Sometimes, our bodies just need a little help.
Several nutritional supplements claim to lower cholesterol naturally. Can any of them replace cholesterol-lowering medications? Also: What’s the difference between cultured and fermented foods?
Nutrition Diva is hosted by Monica Reinagel. A transcript is available at Simplecast.
Have a nutrition question? Send an email to nutrition@quickanddirtytips.com or leave a voicemail at 443-961-6206.
Find Nutrition Diva on Facebook and Twitter, or subscribe to the newsletter for more diet and nutrition tips.
Nutrition Diva is a part of Quick and Dirty Tips.
Links:
https://www.quickanddirtytips.com/
https://www.quickanddirtytips.com/nutrition-diva-newsletter
https://www.facebook.com/QDTNutrition/
https://twitter.com/NutritionDiva
https://nutritionovereasy.com/
Hello and welcome to the Nutrition Diva podcast. This is Monica Reinagel and this week we’re taking a look at a handful of non-prescription supplements that claim to reduce cholesterol. Are any of these effective enough to replace prescription medications? Can they be used in combination?
But before we dig into that, Nutrition Diva listener Ramsey asked me to clarify the difference between fermented and cultured foods. But what exactly is the difference between them? Do they have the same benefits?
Easier said than done, Ramsey!
Cultured and fermented foods is a very broad category, encompassing everything from yogurt to kimchi to beer, wine, and cheese. Cultured foods are a subcategory of fermented foods in which a “culture” of bacteria and/or yeast is used to jump-start the fermentation process—and to provide a bit more control over which microbes are dominant.
Yogurt, kefir, kombucha, and vinegar are all examples of fermented foods that are made by adding microbial cultures to fresh foods.
Another option is wild fermentation, which relies on microbes that are naturally present in or on the foods themselves, or even in the air. Sourdough, traditional sauerkraut, kimchi, and pickled vegetables are examples of wild fermentation. If you’ve ever had fruit salad or coleslaw get fizzy in the fridge, you’ve experienced some wild fermentation!
Cheese is an especially confusing category—some cheeses (like blue cheese and cheddar) are cultured with various strains of bacteria and fermented. Others (such as ricotta or paneer) are not fermented, they are simply curdled with acid. Cottage cheese is traditionally made by curdling and not culturing. However, some brands of cottage cheese now have probiotic bacteria added to them. These are usually labeled as containing “live and active cultures.”
It's really difficult to make blanket statements that apply to all fermented and cultured foods. Labeling conventions (such as “live and active cultures”) are somewhat inconsistent. And not all bacteria involved in fermentation are considered to be probiotic. That designation is reserved for bacteria that have been shown to have specific beneficial effects in the body (and the foods that contain them.)
And even for foods that are considered to be probiotic foods, the specific benefits are going to depend on the nutritional aspects of the food that is being fermented—as well as which yeasts and bacteria are involved in the fermentation.
So, for example, yogurt provides protein and calcium from the milk, in addition to probiotic bacteria. Fermented cabbage, on the other hand, will contain vitamin C, K, folate, and other nutrients that are found in cabbage. And, of course, some fermented foods also contain elements that we may be trying to limit in our diets, such as the alcohol in wine and beer, or the saturated fat in cheese, or the sodium in sauerkraut or kimchi.
If you’re trying to maximize your gut health and overall nutrition, try to incorporate a variety of different cultured and fermented foods into your diet, being mindful of any specific aspects (such as sodium or alcohol) that you may wish to limit.
And now, let’s talk about cholesterol-lowering supplements. I recently got an email about this from Debbie, who wrote:
“I consider myself very healthy and fit, but my cholesterol keeps going up every year and is now high enough that I can no longer ignore it.”
At 71, Debbie isn’t on any prescription drugs (Go, Debbie!) and she really didn’t want to start taking a cholesterol-lowering medication. Looking around online, she found three nutritional supplements that all claimed to lower cholesterol. But each featured a different active ingredient. One had cocoa flavanols, another contained phytosterols, and a third was an extract from red yeast rice.
“Is there any research as to which is most effective?” Debbie asked. “Since they are all different ingredients, should I take more than one?”
Red yeast rice extract is traditional Chinese medicine made by fermenting a certain variety of rice with a specific strain of yeast. Some studies indicate that its cholesterol-lowering effects are comparable to that of statin drugs, which are the most commonly prescribed cholesterol-lowering medications. And there’s a good reason for that. Red rice yeast extract contains a naturally occurring compound called monacolin K, which is chemically identical to a prescription cholesterol-lowering medication known as lovastatin.
Unlike a prescription medication, however, the potency of red yeast rice extract supplements may vary, which obviously creates some concerns about dosing and safety. In fact, the FDA has attempted to block the sale of red yeast rice extracts in the U.S. but has not entirely succeeded at removing them from the marketplace.
But if your goal is to stay off statin medications, then red yeast rice extract isn’t a very good solution. And, if a statin drug does turn out to be necessary, I think you’d be better off with a prescription version of the drug, which would be better regulated in terms of potency, better monitored in terms of possible adverse effects or side effects, is more likely to be covered by insurance!
But what about these other two supplements?
Cocoavia Cardio Health is a heart health supplement containing cocoa flavonols. You could get cocoa flavanols from eating chocolate, of course, but not as concentrated a dose as you’d get from this supplement, which has been put to the test in double-blind, placebo-controlled studies.
The flavanol supplement was found to improve a number of aspects of cardiovascular health. Subjects taking the cocoa flavanols had improved endothelial function (basically, how well the blood vessels contract and relax), as well as modest reductions in their blood pressure and cholesterol levels. Total cholesterol levels fell by about 5% on average—and that may not be enough to bring high cholesterol levels into a low-risk range.
Which brings us to the phytosterol supplements—which are sold under a variety of brand names. Phytosterols are compounds found in plants that are very similar in structure to cholesterol. In fact, they are so similar that they can actually occupy the cellular receptors for cholesterol, thereby preventing it from being absorbed in the intestine.
Studies have shown that a phytosterol supplement lowered LDL cholesterol by 8-10%. For some people, this could allow them to control cholesterol without medication. But it can also be taken together with statin medications to improve their efficacy. Adding a phytosterol supplement can be comparable to doubling the dose of a statin medication. And unlike statins or red yeast rice extract, phytosterols do not have serious side effects or safety concerns.
The effective dose of phytosterols is 1,800-2,000 mg. (There does not appear to be any additional benefit to taking more than that.) In addition to nutritional supplements, phytosterols are also available in functional food products such as butter replacements. (Benecol is one popular brand.) You’d need to eat about 4 tablespoons/day to get the recommended dose—which would obviously also add a few hundred calories to your diet. And of course, phytosterols are also available in regular old foods!
The primary sources of phytosterols in the typical diet are nuts, seeds, soybeans, and other legumes, avocados, as well as nut, seed, and olive oils. Typical intake of dietary phytosterols is estimated to vary from 150 to 450 mg/day. Vegetarians and vegans tend to be at the top end of that range (probably because of their higher intake of legumes and nuts). I would wager that users of the Nutrition GPA app that you’ve heard me mention also tend toward the higher end of that range—because the foods encouraged by that app include a lot of foods that are higher in phytosterols.
You could always take an approach similar to the one I recommend for calcium supplementation: instead of taking the entire recommended amount as a supplement, you could use a supplement (or functional food product) just to close the gap between the target and what your healthy diet already provides.
Finally, because the cocoa flavanols and the phytosterols work through different mechanisms, you could potentially take both. But in the interests of getting the biggest bang for your buck, and minimizing the number of supplements you are taking, I think I’d be inclined to see how far you get with the phytosterols first.
Of course, you’d want to run all of this past your doctor. Depending on your situation and other risk factors, they may be willing to let you try a phytosterol supplement for a few months to see whether it’s enough to get your levels into a safe range.
But if, despite all your efforts with diet and lifestyle and nutritional supplements, you do end up having to take a statin medication to control your cholesterol, I don’t want you to feel like this is a personal or moral failure. Sometimes, our bodies just need a little help. Even though we may prefer to be drug-free, the benefits may outweigh the risks. Also: rest assured that your efforts with diet and lifestyle have not been wasted: You will likely get better results and need less medication as a result.
Have a nutrition question you’d like me to answer? Email it to me at nutrition@quickanddirtytips.com or call the Nutrition Diva listener line at 443-961-6206, and your question could be featured in a future episode!
Also, I wanted to let you know about a special program that I am offering later this month. It’s on Overcoming Stress and Emotional Eating. If this is something you struggle with, you are not alone! It’s one of the things that people most frequently ask for my help with and right now, before we get into the holidays, seems like the perfect time. You can learn more at weighless.life/stress.