Cholesterol: Not Really a Bad Guy - Part 2 |
By Dr. Tom Wnorowski
First published at www.MohrResults.com, August 2007
In the last article, I told you that I would discuss a couple of alternatives to the statin drugs that are most often prescribed for hypercholesterolemia. I’ll get to that in a minute, but first I feel compelled to let you in on some recent reports from the other side of the “lake”. Uh, that would be Europe.
The law of unintended consequences raised its ugly head when statins are either switched or discontinued. In a British report, it was noted that either situation has the possibility of raising lipids to dangerous levels, and of increasing thrombotic events as much as three-fold. Those persons with acute coronary syndromes are most at risk for this kind of rebound. Careful weaning from statins is warranted.
Lancet, the highly-respected British medical journal, and Circulation, an American journal, add that statins are likely to do more than merely lower cholesterol levels. They affect LDL oxidation, platelet activation, and leukocyte adhesion as well. Whether or not these mechanisms were implicated in coronary exacerbations is difficult to determine. The take home message is that statin therapy is not to be manipulated unnecessarily, and that one’s physician should monitor lipid levels more closely after any changes are made. Yes, more data are needed.
If you would like to learn more about this topic, look to a British medical abstract reporting agency named Bandolier. Subscription is costly, but you should be able to get some direction.
On the complementary side, there is some evidence that an herbal called guggul has anti-hypercholesterolemia properties. The best double-blind, placebo-controlled study was cited in a 1994 issue of Cardiovascular Drugs Therapy, wherein thirty patients were treated with 100 mg of guggulsterones daily. After twenty-four weeks of treatment this group experienced an 11.7% decrease in total cholesterol, a 12.7% decrease in LDL, a 12% decrease in triglycerides, and an 11.1% drop in the total cholesterol/HDL ratio, which, by the way, is a better indicator of cardiovascular health than total cholesterol alone. That ratio is most desirable when it is 4.5-5.0. A separate independent study, reported in the Indian Journal of Medical Research, found similar results. Other than occasional mild gastrointestinal distress, there are no significant side effects to guggul, and there are no reports of adverse drug interactions.
A favorite complementary approach to managing cholesterol is policosanol, a sugar cane derivative. Comparative trials have found this aliphatic primary alcohol to be substantially as effective as statin drugs. It also may be effective for intermittent claudication, presumably because of its antiplatelet effects. Several issues of Current Therapeutic Research over a five-year period have reported that policosanol, combined with a diet that limits dietary cholesterol to 300 mg a day, improved LDL levels by 25.6%, total cholesterol by 17.4%, HDLs by 28.4%, and triglycerides by 5.2%. These were statistically significant findings.
The exact mechanism by which policosanol works is uncertain, but evidence suggests that it may impair cholesterol synthesis in its various stages. In doses from 5 to 10 mg a day, starting with the lower, results can be seen in as little as two months. This may seem like a long time. Compared to synthetic drugs, it is. We must remember that
natural alternatives, containing all the ingredients that nature gave them, work more gently and more slowly because their most active components are not isolated.
The only cautions with this herbal are for persons with impaired coagulation homeostasis. In rare instances insomnia may occur. For this reason policosanol is best taken early in the day. It should not be paired with any antiplatelet or anticoagulant agent, such as warfarin.
I’ll save red yeast rice for another time.
More and more, research dollars find their way into complementary and alternative medicine. This is by no means a license to forgo allopathic medicine. In all cases, do not self-medicate or self-diagnose. Never try to address a condition without the knowledge of your physician. The information here is for education only, and is not intended to treat any disease.
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