Cholesterol supplements
integratori per il colesterolo

Lowering cholesterol is possible. Let’s find out how

Cholesterol is a fat necessary for life: it is in fact one of the main constituents of cell membranes and participates in the synthesis of vitamin D and other substances.
Furthermore, one of its fundamental roles is to contribute to the maintenance of cell integrity.
Cholesterol is mainly produced by our body, but some of it can be introduced through the diet.
However, an excess of this fat can be risky, as it increases the chances of developing illnesses such as heart attack and stroke.
Cholesterol control comes through prevention
There are several factors that can impact an increase in cholesterol levels, including:

  • improper diet
  • overweight and obesity
  • physical inactivity
  • diabetes
  • smoking
  • age.

It is clear that prevention is essential for cholesterol control.
A preventative dietary strategy, effective for keeping cholesterol values within normal levels, should be followed throughout life and should include lifestyle changes that include:

  • a healthy diet (limiting, as much as possible, the intake of saturated fats, such as whole milk and red meat, trans fats and sugars)
  • body weight control
  • regular physical activity
  • avoid/limit bad habits like smoking and drinking alcohol.

These changes help reduce the concentration of fats such as cholesterol (LDL cholesterol* – the dreaded “bad cholesterol”, and total cholesterol) and triglycerides and instead increase the levels of good cholesterol (HDL cholesterol*).

*LDL (Low Density Lipoprotein); HDL (High Density Lipoprotein).

 

Natural components to fight cholesterol

Foods rich in plant ingredients, such as fruit and vegetables, can represent natural remedies to control cholesterol: a diet rich in fruit and vegetables (at least 5 servings a day) helps to reduce high cholesterol and prevent some chronic diseases.
The properties and positive effects of fruit and vegetables have been attributed to their low caloric value and high content of dietary fiber and nutrients (vitamins and minerals), and of components with protective and antioxidant action (such as phenolic compounds).
Many foods of plant origin contain high levels of folic acid, which is important for lowering the levels of homocysteine (an amino acid normally present in our body) which, if present in excess, can favor the formation of atherosclerotic plaques.
Grain (preferably whole grain), fruit (including nuts), vegetables and legumes are all excellent sources of fiber.
Carbohydrates (or sugars) can also be part of a healthy diet, but with some precautions: it is better to choose carbohydrates with a low glycemic index (GI), which, compared to sugars with a higher GI, have a lesser effect on blood sugar.
Furthermore, the consumption of so-called “simple sugars” (present in sweets and sugary drinks) should be reduced in favor of complex sugars, such as those present in bread and pasta. These sugars, in fact, worsen the absorption of sugars, increase the level of triglycerides and reduce the values of good cholesterol.
Fruit is also a natural source of simple sugars; nonetheless, research has consistently shown that these sugars, compared to those contained in sweets, have an “anti-obesity” effect.

 

What if nutrition alone isn’t enough?

In the presence of certain conditions, it may be necessary to intervene with medical treatment to control cholesterol (for example with statins, which act on LDL cholesterol by slowing down its production and favoring its elimination).
The intake of functional foods and food supplements to be used in combination with a healthy dietary regime or in addition to a medical treatment can represent a valid alternative.

 

Food supplements: what are they?

As the word itself says, food supplements are products designed to complete the diet, not to replace it.
Food supplements are a concentrated source of nutrients (i.e. vitamins and minerals) or other substances such as amino acids, essential fatty acids, fiber and plant-based extracts.
They usually come in pre-dosed forms such as capsules, tablets, sachets, vials and the like.
Food supplements can contribute to the well-being of the body by supplying nutrients or other substances useful for the body’s functions.
The substances and plant preparations contained in food supplements are defined as “botanicals”: such substances may include:

  • the whole plant (or parts of it) in untreated form, usually dried;
  • vegetable products usually obtained by extraction, distillation, pressing, fractionation, purification, concentration, grinding and pulverization.

 

Cholesterol and food supplements

Current guidelines for the management of dyslipidemia mention among the nutrients aimed at controlling cholesterol:

  • Phytosterols (plant sterols), naturally found in vegetable oils, vegetables, fresh fruit, chestnuts, cereals and legumes. Phytosterols compete with cholesterol for intestinal absorption, thus helping to control total cholesterol levels;
  • Soy proteins, can be used as vegetable substitutes for animal proteins;
  • Fibers, mainly present in whole grains, vegetables and fruits. The water-soluble variety (i.e. oat bran) is the most effective;
  • Omega 3 unsaturated fatty acids, present in fish oil, chestnuts, some vegetables and some seed oils;
  • Monacolin: contained in red yeast rice, used in China as food coloring and flavor enhancer for centuries; monacolins are produced by the action of a yeast, called Monascus purpureus, which is also responsible for the red color and the aroma typical of red yeast rice.
    In addition, monacolin K has a chemical structure identical to a molecule used to lower cholesterol levels, lovastatin, belonging to the statin family;
  • Policosanols found in sugar cane, rice and wheat germ;
  • Berberine: isolated from many types of medicinal plants, this substance is historically used in traditional Chinese medicine.

 

The capacity of flaxseed and flaxseed oil to lower cholesterol levels is still debated: studies on flaxseed supplements, including whole flaxseed, have shown greater effects in women (especially those in post- menopause) than in men and in patients starting with high cholesterol levels.
Flax does not contain gluten, so people who are sensitive or intolerant to gluten can consume flax-based products in their diet.

 

Side effects

To limit any side effects due to improper use, the packaging of food supplements must have a label containing the nutritional composition, the beneficial effect and instructions for use.
Food supplements aimed at controlling cholesterol are not entirely free of unwanted effects, therefore it is always advisable to inform your doctor of the active ingredients they contain.

Bibliography

  • 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias – European Heart Journal. 2016;37:2999–3058
  • Barrios V, Escobar C, Cicero AF, et al. Atheroscler Suppl. 2017;24:1-15.
  • Cox RA and García-Palmieri MR. Cholesterol, Triglycerides, and Associated Lipoproteins. In Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 3. Walker HK, Hall WD, Hurst JW, editors. NCBI Bookshelf.
  • Ganorkar PM. and Jain RK. IFRJ. 2013;20(2): 519-25
  • Heinz T, Schuchardt JP, Möller K, et al.Nutr Res. 2016;36(10):1162-1170
  • ISS- Epicentro – fitosorveglianza. Disponibile al link: http://www.epicentro.iss.it/fitosorveglianza/. Ultimo accesso: Luglio 2019
  • ISS-Epicentro. Colesterolo e Ipercolesterolemia. Disponibile al link: https://www.epicentro.iss.it/colesterolo/. Ultimo accesso: Luglio 2019
  • Marangoni F. Nutraceutici per il controllo della colesterolemia: tutto quello che bisogna sapere. AP&B. Alimentazione Nutrizione e Benessere. Anno IV numero 3. Nutrition Foundation of Italy e Pacini Medicina. Disponibile al link: https://www.pacinimedicina.it/wp-content/uploads/APB_3_17_online.pdf. Ultimo accesso: Luglio 2019.
  • Ministero della Salute – direzione generale per l’igiene e la sicurezza degli alimenti e la nutrizione – Linee guida sulla documentazione a supporto dell’impiego di sostanze e preparati vegetali (botanicals) negli integratori alimentari di cui al DM 9 luglio 2012- Revisione gennaio 2015
  • Ministero della Salute – Integratori alimentari e Linee guida ministeriali (LGM). Disponibile al link: http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=1267&area=Alimenti%20particolari%20e%20integratori&menu=integratori. Ultimo accesso: Luglio 2019
  • Ministero della Salute – Linee guida per la prevenzione dell’aterosclerosi. Documento approvato dalla Commissione Consultiva per i prodotti destinati ad un’alimentazione particolare. Settembre 2004
  • NIH – NCCI. Red Yeast Rice. Disponibile al link: https://nccih.nih.gov/health/redyeastrice. Ultimo accesso: Luglio 2019
  • NIH –NCCI. Flaxseed and Flaxseed Oil. Disponibile al link: https://nccih.nih.gov/health/flaxseed/ataglance.htm. Ultimo accesso: Luglio 2019
  • NIH- NCCI. Cholesterol Management at a Glance. Disponibile al link: https://nccih.nih.gov/health/cholesterol/at-a-glance. Ultimo accesso: Luglio 2019
  • Sharma SP, Chung HJ, Kim HJ, et al. Nutrients. 2016 Oct 14;8(10). pii: E633.
  • Vafa MR, Haghighatjoo E, Shidfar F, et al.Int J Prev Med. 2011; 2(2): 94–100
  • Zhang J, Li Q, Wu Y, et al. Cell Commun Signal. 2019;17(1):15.