Side-Stepping Statins: Natural strategies for reducing cholesterol

For more on heart health beyond the headline hype, check out my FUELED Wellness + Nutrition podcast where I’m joined by cardiologist Richard Milani of Ochsner Health.  

Dealing with high cholesterol used to seem pretty straightforward:  Oatmeal was good, eggs were bad.  Total cholesterol less than 200 was good, higher than 200 meant, well, more oatmeal.  

Nowadays, total cholesterol doesn’t really matter.  In fact, ‘total’ cholesterol can be totally misleading, says Dr. Carl Lavie, Medical Director, Cardiac Rehabilitation and Prevention with Ochsner Health. He gives the example of a person with a total cholesterol of 170 and an HDL of 30 – they’ll be at a higher risk for cardiovascular disease than a person with a total cholesterol of 230 and an HDL of 80.  

If you are diagnosed with high cholesterol, ask your doctor for a three-month window to improve it through diet and exercise alone, without incorporating statin drugs (if other risk factors allow for it). If statin drugs are added at the same time you incorporate nutrition and activity modifications, it’s impossible to tease out the benefit of lifestyle changes alone. Then if your levels are still out of range after three months, it may be time to consider medication and/or natural alternatives.

While there’s some debate over just how much of a protective effect HDL gives us, maintaining optimal levels of HDL and LDL continues to be a prime focus in the prevention of heart disease. 

This explains why statin drugs have been among the top-selling prescription drug for years. Statins reduce LDL cholesterol more than other types of drugs and are moderately effective at lowering triglycerides and raising HDL cholesterol.  These benefits, combined with their anti-inflammatory properties, make statin drugs very effective at reducing the incidence of heart attack, and stroke and other symptoms of heart and vascular disease.

But this effectiveness is not without side effects.  Muscle pain is the most commonly reported negative side effect.  Statin drugs are also associated with an increased risk of liver problems, so liver enzymes should be monitored periodically.    

Even with the potential adverse side effects, many physicians agree that the benefits of taking statin drugs outweigh the potential negative side effects – particularly for people with a high risk of cardiovascular disease. 

But it’s the possibility of side effects like these that has some people seeking out more natural approaches to reduce cholesterol levels.  

Red yeast rice is one such alternative.  Supplementing with 1200 milligrams twice daily may help to lower LDL cholesterol levels by as much as 33 percent.   But since red yeast rice contains substances similar to statin drugs, it has the potential to cause similar side effects, including elevated liver enzymes and muscle pain.  It may also increase the risk of bleeding and can alter blood sugar levels.

So while red yeast rice is considered to be natural, it acts like a drug in our bodies, so supplementation should be monitored by a physician. 

Niacin is another compound that occurs naturally.  It can raise HDL cholesterol considerably, often with better results than prescription drugs.  It also reduces LDL cholesterol, although less significantly. 

Over-the-counter niacin supplements are usually sold in strengths up to 1,000 milligrams, while prescription-strength dosages may range up to 4,000 milligrams or more.

Most people taking niacin experience skin flushing when they begin treatment or increase the dosage.  As with red yeast, high dose niacin can result in altered alter blood sugar levels and elevated liver enzymes, so physician monitoring is essential.

Soluble fiber can also help block fat and cholesterol from being absorbed into the bloodstream, translating to a reduction in total and LDL cholesterol.  For maximum benefit, aim for at least 10 to 25 grams of soluble fiber per day. 

Oatmeal and Cheerios get much of the glory as a cholesterol-lowering options.  And while they’re *fine*, they’re really not that fantastic. A typical serving gives us just about one or two grams of soluble fiber. Beans (think red beans, black beans, lentils) have four to five grams of soluble fiber per cup, while most fresh fruits and vegetables provide one to three grams per serving.  

Since it can be challenging to reach 10 to 25 grams daily from food alone, I’ll typically recommend supplementing with soluble fiber in the form of psyllium, which packs in six grams of soluble fiber per tablespoon. It’s available in powder form (easy to blend into smoothies) or in capsule form. Gradually increase fiber intake and drink plenty of fluids to minimize intestinal discomfort.  

Omega-3 fatty acids (think salmon, sardines, flax and walnuts) are associated with a drop in risk of heart disease, even though they don’t lower LDL cholesterol (and in fact they may even raise LDL levels just slightly).  But omega-3 fats may benefit the heart in other ways, by helping to prevent blood clots from forming, reducing inflammation, and reducing triglyceride levels.

Each of these natural approaches have potential help to reduce our risk for heart and vascular disease, but keep in mind that they’re far more effective when combined with a heart-smart diet that emphasizes plant-based fats and fiber-rich veggies. 

Maintaining a healthy weight will also help to improve your cholesterol and triglyceride levels. Incorporating at least 30 minutes of movement daily will help you achieve and maintain a healthy weight and can also raise those ‘good’ HDL cholesterol levels.

Keep in mind that even natural supplements can have side effects, including interactions with medications.  Always check with your physician and pharmacist before beginning any supplement regime.  

Molly Kimball, RD, CSSD is a registered dietitian + nutrition journalist in New Orleans, and founder of Ochsner Eat Fit nonprofit restaurant initiative. Tune in to her podcast, FUELED | Wellness + Nutrition and follow her on Facebook, Instagram and Twitter at @MollyKimballRD. See more of Molly’s articles + TV segments at www.mollykimball.com.