Cholesterol-lowering supplements - includes related article

Nutrition Action Healthletter, Nov, 1997 by David Schardt

"Reduce Your Cholesterol up to 15% in 4 weeks!"

"Literally flush cholesterol out of cell membranes."

Cholest-Away, Cholest-Off, Cholest-Arrest. The list goes Cholest-on-and-on.

Interested in lowering your high cholesterol "naturally" with a pill or powder? Want to avoid the bother and expense of a doctor, a prescription, or lab tests?

Then you're a candidate for one of the hot new "cholesterol-lowering" supplements made from exotic gums, soybean byproducts, grains, trace metals, garlic, and anything else that shows the slightest hint of working. They're as close as your favorite drug store.

But being cheaper and more easily available comes at a price. Prescription and over-the-counter drugs are tested for effectiveness--and safety--in thousands of people, often for years, before the Food and Drug Administration approves them.

Supplements, which don't need FDA approval, are tested on dozens--occasionally hundreds--of people, seldom for more than six months.

In some of those limited tests, a few supplements seem to lower cholesterol levels. Should you take them? Not before you read this article.

We start with supplements that are supported by the most evidence and end with those supported by the least.

Niacin

Niacin is the only supplement that's been proven--in tests as rigorous as those for a prescription drug--to lower cholesterol.

Two to three grams (2,000 to 3,000 ma) a day can lower LDL ("bad") cholesterol by 20 to 30 percent and raise HDL ("good") cholesterol by 20 to 35 percent. The National Cholesterol Education Program recommends niacin as one of the primary treatments for high cholesterol.

But don't even think about taking it without talking to your doctor.

"Large doses of niacin are not supplements, but drugs," says Louis Lasagna, dean of the Sackler School of Graduate Biomedical Sciences at Tufts University in Boston.

"Niacin is capable of damaging the liver, activating peptic ulcers, impairing glucose tolerance, and precipitating gouty attacks," he adds. And many niacin-takers suffer from flushing, headaches, nausea, heartburn, and diarrhea.

Soluble Fibers

A diet rich in beans, whole grains, fruit, and other foods high in soluble fiber can help lower cholesterol levels. There's no question about that.

But what about skipping the foods and taking just the fiber?

"More than 50 studies have found that certain soluble fiber supplements significantly lower cholesterol levels, including LDL, in those with elevated cholesterol," says Stephen Glore of the University of Oklahoma Health Sciences Center in Oklahoma City.

The most-studied fibers: guar gum, pectin, and psyllium. "The research shows that consuming from six to 40 grams of pectin, eight to 36 grams of gums such as guar gum, or ten to 30 grams of psyllium each day can have this effect," says Glore.

But not all soluble fiber supplements are equal, says fiber expert Gene Spiller of the Center for Health Research and Studies in Los Altos, California.

"The effectiveness of a soluble fiber depends, in part, on the strength of the gel it forms," he explains. Some methods of processing the raw fiber may break up its carbohydrate strands, weakening the gel.

"That means that you really have to test each soluble fiber product to make sure it works effectively."

A search through the medical literature turned up only two brands with good, published research showing that they can lower cholesterol.

* Metamucil, made by Procter & Gamble, contains the soluble fiber psyllium. While it has been approved for sale only as a laxative, Metamucil also seems to lower cholesterol.

For example, in six studies, ten grams a day (about three teaspoons of regular flavor) for 1 1/2 to four months dropped cholesterol by four to fifteen percent--and LDL by six to twenty percent--in 169 men and women who began with an average cholesterol of around 250.[1]

There's a downside, though. Some people are allergic to psyllium. If you're in that group (and there's no way to tell), eating Metamucil--or any other product that contains psyllium--could cause wheezing, chest tightness, or rashes. In rare cases, it sends people into life-threatening anaphylactic shock.

(You can also find psyllium in Kellogg's Bran Buds cereal. But to get ten grams of psyllium you'd have to eat almost three servings. The company has asked the FDA for permission to make a health claim that foods with psyllium can help lower cholesterol. Given the possible allergic reactions, the fact that the cereal has only been tested on about 250 people for three months or less, and the danger of portraying foods as "magic bullets," we've opposed putting health claims on psyllium-containing foods.)

* Fiber Plan, from Shaklee Corporation, is a mixture of the soluble fibers psyllium, pectin, guar gum, and locust bean gum. In two good studies, Fiber Plan lowered cholesterol. In the longer of the two, 15 grams a day for six months lowered LDL by 14 percent in 24 men and women with average cholesterol of 235.[2]

Phytosterols

Plants like soybeans, wheat, and rice can make compounds called phytosterols, which resemble cholesterol so closely that our digestive tracts can't distinguish one from the other.