High Cholesterol (Holistic)Skip to the navigation
About This Condition
Reduce risk with fiber
Add whole grains, legumes, fruits, and vegetables to your meals to reduce heart disease risk
Add soy protein to your diet
30 grams (about 1 ounce) a day of powdered soy protein added to food or drinks can help lower cholesterol
Check out natural vegetable fats (plant sterols and stanols)
Take 1.6 grams a day as a supplement or in specially fortified margarines to help reduce cholesterol
Get some supplemental garlic
600 to 900 mg a day of a standardized garlic extract may help lower cholesterol and prevent hardening of the arteries
Raise “good” cholesterol with exercise
Start a regular exercise program to help raise HDL ("good") cholesterol
Cut the bad fats
Foods that contain saturated fat, hydrogenated fat, and cholesterol (such as animal products, fried foods, and baked snacks) can raise cholesterol.
Cut the bad fats
Foods that contain saturated fat, hydrogenated fat, and cholesterol (such as animal products, fried foods, and baked snacks) can raise cholesterol
Pick a plant-based diet
Emphasize vegetarian meals whenever possible to reap the rewards of avoiding animal fats and increasing fiber and other cholesterol-stabilizing nutrients
Get and stay trim
Aim for a healthy body weight to avoid problems with blood lipids and other heart disease risk factors
Use a regular program of aerobic exercise to maintain optimal blood lipid levels and lower heart disease risk
Avoid the habit
Maintain healthy HDL (“good”) cholesterol levels and low heart disease risk by avoiding cigarette smoke
Protect with antioxidants
Use at least 100 mg per day vitamin C and/or up to 400 IU vitamin E to protect LDL cholesterol from damage that can increase heart disease risk
About This Condition
Although it is by no means the only major risk factor, elevated serum (blood) cholesterol is clearly associated with a high risk of heart disease.
Most doctors suggest cholesterol levels should stay under 200 mg/dl. As levels fall below 200, the risk of heart disease continues to decline. Many doctors consider cholesterol levels of no more than 180 to be optimal. A low cholesterol level, however, is not a guarantee of good heart health, as some people with low levels do suffer heart attacks.
Medical laboratories now subdivide total cholesterol measurement into several components, including LDL (“bad”) cholesterol, which is directly linked to heart disease, and HDL (“good”) cholesterol, which is protective. The relative amount of HDL to LDL is more important than total cholesterol. For example, it is possible for someone with very high HDL to be at relatively low risk for heart disease even with total cholesterol above 200. Evaluation of changes in cholesterol requires consultation with a healthcare professional and should include measurement of total serum cholesterol, as well as HDL and LDL cholesterol.
The following discussion is limited to information about lowering serum cholesterol levels or increasing HDL cholesterol using natural approaches. Because high cholesterol is linked to atherosclerosis and heart disease, people concerned about heart disease should also learn more about atherosclerosis.
This condition does not produce symptoms. Therefore, it is prudent to visit a health professional on a regular basis to have cholesterol levels measured.
Healthy Lifestyle Tips
Exercise increases protective HDL cholesterol,1 an effect that occurs even from walking.2 Total and LDL cholesterol are typically lowered by exercise, especially when weight-loss also occurs.3 Exercisers have a relatively low risk of heart disease.4 However, people over 40 years of age, or who have heart disease, should talk with their doctor before starting an exercise program; overdoing it may actually trigger heart attacks.5
Obesity increases the risk of heart disease,6 in part because weight gain lowers HDL cholesterol.7 Weight loss reduces the body’s ability to make cholesterol, increases HDL levels, and reduces triglycerides (another risk factor for heart disease).8 , 9 Weight loss also leads to a decrease in blood pressure.
Smoking is linked to a lowered level of HDL cholesterol10 and is also known to cause heart disease.11Quitting smoking reduces the risk of having a heart attack.12
The combination of feelings of hostility, stress, and time urgency is called type A behavior. Men,13 , 14 but not women,15 with these traits are at high risk for heart disease in most, but not all, studies.16 Stress17 or type A behavior18 may elevate cholesterol in men. Reducing stress and feelings of hostility has reduced the risk of heart disease.19
The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.
|Add some olive oil||
Monounsaturated fats, such as the fats in olive oil, lower LDL (“bad”) cholesterol, especially when the olive oil replaces saturated fats, such as many fats from meat and dairy, in the diet.
Olive oil lowers LDL cholesterol,20 , 21 especially when the olive oil replaces saturated fat in the diet.22 People from countries that use significant amounts of olive oil appear to be at low risk for heart disease.23 A double-blind trial showed that a diet high in monounsaturated fatty acids from olive oil, lowers cardiovascular disease risk by 25%, as compared with a 12% decrease from a low-fat (25% fat) diet.24The trial also found that low-fat diets decrease HDL cholesterol by 4%, which is undesirable, since HDL cholesterol is protective against heart disease. Diets high in monounsaturated fatty acids from olive oil do not adversely affect HDL levels. Although olive oil is clearly safe for people with elevated cholesterol, it is, like any fat or oil, high in calories, so people who are overweight should limit its use.
Eating sugar has been reported to reduce HDL (“good”) cholesterol and to increase other heart disease risk factors.
Eating sugar has been reported to reduce protective HDL cholesterol25 and increases other risk factors linked to heart disease.26 However, higher sugar intake has been associated with only slightly higher risks of heart disease in most reports.27 Although the exact relationship between sugar and heart disease remains somewhat unclear, many doctors recommend that people with high cholesterol reduce their sugar intake.
|Eat canola oil and flaxseed||
People who eat diets high in alpha-linolenic acid—found in canola oil and flaxseed products—have high blood levels of omega-3 fatty acids, which may protect against heart attacks.
Doctors and researchers are interested in alpha-linolenic acid (ALA)—the special omega-3 fatty acid found in large amounts in flaxseeds and flaxseed oil. ALA is a precursor to EPA, a fatty acid from fish oil that is believed to protect against heart disease. To a limited extent, ALA converts to EPA within the body.28 However, unlike EPA, ALA does not lower triglyceride levels (a risk factor for heart disease).29 Preliminary research on the effects of ALA from flaxseed has produced conflicting results.
In 1994, researchers conducted a study in people with a history of heart disease, using what they called the “Mediterranean” diet.30 The diet was significantly different from what people from Mediterranean countries actually eat, in that it contained little olive oil. Instead, the diet included a special margarine high in ALA. Those people assigned to the “Mediterranean” diet had a remarkable 70% reduced risk of dying from heart disease compared with the control group during the first 27 months. Similar results were also confirmed after almost four years.31 Although cholesterol levels fell only modestly in the “Mediterranean” diet group, the positive results suggest that people with elevated cholesterol attempting to reduce the risk of heart disease should consider such a diet. The diet was high in beans and peas, fish, fruit, vegetables, bread, and cereals; and low in meat, dairy fat, and eggs. Although the authors believe that the high ALA content of the diet was partially responsible for the surprising outcome, other aspects of the diet may have been partly or even totally responsible for decreased death rates. Therefore, the success of the “Mediterranean” diet does not prove that ALA protects against heart disease.32
|Eat more fish||
Eating fish has been reported to increase HDL “good” cholesterol and is linked to a reduced risk of heart disease in most but not all studies.
|Get good omega-6 fatty acids||
Many vegetable oils, nuts, and seeds contain omega-6 polyunsaturated fatty acids that improve the ratio between “bad” and “good” cholesterol. (When choosing oils, avoid partially-hydrogenated oils, which increase heart disease risk.
Many vegetable oils, nuts, and seeds contain omega-6 polyunsaturated fatty acids that lower total and LDL cholesterol.37 , 38 , 39 HDL cholesterol remains unchanged by an increase in omega-6 fats, so the ratio between “bad” and “good” cholesterol is improved.40 , 41 When choosing oils containing omega-6 fats, avoiding partially-hydrogenated oils is important since partial hydrogenation results in the formation of trans fatty acids that raise LDL cholesterol and increase heart disease risk.42 , 43
|Get your garlic||
Eating garlic has helped to lower cholesterol in some, but not all, research. It is also known to act as a blood thinner and may reduce other heart disease risk factors.
Garlic is available as a food, as a spice in powder form, and as a supplement. Eating garlic has helped to lower cholesterol in some research, though several double-blind trials have not found garlic supplements to be thusly effective. Although some of the negative reports have been criticized, the relationship between garlic and cholesterol lowering remains unproven. However, garlic is known to act as a blood thinner and may reduce other risk factors for heart disease. For these reasons, some doctors recommend eating garlic as food, taking 900 mg of garlic powder from capsules, or using a tincture of 2 to 4 ml, taken three times daily.
Research consistently shows that people who frequently eat nuts have a reduced risk of heart disease, possibly because eating nuts lowers cholesterol.
Preliminary research consistently shows that people who eat nuts frequently have a dramatically reduced risk of heart disease.44 , 45 This apparent beneficial effect is at least partially explained by preliminary and controlled research demonstrating that nut consumption lowers cholesterol levels.46 , 47 Of nuts commonly consumed, almonds48 , 49 and walnuts50 , 51 , 52 may be most effective at lowering cholesterol. Macadamia nuts have been less beneficial in most studies,53 , 54 , 55 although one controlled trial found a cholesterol-lowering effect from macadamia nuts.56Hazelnuts,57 and pistachio nuts,58 , 59 have also been reported to help lower cholesterol.
Nuts contain many factors that could be responsible for protection against heart disease, including fiber, vitamin E, alpha-linolenic acid (found primarily in walnuts), oleic acid, magnesium, potassium, and arginine. Therefore, exactly how nuts lower cholesterol or lower the risk of heart disease remains somewhat unclear. Some doctors even believe that nuts may not be directly protective; rather, people busy eating nuts will not simultaneously be eating eggs, dairy, or trans fatty acids from margarine and processed food, the avoidance of which would reduce cholesterol levels and the risk of heart disease.60 , 61 Nonetheless, the remarkable consistency of research outcomes strongly suggests that nuts do help protect against heart disease. Although nuts are loaded with calories, a preliminary trial surprisingly reported that adding hundreds of calories per day from nuts for six months did not increase body weight in humans62—an outcome supported by other reports.63 Even when increasing nut consumption has led to weight gain, the amount of added weight has been remarkably less than would be expected, given the number of calories added to the diet.64 Given the number of calories per ounce of nuts, scientists do not understand why moderate nut consumption apparently has so little effect on body weight.
|Reduce risk with fiber||
Add whole grains, legumes, fruits, and vegetables to your meals to reduce heart disease risk.
Soluble fiber from beans,65 oats,66 psyllium seed,67 glucomannan, and fruit pectin68 has lowered cholesterol levels in most trials.69 , 70 Doctors often recommend that people with elevated cholesterol eat more of these high-soluble fiber foods. However, even grain fiber (which contains insoluble fiber and does not lower cholesterol) has been linked to protection against heart disease, though the reason for the protection remains unclear.71 It makes sense for people wishing to lower their cholesterol levels and reduce the risk of heart disease to consume more fiber of all types. Some trials have used 20 grams of additional fiber per day for several months to successfully lower cholesterol.72 Psyllium has also been found to enhance the effect of the cholesterol-lowering drug simvastatin.73
Oat bran is rich in a soluble fiber called beta-glucan. In 1997, the U.S. Food and Drug Administration passed a unique ruling that allowed oat bran to be registered as the first cholesterol-reducing food at an amount providing 3 grams of beta-glucan per day, although some evidence suggests this level may not be high enough to make a significant difference.74 Several double-blind and other controlled trials have shown that oat bran75 , 76 , 77 and oat milk78 supplementation may significantly lower cholesterol levels in people with elevated cholesterol, but only weakly lowers them in people with healthy cholesterol levels.79
Flaxseed , another good source of soluble fiber, has been reported to lower total and LDL cholesterol in preliminary studies.80 , 81 A double-blind trial found that while both flaxseed and sunflower seed lowered total cholesterol, only flaxseed significantly lowered LDL.82 Amounts of flaxseed used in these trials typically range from 30–50 grams per day. A controlled trial found that partially defatted flaxseed, containing 20 grams of fiber per day, significantly lowered LDL cholesterol, suggesting that at least one of the cholesterol-lowering components in flaxseed is likely to be the fiber in this product, as opposed to the oil removed from it.83 Controlled trials of flaxseed oil alone have shown inconsistent effects on blood cholesterol.84 , 85 , 86
|Choose coffee carefully||
Drinking boiled or French press coffee increases cholesterol levels, but drinking paper-filtered coffee does not, as paper coffee filters keep the offending chemicals from entering the cup.
Drinking boiled or French press coffee increases cholesterol levels.87 Modern paper coffee filters trap the offending chemicals and keep them from entering the cup. Therefore, drinking paper-filtered coffee does not increase cholesterol levels.88 , 89 Espresso coffee has amounts of the offending chemicals midway between those of other unfiltered coffees and paper-filtered coffee,90 but there is little research investigating the effect of espresso on cholesterol levels, and studies to date have produced conflicting results.91 , 92 The effects of decaffeinated coffee on cholesterol levels remain in debate.93
|Eat smaller, eat often||
When people eat a number of small meals, studies have shown that serum cholesterol levels fall compared with the effect of eating the same food in three big meals.
When people eat a number of small meals, serum cholesterol levels fall compared with the effect of eating the same food in three big meals.94 , 95 People with elevated cholesterol levels should probably avoid very large meals and eat more frequent, smaller meals.
|Enjoy a drink||
People who have one to two drinks per day appear to live longer and are less likely to have heart disease.
Moderate drinking (one to two drinks per day) increases protective HDL cholesterol.96 This effect happens equally with different kinds of alcohol-containing beverages.97 , 98 Alcohol also acts as a blood thinner,99 an effect that should lower heart disease. However, alcohol consumption may cause liver disease (e.g., cirrhosis), cancer, high blood pressure, alcoholism, and, at high intake, an increased risk of heart disease. As a result, some doctors never recommend alcohol, even for people with high cholesterol. Nevertheless, those who have one to two drinks per day appear to live longer100 and are clearly less likely to have heart disease.101 Therefore, some people at very high risk of heart disease—those who are not alcoholics, who have healthy livers and normal blood pressure, and who are not at high risk for cancer, particularly breast cancer—are likely to receive more benefit than harm, from light drinking.
|Go easy on the eggs||
Until more is known about the link between eggs and heart disease, limiting eggs to one per day may be a good idea for people with diabetes.
Most dietary cholesterol comes from egg yolks. Eating eggs has increased serum cholesterol in most studies.102 However, eating eggs does not increase serum cholesterol as much as eating foods high in saturated fat, and eating eggs may not increase serum cholesterol at all if the overall diet is low in fat.103
Egg consumption does not appear to be totally safe, however, even for people consuming a low-fat diet. When cholesterol from eggs is cooked or exposed to air, it oxidizes. Oxidized cholesterol is linked to increased risk of heart disease.104 Eating eggs also makes LDL cholesterol more susceptible to damage, a change linked to heart disease.105
Whether or not egg eaters are more likely to die from heart disease is a matter of controversy. In one preliminary study, egg eaters had a higher death rate from heart disease, even when serum cholesterol levels were not elevated.106 However, another preliminary study found no evidence of an overall significant association between egg consumption, and risk of heart disease or stroke, except in people with diabetes.107 Until more is known, limiting egg consumption may be a good idea, particularly for people with existing heart disease or diabetes.
|Replace meat with soy||
Soy protein has been shown to reduce cholesterol levels. And if soy replaces animal protein, the cholesterol-lowering effect is even more pronounced.
Tofu, tempeh, miso, and some protein powders in health food stores, are derived from soybeans. In 1995, an analysis of many trials proved that soy reduces both total and LDL cholesterol.108 Since then, other double-blind and other controlled trials have confirmed these findings.109 , 110 , 111 , 112 Trials showing statistically significant reductions in cholesterol have generally used more than 30 grams per day of soy protein. However, if soy replaces animal protein in the diet, as little as 20 grams per day has been shown to significantly reduce both total and LDL cholesterol.113 Isoflavones found in soy beans appear to be key cholesterol-lowering ingredients of the bean,114 , 115 but animal research suggests other components of soy are also important.116 , 117
|Try a vegetarian diet||
Vegetarians have lower cholesterol than meat eaters, in part because they avoid animal fat. Vegans (people who eat no meat, dairy, or eggs) have the lowest cholesterol levels.
Vegetarians have lower cholesterol118 and less heart disease119 than meat eaters, in part because they avoid animal fat. Vegans (people who eat no meat, dairy, or eggs) have the lowest cholesterol levels,120 and switching from a standard diet to a vegan diet, along with other lifestyle changes, has been reported to reverse heart disease in controlled research.121 , 122
|Cut the bad fats||
Foods that contain saturated fat, hydrogenated fat, and cholesterol can raise cholesterol.
Eating animal foods containing saturated fat is linked to high cholesterol levels123 and heart disease.124 Significant amounts of animal-based saturated fat are found in beef, pork, veal, poultry (particularly in poultry skins and dark meat), cheese, butter, ice cream, and all other forms of dairy products not labeled “fat free.” Avoiding consumption of these foods reduces cholesterol and has been reported to reverse even existing heart disease.125
Unlike other dairy foods, skimmed milk, nonfat yogurt, and nonfat cheese are essentially fat-free. Dairy products labeled “low fat” are not particularly low in fat. A full 25% of calories in 2% milk come from fat. (The “2%” refers to the fraction of volume filled by fat, not the more important percentage of calories coming from fat.)
In addition to large amounts of saturated fat from animal-based foods, Americans eat small amounts of saturated fat from coconut and palm oils. Palm oil has been reported to elevate cholesterol.126 , 127 Research regarding coconut oil is mixed, with some trials finding no link to heart disease,128 while other research reports that coconut oil elevates cholesterol levels.129 , 130
Despite the links between saturated fat intake and serum cholesterol levels, not every person responds to appropriate dietary changes with a drop in cholesterol. A subgroup of people with elevated cholesterol who have what researchers call “large LDL particles” has been reported to have no response even to dramatic reductions in dietary fat.131 (LDL is the “bad” cholesterol most associated with an increased risk of heart disease.) This phenomenon is not understood. People who significantly reduce intake of animal fats for several months but do not see significant a reduction in cholesterol levels should discuss other approaches to lowering cholesterol with a doctor.
Yogurt, acidophilus milk, and kefir are fermented milk products that have been reported to lower cholesterol in most,132 , 133 , 134 , 135 , 136 , 137 , 138 but not all, double-blind and other controlled research.139 , 140 , 141 Until more is known, it makes sense for people with elevated cholesterol who consume these foods, to select nonfat varieties.
While coconut oil is high in saturated fat, some evidence suggests it does not cause unhealthy changes in blood cholesterol levels compared with other saturated fats. In a controlled study of people with high cholesterol, coconut oil resulted in higher total and LDL cholesterol levels compared with safflower oil (a polyunsaturated oil), but lower levels compared with butter, while HDL levels were similar for all three diets.142 Another controlled study compared coconut oil with canola oil,143 and found that coconut oil raised total and LDL cholesterol in people with high cholesterol who were not taking cholesterol-lowering drugs, but did not affect these levels in people who were taking these drugs. HDL levels were not reported in this study.fatty acids (TFAs) are found in many processed foods containing partially hydrogenated oils. The highest levels occur in margarine. Margarine consumption is linked to increased risk of unfavorable changes in cholesterol levels144 and heart disease.145 Margarine and other processed foods containing partially hydrogenated oils should be avoided.
|Watch the margarine||
Most margarines contain high levels of trans fatty acids and are linked to high cholesterol and heart disease.
Trans fatty acids (TFAs) are found in many processed foods containing partially hydrogenated oils. The highest levels occur in margarine. Margarine consumption is linked to increased risk of unfavorable changes in cholesterol levels146 and heart disease.147 Margarine and other processed foods containing partially hydrogenated oils should be avoided.
However, special therapeutic margarines are now available that contain substances, called phytostanols, that block the absorption of cholesterol.148 The FDA has approved some of these margarines as legitimate therapeutic agents for lowering blood cholesterol levels. The best-known of these products is Benecol™. The cholesterol-lowering effect of these margarines has been demonstrated in numerous double-blind and other controlled trials.149 , 150 , 151 , 152 , 153 , 154 , 155
Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.
For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.
3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
2,900 to 15,000 mg daily
Beta-glucan is a type of soluble fiber that has been shown to lower total and LDL (“bad”) cholesterol and raise HDL (“good”) cholesterol.
Beta-glucan is a type of soluble fiber molecule derived from the cell wall of baker’s yeast, oats and barley, and many medicinal mushrooms, such as maitake. Beta-glucan is the key factor for the cholesterol-lowering effect of oat bran.156 , 157 , 158 , 159 As with other soluble-fiber components, the binding of cholesterol (and bile acids) by beta-glucan and the resulting elimination of these substances in the feces is very helpful for reducing blood cholesterol.160 , 161 , 162 Results from a number of double-blind trials with either oat- or yeast-derived beta-glucan indicate typical reductions, after at least four weeks of use, of approximately 10% for total cholesterol and 8% for LDL (“bad”) cholesterol, with elevations in HDL (“good”) cholesterol ranging from zero to 16%.163 , 164 , 165 , 166 , 167 For lowering cholesterol levels, the amount of beta-glucan used has ranged from 2,900 to 15,000 mg per day.
200 to 500 mcg daily
Chromium supplementation has reduced total cholesterol and LDL cholesterol and increased HDL cholesterol in double-blind and other controlled trials.
Chromium supplementation has reduced total cholesterol,168 , 169 LDL cholesterol170 , 171 and increased HDL cholesterol172 , 173 in double-blind and other controlled trials, although other trials have not found these effects.174 , 175 One double-blind trial found that high amounts of chromium (500 mcg per day) in combination with daily exercise was highly effective, producing nearly a 20% decrease in total cholesterol levels in just 13 weeks.176
Brewer’s yeast , which contains readily absorbable and biologically active chromium, has also lowered serum cholesterol.177 People with higher blood levels of chromium appear to be at lower risk for heart disease.178 A reasonable and safe intake of supplemental chromium is 200 mcg per day. People wishing to use brewer’s yeast as a source of chromium should look for products specifically labeled “from the brewing process” or “brewer’s yeast,” since most yeast found in health food stores is not brewer’s yeast, and does not contain chromium. Optimally, true brewer’s yeast contains up to 60 mcg of chromium per tablespoon, and a reasonable intake is 2 tablespoons per day.
10 to 30 grams three times per day with meals
Fenugreek seeds contain compounds that inhibit both cholesterol absorption in the intestines and cholesterol production by the liver.
Fenugreek seeds contain compounds known as steroidal saponins that inhibit both cholesterol absorption in the intestines and cholesterol production by the liver.179 Dietary fiber may also contribute to fenugreek’s activity. Multiple human trials (some double-blind) have found that fenugreek may help lower total cholesterol in people with moderate atherosclerosis or those having insulin-dependent or non-insulin-dependent diabetes.180 , 181 , 182 One human double-blind trial has also shown that defatted fenugreek seeds may raise levels of beneficial HDL cholesterol.183 One small preliminary trial found that either 25 or 50 grams per day of defatted fenugreek seed powder significantly lowered serum cholesterol after 20 days.184 Germination of the fenugreek seeds may improve the soluble fiber content of the seeds, thus improving their effect on cholesterol.185 Fenugreek powder is generally taken in amounts of 10 to 30 grams three times per day with meals.
4 to 13 grams daily
Glucomannan is a water-soluble dietary fiber that has been shown to significantly reduce total blood cholesterol, LDL cholesterol, and triglycerides, and to raise HDL cholesterol.
Glucomannan is a water-soluble dietary fiber that is derived from konjac root. Controlled186 , 187 and double-blind188 , 189 trials have shown that supplementation with glucomannan significantly reduced total blood cholesterol, LDL cholesterol, and triglycerides, and in some cases raised HDL cholesterol. Effective amounts of glucomannan for lowering blood cholesterol have been 4 to 13 grams per day.
3 grams daily
Supplementing with HMB, or beta hydroxy-beta-methylbutyrate, is an effective way to lower total and LDL cholesterol.
The combined results of nine double-blind trials indicate that supplementing with HMB, or beta hydroxy-beta-methylbutyrate, effectively lowers total and LDL cholesterol.190 All trials used 3 grams per day, taken for three to eight weeks.
300 mg pantethine taken two to four times per day
Pantethine, a byproduct of vitamin B5 (pantothenic acid), may help reduce the amount of cholesterol made by the body.
Pantethine , a byproduct of vitamin B5 (pantothenic acid), may help reduce the amount of cholesterol made by the body. Several preliminary and several controlled trials have found that pantethine (300 mg taken two to four times per day) significantly lowers serum cholesterol levels and may also increase HDL.191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 , 199However, a double-blind trial in people whose high blood cholesterol did not change with diet and drug therapy, found that pantethine was also not effective.200 Common pantothenic acid has not been reported to have any effect on high blood cholesterol.
5 to 10 grams per day with meals
Psyllium has been shown to be effective at lowering total and LDL (“bad”) cholesterol.
Use of psyllium has been extensively studied as a way to reduce cholesterol levels. An analysis of all double-blind trials in 1997 concluded that a daily amount of 10 grams psyllium lowered cholesterol levels by 5% and LDL cholesterol by 9%.201 Since then, a large controlled trial found that use of 5.1 grams of psyllium two times per day significantly reduced serum cholesterol as well as LDL-cholesterol.202 Generally, 5 to 10 grams of psyllium are added to the diet per day to lower cholesterol levels. The combination of psyllium and oat bran may also be effective at lowering LDL cholesterol.203
Red Yeast Rice
1.2 to 2.4 grams (5 to 10 mg of monacolins) daily in divided amounts
One of the ingredients in red yeast rice appears to block the production of cholesterol in the liver.
Researchers have determined that one of the ingredients in red yeast rice, called monacolin K, inhibits the production of cholesterol by stopping the action of the key enzyme in the liver (HMG-CoA reductase) that is responsible for manufacturing cholesterol.204 Monacolin K is the same compound as lovastatin (Mevacor), a prescription drug used to treat high cholesterol. However, the amount of monacolin K in red yeast rice is small (5 mg per 2.4 grams of red yeast rice) when compared with the 20 to 40 mg of lovastatin typically used to lower cholesterol levels.205 It appears that monacolin compounds present in red yeast rice work together with monacolin K to produce a greater cholesterol-lowering effect than would be expected from the small amount of monacolin K alone.
The red yeast rice used in various studies was a proprietary product called Cholestin, which contains ten different monacolins.
Note: Cholestin has been banned in the United States, as a result of a lawsuit alleging patent infringement.
Other red yeast rice products currently on the market differ from Cholestin in their chemical makeup. None contain the full complement of ten monacolin compounds that are present in Cholestin, and some contain a potentially toxic fermentation product called citrinin.206 Despite these concerns, other red yeast rice products are being widely used and both anecdotal reports and clinical research suggest that they have a similar safety and efficacy profile as that of Cholestin.207 , 208 , 209
1.7 grams daily
Sitostanol, a synthetic molecule related to beta-sitosterol, is available in margarine form and has also been shown to lower cholesterol levels.
A synthetic molecule related to beta-sitosterol, sitostanol, is available in a special margarine and has also been shown to lower cholesterol levels. In one controlled trial, supplementation with 1.7 grams per day of a plant-sterol product containing mostly sitostanol, combined with dietary changes, led to a dramatic 24% drop in LDL (“bad”) cholesterol compared with only a 9% decrease in the diet-only part of the trial.210Other controlled and double-blind trials have confirmed these results.211 , 212 , 213 , 214 , 215 , 216 , 217 A review of double-blind trials on sitostanol found that a reduction in the risk of heart disease of about 25% may be expected from use of sitostanol-containing spreads, a larger clinical effect than that produced by people reducing their saturated fat intake.218 Supplementation with sitostanol in the amount of 1.8 grams per day for six weeks has also been shown to enhance the cholesterol-lowering effect of statin drugs.219
25 grams soy protein per day
Soy supplementation has been shown to lower cholesterol. Soy contains isoflavones, which are believed to be soy’s main cholesterol-lowering ingredients.
Soy supplementation has been shown to lower cholesterol in humans.220 Soy is available in foods such as tofu, miso, and tempeh and as a supplemental protein powder. Soy contains isoflavones, naturally occurring plant components that are believed to be soy’s main cholesterol-lowering ingredients. A controlled trial showed that soy preparations containing high amounts of isoflavones effectively lowered total cholesterol and LDL (“bad”) cholesterol, whereas low-isoflavone preparations (less than 27 mg per day) did not.221 However, supplementation with either soy222 or non-soy isoflavones (from red clover)223 in pill form failed to reduce cholesterol levels in a group of healthy volunteers, suggesting that isoflavone may not be responsible for the cholesterol-lowering effects of soy. Further trials of isoflavone supplements in people with elevated cholesterol, are needed to resolve these conflicting results. In a study of people with high cholesterol levels, a soy preparation that contained soy protein, soy fiber, and soy phospholipids lowered cholesterol levels more effectively than isolated soy protein.224
Vitamin B3 (Niacin)
1,500 to 3,000 mg daily under a doctor's supervision
High amounts (several grams per day) of niacin, a form of vitamin B3, have been shown to lower cholesterol.
High amounts (several grams per day) of niacin, a form of vitamin B3, lower cholesterol, an effect recognized in the approval of niacin as a prescription medication for high cholesterol.225 The other common form of vitamin B3—niacinamide—does not affect cholesterol levels. Some niacin preparations have raised HDL cholesterol better than certain prescription drugs.226 Some cardiologists prescribe 3 grams of niacin per day or even higher amounts for people with high cholesterol levels. At such intakes, acute symptoms (flushing, headache, stomachache) and chronic symptoms (liver damage, diabetes, gastritis, eye damage, possibly gout) of toxicity may be severe. Many people are not able to continue taking these levels of niacin due to discomfort or danger to their health. Therefore, high intakes of niacin must only be taken under the supervision of a doctor.
Symptoms caused by niacin supplements, such as flushing, have been reduced with sustained-release (also called “time-release”) niacin products. However, sustained-release forms of niacin have caused significant liver toxicity and, though rarely, liver failure.227 , 228 , 229 , 230 , 231 One partial time-release (intermediate-release) niacin product has lowered LDL cholesterol and raised HDL cholesterol without flushing, and it also has acted without the liver function abnormalities typically associated with sustained-release niacin formulations.232 However, this form of niacin is available by prescription only.
1,000 mg daily
Vitamin C appears to protect LDL cholesterol from damage, and in some trials, cholesterol levels have fallen when people supplement with vitamin C.
Vitamin C appears to protect LDL cholesterol from damage.233 In some clinical trials, cholesterol levels have fallen when people with elevated cholesterol supplement with vitamin C.234 Some studies report that decreases in total cholesterol occur specifically in LDL cholesterol.235 Doctors sometimes recommend 1 gram per day of vitamin C. A review of the disparate research concerning vitamin C and heart disease, however, has suggested that most protection against heart disease from vitamin C, is likely to occur with as little as 100 mg per day.236
Refer to label instructions
Artichoke has moderately lowered cholesterol and triglycerides in some trials.
Artichoke has moderately lowered cholesterol and triglycerides in some,237 , 238 but not all,239 human trials. One double-blind trial found that 900 mg of artichoke extract per day significantly lowered serum cholesterol and LDL cholesterol but did not decrease triglycerides or raise HDL cholesterol.240 However, in another double-blind trial, supplementation with an artichoke extract significantly increased HDL cholesterol.241 Cholesterol-lowering effects occurred when using 320 mg of standardized leaf extract taken two to three times per day for at least six weeks.
4 to 12 mg daily
Astaxanthin has antioxidant and other properties that may help improve blood cholesterol regulation and protect against lipoprotein oxidation.
Astaxanthin is a member of the carotenoid family that has antioxidant and other properties that may help improve blood cholesterol regulation and protect against lipoprotein oxidation, according to test tube and animal studies.242 , 243 One double-blind trial in normal weight people with high blood triglycerides found astaxanthin, taken in amounts of either 6 mg or 12 mg per day, raised HDL cholesterol, but had no effect on total or LDL cholesterol. However, another double-blind trial in overweight people, using 20 mg per day of astaxanthin, found no significant change in blood lipids compared to a placebo.
15 to 20 drops of tincture twice per day for six months
In one trial, people who took a tincture of Achillea wilhelmsii had significant reductions in total cholesterol, LDL cholesterol, and triglycerides and an increase in HDL cholesterol.
In a double-blind trial, people with moderately high cholesterol took a tincture of Achillea wilhelmsii, an herb used in traditional Persian medicine.244 Participants in the trial used 15 to 20 drops of the tincture twice daily for six months. At the end of the trial, participants experienced significant reductions in total cholesterol, LDL cholesterol and triglycerides, as well as an increase in HDL cholesterol compared to those who took placebo. No adverse effects were reported.
500 mg twice per day
Berberine, a compound found in certain herbs such as goldenseal, barberry, and Oregon grape, has been found to lower serum cholesterol levels.
Berberine, a compound found in certain herbs such as goldenseal, barberry, and Oregon grape, has been found to lower serum cholesterol levels. In a study of people with high cholesterol levels, 500 mg of berberine taken twice a day for three months lowered the average cholesterol level by 29%. No significant side effects were reported, except for mild constipation.245
Berberine (Type 2 Diabetes)
500 mg of berberine taken twice a day for three months
Berberine, a compound found in certain herbs such as goldenseal, barberry, and Oregon grape, has been found to lower serum cholesterol levels.
Berberine, a compound found in certain herbs such as goldenseal, barberry, and Oregon grape, has been found to lower serum cholesterol levels. In a study of people with high cholesterol levels, 500 mg of berberine taken twice a day for three months lowered the average cholesterol level by 29%. No significant side effects were reported, except for mild constipation.246
0.8 to 3.2 grams daily
Beta-sitosterol blocks cholesterol absorption and has been shown in studies to reduce blood levels of cholesterol.
Soy contains phytosterols. One such molecule, beta-sitosterol, is available as a supplement. Beta-sitosterol alone, and in combination with similar plant sterols, has been shown to reduce blood levels of cholesterol in preliminary and controlled trials.247 , 248 , 249 , 250 This effect may occur because beta-sitosterol blocks absorption of cholesterol.251 In studying the effects of 0.8, 1.6, and 3.2 grams of plant sterols per day, one double-blind trial found that higher intake of sterols tended to result in greater reduction in cholesterol, though the differences between the effects of these three amounts were not statistically significant.252
800 to 1,000 mg daily
Some trials have shown that supplementing with calcium reduces cholesterol levels.
Caution: Calcium supplements should be avoided by prostate cancer patients.
Some preliminary253 and double-blind254 , 255 trials have shown that supplemental calcium reduces cholesterol levels. Possibly the calcium is binding with and preventing the absorption of dietary fat.256 However, other research has found no substantial or statistically significant effects of calcium supplementation on total cholesterol or HDL (“good”) cholesterol.257 Reasonable supplemental levels are 800 to 1,000 mg per day.
4 to 32 grams per day
Activated charcoal has the ability to attach (adsorb) cholesterol and bile acids present in the intestine, preventing their absorption.
Activated charcoal has the ability to adsorb (attach to) cholesterol and bile acids present in the intestine, preventing their absorption.258 , 259 Reducing the absorption of bile acids results in increased cholesterol breakdown by the liver. In controlled studies of people with high cholesterol, activated charcoal reduced total- and LDL-cholesterol levels, when given in amounts from 4 to 32 grams per day. Larger amounts were more effective: reductions in total and LDL cholesterol were 23% and 29%, respectively, with 16 grams daily, and 29% and 41% with 32 grams daily.260 Similar results were reported in other controlled261 and preliminary262 studies using 16 to 24 grams per day, but one small double-blind trial found no effect of either 15 or 30 grams per day in patients with high cholesterol.263
3 to 4 mg daily
Copper deficiency has been linked to high blood cholesterol, supplementing with it may correct a deficiency and lower cholesterol.
Deficiency of the trace mineral copper has been linked to high blood cholesterol.264 , 265 In a controlled trial, daily supplementation with 3 to 4 mg of copper for eight weeks decreased blood levels of total cholesterol and LDL cholesterol, in a group of people over 50 years of age.266
500 mg three times per day after meals
Supplementing with a cranberry extract has been shown to help lower total and LDL ("bad") cholesterol in people with type 2 diabetes taking hypoglycemic medication.
In a double-blind trial, supplementation with a cranberry extract (500 mg three times per day after meals) for 12 weeks significantly lowered serum total cholesterol and LDL cholesterol levels compared with placebo in patients with type 2 diabetes who were taking oral hypoglycemic medication.267
600 to 900 mg a day of a standardized herbal extract
Taking garlic may help lower cholesterol and prevent hardening of the arteries.
Reports on many double-blind garlic trials performed through 1998 suggested that cholesterol was lowered by an average of 9 to 12% and triglycerides by 8 to 27% over a one-to-four month period.268 , 269 , 270 Most of these trials used 600 to 900 mg per day of garlic supplements. More recently, however, several double-blind trials have found garlic to have minimal success in lowering cholesterol and triglycerides.271 , 272 , 273 , 274 , 275 One negative trial has been criticized for using a steam-distilled garlic “oil” that has no track record for this purpose,276 while the others used the same standardized garlic products as the previous positive trials. Based on these findings, the use of garlic should not be considered a primary approach to lowering high cholesterol and triglycerides.277Part of the confusion may result from differing effects from dissimilar garlic products. In most but not all trials, aged garlic extracts and garlic oil (both containing no allicin) have not lowered cholesterol levels in humans.278 , 279 Therefore, neither of these supplements can be recommended at this time for cholesterol lowering. Odor-controlled, enteric-coated tablets standardized for allicin content are available and, in some trials, appear more promising.280 Doctors typically recommend 900 mg per day (providing 5,000 to 6,000 mcg of allicin), divided into two or three admininstrations.
3 cups daily
Green tea has been shown to lower total cholesterol levels and improve people’s cholesterol profile.
Green tea has been shown to lower total cholesterol and LDL cholesterol levels according to several preliminary and controlled trials.281 , 282 , 283 , 284 , 285 , 286 However, not all trials have found that green tea intake lowers lipid levels.287 Much of the research documenting the health benefits of green tea is based on the amount of green tea typically drunk in Asian countries—about three cups per day, providing 240 to 320 mg of polyphenols.
Green Tea Enriched with Theaflavins
75 mg of theaflavins, 150 mg of green tea catechins, and 150 mg of other tea polyphenols daily
An extract of green tea, enriched with a compound present in black tea (theaflavins), has been found to lower serum cholesterol in people with moderately high cholesterol levels.
An extract of green tea, enriched with a compound present in black tea (theaflavins), has been found to lower serum cholesterol in a double-blind study of people with moderately high cholesterol levels. The average reduction in total serum cholesterol during the 12-week study was 11.3%, and the average reduction in LDL cholesterol was 16.4%. The extract used in this study provided daily 75 mg of theaflavins, 150 mg of green tea catechins, and 150 mg of other tea polyphenols.
25 mg guggulsterones three times per day
Guggul appears to be helpful in lowering cholesterol and raising HDL (“good”) cholesterol.
Guggul , a mixture of substances taken from a plant, is an approved treatment for elevated cholesterol in India and has been a mainstay of the Ayurvedic approach to preventing atherosclerosis. One double-blind trial studying the effects of guggul reported that serum cholesterol dropped by 17.5%.288 In another double-blind trial comparing guggul to the drug clofibrate, the average fall in serum cholesterol was slightly greater in the guggul group; moreover, HDL cholesterol rose in 60% of people responding to guggul, while clofibrate did not elevate HDL.289 A third double-blind trial found significant changes in total and LDL cholesterol levels, but not in HDL.290 However, in another double-blind trial, supplementation with guggul for eight weeks had no effect on total serum cholesterol, but significantly increased LDL-cholesterol levels, compared with a placebo.291 Daily intakes of guggul are based on the amount of guggulsterones in the extract. The recommended amount of guggulsterones is 25 mg taken three times per day. Most extracts contain 5 to 10% guggulsterones, and doctors familiar with their use usually recommend taking guggul for at least 12 weeks before evaluating its effect.
Inositol Hexaniacinate (Vitamin B3)
500 to 1,000 mg of inositol hexaniacinate three times daily under medical supervision
Inositol hexaniacinate, a special form of vitamin B3, has been reported to lower serum cholesterol, and apparently without the toxicity of high levels of niacin.
In an attempt to avoid the side effects of niacin, alternative health practitioners increasingly use inositol hexaniacinate, recommending 500 to 1,000 mg, taken three times per day, instead of niacin.292 , 293 This special form of niacin has been reported to lower serum cholesterol but so far has not been found to cause significant toxicity.294 Unfortunately, compared with niacin, far fewer investigations have studied the possible positive or negative effects of inositol hexaniacinate. As a result, people using inositol hexaniacinate should not take it without the supervision of a doctor, who will evaluate whether it is helpful (by measuring cholesterol levels) and will make sure that toxicity is not occurring (by measuring liver enzymes, uric acid and glucose levels, and by taking medical history and doing physical examinations).
1 to 3 grams krill oil daily
In one study of people with high cholesterol or triglycerides, supplementing with krill oil lowered total cholesterol, LDL cholesterol, and triglycerides, and increased HDL-cholesterol.
In a double-blind study of people with elevated blood levels of cholesterol and triglycerides, supplementing with 1 to 3 grams per day of krill oil from Antarctic krill (a zooplankton crustacean) for three months decreased total and LDL cholesterol levels and increased HDL cholesterol levels. Krill oil was significantly more effective than either a placebo or small amounts of regular fish oil containing 900 mg per day of omega-3 fatty acids.295
50 to 100 mg daily
Supplementing with royal jelly may lower cholesterol levels.
Royal jelly has prevented the cholesterol-elevating effect of nicotine296 and has lowered serum cholesterol in animal studies.297 Preliminary human trials have also found that royal jelly may lower cholesterol levels.298 , 299 An analysis of cholesterol-lowering trials shows that 50 to 100 mg per day is the typical amount used in such research.300
200 mg daily
Tocotrienols may lower cholesterol levels. Tocotrienols inhibited cholesterol synthesis in test-tube studies, and two trials found that tocotrienols reduced cholesterol levels by 13–15%.
Tocotrienols , a group of food-derived compounds that resemble vitamin E, may lower blood levels of cholesterol, but evidence is conflicting. Although tocotrienols inhibited cholesterol synthesis in test-tube studies,301 , 302 human trials have produced contradictory results. Two double-blind trials found that 200 mg per day of either gamma-tocotrienol303 or total tocotrienols304 were more effective than placebo, reducing cholesterol levels by 13–15%. However, in another double-blind trial, 200 mg of tocotrienols per day failed to lower cholesterol levels,305 and a fourth double-blind trial found 140 mg of tocotrienols and 80 mg of vitamin E (d-alpha-tocopherol) daily resulted in no changes in total cholesterol, LDL cholesterol, or HDL cholesterol levels.306
Refer to label instructions
Saponins in alfalfa seeds may block cholesterol absorption and prevent the formation of atherosclerotic plaques.
Animal studies indicate that saponins in alfalfa seeds may block absorption of cholesterol and prevent the formation of atherosclerotic plaques.307 However, consuming the large amounts of alfalfa seeds (80 to 120 grams per day) needed to supply high doses of these saponins may potentially cause damage to red blood cells in the body.308
Refer to label instructions
Chitosan is a fiber-like supplement that has been shown to lower cholesterol and raise HDL (“good”) cholesterol).
The fiber-like supplement chitosan appears to reduce the absorption of bile acids or cholesterol; either of these effects may cause a lowering of blood cholesterol. 309 This effect has been repeatedly demonstrated in animals, and a preliminary human study showed that 3 to 6 grams per day of chitosan taken for two weeks resulted in a 6% drop in cholesterol and a 10% increase in HDL ("good") cholesterol.310 Another preliminary trial showed a 43% lowering of total cholesterol in people being treated for kidney failure with dialysis who took 4 grams per day of chitosan for 12 weeks. These people also appeared to have improved kidney function and less severe anemia after chitosan treatment. 311 In a double-blind trial, however, administration of 2.4 grams of chitosan per day for three months to people with high cholesterol had no effect on their cholesterol levels. 312 Another study also found no cholesterol-lowering effect of chitosan when taken in amounts up to 6.75 grams per day for 8 weeks.313
Chitosan in large amounts, given with vitamin C, has been shown to reduce dietary fat absorption in animals fed a high-fat diet.314 , 315 , 316 However, the absorption of minerals and fat-soluble vitamins was also reduced by feeding animals large amounts of chitosan.317 In studies in humans, chitosan did not reduce the absorption of dietary fat.318 , 319
Refer to label instructions
Chondroitin sulfate has lowered serum cholesterol levels in preliminary trials.
Chondroitin sulfate has lowered serum cholesterol levels in preliminary trials.320 , 321 Years ago, this supplement dramatically reduced the risk of heart attacks in a controlled, six-year follow-up of people with heart disease.322 The few doctors aware of these older clinical trials sometimes tell people with a history of heart disease or elevated cholesterol levels, to take approximately 500 mg of chondroitin sulfate three times per day.
Refer to label instructions
One trial found that supplementing with creatine significantly lowered serum total cholesterol and triglycerides in people with high cholesterol.
A double-blind trial found that 20 grams per day of creatine taken for five days, followed by ten grams per day for 51 days, significantly lowered serum total cholesterol and triglycerides, but did not change either LDL or HDL cholesterol, in both men and women.323 However, another double-blind trial found no change in any of these blood levels in trained athletes using creatine during a 12-week strength training program.324 Creatine supplementation in this negative trial was lower—only 5 grams per day were taken for the last 11 weeks of the study.
Refer to label instructions
Preliminary Chinese research has found that high doses of the herb fo-ti may lower cholesterol levels.
Preliminary Chinese research has found that high doses (12 grams per day) of the herb fo-ti may lower cholesterol levels. Double-blind or other controlled trials are needed to determine fo-ti’s use in lowering cholesterol. A tea may be made from processed roots by boiling 3 to 5 grams in a cup of water for 10 to 15 minutes. Three or more cups should be drunk each day. Fo-ti tablets containing 500 mg each are also available. Doctors may suggest taking five of these tablets three times per day.
Refer to label instructions
Some preliminary trials report that L-carnitine reduces serum cholesterol and raises HDL cholesterol.
L-carnitine is needed by heart muscle to utilize fat for energy. Some,325 , 326 but not all, preliminary trials report that carnitine reduces serum cholesterol.327 HDL cholesterol has also increased in response to carnitine supplementation.328 , 329 People have been reported in controlled research to stand a greater chance of surviving a heart attack if they are given L-carnitine supplements.330 Most trials have used 1 to 4 grams of carnitine per day.
Lecithin (Phosphatidyl Choline)
Refer to label instructions
Taking lecithin supplements may be a useful way to lower cholesterol.
Although lecithin has been reported to increase HDL cholesterol and lower LDL cholesterol,331 a review of the research found that the positive effect of lecithin was likely due to the polyunsaturated fat content of the lecithin.332 If this is so, it would make more sense to use inexpensive vegetable oil, rather than take lecithin supplements. However, an animal study found a cholesterol-lowering effect of lecithin independent of its polyunsaturate content.333 A double-blind trial found that 20 grams of soy lecithin per day for four weeks had no significant effect on total cholesterol, LDL cholesterol, HDL cholesterol, or triglycerides.334 Whether taking lecithin supplements is a useful way to lower cholesterol in people with elevated cholesterol levels remains unclear.
Refer to label instructions
In a preliminary study, magnesium supplementation lowered total cholesterol and increased HDL ("good") cholesterol levels.
Magnesium is needed by the heart to function properly. Although the mechanism is unclear, magnesium supplements (430 mg per day) lowered cholesterol in a preliminary trial.335 Another preliminary study reported that magnesium deficiency is associated with a low HDL cholesterol level.336 Intravenous magnesium has reduced death following heart attacks in some, but not all, clinical trials.337 Though these outcomes would suggest that people with high cholesterol levels should take magnesium supplements, an isolated double-blind trial reported that people with a history of heart disease assigned to magnesium supplementation experienced an increased number of heart attacks.338 More information is necessary before the scientific community can clearly evaluate the role magnesium should play for people with elevated cholesterol.
Refer to label instructions
The mushroom maitake may lower fat levels in the blood and be useful in lowering cholesterol.
Animal studies suggest that the mushroom maitake may lower fat levels in the blood.339 This research is still preliminary and requires confirmation with controlled human trials.
Refer to label instructions
Policosanol may affect cholesterol levels by inhibiting cholesterol production by the liver but most research has casted doubt on its effectiveness.
Test tube and animal studies indicate that policosanol is capable of inhibiting cholesterol production by the liver.340 , 341 Extensive preliminary and double-blind research in Cuba and other countries in Latin America has demonstrated that taking 10 to 20 mg per day of policosanol extracted from sugar cane results in significant changes in blood cholesterol levels, including total cholesterol (17 to 21% lower on average), LDL cholesterol (21 to 29% lower), and HDL cholesterol (7 to 29% higher).342 , 343 , 344 , 345 , 346 , 347 , 348 , 349 , 350 , 351 , 352 However, virtually all of this research was conducted by a single research group from Cuba. Follow-up double-blind studies performed in the United States,353 , 354 Canada,355 Italy,356 and Germany357 found that sugar cane-derived policosanol in amounts of 10 to 80 mg per day taken for 12 weeks had no effect on serum cholesterol levels in people with initially high cholesterol levels. Therefore, it seems doubtful that policosanol has a beneficial effect on serum cholesterol levels.
150 mg per day
Preliminary research suggests that Pycnogenol may lower LDL cholesterol and raise HDL cholesterol in people with normal cholesterol levels.
A preliminary study reported that 150 mg per day of Pycnogenol lowered LDL cholesterol and raised HDL cholesterol in two-thirds of a group of people with normal cholesterol levels.358 Double-blind research is needed to confirm these findings.
Refer to label instructions
Sea buckthorn contains flavonoids and essential fatty acids that may influence blood cholesterol according to animal and preliminary human research.
Sea buckthorn contains flavonoids and essential fatty acids that may influence blood cholesterol according to animal and preliminary human research.359 , 360 , 361 In a double-blind trial, people with normal blood cholesterol who consumed 28 grams per day of pureed sea buckthorn berries for three months experienced no change in their blood cholesterol.362 Similarly, a double-blind trial of 300 ml per day of sea buckthorn berry juice found no cholesterol-lowering effect in people with normal blood cholesterol.363 Double-blind studies of people with high cholesterol are needed to determine whether sea buckthorn is an effective treatment for this condition.
Refer to label instructions
A double-blind trial found that, in people with moderately elevated cholesterol levels, supplementing with selenium in the form of high-selenium yeast resulted in a small but statistically significant decrease in serum cholesterol.
In a double-blind trial, supplementation with selenium (100 or 200 mcg per day) in the form of high-selenium yeast for six months resulted in a small but statistically significant decrease in serum cholesterol levels, compared with a placebo, in people with moderately elevated cholesterol levels. Selenium in the amount of 300 mcg per day was resulted in a smaller decrease in cholesterol levels that was not statistically significant.364 High-selenium yeast contains one or more unique selenium-containing compounds that are not present in other selenium supplements. Additional research is therefore needed to determine whether other forms of selenium also lower cholesterol levels.
Refer to label instructions
In one trial, supplementing with vitamin E increased levels of protective HDL cholesterol.
In one double-blind trial,365 vitamin E increased protective HDL cholesterol, but several other trials,366 , 367 , 368 found no effect of vitamin E. However, vitamin E is known to protect LDL cholesterol from damage.369 Most cardiologists believe that only damaged LDL increases the risk of heart disease. Studies of the ability of vitamin E supplements to prevent heart disease have produced conflicting results,370 but many doctors continue to recommend that everyone supplement 400 IU of vitamin E per day to lessen the risk of having a heart attack.
Refer to label instructions
Wild yam has been reported to raise HDL (“good”) cholesterol in preliminary research.
Wild yam has been reported to raise HDL cholesterol in preliminary research. Doctors sometimes recommend 2 to 3 ml of tincture taken three to four times per day, or 1 to 2 capsules or tablets of dried root taken three times per day. 371
- High-Fiber Diet
1. Reaven PD, McPhillips JB, Barrett-Connor EL, Criqui MH. Leisure time exercise and lipid and lipoprotein levels in an older population. J Am Geriatr Soc 1990;38:847-54.
2. Duncan JJ, Gordon NF, Scott CB. Women walking for health and fitness—how much is enough? JAMA 1991;266:3295-9.
3. Tran ZV, Weltman A. Differential effects of exercise on serum lipid and lipoprotein levels seen with changes in body weight: a meta-analysis. JAMA 1985;254:919-24.
4. Pekkanen J, Marti B, Nissinen A, Tuomilehto J. Reduction of premature mortality by high physical activity: a 20-year follow-up of middle-aged Finnish men. Lancet 1987;1:1473-7.
5. Willich SN, Lewis M, Lowel H, et al. Physical exertion as a trigger of acute myocardial infarction. Triggers and Mechanisms of Myocardial Infarction Study Group. N Engl J Med 1993;329:1684-90.
6. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:968-77.
7. Glueck CJ, Taylor HL, Jacobs D, et al. Plasma high-density lipoprotein cholesterol: association with measurements of body mass: the Lipid Research Clinics Program Prevalence Study. Circulation 1980;62(Suppl IV):IV62-9.
8. Di Buono M, Hannah JS, Katzel LI, Jones PJH. Weight loss due to energy restriction suppresses cholesterol bioshynthesis in overweight, mildly hypercholesterolemic men. J Nutr 1999;129:1545-8.
9. Wood PD, Stefanick ML, Dreon DM, et al. Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med 1988;319:1173-9.
10. Dwyer JH, Rieger-Ndakorerwa GE, Semmer NK, et al. Low-level cigarette smoking and longitudinal change in serum cholesterol among adolescents. JAMA 1988;2857-62.
11. Khosla S, Laddu A, Ehrenpreis S, Somberg JC. Cardiovascular effects of nicotine: relation to deleterious effects of cigarette smoking. Am Heart J 1994;127:1669-71 [editorial/review].
12. Nyboe J, Jensen G, Appleyard M, Schnohr P. Smoking and the risk of first acute myocardial infarction. Am Heart J 1991;122:438.
13. Kawachi I, Sparrow D, Spiro A 3rd, et al. A prospective study of anger and coronary heart disease. The Normative Aging Study. Circulation 1996;94:2090-5.
14. Jiang W, Babyak M, Krantz DS, et al. Mental stress-induced myocardial ischemia and cardiac events. JAMA 1996;275:1651-6.
15. Bower B. Women take un-type A behavior to heart. Sci News 1993;144:244.
16. Dimsdale JE. A perspective on type A behavior and coronary disease. N Engl J Med 1988;318:110-2 [editorial].
17. McCann BS, Warnick R, Knopp RH. Changes in plasma lipids and dietary intake accompanying shifts in perceived workload and stress. Psychosomatic Med 1990;52:97-108.
18. Lundberg U, Hedman M, Melin B, Frankenhaeuser M. Type A Behavior in healthy males and females as related to physiological reactivity and blood lipids. Psychosomatic Med 1989;51:113-22.
19. Friedman M, Thoresen CE, Gill JJ, et al. Alteration of type A behavior and reduction in cardiac recurrences in postmyocardial infarction patients. Am Heart J 1984;108:237-48.
20. Baggio G, Pagnan A, Muraca M, et al. Olive-oil-enriched diet: effect on serum lipoprotein levels and biliary cholesterol saturation. Am J Clin Nutr 1988;47:960-4.
21. Kris-Etherton PM, Pearson TA, Wan Y, et al. High-monounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations. Am J Clin Nutr 1999;70:1009-15.
22. Grundy SM. Monounsaturated fatty acids and cholesterol metabolism: implications for dietary recommendations. J Nutr 1989;119:529-33 [review].
23. Keys A, ed. Coronary heart disease in seven countries. Circulation 1970;41(Suppl Q):I1-211.
24. Kris-Etherton PM, Pearson TA, Wan Y, et al. High-monounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations. Am J Clin Nutr 1999;70:1009-15.
25. Yudkin J, Kang SS, Bruckdorfer KR. Effects of high dietary sugar. Br Med J 1980;281:1396.
26. Reiser S. Effect of dietary sugars on metabolic risk factors associated with heart disease. Nutr Health 1985;3:203-16.
27. Liu K, Stamler J, Trevisan M, Moss D. Dietary lipids, sugar, fiber, and mortality from coronary heart disease. Bivariate analysis of international data. Arteriosclerosis 1982;2:221-7.
28. Mantzioris E, James MJ, Bibson RA, Cleland LG. Dietary substitution with an alpha-linolenic acid-rich vegetable oil increases eicosapentaenoic acid concentrations in tissues. Am J Clin Nutr 1994;59:1304-9.
29. Layne KS, Goh YK, Jumpsen JA, et al. Normal subjects consuming physiological levels of 18:3(n-3) and 20:5(n-3) from flaxseed or fish oils have characteristic differences in plasma lipid and lipoprotein fatty acid levels. J Nutr 1996;126:2130-40.
30. de Lorgeril M, Renaud S, Mamelle N, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994;343:1454-9.
31. de Lorgeril M, Salen P, Martin JL, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999;99:779-85.
32. Rice RD. Mediterranean diet. Lancet 1994;344:893-4 [letter].
33. Santos MJ, Lopez-Jurado M, Llopis J, et al. Influence of dietary supplementation with fish on plasma total cholesterol and lipoprotein cholesterol fractions in patients with coronary heart disease. J Nutr Med 1992;3:107-15.
34. Kromhout D, Bosschieter EB, de Lezenne Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med 1985;312:1205-9.
35. Ascherio A, Rimm EB, Stampfer MJ, et al. Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among men. N Engl J Med 1995;332:977-82.
36. Albert CM, Manson JE, O'Donnell C, et al. Fish consumption and the risk of sudden death in the Physicians' Health Study. Circulation 1996;94(Suppl 1):I-578 [abstract #3382].
37. Howell WH, McNamara DJ, Tosca MA, et al. Plasma lipid and lipoprotein responses to dietary fat and cholesterol: a meta-analysis. Am J Clin Nutr 1997;65:1747-64 [review].
38. Clarke R, Frost C, Collins R, Appleby P, Peto R. Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. Br Med J 1997;314:112-7 [review].
39. Mensink RP, Katan MB. Effects of dietary fatty acids on serum lipids and lipoproteins: a meta-analysis of 27 trials. Arterioscler Thromb 1992;12:911-9 [review].
40. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003;77:1146 -55 [review].
41. Siguel E. A new relationship between total/high density lipoprotein cholesterol and polyunsaturated fatty acids. Lipids 1996;31(suppl):S51-S56.
42. Willett WC, Stampfer MJ, Manson JE, et al. Intake of trans fatty acids and risk of coronary heart disease among women. Lancet 1993;341:581-5.
43. Lichtenstein AH, Ausman LM, Jalbert SM, Schaefer EJ. Effects of different forms of dietary hydrogenated fats on serum lipoprotein cholesterol levels. N Engl J Med 1999;340:1933-40.
44. Hu FB, Stampfer MJ, Manson JE, et al. Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study. BMJ 1998;317:1341-5.
45. Fraser GE, Sabaté J, Beeson WL, Strahan TM. A possible protective effect of nut consumption on risk of coronary heart disease. Arch Intern Med 1992;152:1416-24.
46. Abbey M, Noakes M, Belling GB, Nestel PJ. Partial replacement of saturated fatty acids with almonds or walnuts lowers total plasma cholesterol and low-density-lipoprotein cholesterol. Am J Clin Nutr 1994;59:995-9.
47. Hu FB, Stampfer MJ. Nut consumption and risk of coronary heart disease: a review of epidemiologic evidence. Curr Atheroscler Rep 1999;1:204-9.
48. Spiller GA, Jenkins DA, Bosello O, et al. Nuts and plasma lipids: an almond-based diet lowers LDL-C while preserving HDL-C. J Am Coll Nutr 1998;17:285-90.
49. Spiller GA, Jenkins DJ, Cragen LN, et al. Effect of a diet high in monounsaturated fat from almonds on plasma cholesterol and lipoproteins. J Am Coll Nutr 1992;11:126-30.
50. Sabaté J, Frasser GE, Burke K, et al. Effects of walnuts on serum lipid levels and blood pressure in normal men. N Engl J Med 1993;328:603-7.
51. Zambon D, Campero B, Perez-Heras A, et al. Effects of walnuts on the serum lipid profile of hypercholesterolemic subjects: the Barcelona Walnut Trial. FASEB J 1998;12:A506 [abstract].
52. Zambon D, Sabate J, Munoz S, et al. Substituting walnuts for monounsaturated fat improves the serum lipid profile of hypercholesterolemic men and women. A randomized crossover trial. Ann Intern Med 2000;132:538-46.
53. Colquhoun D, Moores D, Humphries J, Somerset S. Comparison of a high monounsaturated fatty acid diet (enriched with macadamia nut) and a high carbohydrate diet on blood lipids [abstract]. Proceedings of the 59th European Atherosclerosis Congress. Nice, France: May 1992, 17-21.
54. Curb JD, Wergowski G, Abbott RD, et al. High mono-unsaturated fat macadamia nut diets: effects on serum lipids and lipoproteins. FASEB J 1998;12:A506 [abstract].
55. Fraser GE. Nut consumption, lipids, and risk of a coronary event. Clin Cardiol 1999;22(7 Suppl):III11-5 [review].
56. Curb JD, Wergowske G, Dobbs JC, et al. Serum lipid effects of a high-monounsaturated fat diet based on macadamia nuts. Arch Intern Med 2000;160:1154-8.
57. Durak I, Köksal I, Kaçmaz M, et al. Hazelnut supplementation enhances plasma antioxidant potential and lowers plasma cholesterol levels. Clin Chim Actia 1999;284:113-5 [letter].
58. Edwards K, Kwaw I, Matud J, Kurtz I. Effect of pistachio nuts on serum lipid levels in patients with moderate hypercholesterolemia. J Am Coll Nutr 1999;18:229-32.
59. Gebauer SK, West SG, Kay CD, et al. Effects of pistachios on cardiovascular disease risk factors and potential mechanisms of action: a dose-response study. Am J Clin Nutr 2008;88:651-9.
60. Mirkin G. Walnuts and serum lipids. N Engl J Med 1993;329:358 [letter].
61. Mann GV. Walnuts and serum lipids. N Engl J Med 1993;329:358 [letter].
62. Fraser GE, Jaceldo K, Sabaté J, et al. Changes in body weight with a daily supplement of 340 calories from almonds for six months. FASEB J 1999;13:A539 [abstract].
63. Fraser GE. Nut consumption, lipids, and risk of a coronary event. Clin Cardiol 1999;22(7 Suppl):III11-5 [review].
64. Durak I, Köksal I, Kaçmaz M, et al. Hazelnut supplementation enhances plasma antioxidant potential and lowers plasma cholesterol levels. Clin Chim Actia 1999;284:113-5 [letter].
65. Anderson JW, Chen WJL. Legumes and their soluble fiber: effect on cholesterol-rich lipoproteins. In: Furda I, ed. Unconventional Sources of Dietary Fiber. Washington, DC: American Chemical Society, 1983.
66. Ripsin CM, Keenan JM, Jacobs DR, et al. Oat products and lipid lowering—a meta-analysis. JAMA 1992;267:3317-25.
67. Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr 2000;71:472-9.
68. Miettinen TA, Tarpila S. Effect of pectin on serum cholesterol, fecal bile acids and biliary lipids in normolipidemic and hyperlipidemic individuals. Clin Chim Acta 1977;79:471-7.
69. Glore SR, Van Treeck D, Knehans AW, Guild M. Soluble fiber and serum lipids: a literature review. J Am Dietet Assoc 1994;94:425-36.
70. Romero AL, Romero JE, Galaviz S, Fernandez ML. Cookies enriched with psyllium or oat bran lower plasma LDL cholesterol in normal and hypercholesterolemic men from Northern Mexico. J Am Coll Nutr 1998;17:601-8.
71. Rimm EB, Ascherio A, Giovannucci E, et al. Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease among men. JAMA 1996;275:447-51.
72. Knopp RH, Superko HR, Davidson M, et al. Long-term blood cholesterol-lowering effects of a dietary fiber supplement. Am J Prev Med 1999;17:18-23.
73. Moreyra AE, Wilson AC, Koraym A. Effect of combining psyllium fiber with simvastatin in lowering cholesterol. Arch Intern Med 2005;165:1161-6.
74. Lovegrove JA, Clohessy A, Milon H, Williams CM. Modest doses of beta-glucan do not reduce concentrations of potentially atherogenic lipoproteins. Am J Clin Nutr 2000;72:49-55.
75. Uusitupa MI, Ruuskanen E, Makinen E, et al. A controlled study on the effect of beta-glucan-rich oat bran on serum lipids in hypercholesterolemic subjects: relation to apolipoprotein E phenotype. J Am Coll Nutr 1992;11:651-9.
76. Braaten JT, Wood PJ, Scott FW, et al. Oat beta-glucan reduces blood cholesterol concentration in hypercholesterolemic subjects. Eur J Clin Nutr 1994;48:465-74.
77. Davidson MH, Dugan LD, Burns JH, et al. The hypocholesterolemic effects of beta-glucan in oatmeal and oat bran. A dose-controlled study. JAMA 1991;265:1833-9.
78. Onning G, Wallmark A, Persson M, et al. Consumption of oat milk for 5 weeks lowers serum cholesterol and LDL cholesterol in free-living men with moderate hypercholesterolemia. Ann Nutr Metab 1999;43:301-9.
79. Beer MU, Arrigoni E, Amado R. Effects of oat gum on blood cholesterol levels in healthy young men. Eur J Clin Nutr 1995;49:517-22.
80. Bierenbaum ML, Reichstein R, Watkins TR. Reducing atherogenic risk in hyperlipemic humans with flaxseed supplementation: a preliminary report. J Am Coll Nutr 1993;12:501-4.
81. Cunnane SC, Ganguli S, Menard C, et al. High alpha-linolenic acid flaxseed (Linum usitatissimum): some nutritional properties in humans. Br J Nutr 1993;69:443-53.
82. Arjmandi BH, Khan DA, Juma S, et al. Whole flaxseed consumption lowers serum LDL-cholesterol and lipoprotein(a) concentrations in postmenopausal women. Nutr Res 1998;18:1203-14.
83. Jenkins DJA, Kendall CWC, Vidgen E, et al. Health aspects of partially defatted flaxseed, including effects on serum lipids, oxidative measures, and ex vivo androgen and progestin activity: a controlled crossover trial. Am J Clin Nutr 1999;69:395-402.
84. Kelley DS, Nelson GJ, Love JE, et al. Dietary alpha-linolenic acid alters tissue fatty acid composition, but not blood lipids, lipoproteins or coagulation status in humans. Lipids 1993;28:533-7.
85. Chan JK, Bruce VM, McDonald BE. Dietary a-linolenic acid is as effective as oleic acid and linoleic acid in lowering blood cholesterol in normolipidemic men. Am J Clin Nutr 1991;53:1230-4.
86. Pang D, Allman-Farinelli MA, Wong T, et al. Replacement of linoleic acid with alpha-linolenic acid does not alter blood lipids in normolipidaemic men. Br J Nutr 1998;80:163-7.
87. Urgert R, Schulz AG, Katan MB. Effects of cafestol and kahweol from coffee grounds on serum lipids and serum liver enzymes in humans. Am J Clin Nutr 1995;61:149-54.
88. Superko HR, Bortz WM, Albers JJ, Wood PJ. Lipoprotein and apolipoprotein changes during a controlled trial of caffeinated and decaffeinated coffee drinking in men. Circulation 1989;80:II-86.
89. Nygård O, Refsum H, Velanb PM, et al. Coffee consumption and plasma total homocysteine: The Hordaland Homocysteine Study. Am J Clin Nutr 1997;65:136-43.
90. Gross G, Jaccaud E, Huggett AC. Analysis of the content of the diterpenes cafestol and kahweol in coffee brews. Food Chem Toxicol 1997;35:547-54.
91. D'Amicis A, Scaccini C, Tomassi G, et al. Italian style brewed coffee: effect on serum cholesterol in young men. Int J Epidemiol 1996;25:513-20.
92. D'Avanzo B, Santoro L, Nobill A, La Vecchia C. Coffee consumption and serum cholesterol. GISSI-EFRIM Study Group. Prev Med 1993;22:219-24.
93. [No authors listed.] Regular or decaf? Coffee consumption and serum lipoproteins. Nutr Rev 1992;50:175-8 [review].
94. Jenkins DJA, Khan A, Jenkins AL, et al. Effect of nibbling versus gorging on cardiovascular risk factors: serum uric acid and blood lipids. Metabolism 1995;44:549-55.
95. Edelstein SL, Barrett-Connor EL, Wingard DL, Cohn BA. Increased meal frequency associated with decreased cholesterol concentrations; Rancho Bernardo, CA, 1984-1987. Am J Clin Nutr 1992;55:664-9.
96. Dai WS, Laporte RE, Hom DL, et al. Alcohol consumption and high density lipoprotein cholesterol concentration among alcoholics. Am J Epidemiol 1985;122:620-7.
97. Marques-Vidal P, Ducimetiere P, Evans A, et al. Alcohol consumption and myocardial infarction: a case-control study in France and northern Ireland. Am J Epidemiol 1996;143:1089-93.
98. Rimm EB, Klatsky A, Grobbee D, Stampfer MJ. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits? BMJ 1996;312:731-6 [review].
99. Hendriks HF, Veenstra J, Velthuis-te Wierik EJ, et al. Effect of moderate dose of alcohol with evening meal on fibrinolytic factors. BMJ 1994;304:1003-6.
100. Doll R, Peto AR, Hall E, et al. Mortality in relation to consumption of alcohol: 13 years' observations on male British doctors. BMJ 1994;309:911-8.
101. Hein HO, Suadicani P, Gyntelberg F. Alcohol consumption, serum low density lipoprotein cholesterol concentration, and risk of ischaemic heart disease: six year follow up in the Copenhagen male study. BMJ 1996;736-41.
102. Connor SL, Connor WE. The importance of dietary cholesterol in coronary heart disease. Prev Med 1983;12:115-23 [review].
103. Edington JD, Geekie M, Carter R, et al. Serum lipid response to dietary cholesterol in subjects fed a low-fat, high-fiber diet. Am J Clin Nutr 1989;50:58-62.
104. Raloff J. Oxidized lipids: a key to heart disease? Sci News 1985;127:278.
105. Levy Y, Maor I, Presser D, Aviram M. Consumption of eggs with meals increases the susceptibility of human plasma and low-density lipoprotein to lipid peroxidation. Ann Nutr Metabol 1996;40:243-51.
106. Shekelle RB, Stamler J. Dietary cholesterol and ischaemic heart disease. Lancet 1989;1:1177-9.
107. Hu FB, Stampfer MJ, Rimm EB, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA 1999;281:1387-94.
108. Anderson JW, Johnstone BM, Cook-Newell ME. Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med 1995;3333:276-82.
109. Sirtori CR, Pazzucconi F, Colombo L, et al. Double-blind study of the addition of high-protein soya milk v. cows' milk to the diet of patients with severe hypercholesterolaemia and resistance to or intolerance of statins. Br J Nutr 1999;82:91-6.
110. Teixeira SR, Potter SM, Weigel R, et al. Effects of feeding 4 levels of soy protein for 3 and 6 wk on blood lipids and apolipoproteins in moderately hypercholesterolemic men. Am J Clin Nutr 2000;71:1077-84.
111. Baum JA, Teng H, Erdman JW Jr, et al. Long-term intake of soy protein improves blood lipid profiles and increases mononuclear cell low-density-lipoprotein receptor messenger RNA in hypercholesterolemic, postmenopausal women. Am J Clin Nutr 1998;68:545-51.
112. Crouse JR 3rd, Morgan T, Terry JG, et al. A randomized trial comparing the effect of casein with that of soy protein containing varying amounts of isoflavones on plasma concentrations of lipids and lipoproteins. Arch Intern Med 1999;159:2070-6.
113. Teixeira SR, Potter SM, Weigel R, et al. Effects of feeding 4 levels of soy protein for 3 and 6 wk on blood lipids and apolipoproteins in moderately hypercholesterolemic men. Am J Clin Nutr 2000;71:1077-84.
114. Potter SM, Baum JA, Teng H, et al. Soy protein and isoflavones: their effects on blood lipids and bone density in postmenopausal women. Am J Clin Nutr 1998;68(Suppl):1375-9S.
115. Crouse JR 3rd, Morgan T, Terry JG, et al. A randomized trial comparing the effect of casein with that of soy protein containing varying amounts of isoflavones on plasma concentrations of lipids and lipoproteins. Arch Intern Med 1999;159:2070-6.
116. Greaves KA, Parks JS, Williams JK, Wagner JD. Intact dietary soy protein, but not adding an isoflavone-rich soy extract to casein, improves plasma lipids in ovariectomized cynomolgus monkeys. J Nutr 1999;129:1585-92.
117. Greaves KA, Wilson MD, Rudel LL, et al. Consumption of soy protein reduces cholesterol absorption compared to casein protein alone or supplemented with an isoflavone extract or conjugated equine estrogen in ovariectomized cynomolgus monkeys. J Nutr 2000;130:820-6.
118. Thorogood M, Carter R, Benfield L, et al. Plasma lipids and lipoprotein cholesterol concentrations in people with different diets in Britain. Br Med J (Clin Res Ed) 1987;295:351-3.
119. Burr ML, Sweetnam PM. Vegetarianism, dietary fiber and mortality. Am J Clin Nutr 1982;36:873-7.
120. Resnicow K, Barone J, Engle A, et al. Diet and serum lipids in vegan vegetarians: a model for risk reduction. J Am Dietet Assoc 1991;91:447-53.
121. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336:129-33.
122. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998;280:2001-7.
123. Kromhout D, Menotti A, Bloemberg B, et al. Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: the Seven Countries Study. Prev Med 1995;24:308-15.
124. Tell GS, Evans GW, Folsom AR, et al. Dietary fat intake and carotid artery wall thickness: the Atherosclerosis Risk in Communities (ARIC) study. Am J Epidemiol 1994;139:979-89.
125. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336:129-33.
126. Denke MA, Grundy SM. Comparison of effects of lauric acid and palmitic acid on plasma lipids and lipoproteins. Am J Clin Nutr 1992;56:895-8.
127. Zock PL, de Vries JHM, Katan MB. Impact of myristic acid versus palmitic acid on serum lipid and lipoprotein levels in healthy women and men. Arterioscler Thromb 1994;14:567-75.
128. Kumar PD. The role of coconut and coconut oil in coronary heart disease in Kerala, south India. Trop Doct 1997;27:215-7.
129. Denke MA, Grundy SM. Comparison of effects of lauric acid and palmitic acid on plasma lipids and lipoproteins. Am J Clin Nutr 1992;56:895-8.
130. Mendis S, Kumarasunderam R. The effect of daily consumption of coconut fat and soya-bean fat on plasma lipids and lipoproteins of young normolipidaemic men. Br J Nutr 1990;63:547-52.
131. Dreon DM, Fernstrom HA, Williams PT, Krauss RM. A very-low-fat diet is not associated with improved lipoprotein profiles in men with a predominance of large, low-density lipoproteins. Am J Clin Nutr 1999;69:411-8.
132. Hepner G, Fried R, St Jeor S, et al. Hypocholesterolemic effect of yogurt and milk. Am J Clin Nutr 1979;19-24.
133. Agerholm-Larsen L, Raben A, Haulrik N, et al. Effect of 8 week intake of probiotic milk products on risk factors for cardiovascular diseases. Eur J Clin Nutr 2000;54:288-97.
134. Bertolami MC, Faludi AA, Batlouni M. Evaluation of the effects of a new fermented milk product (Gaio) on primary hypercholesterolemia. Eur J Clin Nutr 1999;53:97-101.
135. Anderson JW, Gilliland SE. Effect of fermented milk (yogurt) containing Lactobacillus acidophilus L1 on serum cholesterol in hypercholesterolemic humans. J Am Coll Nutr 1999;18:43-50.
136. Schaafsma G, Meuling WJ, van Dokkum W, Bouley C. Effects of a milk product, fermented by Lactobacillus acidophilus and with fructo-oligosaccharides added, on blood lipids in male volunteers. Eur J Clin Nutr 1998;52:436-40.
137. Agerbaek M, Gerdes LU, Richelsen B. Hypocholesterolaemic effect of a new fermented milk product in healthy middle-aged men. Eur J Clin Nutr 1995;49:346-52.
138. Richelsen B, Kristensen K, Pedersen SB. Long-term (6 months) effect of a new fermented milk product on the level of plasma lipoproteins—a placebo-controlled and double blind study. Eur J Clin Nutr 1996;50:811-5.
139. De Roos NM, Schouten G, Katan MB. Yoghurt enriched with Lactobacillus acidophilus does not lower blood lipids in healthy men and women with normal to borderline high serum cholesterol levels. Eur J Clin Nutr 1999;53:277-80.
140. Thompson LU, Jenkins DJ, Amer MA, et al. The effect of fermented and unfermented milks on serum cholesterol. Am J Clin Nutr 1982;36:1106-11.
141. Rossouw JE, Burger EM, Van der Vyver P, Ferreira JJ. The effect of skim milk, yoghurt, and full cream milk on human serum lipids. Am J Clin Nutr 1981;34:351-6.
142. Cox C, Mann J, Sutherland W, et al. Effects of coconut oil, butter, and safflower oil on lipids and lipoproteins in persons with moderately elevated cholesterol levels. J Lipid Res 1995;36:1787-95.
143. McKenney JM, Proctor JD, Wright JT et al. The effect of supplemental dietary fat on plasma cholesterol levels in lovastatin-treated hypercholesterolemic patients. Pharmacotherapy 1995;15:565-72.
144. Lichtenstein AH, Ausman LM, Jalbert SM, Schaefer EJ. Effects of different forms of dietary hydrogenated fats on serum lipoprotein cholesterol levels. N Engl J Med 1999;340:1933-40.
145. Willett WC, Stampfer MJ, Manson JE, et al. Intake of trans fatty acids and risk of coronary heart disease among women. Lancet 1993;341:581-5.
146. Lichtenstein AH, Ausman LM, Jalbert SM, Schaefer EJ. Effects of different forms of dietary hydrogenated fats on serum lipoprotein cholesterol levels. N Engl J Med 1999;340:1933-40.
147. Willett WC, Stampfer MJ, Manson JE, et al. Intake of trans fatty acids and risk of coronary heart disease among women. Lancet 1993;341:581-5.
148. Normén L, Dutta P, Lia Å, Andersson H. Soy sterol esters and beta-sitostanol ester as inhibitors of cholesterol absorption in human small bowel. Am J Clin Nutr 2000;71:908-13.
149. Gylling H, Miettinen TA. Cholesterol reduction by different plant stanol mixtures and with variable fat intake. Metabolism 1999;48:575-80.
150. Blair SN, Capuzzi DM, Gottlieb SO, et al. Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy. Am J Cardiol 2000;86:46-52.
151. Jones PJ, Raeini-Sarjaz M, Ntanios FY, et al. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. J Lipid Res 2000;41:697-705.
152. Hallikainen MA, Sarkkinen ES, Uusitupa MI. Plant stanol esters affect serum cholesterol concentrations of hypercholesterolemic men and women in a dose-dependent manner. J Nutr 2000;130:767-76.
153. Vuorio AF, Gylling H, Turtola H, et al. Stanol ester margarine alone and with simvastatin lowers serum cholesterol in families with familial hypercholesterolemia caused by the FH-North Karelia mutation. Arterioscler Thromb Vasc Biol 2000;20:500-6.
154. Nguyen TT, Dale LC, von Bergmann K, Croghan IT. Cholesterol-lowering effect of stanol ester in a US population of mildly hypercholesterolemic men and women: a randomized controlled trial. Mayo Clin Proc 1999;74:1198-206.
155. Moghadasian MH, Frohlich JJ. Effects of dietary phytosterols on cholesterol metabolism and atherosclerosis: clinical and experimental evidence. Am J Med 1999;107:588-94 [review].
156. Bell S, Goldman VM, Bistrian BR, et al. Effect of beta-glucan from oats and yeast on serum lipids. Crit Rev Food Sci Nutr 1999;39:189-202 [review].
157. Behall KM, Scholfield DJ, Hallfrisch J. Effect of beta-glucan level in oat fiber extracts on blood lipids in men and women. J Am Coll Nutr 1997;16:46-51.
158. Braaten JT, Wood PJ, Scott FW, et al. Oat beta-glucan reduces blood cholesterol concentration in hypercholesterolemic subjects. Eur J Clin Nutr 1994;48:465-74.
159. Davidson MH, Dugan LD, Burns JH, et al. The hypocholesterolemic effects of beta-glucan in oatmeal and oat bran. A dose-controlled study. JAMA 1991;265:1833-9.
160. Wood PJ. Physicochemical properties and physiological effects of the (1----3)(1----4)-beta-D-glucan from oats. Adv Exp Med Biol 1990;270:119-27.
161. Uusitupa MI, Miettinen TA, Sarkkinen ES, et al. Lathosterol and other non-cholesterol sterols during treatment of hypercholesterolaemia with beta-glucan-rich oat bran. Eur J Clin Nutr 1997;51:607-11.
162. Lia A, Hallmans G, Sandberg AS, et al. Oat beta-glucan increases bile acid excretion and a fiber-rich barley fraction increases cholesterol excretion in ileostomy subjects. Am J Clin Nutr 1995;62:1245-51.
163. Bell S, Goldman VM, Bistrian BR, et al. Effect of beta-glucan from oats and yeast on serum lipids. Crit Rev Food Sci Nutr 1999;39:189-202 [review].
164. Nicolosi R, Bell SJ, Bistrian BR, et al. Plasma lipid changes after supplementation with beta-glucan fiber from yeast. Am J Clin Nutr 1999;70:208-12.
165. Behall KM, Scholfield DJ, Hallfrisch J. Effect of beta-glucan level in oat fiber extracts on blood lipids in men and women. J Am Coll Nutr 1997;16:46-51.
166. Braaten JT, Wood PJ, Scott FW, et al. Oat beta-glucan reduces blood cholesterol concentration in hypercholesterolemic subjects. Eur J Clin Nutr 1994;48:465-74.
167. Uusitupa MI, Ruuskanen E, Makinen E, et al. A controlled study on the effect of beta-glucan-rich oat bran on serum lipids in hypercholesterolemic subjects: relation to apolipoprotein E phenotype. J Am Coll Nutr 1992;11:651-9.
168. Anderson RA, Cheng N, Bryden NA, Polansky MM, Cheng N, Chi J, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes1997;46:1786-91.
169. Offenbacher EG, Pi-Sunyer FX. Beneficial effect of chromium-rich yeast on glucose tolerance and blood lipids in elderly subjects. Diabetes 1980;29:919-25.
170. Press RI, Geller J, Evans GW. The effect of chromium picolinate on serum cholesterol and apolipoprotein fractions in human subjects. West J Med 1990;152:41-5.
171. Hermann J, Chung H, Arquitt A, et al. Effects of chromium or copper supplementation on plasma lipids, plasma glucose and serum insulin in adults over age fifty. J Nutr Elderly 1998;18:27-45.
172. Riales R, Albrink MJ. Effect of chromium chloride supplementation on glucose tolerance and serum lipids including high-density lipoprotein of adult men. Am J Clin Nutr 1981;34:2670-8.
173. Roeback JR Jr, Hla KM, Chambless LE, Fletcher RH. Effects of chromium supplementation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers. A randomized, controlled trial. Ann Intern Med 1991;115:917-24.
174. Uusitupa MI, Kumpulainen JT, Voutilainen E, et al. Effect of inorganic chromium supplementation on glucose tolerance, insulin response, and serum lipids in noninsulin-dependent diabetics. Am J Clin Nutr 1983;38:404-10.
175. Uusitupa MI, Mykkanen L, Siitonen O, et al. Chromium supplementation in impaired glucose tolerance of elderly: effects on blood glucose, plasma insulin, C-peptide and lipid levels. Br J Nutr 1992;68:209-16.
176. Boyd SG, Boone BE, Smith AR, et al. Combined dietary chromium picolinate supplementation and an exercise program leads to a reduction of serum cholesterol and insulin in college-aged subjects. J Nutr Biochem 1998;9:471-5.
177. Wang MM, Fox EA, Stoecker BJ, et al. Serum cholesterol of adults supplemented with brewer's yeast or chromium chloride. Nutr Res 1989;9:989-98.
178. Newman HA, Leighton RF, Lanese RR, Freedland NA. Serum chromium and angiographically determined coronary artery disease. Clin Chem 1978;541-4.
179. Sauvaire Y, Ribes G, Baccou JC, Loubatieres-Mariani MM. Implication of steroid saponins and sapogenins in the hypocholesterolemic effect of fenugreek. Lipids 1991;26:191-7.
180. Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber officinale Rosc) and fenugreek (Trigonella foenumgraceum L) on blood lipids, blood sugar, and platelet aggregation in patients with coronary artery disease. Prostagland Leukotrienes Essential Fatty Acids 1997;56:379-84.
181. Sharma RD, Raghuram TC, Rao NS. Effect of fenugreek seeds on blood glucose and serum lipids in type I diabetes. Eur J Clin Nutr 1990;44:301-6.
182. Sharma RD, Sarkar DK, Hazra B, et al. Hypolipidaemic effect of fenugreek seeds: A chronic study in non-insulin dependent diabetic patients. Phytother Res 1996;10:332-4.
183. Sharma RD, Raghuram TC, Dayasagar Rao V. Hypolipidaemic effect of fenugreek seeds. A clinical study. Phytother Res 1991;5:145-7.
184. Prasanna M. Hypolipidemic effect of fenugreek: A clinical study. Indian J Pharmacol 2000;32:34-6.
185. Sowmya P, Rajyalakshmi P. Hypocholesterolemic effect of germinated fenugreek seeds in human subjects. Plant Foods Hum Nutr 1999;53:359-65.
186. Vuksan V, Jenkins DJ, Spadafora P, et al. Konjac-mannan (glucomannan) improves glycemia and other associated risk factors for coronary heart disease in type 2 diabetes. A randomized controlled metabolic trial. Diabetes Care 1999;22:913-9.
187. Zhang MY, Huang CY, Wang X, et al. The effect of foods containing refined Konjac meal on human lipid metabolism. Biomed Environ Sci 1990;3:99-105.
188. Arvill A, Bodin L. Effect of short-term ingestion of konjac glucomannan on serum cholesterol in healthy men. Am J Clin Nutr 1995;61:585-9.
189. Walsh DE, Yaghoubian V, Behforooz A. Effect of glucomannan on obese patients: a clinical study. Int J Obes 1984;8:289-93.
190. Nissen S, Sharp RL, Panton L, et al. ß-hydroxy-ß-methylbutyrate (HMB) supplementation in humans is safe and may decrease cardiovascular risk factors. J Nutr 2000;130:1937-45.
191. Galeone F, Scalabrino A, Giuntoli F, et al. The lipid-lowering effect of pantethine in hyperlipidemic patients: a clinical investigation. Curr Ther Res 1983;34:383-90.
192. Miccoli R, Marchetti P, Sampietro T, et al. Effects of pantethine on lipids and apolipoproteins in hypercholesterolemic diabetic and non diabetic patients. Curr Ther Res 1984;36:545-9.
193. Avogaro P, Bon B, Fusello M. Effect of pantethine on lipids, lipoproteins and apolipoproteins in man. Curr Ther Res 1983;33;488-93.
194. Coronel F, Tornero F, Torrente J, et al. Treatment of hyperlipemia in diabetic patients on dialysis with a physiological substance. Am J Nephrol 1991;11:32-6.
195. Arsenio L, Bodria P, Magnati G, et al. Effectiveness of long-term treatment with pantethine in patients with dyslipidemia. Clin Ther 1986;8:537-45.
196. Prisco D, Rogasi PG, Matucci M, et al. Effect of oral treatment with pantethine on platelet and plasma phospholipids in IIa hyperlipoproteinemia. Angiology 1987;38:241-7.
197. Gaddi A, Descovich GC, Noseda G, et al. Controlled evaluation of pantethine, a natural hypolipidemic compound, in patients with different forms of hyperlipoproteinemia. Atherosclerosis 1984;50:73-83.
198. Rumberger JA, Napolitano J, Azumano I, et al. Pantethine, a derivative of vitamin B5 used as a nutritional supplement, favorably alters low-density lipoprotein cholesterol metabolism in low- to moderate-cardiovascular risk North American subjects: a triple-blinded placebo and diet-controlled investigation. Nutr Res 2011;31:608-15.
199. Evans M, Rumberger JA, Azumano I, et al. Pantethine, a derivative of vitamin B5, favorably alters total, LDL and non-HDL cholesterol in low to moderate cardiovascular risk subjects eligible for statin therapy: a triple-blinded placebo and diet-controlled investigation. Vasc Health Risk Manag 2014;10:89–100.
200. Da Col PG, et al. Pantethine in the treatment of hyper-cholesterolemia: a randomized double-blind trial versus tiadenol. Curr Ther Res 1984;36:314.
201. Olson BH, Anderson SM, Becker MP, et al. Psyllium-enriched cereals lower blood total cholesterol and LDL cholesterol, but not HDL cholesterol, in hypercholesterolemic adults: Results of a meta-analysis. J Nutr 1997;127:1973-80.
202. Anderson JW, Davidson MH, Blonde L, et al. Long-term cholesterol-lowering effects as an adjunct to diet therapy in the treatment of hypercholesterolemia. Am J Clin Nutr 2000;71:1433-8.
203. Romero AL, Romero JE, Galaviz S, Fernandez ML. Cookies enriched with psyllium or oat bran lower plasma LDL cholesterol in normal and hypercholesterolemic men from Northern Mexico. J Am Coll Nutr 1998;17:601-8.
204. Endo A. Monacolin K, a new hypocholesterolemic agent produced by a Monascus species. J Antibiot (Tokyo) 1979;32:852-4.
205. Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231-6.
206. Heber D, Lembertas A, Lu QY, et al. An analysis of nine proprietary Chinese red yeast rice dietary supplements: implications of variability in chemical profile and contents. J Altern Complement Med 2001;7:133-9.
207. Huang CF, Li TC, Lin CC, et al. Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients. Eur J Cardiovasc Prev Rehabil 2007;14:438-40.
208. Halbert SC, French B, Gordon RY, Farrar JT, Schmitz K, Morris PB, et al. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Am J Cardiol 2010;105:198-204.
209. Venero CV, Venero JV, Wortham DC, Thompson PD. Lipid-lowering efficacy of red yeast rice in a population intolerant to statins. Am J Cardiol 2010;105:664-6.
210. Jones PJ, Ntanios FY, Raeini-Sarjaz M, Vanstone CA. Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men. Am J Clin Nutr 1999;69:1144-50.
211. Blair SN, Capuzzi DM, Gottlieb SO, et al. Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy. Am J Cardiol 2000;86:46-52.
212. Jones PJ, Raeini-Sarjaz M, Ntanios FY, et al. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. J Lipid Res 2000;41:697-705.
213. Hallikainen MA, Sarkkinen ES, Uusitupa MI. Plant stanol esters affect serum cholesterol concentrations of hypercholesterolemic men and women in a dose-dependent manner. J Nutr 2000;130:767-76.
214. Vuorio AF, Gylling H, Turtola H, et al. Stanol ester margarine alone and with simvastatin lowers serum cholesterol in families with familial hypercholesterolemia caused by the FH-North Karelia mutation. Arterioscler Thromb Vasc Biol 2000;20:500-6.
215. Nguyen TT, Dale LC, von Bergmann K, Croghan IT. Cholesterol-lowering effect of stanol ester in a US population of mildly hypercholesterolemic men and women: a randomized controlled trial. Mayo Clin Proc 1999;74:1198-206.
216. Hyun YJ, Kim OY, Kang JB, et al. Plant stanol esters in low-fat yogurt reduces total and low-density lipoprotein cholesterol and low-density lipoprotein oxidation in normocholesterolemic and mildly hypercholesterolemic subjects. Nutr Res 2005;25:743-55.
217. Plat J, Brufau G, Dallinga-Thie GM, et al. A plant stanol yogurt drink alone or combined with a low-dose statin lowers serum triacylglycerol and non-HDL cholesterol in metabolic syndrome patients. J Nutr 2009;139:1143-9.
218. Law M. Plant sterol and stanol margarines and health. BMJ 2000;320:861-4.
219. Goldberg AC, Ostlund RE Jr, Bateman JH, et al. Effect of plant stanol tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs. Am J Cardiol 2006;97:376-9.
220. Carrol KK, Kurowska EM. Soy consumption and cholesterol reduction: review of animal and human studies. J Nutr 1995;125:594-7S.
221. Crouse JR 3rd, Morgan T, Terry JG, et al. A randomized trial comparing the effect of casein with that of soy protein containing varying amounts of isoflavones on plasma concentrations of lipids and lipoproteins. Arch Intern Med 1999;159:2070-6.
222. Nestel PJ, Yamashita T, Sasahara T, et al. Soy isoflavones improve systemic arterial compliance but not plasma lipids in menopausal and perimenopausal women. Arterioscler Thromb Vasc Biol 1997;17:3392-8.
223. Samman S, Lyons, Wall PM, et al. The effect of supplementation with isoflavones on plasma lipids and oxidisability of low density lipoprotein in premenopausal women. Atherosclerosis 1999;147:277-83.
224. Hoie LH, Morgenstern EC, Gruenwald J, et al. A double-blind placebo-controlled clinical trial compares the cholesterol-lowering effects of two different soy protein preparations in hypercholesterolemic subjects. Eur J Nutr 2005;44:65-71.
225. Brown WV. Niacin for lipid disorders. Postgrad Med 1995;98:185-93 [review].
226. Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177-84.
227. McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained—vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994;271:672-7.
228. Knopp RH, Ginsberg J, Albers JJ, et al. Contrasting effects of unmodified and time-release forms of niacin on lipoproteins in hyperlipidemic subjects: clues to mechanism of action of niacin. Metabolism 1985;34:642-50.
229. Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994;121:252-8.
230. Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med 1992;92:77-81 [Review].
231. Knopp RH. Niacin and hepatic failure. Ann Intern Med 1989;111:769 [letter].
232. Goldberg A, Alagona P Jr, Capuzzi DM, et al. Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia. Am J Cardiol 2000;85:1100-5.
233. Frei B. Ascorbic acid protects lipids in human plasma and low-density lipoprotein against oxidative damage. Am J Clin Nutr 1991;54:1113S-8S.
234. Simon JA. Vitamin C and cardiovascular disease: a review. J Am Coll Nutr 1992;11:107-27.
235. Gatto LM, Hallen GK, Brown AJ, Samman S. Ascorbic acid induces a favorable lipoprotein profile in women. J Am Coll Nutr 1996;15;154-8.
236. Balz F. Antioxidant Vitamins and Heart Disease. Presented at the 60th Annual Biology Colloquium, Oregon State University, February 25, 1999.
237. Fintelmann V. Antidyspeptic and lipid-lowering effect of artichoke leaf extract. Zeitschirfit fur Allgemeinmed 1996;72:1-19.
238. Bundy R, Walker AF, Middleton RW, et al. Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: a randomized, double blind placebo controlled trial. Phytomedicine 2008;15:668-75.
239. Heckers H, Dittmar K, Schmahl FW, Huth K. Inefficiency of cynarin as therapeutic regimen in familial type II hyperlipoproteinemia. Atherosclerosis 1977;26:249-53.
240. Englisch W, Beckers C, Unkauf M, et al. Efficacy of artichoke dry extract in patients with hyperlipoproteinemia. Arzneimittelforschung 2000;50:260-5.
241. Rondanelli M, Giacosa A, Opizzi A, et al. Beneficial effects of artichoke leaf extract supplementation on increasing HDL-cholesterol in subjects with primary mild hypercholesterolaemia: a double-blind, randomized, placebo-controlled trial. Int J Food Sci Nutr 2013;64:7-15.
242. Hussein G, Nakagawa T, Goto H, et al. Astaxanthin ameliorates features of metabolic syndrome in SHR/NDmcr-cp. Life Sci 2007; 80:522-9.
243. Fassett RG, Coombes JS. Astaxanthin in cardiovascular health and disease. Molecules 2012 20;17:2030-48 [review].
244. Asgary S, Naderi GH, Sarrafzadegan N, et al. Antihypertensive and antihyperlipidemic effects of Achillea wilhelmsii. Drugs Exp Clin Res 2000;26:89-93.
245. Kong W, Wei J, Abidi P, et al. Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins. Nat Med 2004;10:1344-51.
246. Kong W, Wei J, Abidi P, et al. Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins. Nat Med 2004;10:1344-51.
247. Lees AM, Mok HYI, Lee RS, et al. Plant sterols as cholesterol-lowering agents: clinical trials in patients with hypercholesterolemia and studies of sterol balance. Atherosclerosis 1977;28:325-38.
248. Chen SC, Judd JT, Kramer M, et al. Phytosterol intake and dietary fat reduction are independent and additive in their ability to reduce plasma LDL cholesterol. Lipids 2009;44:273-81.
249. Pelletier X, Belbraouet S, Mirabel D, et al. A diet moderately enriched in phytosterols lowers plasma cholesterol concentrations in normocholesterolemic humans. Ann Nutr Metab 1995;39:291-5.
250. Korpela R, Tuomilehto J, Hogstrom P, et al. Safety aspects and cholesterol-lowering efficacy of low fat dairy products containing plant sterols. Eur J Clin Nutr 2006;60:633-42.
251. Grundy SM, Ahrens EH Jr, Davignon J. The interaction of cholesterol absorption and cholesterol synthesis in man. J Lipid Res 1969;10:304-15 [review].
252. Hendriks HF, Weststrate JA, van Vliet T, Meijer GW. Spreads enriched with three different levels of vegetable oil sterols and the degree of cholesterol lowering in normocholesterolaemic and mildly hypercholesterolaemic subjects. Eur J Clin Nutr 1999;53:319-27.
253. Yacowitz H, Fleischman AI, Bierenbaum ML. Effects of oral calcium upon serum lipids in man. Br Med J 1965;1:1352-4.
254. Bell L, Halstenson CE, Halstenson CJ, et al. Cholesterol-lowering effects of calcium carbonate in patients with mild to moderate hypercholesterolemia. Arch Intern Med 1992;152:2441-4.
255. Karanja N, Morris CD, Illingworth DR, Plasma lipids and hypertension: response to calcium supplementation. Am J Clin Nutr 1987;45:60-5.
256. Denke MA, Fox MM, Schulte MC. Short-term dietary calcium fortification increases fecal saturated fat content and reduces serum lipids in men. J Nutr 1993;123:1047-53.
257. Bostick RM, Fosdick L, Grandits GA, et al. Effect of calcium supplementation on serum cholesterol and blood pressure. Arch Fam Med 2000;9:31-9.
258. Krasopoulos JC, De Bari VA, Needle MA. The adsorption of bile salts on activated carbon. Lipids 1980;15:365-70.
259. Tishler PV, Winston SH, Bell SM. Correlative studies of the hypocholesterolemic effect of a highly activated charcoal. Methods Find Exp Clin Pharmacol 1987;9:799-806.
260. Neuvonen PJ, Kuusisto P, Vapaatalo H, Manninen V. Activated charcoal in the treatment of hypercholesterolaemia: dose-response relationships and comparison with cholestyramine. Eur J Clin Pharmacol 1989;37:225-30.
261. Park GD, Spector R, Kitt TM. Superactivated charcoal versus cholestyramine for cholesterol lowering: a randomized cross-over trial. J Clin Pharmacol 1988;28:416-9.
262. Neuvonen PJ, Kuusisto P, Manninen V, et al. The mechanism of the hypocholesterolaemic effect of activated charcoal. Eur J Clin Invest 1989;19:251-4.
263. Hoekstra JB, Erkelens DW. No effect of activated charcoal on hyperlipidaemia. A double-blind prospective trial. Neth J Med 1988;33:209-16.
264. Davis GK, Mertz W. Copper. In: Mertz W, ed. Trace elements in human and animal nutrition, vol. 1. 5th ed. San Diego: Academic Press, 1987, 301-64 [review].
265. Klevay LM. Dietary copper: a powerful determinant of cholesterolemia. Med Hypotheses 1987;24:111-9 [review].
266. Hermann J, Chung H, Arquitt A, et al. Effects of chromium or copper supplementation on plasma lipids, plasma glucose and serum insulin in adults over age fifty. J Nutr Elderly 1998;18:27-45.
267. Lee IT, Chan YC, Lin CW, et al. Effect of cranberry extracts on lipid profiles in subjects with Type 2 diabetes. Diabet Med 2008;25:1473-7.
268. Warshafsky S, Kamer R, Sivak S. Effect of garlic on total serum cholesterol: A meta-analysis. Ann Int Med 1993;119(7)599-605.
269. Silagy C, Neil A. Garlic as a lipid-lowering agent—a meta-analysis. J R Coll Phys London 1994;28(1):39-45.
270. Neil HA, Silagy CA, Lancaster T, et al. Garlic powder in the treatment of moderate hyperlipidaemia: A controlled trial and a meta-analysis. J R Coll Phys 1996;30:329-34.
271. Gardner CD, Lawson LD, Block E, et al. Effect of raw garlic vs commercial garlic supplements on plasma lipid concentrations in adults with moderate hypercholesterolemia: a randomized clinical trial. Arch Intern Med 2007;167:346-53.
272. McCrindle BW, Helden E, Conner WT. Garlic extract therapy in children with hypercholesterolemia. Arch Pediatr Adolesc Med 1998;152:1089-94.
273. Isaacsohn JL, Moser M, Stein EA, et al. Garlic powder and plasma lipids and lipoproteins. Arch Intern Med 1998;158:1189-94.
274. Berthold HK, Sudhop T, von Bergmann K. Effect of a garlic oil preparation on serum lipoproteins and cholesterol metabolism. JAMA 1998;279:1900-2.
275. Superko HR, Krauss RM. Garlic powder, effect on plasma lipids, postprandial lipemia, low-density lipoprotein particle size, high-density lipoprotein subclass distribution and lipoprotein(a). J Am Coll Cardiol 2000;35:321-6.
276. Lawson L. Garlic oil for hypercholesterolemia—negative results. Quart Rev Natural Med Fall 1998;185-6.
277. Lawson LD. Garlic powder for hyperlipidemia—analysis of recent negative results. Quart Rev Natural Med Fall, 1998;187-9.
278. Berthold HK, Sudhop T, von Bergmann K. Effect of a garlic oil preparation on serum lipoproteins and cholesterol metabolism. JAMA 1998;279:1900-2.
279. Silagy C, Neil A. Garlic as a lipid-lowering agent—a meta-analysis. J R Coll Phys London 1994;28(1):39-45.
280. Silagy C, Neil A. Garlic as a lipid-lowering agent—a meta-analysis. J R Coll Phys London 1994;28(1):39-45.
281. Kono S, Shinchi K, Ikeda N, et al. Green tea consumption and serum lipid profiles: A cross-sectional study in Northern Kyushu, Japan. Prev Med 1992;21:526-31.
282. Yamaguchi Y, Hayashi M, Yamazoe H, et al. Preventive effects of green tea extract on lipid abnormalities in serum, liver and aorta of mice fed an atherogenic diet. Nip Yak Zas 1991;97:329-37.
283. Sagesaka-Mitane Y, Milwa M, Okada S. Platelet aggregation inhibitors in hot water extract of green tea. Chem Pharm Bull 1990;38:790-3.
284. Stensvold I, Tverdal A, Solvoll K, et al. Tea consumption. Relationship to cholesterol, blood pressure, and coronary and total mortality. Prev Med 1992;21:546-53.
285. Wu AH, Spicer D, Stanczyk FZ, et al. Effect of 2-month controlled green tea intervention on lipoprotein cholesterol, glucose, and hormone levels in healthy postmenopausal women. Cancer Prev Res 2012;5:393-402.
286. Zheng XX, Xu YL, Li SH, et al. Green tea intake lowers fasting serum total and LDL cholesterol in adults: a meta-analysis of 14 randomized controlled trials. Am J Clin Nutr 2011;94:601-10.
287. Tsubono Y, Tsugane S. Green tea intake in relation to serum lipid levels in middle-aged Japanese men and women. Ann Epidemiol 1997;7:280-4.
288. Agarwal RC, Singh SP, Saran RK, et al. Clinical trial of gugulipid new hypolipidemic agent of plant origin in primary hyperlipidemia. Indian J Med Res 1986;84:626-34.
289. Nityanand S, Srivastava JS, Asthana OP. Clinical trials with Gugulipid—a new hypolipidemic agent. J Assoc Phys India 1989; 37:323-8.
290. Singh RB, Niaz MA, Ghosh S. Hypolipidemic and antioxidant effects of Commiphora mukul as an adjunct to dietary therapy in patients with hypercholesterolemia. Cardiovasc Drugs Ther 1994;8:659-64.
291. Szapary PO, Wolfe ML, Bloedon LT, et al. Guggulipid for the treatment of hypercholesterolemia: an randomized controlled trial. JAMA 2003;290:765-72.
292. Head KA. Inositol hexaniacinate: a safer alternative to niacin. Alt Med Rev 1996;1:176-84 [review].
293. Murray M. Lipid-lowering drugs vs. Inositol hexaniacinate. Am J Natural Med 1995;2:9-12 [review].
294. Dorner Von G, Fisher FW. Zur Beinflussung der Serumlipide und-lipoproteine durch den Hexanicotinsaureester des m-Inositol. Arzneimittel Forschung 1961;11:110-3.
295. Bunea R, El Farrah K, Deutsch L. Evaluation of the effects of Neptune Krill Oil on the clinical course of hyperlipidemia. Altern Med Rev 2004;9:420-28.
296. Abou-Hozaifa BM, Badr El-Din NK. Royal jelly, a possible agent to reduce the nicotine-induced atherogenic lipoprotein profile. Saudi Med J 1995;16:337-42.
297. Abou-Hozaifa BM, Roston AAH, El-Nokaly FA. Effects of royal jelly and honey on serum lipids and lipoprotein cholesterol in rats fed cholesterol-enriched diet. J Biomed Sci Ther 1993;9:35-44.
298. Cho YT. Studies on royal jelly and abnormal cholesterol and triglycerides. Am Bee J 1977;117:36-9.
299. Liusov VA, Zimin IU. Experimental rational and trial of therapeutic use of bee raising product in cardiovascular diseases. Kardiologia 1983;23:105-9 [in Russian].
300. Vittek J. Effect of royal jelly on serum lipids in experimental animals and humans with atherosclerosis. Experientia 1995;51:927-35.
301. Parker RA, Pearce BC, Clark RW, et al. Tocotrienols regulate cholesterol production in mammalian cells by post-transcriptional suppression of 3-hydroxy-3-methylglutaryl-coenzyme A reductase. J Biol Chem 1993;268(15):11230-8.
302. Pearce BC, Parker RA, Deason ME, et al. Hypocholesterolemic activity of synthetic and natural tocotrienols. J Med Chem 1992;35:3595-606.
303. Qureshi AA, Bradlow BA, Brace L, et al. Response of hypercholesterolemic subjects to administration of tocotrienols. Lipids 1995;30:1171-7.
304. Qureshi AA, Qureshi N, Wright JJ, et al. Lowering serum cholesterol in hypercholesterolemic humans by tocotrienols (palmvitee). Am J Clin Nutr 1991;53:1021-6S.
305. Wahlqvist ML, Krivokuca-Bogetic A, Lo CS, et al. Differential serum response of tocopherols and tocotrienols during vitamin supplementation in hypercholesterolemic individuals without change in coronary risk factors. Nutr Res 1992;12:S181-201.
306. Mensink RP, van Houwelingen AC, Kromhout D, Hornstra G. A vitamin E concentrate rich in tocotrienols had no effect on serum lipids, lipoproteins, or platelet function in men with mildly elevated serum lipid concentrations. Am J Clin Nutr 1999;69:213-9.
307. Story JA. Alfalfa saponins and cholesterol interactions. Am J Clin Nutr 1984;39:917-29.
308. Malinow MR, Bardana EJ, Goodnight SH. Pancytopenia during ingestion of alfalfa seeds. Lancet 1981;1(8220 Pt 1):615.
309. Koide SS. Chitin-chitosan: properties, benefits and risks. Nutr Res 1998;18:1091-101 [review].
310. Maezaki Y, Tsuji K, Nakagawa Y, et al. Hypocholesterolemic effect of chitosan in adult males. Biosci Biotech Biochem 1993;57:1439-44.
311. Jing SB, Li L, Ji D, et al. Effect of chitosan on renal function in patients with chronic renal failure. J Pharm Pharmacol 1997;49:721-3.
312. Metso S, Ylitalo R, Nikkila M, et al. The effect of long-term microcrystalline chitosan therapy on plasma lipids and glucose concentrations in subjects with increased plasma total cholesterol: a randomised placebo-controlled double-blind crossover trial in healthy men and women. Eur J Clin Pharmacol 2003;59:741-6.
313. Tapola NS, Lyyra ML, Kolehmainen RM, et al. Safety aspects and cholesterol-lowering efficacy of chitosan tablets. J Am Coll Nutr 2008;27:22-30.
314. Deuchi K, Kanauchi O, Imasato Y, et al. Effect of the viscosity or deacetylation degree of chitosan on fecal fat excreted from rats fed on a high-fat diet. Biosci Biotech Biochem 1995;59:781-5.
315. Deuchi K, Kanauchi O, Imasato Y, et al. Decreasing effect of chitosan on the apparent fat digestibility by rats fed on a high-fat diet. Biosci Biotech Biochem 1994;58:1613-6.
316. Kanauchi O, Deuchi K, Imasato Y, et al. Increasing effect of a chitosan and ascorbic acid mixture on fecal dietary fat excretion. Biosci Biotech Biochem 1994;58:1617-20.
317. Deuchi K, Kanauchi O, Shizukuishi M, et al. Continuous and massive intake of chitosan affects mineral and fat-soluble vitamin status in rats fed on a high-fat diet. Biosci Biotech Biochem 1995;59:1211-6.
318. Gades MD, Stern JS. Chitosan supplementation and fecal fat excretion in men. Obes Res 2003;11:683-8.
319. Gades MD, Stern JS. Chitosan supplementation does not affect fat absorption in healthy males fed a high-fat diet, a pilot study. Int J Obes Relat Metab Disord 2002;26:119-22.
320. Izuka K, Murata K, Nakazawa K, et al. Effects of chondroitin sulfates on serum lipids and hexosamines in atherosclerotic patients: With special reference to thrombus formation time. Jpn Heart J 1968;9:453-60.
321. Nakazawa K, Murata K. Comparative study of the effects of chondroitin sulfate isomers on atherosclerotic subjects. ZFA 1979;34:153-9.
322. Morrison LM, Enrick NL. Coronary heart disease: reduction of death rate by chondroitin sulfate A. Angiology 1973;24:269-87.
323. Earnest CP, Almada AL, Mitchell TL. High-performance capillary electrophoresis-pure creatine monohydrate reduces blood lipids in men and women. Clin Sci 1996;91:113-8.
324. Volek JS, Duncan ND, Mazzetti SA, et al. No effect of heavy resistance training and creatine supplementation on blood lipids. Int J Sport Nutr Exerc Metab 2000;10:144-56.
325. Pola P, Savi L, Grilli M, et al. Carnitine in the therapy of dyslipidemic patients. Curr Ther Res 1980;27:208-16.
326. Stefanutti C, Vivenzio A, Lucani G, et al. Effect of L-carnitine on plasma lipoprotein fatty acids pattern in patients with primary hyperlipoproteinemia. Clin Ter 1998;149:115-9.
327. Maebashi M, Kawamura N, Sato M, et al. Lipid-lowering effect of carnitine in patients with type-IV hyperlipoproteinaemia. Lancet 1978;ii:805-7.
328. Rossi CS, Siliprandi N. Effect of carnitine on serum HDL-cholesterol: report of two cases. Johns Hopkins Med J 1982;150:51-4.
329. Pola P, Savi L, Grilli M, et al. Carnitine in the therapy of dyslipidemic patients. Curr Ther Res 1980;27:208-16.
330. Davini P, Bigalli A, Lamanna F, Boem A. Controlled study on L-carnitine therapeutic efficacy in post-infarction. Drugs Exp Clin Res 1992;18:355-65.
331. Childs MT, Bowlin JA, Ogilvie JT, et al. The contrasting effects of a dietary soya lecithin product and corn oil on lipoprotein lipids in normolipidemic and familial hypercholesterolemic subjects. Atherosclerosis 1981;38:217-28.
332. Knuiman JT, Beynen AC, Katan MB. Lecithin intake and serum cholesterol. Am J Clin Nutr 1989;49:266-8.
333. Wilson TA, Meservey CM, Nicolosi RJ. Soy lecithin reduces plasma lipoprotein cholesterol and early atherogenesis in hypercholesterolemic monkeys and hamsters: beyond linoleate. Atherosclerosis 1998;140:147-53.
334. Oosthuizen W, Vorster HH, Vermaak WJ, et al. Lecithin has no effect on serum lipoprotein, plasma fibrinogen and macro molecular protein complex levels in hyperlipidaemic men in a double-blind controlled study. Eur J Clin Nutr 1998;52:419-24.
335. Davis WH, Leary WP, Reyes AJ, Olhaberry JV. Monotherapy with magnesium increases abnormally low high density lipoprotein cholesterol: a clinical assay. Curr Ther Res 1984;36:341-6.
336. Nozue T, Kobayashi A, Uemasu F, et al. Magnesium status, serum HDL cholesterol, and apolipoprotein A-1 levels. J Pediatr Gastroenterol Nutr 1995;20:316-8.
337. Baxter GF, Sumeray MS, Walker JM. Infarct size and magnesium: insights into LIMIT-2 and ISIS-4 from experimental studies. Lancet 1996;348:1424-6.
338. Galloe AM, Rasmussen HS, Jorgensen LN, et al. Influence of oral magnesium supplementation on cardiac events among survivors of an acute myocardial infarction. BMJ 1993;307:585-7.
339. Kubo K, Nanba H. Anti-hyperliposis effect of maitake fruit body (Grifola frondosa). I. Biol Pharm Bull 1997;20:781-5.
340. Menendez R, Arruzazabala L, Más R, et al. Cholesterol-lowering effect of policosanol on rabbits with hypercholesterolaemia induced by a wheat starch-casein diet. Br J Nutr 1997;77:923-32.
341. Gouni-Berthold I, Berthold HK. Policosanol: clinical pharmacology and therapeutic significance of a new lipid-lowering agent. Am Heart J 2002;143:356-65 [review].
342. Gouni-Berthold I, Berthold HK. Policosanol: clinical pharmacology and therapeutic significance of a new lipid-lowering agent. Am Heart J 2002;143:356-65 [review].
343. Mirkin A, Mas R, Martinto M, et al. Efficacy and tolerability of policosanol in hypercholesterolemic postmenopausal women. Int J Clin Pharmacol Res 2001;21:31-41.
344. Castano G, Mas R, Fernandez JC, et al. Effects of policosanol in older patients with type II hypercholesterolemia and high coronary risk. J Gerontol A Biol Sci Med Sci 2001;56:M186-92.
345. Castano G, Mas R, Fernandez L et al. Effects of policosanol 20 versus 40 mg/day in the treatment of patients with type II hypercholesterolemia: A 6-month double-blind study. Int J Clin Pharmacol Res 2001;21:43-57.
346. Aneiros E, Calderon B, Más R, et al. Effect of successive dose increases of policosanol on the lipid profile and tolerability of treatment. Curr Ther Res1993;54:304-12.
347. Pons P, Rodríquez M, Más R, et al. One-year efficacy and safety of policosanol in patients with type II hypercholesterolemia. Curr Ther Res 1994;55:1084-92.
348. Castano G, Canetti M, Moreira M, et al. Efficacy and tolerability of policosanol in elderly patients with type II hypercholesterolemia: a 12-month study. Curr Ther Res 1995;56:819-28.
349. Castano G, Tula L, Canetti M, et al. Effects of policosanol in hypertensive patients with type II hypercholesterolemia. Curr Ther Res 1996;57:691-9.
350. Mas R, Castano G, Illnait J, et al. Effects of policosanol in patients with type II hypercholesterolemia and additional coronary risk factors. Clin Pharmacol Ther 1999;65:439-47.
351. Torres O, Agramonte AJ, Illnait J, et al. Treatment of hypercholesterolemia in NIDDM with policosanol. Diabetes Care 1995;18:393-7.
352. Canetti M, Moreira M, Mas R, et al. A two-year study on the efficacy and tolerability of policosanol in patients with type II hyperlipoproteinaemia. Int J Clin Pharmacol Res 1995;15:159-65.
353. Cubeddu LX, Cubeddu RJ, Heimowitz T, et al. Comparative lipid-lowering effects of policosanol and atorvastatin: a randomized, parallel, double-blind, placebo-controlled trial. Am Heart J 2006;152:982.e1-982.e5.
354. Dulin MF, Hatcher LF, Sasser HC, Barringer TA. Policosanol is ineffective in the treatment of hypercholesterolemia: a randomized controlled trial. Am J Clin Nutr 2006;84:1543-8.
355. Kassis AN, Jones PJH. Lack of cholesterol-lowering efficacy of Cuban sugar cane policosanols in hypercholesterolemic persons. Am J Clin Nutr 2006;84:1003-8.
356. Francini-Pesenti F, Beltramolli D, Dall'Acqua S, Brocadello F. Effect of sugar cane policosanol on lipid profile in primary hypercholesterolemia. Phytother Res 2008;22:318¬22.
357. Berthold HK, Unverdorben S, Degenhardt R, et al. Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia: a randomized controlled trial. JAMA 2006;295:2262-9.
358. Devaraj S, Vega-López S, Kaul N, et al. Supplementation with a pine bark extract rich in polyphenols increases plasma antioxidant capacity and alters the plasma lipoprotein profile. Lipids 2002;37:931-4.
359. Wang JL, Zhang MS, Xu ZQ, et al. Clinical observation on effects of sea buckthorn total flavones on ischemic heart diseases. Shanxi Med Res 1985;2:60-67 [in Chinese].
360. Liu BW, Wu ZF, Liu WZ, et al. Preliminary observation on the effects of seabuckthorn berry juice on hyperlipemia and coronary heart disease. Shanxi Med Res 1985;2:68-73 [in Chinese]
361. Natural Medicines Comprehensive Database citation: Zhang MS, et al. Treatment of ischemic heart diseases with flavonoids of Hippophaerhamnoides. Chinese J Cardiol 1987;15:97-9.Pubmed citation: Zhang MS. A control trial of flavonoids of Hippophaerhamnoides L. in treating ischemic heart disease. ZhonghuaXinXue Guan Bing ZaZhi 1987;15:97-9 [in Chinese].
362. Larmo PS, Yang B, Hurme SA, et al. Effect of a low dose of sea buckthorn berries on circulating concentrations of cholesterol, triacylglycerols, and flavonols in healthy adults. Eur J Nutr 2009;48:277-82.
363. Eccleston C, Baoru Y, Tahvonen R et al. Effects of an antioxidant-rich juice (sea buckthorn) on risk factors for coronary heart disease in humans. JNutrBiochem 2002;13:346-354.
364. Rayman MP, Stranges S, Griffin BA, et al. Effect of supplementation with high-selenium yeast on plasma lipids: a randomized trial. Ann Intern Med 2011;154:656-65.
365. Cloarec MJ, Perdriset GM, Lamberdiere FA, et al., Alpha-tocopherol: effect on plasma lipoproteins in hypercholesterolemic patients. Isr J Med Sci 1987;23:869-72.
366. Kesaniemi YA, Grundy SM. Lack of effect of tocopherol on plasma lipids and lipoproteins in man. Am J Clin Nutr 1982;36:224-8.
367. Kalbfleisch JH, Barboriak JJ, Else BA, et al. alpha-Tocopherol supplements and high-density-lipoprotein-cholesterol levels. Br J Nutr 1986;55:71-7.
368. Stampfer MJ, Willett W, Castelli WP, et al. Effect of vitamin E on lipids. Am J Clin Pathol 1983;79:714-6.
369. Belcher JD, Balla J, Balla G, et al. Vitamin E, LDL, and endothelium: Brief oral vitamin supplementation prevents oxidized LDL-mediated vascular injury in vitro. Arterioscler Thromb 1993;13:1779-89.
370. Traber MG. Does vitamin E decrease heart attack risk? summary and implications with respect to dietary recommendations. J Nutr 2001;131:395S-7S. [review].
371. Araghiniknam M, Chung S, Nelson-White T, et al. Antioxidant activity of dioscorea and dehydroepiandrosterone (DHEA) in older humans. Life Sci 1996;11:147-57.
Last Review: 10-23-2014
Copyright © 2014 Aisle7. All rights reserved. Aisle7.com
The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2015.