Cholesterol lowering supplements, natural ways using vitamin, herbs, diet and foods - Natural therapy for healthy blood cholesterol level management, by Ray Sahelian, M.D.
June 26 2017

Is cholesterol in the diet the problem or is it inflammation?
In my opinion, the excess consumption of simple, highly processed carbohydrates (sugar, sweets, flour and products made from them, cookies, pastries, white bread, sugared sodas, cakes, etc.), and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods, and trans fats, are more of a problem in causing blood vessel and heart disease, not the cholesterol present in eggs or other foods. Cholesterol in eggs does not seem to cause any harm to the heart. It is okay to eat egg yolks.

There is no reason to limit cholesterol in the diet to 300 milligrams a day because it is not associated with an increased risk of heart disease.

Cholesterol lowering supplement formulas
There are dozens of formulas and individual products on the market that may help manage elevated cholesterol levels, I will mention a few below:

Lowering high cholesterol with supplements
There's still much research that needs to be done before we can make any firm recommendations regarding the use of supplements to lower cholesterol levels. In the meantime there is some preliminary research that suggests the following nutrients and herbs should be looked into. Some of these supplements may not necessarily lower cholesterol levels, but because they are potent antioxidants they could prevent the bad LDL cholesterol from sticking to the walls of arteries -- thus preventing hardening of the arteries -- or they could thin the blood thus improving circulation. Another way some could be of benefit is by reducing inflammation which would make it less likely for the inner lining of blood vessels to get inflamed and get clogged up.
   Many doctors consider lowering cholesterol numbers with drugs to be the only objective without recognizing the importance of the other aspects of cardiovascular health that many dietary supplements can provide: reduction of inflammation, reduction of oxidation, and improvement in circulation.
   I will update this cholesterol article as more studies becomes available. I suggest you start with one or two supplements for a few weeks to see how they work before adding others. Please discuss with your physician to see if they are appropriate for you. Also, see below for dietary suggestions on how to manage high cholesterol levels. Statin drugs -- Lipitor, Mevacor, Zocor, Pravachol, Crestor, etc. -- used to lower cholesterol levels have serious side effects including muscle aches, liver damage, and memory loss. They may also raise blood sugar levels. I prefer trying the natural approaches first before resorting to these prescription drugs.

 Psyllium - Take half a teaspoon in a glass of water with a meal two or three times a day. Psyllium is a fiber, safe to consume, that reduces cholesterol levels and cardiac risk. Flax fiber is another good option. See a list of other fibers that could be of benefit including flax seed, chia seed, pectin, glucomannan, inulin, and others. Supplementing one's diet with psyllium fiber has positive effects on blood lipids while reducing cardiovascular risk. Adding psyllium to the diet also helps regulate bowel movements.

Pectin, whether from apple or grapefruit, could be helpful to lower levels of cholesterol. Modified citrus pectin is a fiber that has shown some benefits and it is available as a supplement.
Beta glucan is a fiber that could be helpful, research has been done with beta glucan and cholesterol.
Fish oils work well, especially in combination with garlic or other supplements, to improve circulation. They have anti-platelet activity. Krill oil is an alternative to fish oils and has also been shown in studies to reduce low density lipoprotein levels.
CoQ10 is an essential nutrient that is depleted in the blood in those who are taking stating drugs such as Lipitor, Mevacor, Crestor, and others. Taking extra Coenzyme Q10, such as 20 to 60 mg a few times a week, should be considered, not necessarily to lower cholesterol levels, but to maintain healthy coenzyme Q10 levels while on statin therapy.
Natural vitamin C with bioflavonoids as antioxidants are helpful in reducing oxidation of cholesterol but are not likely to make a significant difference in levels.
Natural vitamin E complex keeps cholesterol from being oxidized but is not likely to reduce cholesterol levels. Vitamin E supplements need only be taken a few times a week since they are fat soluble.
Niacin lowers cholesterol, LDL, Lp(a), and triglycerides while raising HDL (the good cholesterol). Slow release preparations are better.
Curcumin is a powerful antioxidant extracted from turmeric root.
 Artichoke leaf extract is a supplement to consider to lower cholesterol levels. Artichoke Leaf Extract supplements may be of benefit.
 Effect on LDL-cholesterol of a large dose of a dietary supplement with plant extracts in subjects with untreated moderate hypercholesterolaemia: a randomised, double-blind, placebo-controlled study. Eur J Nutr. 2012. Department of Research, Laboratoire Lescuyer, Aytre Cedex, France. We determined the effect of 4 weeks of supplementation, then, withdrawal of a dietary supplement (DS) containing red yeast rice extract, policosanol and artichoke leaf extract at twice the recommended daily dose (6 tablets, 6-TAB) compared to the usual dose (3-TAB) or to a placebo, on blood lipid profiles and safety biomarkers. Forty-five healthy subjects (15 per group), with untreated hypercholesterolaemia, were included in this randomised, double-blind, placebo-controlled clinical trial. After 4 weeks of supplementation, LDL-C was significantly lower in 6-TAB and 3-TAB compared to placebo, although no difference in LDL-cholesterol was observed between the two groups, while no effect was seen on triacylglycerol and HDL-cholesterol. The muscle breakdown biomarkers, as well as biomarkers of liver and renal function, were altered by neither dose of the DS. Supplementation with twice the recommended dose of the DS was effective in reducing LDL-cholesterol and appeared safe, but according to the present results, no additional benefit could be achieved compared to the recommended dose.
 Beta sitosterol is a well known phytosterol. Phytosterols have been known since the 1950s as nutrients that can maintain healthy cholesterol levels. Consider adding a little soy to your diet and reduce saturated meats or you may take a soy protein supplement. See stanol for additional information and also sterol information. If you normally consume soy products, there is no need to consume additional soy foods. Plant sterols, structurally similar to cholesterol, have been shown to lower both total and LDL cholesterol in the body in therapeutic amounts. Even the FDA and the National Cholesterol Education Panel recommend phytosterols in the diet.
Green tea extract to prevent oxidation of lipids. Or, you can drink a cup of green tea a day. In fact, most teas have excellent antioxidant activity.
Red yeast rice may be helpful in lowering cholesterol levels although different brands may have different effects.
Sytrinol has flavones from orange, tangerines and palm fruit.
 Policosanol -- This sugar cane extract may sometimes reduce cholesterol although research studies have shown conflicting results. Octacosanol is a waxy substance present in some plant oils and is one of the primary components of the sugar cane extract policosanol.
Grape seed extract has been studied in animals with good results in terms of reducing atherosclerosis, which is another name for hardening of the arteries..
 Licorice extract used a few times a week, or you can drink licorice tea 2 or 3 times a week.
Mangosteen is a fruit extract available as a dietary supplement with very strong antioxidant activity. It protects LDL cholesterol from oxidative damage.

Fats, also called lipids, serve as a major source of fuel for the body's metabolic processes. Fats are obtained from food or formed in the body, mostly in the liver, and can be stored in fat cells for future use. Fats are essential components of cell membranes, of the myelin sheaths that surround nerve cells, and of bile. The two major fats in the blood are cholesterol and triglycerides. They attach themselves to certain proteins so they can travel throughout the bloodstream; the combined fats and proteins are called lipoproteins. The major lipoproteins are chylomicrons, very low density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). HDL cholesterol is the good cholesterol while LDL cholesterol is called the bad cholesterol.

Low cholesterol diet
Our choice of food intake can reduce cholesterol levels more than may doctors realize. A diet rich in fatty fish may protect the heart and blood vessels by reducing inflammation. Individuals with the highest cell levels of docosahexaenoic acid (DHA), a type of omega-3 fatty acid found in fish such as salmon and mackerel, have lower levels of C-reactive protein in their blood. C-reactive protein (CRP), a marker of blood vessel inflammation, is associated with risk of heart disease. In a study of nearly 28,000 women, levels CRP were more accurate than levels of "bad" cholesterol at predicting the risk of heart attack and other cardiovascular problems.
   Bulking up the diet with soy, plant sterols, vegetables, almonds, and legumes such as beans and peas and other high fiber sources can lower cholesterol and the risk of heart disease. Incorporate more cholesterol lowering foods in your daily diet. Those who eat frequently throughout the day have lower "bad" cholesterol levels compared with those who tend to down one or two large meals per day.

A diet rich in fiber and vegetables can lower cholesterol just as much as taking a statin drug. People who cannot tolerate statin drugs because of side effects can try the diet, which the volunteers easily followed. David Jenkins of St. Michael's Hospital and the University of Toronto and colleagues created what they called a diet "portfolio" high in soy protein, almonds, and cereal fiber as well as plant sterols -- plant-based compounds used in cholesterol-lowering margarines, salad dressing and other products. They tested their diet on 34 overweight men and women, comparing it with a low-fat diet and with a normal diet plus a generic statin drug lovastatin. Each volunteer followed each regimen for one month, with a break in between each treatment cycle. Writing in the American Journal of Clinical Nutrition, Jenkins and colleagues said the low-fat diet lowered LDL -- the low-density lipoprotein or "bad" cholesterol -- by 8.5 percent after a month. Statins lowered LDL by 33 percent and the "portfolio" diet lowered LDL by nearly 30 percent. The portfolio was rich in soy milk, soy burgers, almonds, oats, barley, psyllium seeds, okra and eggplant. The Almond Board of California helped fund the study, as did several food makers and the Canadian Natural Sciences and Engineering Research Council of Canada.

Soy protein -- such as that found in tofu, soy milk or soy powder -- can lower cholesterol levels as long as the raw soy is uncooked. Soy-fortified muffins, cereals or nutritional bars in which the soy protein is baked at high temperatures does not provide the benefit. Cooking the tofu does not destroy the key proteins because they have been stabilized. The health benefit also is found in such products as soy powder sprinkled on food or in milkshakes, or edamame, a raw or parboiled edible form of soybeans popular in Japan.

Exercise
Being physically fit boosts levels of "good" HDL cholesterol and improves the removal of "bad" forms of cholesterol. Exercise can reduce cholesterol and levels of CRP - c reactive protein.

Risk of high cholesterol
Abnormal levels of fats circulating in the bloodstream, especially high cholesterol, can lead to long-term problems. The risk of having atherosclerosis and coronary artery or carotid artery disease (and therefore the risk of having a heart attack or stroke) increases as a person's total cholesterol level increases. Low cholesterol levels are therefore generally better than high ones, although extremely low cholesterol levels may not be healthy either. A normal level is probably 140 to 200 milligrams of cholesterol per deciliter of blood (mg/dL). The risk of a heart attack more than doubles when the total cholesterol level approaches 300 mg/dL. Getting a cholesterol test every 3 years after age 45 is a good idea, particularly for those who are overweight or have a history of heart disease. There is no proof at this time that lowering cholesterol levels through the use of statin drugs makes people live longer, especially if the level is only mildly or moderately elevated.

Different types - the good, the bad, and the ugly?
Not all cholesterol increases the risk of heart disease or atherosclerosis. The cholesterol carried by LDL (the so-called bad cholesterol) increases the risk; the cholesterol carried by HDL (the so-called good cholesterol) lowers the risk and is beneficial. Ideally, LDL cholesterol levels should be below 120 mg/dL, and HDL cholesterol levels should be above 50 mg/dL. The HDL cholesterol level should account for more than 25 percent of the total cholesterol. The total cholesterol level may be less important as a risk factor for heart disease or strokes than the total cholesterol to HDL cholesterol ratio. Whether high levels of triglycerides increase the risk of heart disease or strokes is uncertain. Blood levels of triglycerides above 250 mg/dL are considered abnormal, but high levels don't appear to uniformly increase the risk of atherosclerosis or coronary artery disease.

Statin drugs, are they worth it?
 Without a doubt, statin drugs do lower cholesterol levels and possibly reduce the rate of heart attacks. But do they also reduce mortality? There is no proof at this time that lowering cholesterol levels through the use of statin drugs improves overall mortality, particularly in people who only have a mildly or moderately high cholesterol level. Taking statins does not reduce cardiac deaths among people who have no heart disease before starting the medications.

Side effects of statins include damage to muscle tissue, harm to kidneys, elevated liver function tests, depletion of CoQ10, and slight damage to brain cells leading to mild impairment of mental function. My impression is that statins are being overprescribed.

BAYCOL- cerivastatin - pulled off market in Aug 2001 for rhabdomyolisis (excessive muscle breakdown) and deaths
CRESTOR-- rosuvastatin -- causes more muscle and kidney damage than the other statins. AstraZeneca's cholesterol-lowering drug Crestor has more than twice the side effects of rival statin drugs, including deaths. Adverse effects include muscle damage known as rhabdomyolysis; proteinuria or protein in the urine; nephropathy, a reduced ability of the kidneys to filter toxins from the blood; and kidney failure.
LESCOL- fluvastatin
LIPITOR- atorvastatin - The popular cholesterol-reducing drug Lipitor made by Pfizer does not prevent obstruction of the heart valve that leads to the aorta, the body's largest artery, according to June 2005 findings published in The New England Journal of Medicine. In a study conducted to determine whether the cholesterol drug, also known by its generic name atorvastatin, did more than just reduce cholesterol, doctors found that Lipitor failed to prevent obstructions that can keep the heart from pumping blood adequately. The condition, known as calcified aortic stenosis, occurs when a key heart valve narrows or becomes blocked, preventing the heart from pumping blood properly and can manifest itself in spite of reductions of cholesterol levels.
MEVACOR- lovastatin
PRAVACHOL- pravastatin
ZOCOR- simvastatin is made by Merck

Taking certain cholesterol-lowering drugs at the same time as grapefruit juice can increase the risk of potentially life-threatening muscle toxicity. The risk was greatest with Merck & Co Inc's Zocor, or simvastatin, which went on sale without prescription in Britain, and Pfizer Inc's Lipitor. The problem occurs because grapefruit contains a chemical that inactivates a liver enzyme involved in drug metabolism. As a result, regular consumption of grapefruit juice can lead to excessively high levels of medicine in the blood. The risk of serious muscle problems also increases when these cholesterol pills, or statins, are taken along with some other drugs, including HIV protease inhibitors

Today’s top-selling statins could be risky when taken with other drugs called fibrates by older people with diabetes. Fibrates alone can be dangerous. These drugs lower triglycerides and often are taken by diabetics.

Statin drugs, such as Lipitor or Zocor, widely used for lowering cholesterol, may slightly impair brain function and perhaps harm brain cells. Doctors have known for quite some time that these drugs cause muscle tissue damage and lower CoQ10 levels in the blood. How statins interfere with optimal brain function is not clear, but my best guess is due to interference with cholesterol metabolism. Cholesterol is involved in the formation of pregnenolone and other hormones in the brain. These hormones are crucial for memory. There's still so much we don't know about the long term risks of statins. I only recommend their use in cases of very high cholesterol levels where natural remedies have failed. Besides, even though lowering cholesterol is important, too much emphasis has been placed on cholesterol reduction as opposed to reducing the whole inflammatory process that leads to clogging of vessels with plaques.

Cancer
 High blood levels of iron coupled with high levels of very low density (VLDL) lipoprotein cholesterol appear to interact to increase the risk of cancer. Iron and lipids combine to create oxidative stress, and oxidative stress has a role in the development of cancer.
   Men with high cholesterol levels, particularly if they were detected before the age of 50, may have an increased risk of developing prostate cancer

Mental function
The build-up of cholesterol plaques in arteries, a common occurrence with aging, contributes to the reduced thinking ability and dementia seen in many elderly individuals. To improve mental function, see memory.

Measuring skin cholesterol
Measuring the content of cholesterol in skin tissue is a noninvasive way to assess the thickness of the carotid artery wall. The test involves applying a special solution to a small area of the palm for one minute. The area is then blotted dry and an indicator solution applied, which turns blue. The hue depends on the cholesterol level, and can be accurately measured with a probe connected to a computer.

Testing for levels and type of cholesterol, are detailed tests necessary?
There is no proof that new tests that measure individual particles of LDL -- so-called bad cholesterol -- help in the overall management of a patient or help reduce overall mortality. Several companies including Quest Diagnostics Inc and privately held Atherotech Inc, LipoScience Inc and Berkeley HeartLab Inc have developed refined tests that measure the size and concentration of individual LDL particles. Smaller LDL particles are thought to be more dangerous than larger ones because they can easily become embedded in artery walls, forming clots that may break off and cause a heart attack or stroke. Studies show the higher the LDL particle number, the higher the risk for heart disease, regardless of the levels of other fats, such as high-density lipoprotein or HDL, the so-called good cholesterol considered protective against heart disease. Nevertheless, there is no evidence that tests measuring LDL concentrations are any better than traditional assessments, or influence overall management of cholesterol levels. With the cost of health care being so high, there is no reason to spend additional dollars on these detailed cholesterol tests. April 2009.

Achilles Tendon Pain and Cholesterol deposits
A painful Achilles tendon could be a sign of an inherited tendency to have high cholesterol, which carries a high risk of early heart disease. Wider recognition of the link between Achilles tendon pain and so-called "heterozygous familial hypercholesterolemia" -- or HeFH -- could lead to earlier diagnosis of this disorder. HeFH is the most common genetic disorder in Europe and the USA affecting 1 in 500 people. It is due to a mutation of a gene controlling removal of cholesterol from the blood circulation. Levels of cholesterol are doubled from birth and untreated it leads to coronary heart disease early in life. One feature of untreated HeFH is that cholesterol is deposited not only in the arteries but also at certain sites in tendons. This may lead to swelling and painful inflammation of the Achilles tendon.

Cholesterol Research studies
Effect of combined supplementation of fish oil with garlic pearls on the serum lipid profile in hypercholesterolemic subjects.
Indian Heart J. 2005.
Department of Home Science, Women's Christian College, Chennai
Elevated total cholesterol, especially low-density lipoprotein has been documented as the leading risk factor for the coronary artery disease among Indians. Studies with fish oil supplementation alone have shown an increase in low-density lipoprotein, thereby enhancing the risk associated with incidence of coronary artery disease in hypercholesterolemic subjects. In view of this, the effect of a combined supplementation of fish oil with garlic pearls on the serum lipid profile of subjects with high cholesterol was studied. We administered 600 mg of fish oil with 500 mg of garlic pearls (garlic oil) per day to 16 subjects with high cholesterol (age range: 30-60 years) with a total cholesterol above 220 mg/dl for 60 days. Significant reductions were seen in all the lipid parameters (except high-density lipoprotein which was increased) in the test group after 60 days compared to that of the control group. The co-administration of garlic pearls with fish oil was found to be more effective than placebo in the management of dyslipidemia.

Naturally low cholesterol levels are associated with poorer performance on a variety of cognitive measures.

Consumer advocates backed by some prominent doctors and researchers have questioned a new U.S. policy recommending wider use of statin drugs to lower cholesterol. The new cholesterol guidelines, published in July, 2004, suggest that people without high cholesterol levels should take statin drugs to get their levels even lower. The National Institutes of Health and the National Cholesterol Education Program panel that issued the guidelines cited several studies showing that people who used statins greatly lowered their risk of heart disease. But the Center for Science in the Public Interest disputed the interpretation of the studies and accused the panel members of having been influenced by their connections to drug companies. "There is strong evidence to suggest that an objective, independent reevaluation of the scientific evidence from the five new studies of statin therapy would lead to different conclusions than those presented by the current NCEP," reads the CSPI letter, signed by 35 cardiologists, nutritionists and other health professionals. "The studies cited do not demonstrate that statins benefit women of any age or men over 70 who do not already have heart disease," said John Abramson, a clinical instructor in primary care at Harvard Medical School, who signed the letter. "Furthermore, we are concerned about the findings from one of the five cited studies showing that statin therapy significantly increases the risk of cancer in the elderly."

People with metabolic syndrome -- a cluster of conditions that can include problems with weight, blood pressure, cholesterol, and blood sugar control -- are much more likely to die from heart disease and other causes than those without the syndrome.

An antioxidant found in blueberries and grapes appears to lower cholesterol as effectively as a commercial drug. A blueberry compound, called pterostilbene, activates a cellular structure that helps lower cholesterol -- the same mode of action as the cholesterol-lowering drug ciprofibrate, sold under the name Lipanor.

People with the eating disorder anorexia nervosa are more likely to attempt suicide if their cholesterol levels are low,. For several years, numerous studies have identified a link between low cholesterol and risk of suicide. However, it's far from clear if there's a cause and effect.  Conceivably, low cholesterol might lower brain chemicals that affect mood, but on the other hand depression might cause a drop in cholesterol. Or, perhaps a third irregularity results in a drop in both cholesterol and mood-related hormones. Dr. Sahelian says: Perhaps low cholesterol levels decrease levels of pregnenolone and other hormones in the brain leading to low mood.

The National Cholesterol Education Program is advising doctors to consider more intensive treatment options for people at high and moderately high risk for a heart attack. These options include setting lower treatment goals for LDL ("bad") cholesterol and initiating cholesterol-lowering therapy at lower LDL thresholds. The update is based on a review of five relatively recent clinical trials of statin therapy that show a direct relationship between lower LDL cholesterol levels and reduced risk for heart attacks and death. The LDL goal for patients at very high risk has been lowered from less than 100 to less than 70.

 Vitamin E and CoQ10 work well together for heart and circulation
 One of the early signs of vascular disease is inflammation within the walls of the arteries. This inflammation attracts white blood cells and other types of cells floating in the blood to the damaged inner lining of the arteries, resulting in plaque formation and increased likelihood of clotting. The initial inflammation and subsequent damage can result from a number of factors, including oxidation or free radical damage, high cholesterol, and high homocysteine.
     Researchers gave 21 baboons a high fat, high-cholesterol diet (just like my Thanksgiving meal) daily for 7 weeks and measured the blood level of a substance you will hear of more in the future called CRP, short for C-reactive protein. CRP is a marker for inflammation. The higher the CRP, the more damage to the inner lining of a blood vessel, like the coronary arteries in the heart. At the end of the 7 weeks, they continued with this high fat, high cholesterol diet, but this time they added vitamin E. The addition of vitamin E reduced the level of CRP. Then they added COQ10 on top of the vitamin E for another 2 weeks. They discovered that the levels of CRP dropped even further. The researchers conclude, "Dietary supplementation with vitamin E alone reduces the baseline inflammatory status that is indicated by the CRP concentration in healthy adult baboons. Co-supplementation with CoQ10 significantly enhances this effect of vitamin E."
      Dr. Sahelian says: For those of you with a heart condition or high cholesterol, or a family history of heart disease, it would make sense to take vitamin E complex and CoQ10. Discuss with your doctor if these are appropriate for your condition. A reasonable amount would be 30 to 200 units daily of natural vitamin E complex, or 100 to 300 units two or three times a week since vitamin E is fat soluble and can be stored in fat cells. As to CoQ10, a range of 20 to 60 mg is appropriate, a few times a week. CoQ10 is also fat soluble and is best taken with breakfast. Vitamin E can be taken with any meal.

The effects of grapefruit pectin on patients at risk for coronary heart disease without altering diet or lifestyle. Clinical Cardiololoty. 1988 Sep;11(9):589-94.
Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
Dietary intake of cholesterol has been linked to coronary heart disease. The effect of grapefruit pectin ( Citrus paradisi ) on plasma cholesterol, triglycerides, very low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and the low-density lipoprotein:high-density lipoprotein cholesterol ratio was studied. The study design was a 16-week double-blind, crossover (placebo or pectin) using 27 human volunteers screened to be at medium to high risk for coronary heart disease due to hypercholesterolemia. The study did not interfere with the subjects' current diet or lifestyle. Grapefruit pectin supplementation decreased plasma cholesterol 7%, low-density lipoprotein cholesterol 10%, and the low-density lipoprotein : high-density lipoprotein cholesterol ratio 9%. The other plasma lipid fractions studied showed no significant differences. We conclude that a grapefruit pectin-supplemented diet, without change in lifestyle, can significantly reduce plasma cholesterol.

 Additional herbs for a healthy cholesterol level
 Bamboo leaf extract reduces cholesterol in rodent studies.
Rice Bran Oil may be helpful
Tamarind herb has been studied
 Diatomaceous earth supplement was studied in Europe and found to be helpful.

The following substances may reduce or be beneficial to those with high cholesterol levels: beta-carotene, lycopene, cycloartenol, beta-sitosterol, sitostanol, saponin, soybean protein, indoles, dietary fiber, propionate, mevinolin (beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor) and polysaccharides.

Natural Cholesterol Lowering Products on the Market
In an evaluation of more than 90 North American cholesterol -lowering supplements, Consumerlab.com has found most meet their label claims for both dosage and efficacy. Products with sterols, policosanol, guggulsterones, fish oil, garlic, niacin, soy protein, red yeast rice and stanols were reviewed, with only a handful failing the tests. Brands tested include AccuTech (CholesBlock), Albi, Carlson, Essential Phytosterolins (ModuChol), FutureBiotics, GNC, Health From the Sun / Arkopharma (Basikol), Kaire, Life Extension, Lifewise Naturals, Nature's Formulary, Olympian Labs, Puritan's Pride, Rx Vitamins, Vitamin World, and Window Rock (Relestrol).

Emails
Q. Are there natural alternatives to bile acid sequestrants, such as Questran or Cholestyramine? If so, what are they and are they hard to find?
     A. We don't know if there are natural supplements that are identical to the above, but many forms of fiber, such as psyllium, could potentially bind bile acids and cholesterol.

Q. I've long been a periodic fan of your newsletter on various supplements. I'm an avid supplement taker and attribute much of my health and mental acuity to the supplements I take. However, my health has taken a strange turn over the last 2 months. A few months ago I learned that my cholesterol was slightly high (210 total). It was somewhat a shock to me, because I am so very health conscious. Being proactive I decided to attack the cholesterol problem and see what the supplement industry had to offer. After doing my homework I added the following to my supplement
regimen: 1) Policosanol 2) Garlic 3) Artichoke 4) Guggul (somewhere I've read it can lower cholesterol) 5) Beta Sitosterol
     About 1.5 months later I started noticing chest pains, which is strange because I'm only 30. About a month later, the chest pains were getting worse, and I stopped these supplements, not knowing what to blame. Another few weeks later and the chest pains diminished and disappeared. About 1 month after stopping I had a blood test and my cholesterol was measured at 135 total, which could be considered too low (i read that stroke risk is actually 2X higher for cholesterol <160 than for cholesterol >230). Well, they worked, but too well.
     It would be good to warn people to check their cholesterol levels frequently if they begin a supplement based cholesterol lowering plan. They might not notice going too far. In the month of december I lost 30lb, unintentionally. Now I have been found to have gallstones, which are interfering with my body's ability to absorb fat-soluble nutrients. Causes of gallstones are: cholesterol lowering, drugs & rapid weight loss. I think cholesterol lowering supplements might also have this side effect.

Q. Why do you continue to infer that cholesterol levels (lipoproteins) in some way have a significant correlation with probability of arterial plaque buildup? I have scoured available information from apparently well-run tests -- including the often mis-interpreted Framingham study -- and can find no data linking high levels of serum cholesterol to incidents of CVD. Therefore, artificial cholesterol reduction through inhibitors such as, for example, one of the statins, is counter-productive and has not been shown to increase longevity. As you have pointed out, CoQ10 depletion; muscle deterioration; increased cancer risk and so-forth argue against this regimen. A convincing hypothesis now has been developed, based on data from well-run tests. It answers several very inconvenient physiological questions associated with CVD. Such as: "Why do plaque deposits mainly occur in arteries?" "Why are these arteries only situated near the heart?" "Why, within these limited lengths of artery, only at discrete locations -- not uniformly spread over the endothelium?" "Why is there always a lesion associated with the plaque buildup?" "Where does this lesion come from and how can it be prevented?" "Why do plaque deposits consist of several materials, other than just plain cholesterol?" The causes, prevention and treatment are indicated to be other than in the conventional LDL (cholesterol) explanation. I would be delighted if you could point me to any study that demonstrates cholesterol to be causative in vascular plaque formation. I have spent many, many hours, over the last five years, looking for a glimmer of such information. Framingham, MRFIT, The Oslo Trial, The WHO Trial, The Lipid Research Clinics Trial, and several others. Furthermore, as a researcher, have you found any conclusive studies that show statins to prolong life? (Over. say, a five or 10-year trial period.)
     A. Science is not always clear cut, and different scientists can look at the same cholesterol and CVD data and come up with different conclusions. We keep an open mind and adapt our viewpoint as the research comes. Obviously, cholesterol is not the only cause of atherosclerosis, and in my viewpoint statins are being overprescribed. There is no evidence that statins prolong life.

For years I had my cholesterol levels under control, but since my knee injury I've not been active (Master's Track and Field). So zoom went my levels and my capable physician of 23 years wants me on Lipitor. Your cholesterol report helped in that it addressed many issues (symptoms, related conditions and diseases, risk factors) on several different levels (natural, pharmacological, life style), so that your readers have a good basis to do further investigation and provide solid questions for their health care provider. I have benefited from it, and am encouraged to stay on a healthy track. Please continue the great work.

My cholesterol level is low, highest ever tested was 135. I take good quality olive oil, fish oil and coconut oil. I am 66 years old and take AndroGel containing 50 mg of testosterone. My MD says nothing can done to increase my cholesterol level to 200. My daughter also has very low cholesterol also. My sister had very, very low cholesterol and was depressed. She took her own life ultimately. I wonder if I focus on the gallbladder and supplements to improve its function, could that help? I take a low dose Pregnenolone capsule in the morning with food, has improved my mood considerably.
   A. I prefer not to focus on one blood study but rather treat the whole person. If there are no symptoms, then there is no need to treat.

FutureBiotics, Cholesterol Balance, 90 Veggie Caps
Buy Cholesterol balance supplement

Supplement Facts
Serving Size: 3 capsules
Servings Per Container: 30
  Amount Per Serving % Daily Value
Viscofiber Oat ß-Glucan Concentrate (providing 375 mg of oat beta-glucan) 750 mg †
Plant Sterols (providing Beta-Sitosterol, Campesterol, Stigmasterol and Brassicasterol) 600 mg †
Policosanol (containing 60% octacostsonal) 20 mg †
Proprietary Cholesterol Support Compound: Broccoli, Carrot, Tomato, Cauliflower, Brussel Sprouts, Beet, Kala, Spinach leaf, Celery, Radish, Leek, Onion 100 mg †
Futurebiotics BioAccelerators (BioPerine, Ginger root extract, Trikatu, Digezyme, Lactospore) 23 mg †

Other cholesterol formulas available online
Source Naturals, Policosanol Cholesterol Complex, 60 Tablets
California Gold Nutrition, Cholesterol 101, 90 Veggie Caps