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.
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.
Soy has been the object of attention as an alternative treatment for a number of ailments, from lowering cholesterol to reducing menopause symptoms. But Lichtenstein says there is little to support such claims.
"Soy is a great source of low-fat protein," she says. "Replace your hamburger with a soy burger. Use it all through your diet to replace high-fat foods. But the evidence does not support its use in lowering cholesterol."
Red yeast rice contains a natural form of the statin drug Mevacor. Some initial research has shown red yeast rice to be effective in lowering cholesterol, but according to Lee, the FDA has some issues with it because herbal doses can vary widely, which is not something you want in cholesterol control.
Garlic is another food that, despite claims to the opposite, has been shown not to lower cholesterol. A 1998 study in The Journal of the American Medical Association shows that "consuming garlic does not lower cholesterol," and such products cannot be recommended as a way to lower cholesterol.
"Foods like garlic may have many beneficial properties," says Lee. "And it may be useful to include those as part of your diet, but that is different from saying that it can lower cholesterol."
Coenzyme Q10 is the subject of much debate. It's credited with everything from lowering cholesterol to slowing the aging process. But again, there is not much evidence to support it.
"The data is still very inconclusive on it," says Lichtenstein. "None of the reputable health organizations have recommended it. It's too early to say whether it will be useful."
Chromium, lecithin and quercetin and numerous other supplements are purported to reduce cholesterol, but their use is controversial and should be used only under the guidance of your doctor.
"What research shows is that 70% of patients are reluctant to share information about alternative therapies they may be taking with their doctor," says Lichtenstein. "That's a real mistake in general, but especially when it comes to reducing high cholesterol. You need to let your doctor in on everything you're taking before you take it."