The six natural alternatives to statins to lower your cholesterol

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5 days ago

For those of us in middle age and beyond, conversations about cholesterol are hard to avoid – and with good reason. In England, according to the National Institute for Health and Care Excellence, high cholesterol leads to more than 7 per cent of all deaths and affects six in 10 adults, a number that rises for those in middle age: the most recent NHS Health Survey for England found that in the 45-64 age group, 77 per cent of women and 67 per cent of men had raised cholesterol.
Surprisingly, these figures drop in the over-64 age group. Why? Because many of this older cohort are on statins.
Statins are currently prescribed to around eight million people in the UK, and taking this daily tablet is a proven way to lower cholesterol levels and reduce your risk of heart attack or stroke.
'We are the first generation of people who have the opportunity to reduce our cardiovascular risk – still the number-one killer – because we have effective treatments in the form of statins,' says Robin Choudhury, a professor of cardiovascular medicine at the University of Oxford, a consultant cardiologist at John Radcliffe Hospital and the author of The Beating Heart: The Art and Science of Our Most Vital Organ.
The turn against statins
However, for some people with a lower cardiovascular risk, it may be possible to avoid statins by adopting lifestyle changes and/or seeking out other natural options.
This is welcome news for many, because statins are often viewed with mistrust. Some critics argue that perhaps these pills are being doled out too liberally and that lots of people shouldn't be on them at all.
Others think that statins may even be bad for us. In his 2007 book The Great Cholesterol Con, Scottish GP Malcolm Kendrick argues that high cholesterol levels don't cause heart disease, that statins have many more side effects than has been admitted and that their advocates should be asking more questions.
This is something Prof Choudhury finds mystifying. 'I really don't know why people are reluctant to take them,' he says. 'There is one serious side effect associated with statins, called rhabdomyolysis, which is a severe muscle inflammation. But it's extremely rare. It affects one to two patients per 10,000 treated.'
'A lot of people just don't want to take a tablet every day,' suggests Dr Oliver Guttmann, a consultant cardiologist at the Wellington Hospital, part of HCA Healthcare UK. 'People also want to try and do it in what they call the 'natural' way.'
The other natural options
So, are there other effective natural options to statins? The answer is yes – but only up to a point. 'The bottom line,' says Dr Guttmann, 'is that with all the natural alternatives, there's some effectiveness, but they're not magic bullets.'
He accepts, however, that other natural options can play 'a supporting role, especially for those people who are generally healthy and just want to try complementary treatments to decrease mild cholesterol elevation'.
If you have been offered statins and decide not to take them, it's crucial to discuss the risks with your GP or cardiologist.
Prof Choudhury emphasises that if you've already had a heart attack, angina or stroke, or if your percentage risk of a future event is high, taking statins is usually a sensible route that is grounded in evidence. 'For those who have heart disease, very few people have a good reason not to be on statins. For those who've never had an event, it's important to take an holistic view of risk [incorporating blood pressure, diabetes and family history] but for many individuals, alternatives to statins are perfectly reasonable.'
Here are six other cholesterol-lowering options to consider:
Plant sterols and stanols
Plant sterols and stanols, also known as phytosterols, are naturally occurring compounds that have a similar structure to cholesterol. Prof Choudhury explains: 'They help lower LDL cholesterol levels by reducing cholesterol absorption in the gut because they compete for the same absorption sites.'
Found in foods such as vegetable oils, nuts, seeds and whole grains, phytosterols have been shown to lower LDL cholesterol by eight to 10 per cent when eaten regularly as part of a healthy diet. They also work well in combination with statins.
However, according to the British Dietetic Association, you need to consume reasonably large quantities – around 2g – each day, with meals, for them to be effective. Most people achieve this by having a plant sterol- or stanol-fortified mini yogurt drink every day or by eating two to three portions of foods with at least 0.8g of added plant sterol/stanol, such as 10g of fortified spread (eg margarines) or one 250ml glass of fortified milk.
Oats and barley
Oats and barley contain beta-glucans, a soluble fibre, which can be consumed in food or as supplements to regulate blood sugar and lower cholesterol. Cholesterol can go into the blood or the gut, Prof Choudhury explains. 'If you can take that cholesterol out of the gut and stop it being reabsorbed, that has a beneficial net effect on blood cholesterol levels. Beta-glucans bind to the soluble cholesterol that's in the gut and it then exits the bowel.'
Some studies suggest that if a healthy adult consumes around 3g of beta-glucan daily – a bowl of porridge – they can decrease their LDL levels by five to 10 per cent over three months.
Omega-3s
Omega-3 fatty acids do not lower LDL cholesterol, but they have been shown to reduce triglycerides – a different type of fat found in the blood that are deemed to be harmful. Taken in supplement form, omega-3 can lower triglycerides by around 20-30 per cent.
'I tell my patients to take omega-3s all the time,' says Dr Guttmann. 'You find them in oily fish, like salmon and mackerel, though most people take them in supplement form. They work really well taken together with statins to lower your risk of heart disease. They've also been shown to support your brain health, cognitive function and mood.'
Red yeast rice
Commonly used in traditional Chinese medicine, red yeast rice is sometimes described as a natural statin. 'It blocks cholesterol production in the liver in a similar way to statins,' Dr Guttmann explains. 'The problem is, it's very difficult to get the exact amount you need because the dosages and qualities can vary from one supplement to another. People can also sometimes consume red yeast rice in very high doses, which may cause liver problems.'
Prof Choudhury is also concerned by the unregulated nature of red yeast rice capsules, which have been linked to safety issues. 'Statins originated from yeast,' he says, 'and there's a component of red yeast rice [a compound called monacolin K] which has a statin-like action that lowers LDL cholesterol. But it's not a regulated product, so you don't know what you're getting when you take it.'
Psyllium husk
Psyllium husk is a soluble fibre that helps to lower LDL cholesterol levels. When consumed, it forms a gel-like substance in the digestive tract that traps bile acids and prevents their absorption, causing them to be excreted through the stool. The liver responds by pulling in cholesterol from the blood to produce more bile acids, reducing the amount of cholesterol circulating in the blood.
'Psyllium husk is basically a digestive aid,' says Dr Guttmann. 'It's used as a laxative because it helps regulate your bowel movement, and in the process, it can lower cholesterol and decrease reabsorption. If you take it regularly, it probably reduces your LDL level by about five per cent. So it's great if you just want to be living a healthier lifestyle but inadequate as a medical intervention.'
Garlic
Some research suggests that allicin, a chemical found in garlic, can lower your blood pressure and cholesterol. One clove (3-6g) of garlic a day may help decrease your LDL by up to 10 per cent, though the evidence is not yet conclusive. 'The problem is that if you just eat fresh garlic, you need to consume a very high amount,' says Dr Guttmann. 'And that's difficult for most people to achieve. So most people take garlic supplements in quite a high dose. I advise people to try this for a while and then re-monitor their LDL to see how they react to it. But it's certainly not a replacement for statins.'
And one to be sceptical about…
Apple cider vinegar
'The one product often mentioned as an alternative to statins that doesn't really have any significant evidence to back it up is apple cider vinegar,' says Dr Guttmann. 'While it might help to decrease your sugar levels, it does not appear to affect your LDL significantly.'
Prof Choudhury concurs: 'I'm not aware of any convincing evidence to suggest that this is effective.'
Lifestyle changes to lower your cholesterol
'Our cholesterol level is, to a large extent, genetic,' says Prof Choudhury. 'With lifestyle modifications, you can make some impact on it, though usually not more than 10-15 per cent. For people who don't have very high cholesterol, but have other risk factors, it's a sensible thing to do.'
There are five main ways to reduce your cholesterol level without taking statins:
Eat a healthy, balanced diet that's high in fibre
Exercise regularly
Maintain a healthy weight
Limit the amount of alcohol you drink
Stop smoking
For Dr Guttmann, increasing our consumption of dietary fibre is perhaps the quickest and easiest lifestyle change to make. 'Eating a high-fibre diet not only improves your gut health, it also decreases your cholesterol absorption. It binds to the cholesterol in your gut and prevents it being absorbed by the body, which lowers your levels of harmful LDL cholesterol.'
He adds: 'My patients often ask me, 'If I do all of these things, surely it's the same as taking a statin?' But the truth is, because they're all working in a similar way, the benefits are not cumulative.'
He does concede, however, that it very much depends on the individual. 'I've had some patients surprise me,' he nods. 'By changing their diet and lifestyle and by incorporating some of the interventions in the list above, people can achieve dramatic improvements. But, overall, statins are still the gold standard.'
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