BBRAeNEWS No.231 - A Doctor's Corner.

Dear Residents,

BBRA's A Doctor's Corner.

Part 3 of 5 parts.
Supplementing Your Heart Health: Omega-3, Plant Sterols, and More 3
If you have high cholesterol, or if you're at high risk for heart disease and heart attack, some supplements can help lower your cholesterol.
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Niacin for Heart Health
Also known as vitamin B-3 or nicotinic acid, niacin is a well-accepted treatment for high cholesterol. "Niacin is one of my favorites," Guarneri says. "It is tried and true in raising HDL and lowering triglycerides." She prescribes from 500 milligrams to 2 grams daily, depending on the patient's blood levels.
Numerous studies have shown that niacin can significantly improve HDL cholesterol with better results than with statin drugs. Niacin can also improve LDL levels, but less dramatically. "Niacin is one of the most powerful vitamins -- increasing HDL by 15% to 30%, reducing triglycerides by 20% to 50%," she says.
A very small percentage of patients who take niacin have heart rhythm problems. Some people do get hot flushes from niacin, so it's important to start with small doses and increase slowly, under a doctor's supervision.
Psyllium for Heart Health
Psyllium (ispaghula) comes from the husks of seeds from Plantago ovata. Psyllium, either through supplements or high-fiber foods, provides fiber that can reduce total and LDL cholesterol. Fiber’s effects on HDL “good” cholesterol are less clear, although some research suggests fiber may help increase HDL.
Guarneri likes fiber, including psyllium. Just 15 grams of psyllium reduces LDL by up to 9%, she reports. Psyllium also boosts the effects of statin drugs. In an eight-week study, one group of patients took 10 milligrams of psyllium plus 10 milligrams of Zocor, a statin drug. They were compared to patients taking 20 milligrams of Zocor plus a placebo. In the psyllium group, LDL fell by 63, compared with 55 in the statin-only group.
One caution: Psyllium can decrease absorption of other medications. Make sure you talk to your doctor before taking psyllium.
Red Yeast Rice for Heart Health
Red yeast rice is derived from a specific yeast that grows on rice. This extract has been shown to lower total and LDL cholesterol and triglyceride levels, help prevent heart attack, and improve blood flow. "If you want to reduce LDL cholesterol, red yeast rice can do it," says Guarneri. In fact, it contains a substance -- monacolin K -- that is identical to the active ingredient of the cholesterol-lowering statin drug Mevacor.
Data from one study showed that 1,200 milligrams of red yeast rice daily resulted in significant reductions in total cholesterol (19%), LDL cholesterol (26%), and triglycerides (16%). Another study using higher doses of red yeast rice -- 2,400 milligrams to 3,600 milligrams -- found that when red yeast rice was combined with fish oil and lifestyle changes, it lowered bad LDL levels as effectively as the statin Zocor -- about 40%.
Most red yeast rice supplements in the U.S. recommend taking no more than 2,400 milligrams daily. Higher doses increase the risk of side effects, such as muscle pain and tenderness, and possibly liver damage. In addition, do not take red yeast rice if you’re taking a statin cholesterol-lowering medication as this further increases the risk of side effects.
Red yeast rice should not be used by people with liver disease. In addition, it may increase the risk of bleeding and should be used with caution by people taking blood thinners.