinical trial has shown that policosanol actually has no effect on blood lipid levels. There seems to be no good reason to spend your money on it.
