Are supplements effective?
Can supplements help to support the health of heart and arteries by lowering cholesterol? According to medical professionals, only a few can, and even those that are helpful may only work in special cases such as when a person's homocysteine level is too high.
Article Contents
Solid scientific data on efficacy is only available for three supplements: fish oil, plant sterols and the combination of Vitamin B6/B12/folate against a certain risk factor for heart disease.
Fish Oil (Omega-3 Fatty Acids)
Did you know that fish oil or the "long chain omega-3 fatty acids" in fish oil such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) can actually lower triglyceride levels and blood pressure, but only in doses of approximately 4 grams. Some researchers provide a range of 2-5 grams of omega-3 fatty acids a day. That is quite a lot, especially if you consider that most fish oil concentrates consist of 50% and most natural fish oils only 30% or less of omega-3 fatty acids, the rest consisting of plain fat. This doubles or even triples the amount patients must consumed (4-15 grams/day). This may involve swallowing as many as 10 or more softgels every day. Most people would not consider this pleasant, especially given the tendency of the capsules to cause "fish burps." Although consumers like the idea of "one pill a day", lowering triglycerides and blood pressure using only fish oil is clearly insufficient.
However, even at low doses of 0.5 to 1 gram per day, fish oil has some positive effects on cardiovascular health. These include a reduced risk of thrombosis because of blood-thinning properties, anti-inflammatory effects and greater blood vessel flexibility which facilitates the circulation of blood.
Other than the aforementioned fishy aftertaste, only mild gastrointestinal discomfort has been noted as a side effect of taking fish oil. Prolonged bleeding is theoretically possible because of the blood-thinning properties which are similar to aspirin. However, even with large doses of fish oil, the possibility of bleedings appears to be clinically irrelevant.
Overall, omega-3 fatty acids from fish (but not necessarily from plant sources since they consist mainly of "short chain" omega-3 fatty acids) can be as effective in lowering triglycerides as drugs such as fibrates or niacin. The Food and Drug Administration (FDA) has tentatively accknowledged that this may indeed lower the overall risk of heart disease by issuing a qualified health claim: "Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease."
Phytosterols (Plant Sterols)
Plant sterols or "phytosterols" are another example of effective supplements because they lower LDL cholesterol. Two grams, the daily amount recommended by the Food and Drug Administration (FDA), should lower your LDL cholesterol by 10 to 15%. In comparison, statins, which are found in most cholesterol lowering drugs, can lower LDL cholesterol by approximately 30% and modern ones by as much as 50%. Phytosterols compare fairly well to the new prescription drug ezetimibe, as well as the older bile acid sequestrants or "resins" which lower LDL cholesterol by approximately 20%.
Phytosterols have a solubilization problem, meaning they don't dissolve in water or fat. That is why they are "esterified" or chemically coupled to fatty acids, to make them more fat soluble. Even then, they are often "dissolved" in a fairly large amount of fat. For instance, to obtain your daily 2 grams of phytosterols, you may need to consume at least 20 grams or more of fortified spread. In order to lower your cholesterol by 10 to 15%, you must a large amount of less desirable saturated fatty acids which are counterproductive to lowering cholesterol. However, the market currently offers several low-fat products such as yogurt and milk-based drinks that include phytosterol esters.
A word of warning on supplements with phytosterols that are not esterified: most of these are so insoluable they don't even dissolve in the acidic stomach or the basic intestines. Consequently, most phytosterols are excreted without having any effect. That is why a very large amount of unesterified phytosterols (up to 25-50 grams a day) had to be used when they were first introduced as drugs to lower cholesterol in the 1950s under Eli Lilly's tradename "Cytellin." Phytosterols are no longer marketed as drugs for cholesterol reduction. Certain supplement manufacturers claim to have solved the "solubility problem" with their unesterified phytosterols by grinding them down to very fine or nano-sized powder. However, this technique has not been proven to improve the effectiveness of lowering cholesterol. Therefore, if you decide to take phytosterols, make sure they are esterified.
Phytosterols are considered safe since they are not absorbed into the bloodstream, but act in the digestive tract until excreted. The side effects of phytosterolesters only involve gastrointestinal discomfort which is rare.
Vitamins Against Homocysteine
Have you heard of homocysteine? It's a waste product of metabolism that is believed to promote atherosclerosis if present in elevated amounts in our blood. Therefore, many but not all experts consider it yet another risk factor for heart disease. The body contains an intrinsic mechanism to detoxify homocysteine, a process that requires sufficient amounts of Vitamins B6, B12 and folate. Thus, taking these vitamins on a regular basis will allegedly keep your homocysteine low, which in turn keeps your heart healthy.
This reasoning is correct if homocysteine truly is a significant contributor to atherosclerosis (which has yet to be conclusively proven) and if you are lacking Vitamins B6, B12 and folate. If you want to ensure you are taking enough vitamins, a cheap alternative to purchasing a special B6/B12/folate supplement is to take any standard multi-vitamin, multi-mineral product that doses its ingredients according to the FDA's recommendations.
Other Supplements
The following supplements have not been scientifically proven to be beneficial in lowering cholesterol or benefitting heart health:
- Antioxidants (Vitamin C, E, beta-carotin, resveratrol of grape skins and seed extract, minerals such as selenium & polyphenols such as green tea
- Fiber (oats & psyllium husks such as Metamucil
- Garlic
- Polycosanol
We will review these supplements in greater detail in a forthcoming article.
References
- Engler MM, Engler MB.
Omega-3 fatty acids: role in cardiovascular health and disease.
J Cardiovasc Nurs. 2006 Jan-Feb;21(1):17-24, quiz 25-6. Review. - Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R; Stresa Workshop Participants.
Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels.
Mayo Clin Proc. 2003 Aug;78(8):965-78. Review. - Moreau RA, Whitaker BD, Hicks KB.
Phytosterols, phytostanols, and their conjugates in foods: structural diversity, quantitative analysis, and health-promoting uses.
Prog Lipid Res. 2002 Nov;41(6):457-500. Review. - Oh RC, Lanier JB.
Management of hypertriglyceridemia.
Am Fam Physician. 2007 May 1;75(9):1365-71. Review. - Simons LA, Sullivan DR.
Lipid-modifying drugs.
Med J Aust. 2005 Mar 21;182(6):286-9. Review. - Wierzbicki AS.
Homocysteine and cardiovascular disease: a review of the evidence.
Diab Vasc Dis Res. 2007 Jun;4(2):143-50. Review.
| < Prev |
|---|
