Cholesterol Control: The Alternatives

Doctors call it hypercholesterolemia, but most people know it as plain old high cholesterol.

A soft, waxy material, cholesterol is a natural part of fats in the bloodstream and in all the body's cells. Too much cholesterol circulating in the blood can cause sticky deposits to form in the artery walls, blocking blood flow. High cholesterol has no real symptoms, so it can easily go undetected. The normal range for total blood cholesterol is less than 200 mg. More than that, and your risk of heart disease begins to rise.

Given the high-stakes consequences of high cholesterol -- heart attack, stroke -- most people turn to their doctors for the highly effective class of drugs called statins to lower their cholesterol levels. But there are many alternative treatments.

"While there are alternative treatments available, we need to stress that a person's physician must be consulted before any of these are started because some of these can affect prescribed drugs," says Roberta Lee, MD, medical director for the Center for Health and Healing at the Beth Israel Medical Center in New York.

"People want some kind of magic powder to sprinkle on their food to lower cholesterol, but the best alternative treatment is weight loss and eating better, exercise, and quitting smoking, which will give you the best results and may allow a person to avoid medications entirely," says Alice H. Lichtenstein, MD, professor of nutrition at Tufts University and spokeswoman for the American Heart Association.

So, after lifestyle changes to include regular exercise, which foods and supplements are helpful and which are full of hype?

Niacin is a B-complex vitamin that at high doses lowers cholesterol. Doses of 2 to 3 grams per day added to prescribed statin drugs are a common practice, even among wholly unalternative doctors. This combination can decrease cholesterol more than statins can alone and appears to raise levels of beneficial cholesterol, or HDL. But again, this is an addition that needs close attention, says Lichtenstein, because of the potential for serious side effects, including muscle breakdown, which can lead to frequent muscle pain.

Stanol esters, which are in certain margarines such as Take Control or Benecol and in pill-form supplements, are also used in combination with statin drugs. This plant-derived compound can reduce cholesterol by as much as 10% by stopping the absorption of cholesterol. Again, Lee points out that stanol esters should not be used instead of drugs, but added to a treatment plan.

Soluble fiber is very effective at lowering cholesterol. Of course, the best way to get fiber is to eat whole grains and vegetables regularly, but fiber supplements work, too.

How fiber reduces cholesterol is not widely agreed upon, but it appears that it binds to cholesterol and bile acids in the intestine, making it unavailable for absorption. Then, when the liver needs to replace the bile acids that went out with the fiber, it pulls cholesterol from the bloodstream to make more bile acids. It's a pretty neat dietary trick.