High cholesterol and triglycerides: which supplements to assist diet therapy?
High cholesterol and triglycerides: which supplements to assist diet therapy?
Cardiovascular diseases are the leading causes of death in the Italian population. Yet intercepting their risk factors is possible and, as a result, effective preventive strategies can be implemented that reduce the likelihood of finding oneself struggling with potentially fatal events such as heart attack and stroke.
These risk factors include altered blood levels of cholesterol and triglycerides. Managing them and bringing them back, if possible, within ranges considered healthy requires paying special attention to diet as well. However, diet therapy is not always as effective as one would like, also complicit in the difficulties patients have in adhering to the dietary plans offered to them.
Dietary supplements can be a valuable aid both in cases that are more resistant to diet therapy-those in which, despite apparent adherence to the prescribed dietary plan, cholesterol and triglycerides do not decrease as much as one would like-and to increase the patient's adherence to diet therapy itself, motivating him or her in light of the results obtained on altered blood parameters.
But which supplements to choose to assist the hypolipidemic diet?
Fighting cholesterol with supplements
Regarding cholesterol, it is first good to remember the thresholds below or above which the concentration of the different forms in which it is present in the blood stream is considered optimal:
- Total cholesterol: not exceeding 200 mg/dL
- LDL(Low Density Lipoprotein, or "bad" cholesterol): not exceeding 100 mg/dL
- HDL(High Density Lipoprotein, or "good" cholesterol): not less than 50 mg/dL (men) or 40 mg/dL (women)
Whether statin treatment (the gold standard in pharmacological management of hypercholesterolemia) can be used depends on the patient's age and 10-year risk of atherosclerotic disease. In addition, the Italian Drug Agency (Aifa) recognizes the prescription of statins at the expense of the National Health Service (NHS) only in cases where high hypercholesterolemia cannot be corrected by the dietary therapy approach alone, attempted for at least 3 months, and polygenic hypercholesterolemia.
The scope of the nutrition professional in the fight against high cholesterol is therefore quite broad. Any patient should consider changes in his or her dietary habits regardless of statin prescription; what is more, in many cases before turning to the pharmacological approach it is necessary to try the path of reduction through diet therapy.
Fermented red rice supplements have assisted cholesterol-lowering diets for a very long time. Today, however, the ability to take advantage of their properties has been limited by virtue of the fact that they are sources of a true natural statin and, therefore, concerns about their possible side effects. This has led many companies to reformulate their products, focusing on active ingredients other than the monacolins in fermented red rice. Prominent among these isdry extract of artichoke(Cynara cardunculus) titrated in chlorogenic acid and luteolin.
The traditional medicinal use of artichoke was supported in the 20th century by research that demonstrated, among others, its ability to reduce blood lipids and oxidative stress (a phenomenon that contributes to atherosclerosis). Today, even the Ministry of Health recognizes the antioxidant and lipid metabolism-modulating effects of artichoke leaf extract. In order to benefit from these properties, however, it is necessary to use high doses of the active ingredients in the extract. Therefore, it is essential to rely on supplements based on extracts titrated in:
- Chlorogenic acid and derivatives(10-12%): for inhibitory action on cholesterol synthesis, fatty acid synthesis, and digestion of dietary fats;
- luteolin-7-glucoside and derivatives(2-4%): for inhibitory action against cholesterol synthesis and intestinal absorption and antioxidant action against LDL.
In overweight individuals diagnosed with metabolic syndrome not on statin treatment, taking 150 mg daily of such an artichoke extract, prolonged for 6 months, was associated with improvement in total and LDL cholesterol levels and cardiovascular profile (assessed in terms of flow-mediated vasodilation and carotid artery intima-media thickness).
By inhibiting cholesterol synthesis by mechanisms similar to statins (it inhibits the enzyme HMG-CoA reductase), artichoke extract could bring with it the fear of reduced Coenzyme Q10 synthesis (and, therefore, muscle problems). Therefore, it is advisable to choose supplements that also contain this active.
The addition of other ingredients that can control blood cholesterol (such as the same monacolins from fermented red rice, in the concentrations allowed today), antioxidants, and nutrients that promote good cardiometabolic health is an added value not to be underestimated.
Supplements in the management of triglycerides
The same treatment that demonstrated the ability of titrated artichoke extract to reduce total cholesterol and LDL also produced a lowering of triglycerides, in which case, however, the potentially most useful supplements are undoubtedly those based on Omega 3. The efficacy of these polyunsaturated fats in the control of hypertriglyceridemia is now beyond doubt, so much so that the European Food Safety Authority (EFSA) has authorized a nutrition declaration concerning precisely this property of theirs. Not only that, some drugs based on high doses of Omega 3 are used precisely in cases of hypertriglyceridemia.
Under optimal conditions, blood concentrations of triglycerides do not exceed 150 mg/dL. Levels between 150 and 199 mg/dL are of concern, but are not yet considered high enough to prompt the prescription of medication. When 250 mg/dL is exceeded, however, the situation becomes more dangerous; if, then, 500 mg/dL is exceeded, the pancreas also runs serious risks. Referring to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines, it is possible to talk about mildly high triglycerides (between 150 and 199 mg/dL), high triglycerides (between 200 and 499 mg/dL), and very high triglycerides ( 500 mg/dL and above).
The European Society of Cardiology (ESC) suggests that drug treatment should only be considered at concentrations of 200 mg/dL and above. Slightly high triglycerides are enough, however, for cardiovascular risk to increase. This is why the nutrition professional comes into play well before the drugs. His first, fundamental task is to suggest changes in dietary habits that can help correct hypetriglyceridemia-a task in which he can be aided by Omega 3 supplements in particular.
As mentioned, EFSA authorizes the use on the label of the nutrition claim that "DHA helps maintain triglyceride levels in the normalrange." For proper use, however, it is necessary to remember that the dosage needed to hope for this benefit is as much as 2 grams per day of a combination of EPA + DHA.
It is this high dosage, which is difficult to achieve by diet alone, that makes Omega 3 supplements valuable allies in diet therapy. For proper use, it is good to remember that:
- The supplement chosen to manage the problem must contain DHA in combination with EPA;
- the product should be able to provide 2 grams of EPA + DHA per day without forcing too many capsules to be taken;
- A total daily intake of more than 5 grams of EPA + DHA should never be exceeded.
Finally, it is also always worth remembering the importance of relying on products of certified quality, concentration and purity. In the case of marine-derived Omega 3s, the best certification to base your choice on is that issued by theInternational Fish Oil Standards (IFOS) program. To learn more about this, you can listen to episode 10 of "Pearls of Wellness", the podcast on the world of Omega 3 produced by Omegor. It is titled "Which Supplement?" and is available at this link.
Bibliographical references
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Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Executive Summary. https://www.nhlbi.nih.gov/files/docs/guidelines/atp3xsum.pdf
Visseren FLJ et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021 Sep 7;42(34):3227-3337. doi: 10.1093/eurheartj/ehab484
