Naturally Lowering Cholesterol — Niacin + The Super 5 Supplements
(#3 is Surprising)
Statin Drugs for Cholesterol: A One-Trick Pony?
Statin drugs treat dyslipidemia, or abnormally high cholesterol or blood fats (lipids). Using them as the one and only cholesterol solution continues giving cause for concern. Because of intolerable side effects, 20% of all statin users discontinue their use.
Causing central nervous and digestive system issues, we also link statin drugs with kidney and liver damage, muscle breakdown, and pain and weakness (myalgia). Raising risks of diabetes by 9 to 13%, statin drugs increase these risks in postmenopausal women, by as much as 48%.
As some might claim we overstate these concerns, we question whether 40 million Americans should take a drug with these types of risks. Further concerning, is the uncertain risks of dementia with their use. With studies showing no cardiovascular benefit without a prior cardiovascular event, we further question the rationality of prescribing these drugs, especially with healthy alternatives.
The suppression of cardio-protective COQ10 levels, lack of HDL cholesterol benefits, along with the dangers of needing high dosages to lower triglycerides, offer further concern. After 20 years of research, many doubt whether statin drugs are the safe cure-all pharmaceutical companies want us to believe.
While some suggest using red rice yeast as an alternative, it carries the same statin worries, due to the same active compound, monacolin K. Is there a safer, smarter, better alternative to statin drugs, and does science offer us safe and effective non-toxic compounds?
More researchers are focusing on inflammation as the cause of virtually all disease while shifting to other targets such as LDL oxidation and lipid peroxidation. A more effective goal can be the intake of dietary fiber, garlic, lecithin, and omega-3’s, possessing strong relationships with lower cardiovascular disease and adverse events. This leads us to wider acceptance of the role of diet and lifestyle, such as the Mediterranean Diet with its evidence of 25% disease reduction.
The Big Six
#1 Niacin (500 mg to 3,000 per day in 3 divided doses)
We find niacin, vitamin B3, in an array of foods. Essential for brain, gut, heart, and skin function, niacin can correct skin and cholesterol issues.
Because of consistent lipid-lowering studies, prescription FDA-approved niacin products exist for elevated cholesterol levels. Niaspan, a patented form of extended-release niacin, carries a strong relationship with liver toxicity and even liver failure in rare cases. Invariably, we see rare liver toxicity cases with instant-release niacin use up to 1,00 mg.
Instant release niacin causes a flushing sensation which many seem to prefer, while others do not. To lower the flush effect some dose in smaller amounts many times a day, or use of “no-flush niacin”, niacinamide or sustained-release niacin, none of which is optimal.
While inositol shows a modest lipid-lowering benefit, niacinamide shows no effects. Slowly increasing niacin doses and/or taking niacin with food are effective as flush reducing strategies.
Long term adverse effects with niacin are safe depending on the dosage. We see a homocysteine increase with doses in excess of 1,000 mg, with the risk of type 2 diabetes, gastritis, and uric acid in dosages greater than 3 grams.
Healthy postmenopausal women taking doses above 1,000 mg per day showed increased risks of insulin resistance and type 2 diabetes. With studies of men taking more than 2,000 mg, conflicting studies show an elevation in insulin resistance with initial spikes self-correcting over-time.
Daily dosages of 250 mg or less of niacin do not deliver clinical effects, whereas we see strong effects with three divided doses of 500 to 1,800 mg. Despite notable blood lipid improvement, niacin displays mixed evidence of heart disease or mortality improvement.
In comparing statin drugs versus niacin, statins outperform niacin on LDL, while niacin significantly outperforms statins on HDL and triglycerides. Overall, head-to-head comparisons show niacin to be superior with substantially lower doses and negative effects. With results showing in as little as two weeks, niacin has the strongest and most reliable clinical evidence of any cholesterol supplement or medication.
#2 Omega-3’s (1 to 4 grams per day in divided doses (Most especially Krill Oil or Vegan Algae Oil)
Omega-3 fats are polyunsaturated fatty acids (PUFA’s), containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). We consider these “healthy fats”, because of notable anti-inflammatory effects. With insufficient omega-3 in our diets, we believe there is an association with deficiency and cancer, dementia, heart disease, and other chronic conditions.
The two forms of omega-3’s are fish-oil based triglycerides and phospholipid omega-3’s, found in algae and krill oil. Even though some suggest our bodies can produce omega-3’s from an essential fatty acid, ALA in chia, flax, and hemp oil, the DHA and EPA conversion is inefficient with less than .5 and 5%.
Both omega-3 and omega-6’s are critical cell membrane components. They produce cellular energy while acting as precursors to active fat regulators. In influencing the creation of healthier blood vessels, lowering lipids, and reducing the risk of chronic conditions, the ideal omega-3 to omega-6 ratio is 1:1–1:3.
Traditionally, we view omega-3 benefits for blood clotting, decreasing the risk of heart failure and stroke strokes, decreasing triglycerides, heartbeat, and modestly lowering blood pressure. Fish oil, a conventional omega-3 supplement staple, reduces inflammation while protecting the brain, heart, and other organs and systems of the body.
While both forms of omega-3’s lower triglycerides to a remarkable level, recent studies show phospholipid omega-3’s in Neptune Krill Oil, substantially lowering total cholesterol, HDL, and LDL. This is a notable finding, because fish oils, comparatively only show modest effects.
As these studies are recent with more ongoing, we might attribute the difference in benefits to the phospholipid form of krill oil along with modest levels of astaxanthin. This potent antioxidant lowers LDL oxidation and lipid peroxidation. Other studies note, algae oil might be more beneficial than krill oil, whereas others show the opposite.
Beneficial to those in the high-risk category, newer fish oil studies are questioning the cardioprotective benefits of fish oil for healthy individuals, while confirming the overall decreasing risk of cardiac death. With krill oil offering greater bioavailability, some initial trials show krill oil to be 40% more effective than fish oil, whereas others show as much as 2 to 3 times more effectiveness, especially with cardiovascular studies.
#3 Pantethine (300 mg 2 to 3 times per day)
As the analog or derivative of vitamin B5, pantothenic acid, pantethine is a cholesterol superstar supplement. This fat-soluble compound creates coenzyme A, (CoA), an essential cofactor in carbohydrate, lipid, and protein metabolism.
Effecting efficient cholesterol and fat storage in the liver, pantethine can influence healthier body fat distribution. In moving fats and energy-creating mitochondria within the cells, the conversion of fats to energy is not possible without CoA.
Growing evidence shows pantethine significantly lowers LDL, triglycerides, total cholesterol, and lipid peroxidation while raising HDL. This is remarkable considering pantethine improves all lipid targets while lowering cardiovascular disease and risk of death, with no toxicity nor side effects.
The best evidence supports its use for diabetics, triglycerides, and lipid peroxidation. Besides cholesterol applications, pantethine is clinically effective for the prevention of inflammation, inhibition of platelets, immune system, cystinosis, gastrointestinal diseases, athletic performance, and even rheumatoid arthritis.
#4 Dietary Fiber (25 to 38 grams total women/ men, including 10 grams viscous/ soluble fiber)
Scientists believe a contributing disease factor is 95% of individuals only receiving 50% of their daily needed 25 to 38 grams of dietary fiber. High-fiber diets produce a meaningful reduction in cardiovascular-related mortality and heart disease.
Benefits increase with soluble fiber and more so with a certain soluble or fermentable fiber, “viscous” fiber. Viscous fiber decreases LDL and total cholesterol levels while improving glycemic control. When viscous fiber dissolves in water, it forms a thick gel, increasing its “thickness”, sitting in the gastrointestinal system.
Viscous fiber contains polysaccharides, which are complex carbohydrates such as cellulose, glycogen, or starch. These molecules comprise sugars bonds, which we see in beta-glucans, gums, pectins, and psyllium as common examples.
We also find viscous types of soluble fiber reducing food intake and weight. Viscous fiber includes algae, apples, apricots, asparagus, barley, beans, berries, beta-glucans, bran, Brussels sprouts, cereal, chia, citrus, dates, flax, grapefruits, guar gum, legumes, lemons, limes, mangoes, maitake mushrooms, nuts, oats, oat bran, oranges, pectins, psyllium, reishi mushrooms, seaweed, seeds, shiitake mushrooms, sweet potatoes, turnips, and whole grains.
Decreasing cholesterol and influencing blood glucose and insulin response, dietary fiber consistently performs in studies. Even though studies reveal fiber decreases only LDL and total cholesterol by approximately 5–15%, high-fiber diets carry a strong association with lowering cardiovascular disease.
Dietary fiber performs best for weight loss, metabolic disease, total cholesterol, and LDL. With the improvement of gastrointestinal health, dietary fiber is deserving of its place as a top cardiovascular supplement.
#5 Aged Garlic Extract (450 to 600 mg/ 2x/ day or 4 cloves raw garlic)
As a popular root vegetable with an array of medicinal uses, garlic (Allium sativum), is both an ancient food and medicine. Offering us anti-aging actions, garlic possesses notable cardiovascular actions by lowering cardiovascular disease and therefore the risk of death.
Garlic comes in a variety of forms including raw, aged, oil-based, and fully cooked. Cooking garlic prevents its active compound, allicin, from producing its sulfur-containing metabolites, while garlic oil supplements can create high levels of toxicity.
Aged-garlic extracts are effective alternatives to those objecting to consuming raw garlic. Both aged garlic extracts and raw garlic reliably improve total cholesterol, HDL, and LDL, along with mild triglyceride improvement.
Garlic relaxes the blood vessels, providing several health benefits through the hydrogen sulfide from its medicinally active compound, allicin. It uses this same hydrogen sulfide signaling system to influence its anti-cancer and other medicinal actions.
A recent study shows the effects of garlic on reducing central and peripheral blood pressure while improving arterial stiffness, inflammation, and other cardiovascular markers. Besides arteriosclerosis, blood thinning, and diabetes benefits, garlic offers a variety of anti-cancer properties, with 10 grams or 2 cloves per day showing a significant reduction in the risk of multiple types of cancer.
Other garlic benefits include cognition, common cold, detox, fat loss, immune, physical and sexual vitality, yeast infections, and resistance to infection. Trials are underway, testing garlic with dementia and Alzheimer’s.
#6 Lecithin (500 mg to 12 grams/ day)
Lecithin is a naturally occurring essential fat in foods such as beef liver, cauliflower, eggs, oranges, peanuts, and steak. Taken as a medicine and used in the manufacture of medicines, lecithin is used for degenerative diseases such as dementia and Alzheimer’s.
Typically derived from egg yolks, soybeans, and sunflower commercial lecithin products are available in soft gels, powder, and more easily mixable liquid forms. Lecithin is an essential component in the cells of our body.
We find lecithin naturally in all cells with its compound phosphatidylcholine, often interchangeable with lecithin. The primary fat in lecithin, phosphatidylcholine, is a choline-containing a class of phospholipids, the building blocks of all cell membranes.
Choline, a methyl donor, is a critical nutrient in 4 important activities — cell membrane structure and signaling, creating the neurotransmitter acetylcholine, DNA methylation, and blood fats transport. While choline acts as a bile salt in fat digestion, lecithin can burn fat, suppress appetite, and trigger weight loss.
Multiple but small studies show lecithin decreases cholesterol in both healthy and high cholesterol individuals. One smaller study shows lecithin has no effect on LDL or total cholesterol levels.
The lack of results in a single study does not entirely negate the results in several others. The wide range of studied dosages also needs further investigation.
We can confirm choline deficiency carries a strong correlation with blood fats and homocysteine increases. Also worth mentioning, while most users prefer sunflower over soy lecithin, one study specifically reports soy lecithin and not egg lecithin offers cholesterol benefits.
One common lecithin objection is the view lecithin or choline increases trimethylamine N-oxide (TMAO), a toxic molecule from choline, betaine, and carnitine. This gut microbial metabolism chemical byproduct, carries a powerful connection with increasing the risk of cancer, heart attack, and stroke.
TMAO is likely a matter of diet, with its production depending on individual gut microbiomes. Research finds meat-eaters make more TMAO, with the distinction of red meat tripling TMAO levels.
Vegans produce very little TMAO, as high-fiber diets increase friendly bacteria, while decreasing bad bacteria. As our body already produces choline-containing lecithin into the brain, we can better understand evolution would not work towards the manufacture of such a harmful chemical.
As lecithin increases acetylcholine, it might also be useful for mood, sleep, and cognition. Lecithin is also in use for the treatment and/or prevention of skin, digestion, neurologic disorders, and liver conditions, such as non-alcoholic fatty liver disease.
Low-Density Lipoprotein (LDL)
As one of five primary lipoprotein groups, low-density lipoprotein, (LDL) transports fat molecules amongst the body. In delivering fat molecules to cells, LDL is one of the primary testing numbers in blood lipid panels. Doctors view LDL numbers under 100 as ideal, with numbers above 130 and 190, as borderline-high to high.
Traditionally, the LDL number was evaluated and used as a basis for determining cholesterol numbers. The “oxidative hypothesis” tells us, the LDL number is less critical than that of LDL oxidation which leads to arteriosclerosis, the leading cause of death.
- Lecithin (42.95% to 56.15% decrease)
2) Omega-3’s (Krill only) (32% to 39% decrease)
3) Pantethine (30% decrease)
4) Niacin (10% to 20% decrease)
5) Fiber (7% to 16% decrease)
6) Aged Garlic Extract (5% to 15% decrease)
Others: Berberine, cocoa, green tea, pycnogenol, resveratrol, spirulina.
Triglyceride to HDL Ratio:
(Your Game-Changing Number)
LDL and total cholesterol numbers tell us little about our cardiovascular health.
LDL Particle A:
Large, porous, non-harmful LDL particles.
LDL Particle B:
Small, dense particles which can oxidize and attach to arterial walls.
Guess which one of these can predict cardiovascular risk?
Comprising cholesterol, phospholipids, proteins, and triglycerides, LDL can exist in the form of two different LDL phenotype or particle types.
Circulating through the blood, LDL particle composition because of changes with the variety of these molecules enter and exiting. This results in LDL particles ranging from large and fluffy to small and dense.
And naturally, most will realize they’ve never seen LDL particle size on a blood lab. This is because labs report only the basic LDL number for limiting the testing costs.
So, if we do not test LDL particle size, how can we know what size particles we have?
Researchers discovered three decades ago, triglyceride to HDL ratios offer us indirect but fairly accurate LDL-cholesterol particle size estimates.
In analyzing Trig/HDL ratios, those over 3.8 show the highest levels of arteriosclerosis and cardiovascular disease.
These examples with the same LDL number show two very different risk factors:
1) LDL: 180 mg/dL
Trilycerides: 120 mg/dL
HDL: 60 mg/dL.
Trig:HDL Ratio: 100/ 50 = 2.0
2) LDL: 180 mg/dL
Triglyceride: 350 mg/dL
HDL: 50 mg/dL
Trig: HDL Ratio: 350/50 = 7.0
The second blood lab much greater than 3.8 is the one at substantially higher disease and mortality risk.
With studies long showing LDL particle size disease risks, Trig/HDL ratios offer reliable predictors in providing indirect insulin resistance measures.
Trig/HD ratios potentially predict disease and mortality superior to metabolic syndromes.
High-Density Lipoprotein (HDL)
As a protective cholesterol, high-density lipoprotein, (HDL) transports “bad” cholesterol from arteries to the liver, to be broken down and eliminated.
We see an increase in the risk of cardiovascular artery disease, (CAD), with HDL levels less than 40 mg/DL, even in those with normal LDL and total cholesterol levels.
HDL levels of 40 to 60 mg/DL are “normal,” with no positive or negative CAD implications. HDL levels over 60 mg/DL carry a believed CAD risk reduction.
- Omega-3’s (Krill only) (42% to 60% increase)
2) Niacin (15% to 35% increase)
3) Lecithin (14% to 16% increase)
4) Pantethine (10% increase)
Others: Berberine, curcumin, fiber, aged garlic extract, inositol, olive leaf extract, omega-3, spirulina.
Total Cholesterol
Total cholesterol is the sum of cholesterol in the blood. This number is the total amount of LDL and HDL.
Total cholesterol above 200 is borderline high, with a reading over 240 considered high.
1) Niacin (30% decrease)
2) Pantethine (30% decrease)
3) Lecithin (18% to 42% decrease)
4) Omega-3 (Krill only)(13% to 18% decrease)
5) Aged Garlic Extract (8% to 12% decrease)
6) Fiber (7% to 16% decrease)
Others: Ashwagandha, berberine, green tea, inositol, omega-3’s (Krill or Algae only), royal jelly, spirulina.
Triglycerides
The most common type of fat in the body is triglycerides. While not cholesterol, it is a common blood panel measurement, as we believe increasing triglyceride levels increase atherosclerosis risk.
We consider slightly high triglycerides levels in the 150–200 mg/DL range, with high levels being over 200 mg/dl. With an increase in the risk of atherosclerosis, coronary artery disease, and stroke at this level, extremely high triglyceride levels exceeding 500mg/DL can lead to pancreatitis.
- Omega-3’s (20% to 48% decrease)
2) Lecithin (23% to 36% decrease)
3) Niacin (20% to 33% decrease)
4) Pantethine (30% decrease)
5) Fiber (7% to 16% decrease)
Others: Ashwagandha, berberine, black seed oil, curcumin, aged garlic extract, green tea, hibiscus, inositol, spirulina.
LDL Oxidation
Researchers believe the oxidation of LDL is the greatest cholesterol risk factor. We believe this occurs when LDL particles react with free radicals or unstable disease molecules. While olive leaf extract performs the best in studies, we believe simple olive oil will perform similarly on LDL oxidation.
Oxidation is the chemical destabilization of molecules such as LDL cholesterol.
Mistaking oxidized cholesterol for bacteria, your immune system will attempt to fight it off. This can lead to arterial wall inflammation and eventually arteriosclerosis and/or heart disease.
Oxidized LDL, (Ox-LDL), is an additional test by request done after an elevated lipid exam.
- Olive Leaf Extract (25% decrease)
2) Ginkgo Biloba (11% — 22% decrease)
3) Licorice Extract (20% decrease)
4) Astaxanthin (10% decrease)
Others: Blueberry, aged garlic extract, green tea, hesperidin, Panax ginseng, saffron.
Lipid Peroxidation
Lipid peroxidation is the oxidative degradation of lipids. This happens because of free radicals “stealing” electrons from lipids in cell membranes, causing cellular damage.
Peroxidation occurs as free radicals or oxidants attack lipids containing carbon-carbon double bonds, such as polyunsaturated fatty acids (PUFAs).
#1) Pantethine
#2) Astaxanthin
#3) CoQ10
Others: Alpha-lipoic acid, cocoa, creatine, curcumin, L-carnitine, licorice extract, aged garlic extract, olive leaf extract, spirulina, vitamin C.
Final Thoughts
From amongst this list, omega-3’s and dietary fibers are core staple essentials. We conclude the superiority of krill oil, as a phospholipid omega-3 over triglyceride fish oil omega-3s for cardiovascular support.
Taking 4 grams of krill oil provides sufficient astaxanthin protecting against LDL oxidation and lipid peroxidation. Consider using authentic olive oil with meals, providing the strongest LDL oxidation defense.
While instant-release niacin remains a popular option, it should be taken with ongoing liver, kidney, and glucose testing. Extended-release niacin is not safe for this use.
Niacin dosing should be lowered to the lowest effective dosage, as remains effective even at lower dosages. It acts as the fastest option, for those needing to rapidly improve blood fat levels. An alternative strategy could be combining lower dose niacin with higher dose inositol if side effects persist.
Pantethine could be a solid alternative for those not able to use and/or tolerate niacin. Lecithin might be worth serious consideration, with its essential nutrient, choline, and phosphatidylcholine.
Aged garlic extract, while offering modest but consistent lipid effects, offers considerable blood pressure benefits along with lowering cardiovascular disease and adverse events.
What is your favorite supplement?
Your Friend in Health
Mark Stein
