Can I lower my cholesterol naturally?

I started practice in the 1970s, when we knew that elevated cholesterol was a major cause of heart attacks but could not do much about it. The first statin was released in the US in 1987. Before then, we had diet and a few very ineffective medications. The statins proved to work very well at lowering cholesterol and lowering the risk of heart attack, and were very safe for most people.

Today we have additional medications that are used in people whose cholesterol does not get to goal on a statin and/or who cannot take one.

If you have known coronary disease, diabetes or an LDL (“bad”) cholesterol over 190, you need a statin and/or one of the newer agents. No diet change or OTC supplement will get your cholesterol low enough. If your cholesterol is only modestly elevated, there are some alternatives you can try.

Let me start by telling you what will NOT work. Cinnamon, garlic, turmeric and fish oil pills have no or minimal effect.

Red yeast rice is an interesting product. It can contain a chemical identical to lovastatin, and when it does, it lowers LDL cholesterol by 15-25%. The problem with red yeast rice is that it is not standardized, and any given batch may contain variable amounts of this product (sometimes none). Also, why not take the FDA-approved real thing?

Plant sterols and stanols come in capsule or tablet form and in fortified foods, the best known of which is Benecol, a butter substitute. These have been the most-studied of natural products. Replacing butter and margarine with stanol-ester margarine lowered LDL by up to 15%. These products are quite safe.

Soluble fiber is also safe but only very modestly effective. Adding 10 grams/day of psyllium results in a 4-5% drop in LDL cholesterol. This much fiber can cause bloating and may interfere with absorption of medication, so should not be taken with medication.

The best results come when you combine a very low-fat diet with sterols and fiber. When people were given this combination in a lab setting, when their diets were tightly controlled, LDL-C fell 30%. When they were asked to continue the same program on their own, the drop was only 12-15%.

Bottom line: if you are high risk, use the drug(s) you were prescribed. If your cholesterol is only modestly elevated and you are not high risk, give diet and stanols a try.


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