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All of us would have heard of this word.
In fact, about 35% of Malaysians actually suffer from high cholesterol!
In this post, we will be looking into some of the supplements we can get here in Malaysia to help reduce the cholesterol levels.
Everyone talks about cholesterol, but do we really know enough about it?
Cholesterol is a waxy, fat-like substance that the body requires to make new cell membranes, hormones (like estrogen and testosterone), Vitamin D, and substances to help you digest food.
Cholesterol are mainly produced by our own body. In fact, our liver produces around 80% of the cholesterol and the rest comes from dietary sources like meat, eggs, fish and dairy products. Foods derived from plants contain no cholesterol.(Another reason to include more greens in your daily diet)
Cholesterol doesn’t dissolve in water, so it can’t travel through your blood on its own. To help transport cholesterol, your liver produces lipoproteins.
Lipoproteins are particles made from fat and protein. They carry cholesterol and triglycerides (another type of lipid) through your bloodstream. The two major forms of lipoprotein are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
Low-density lipoprotein (LDL) is often called “bad cholesterol.” It carries cholesterol from the liver to the tissues.
High-density lipoprotein (HDL) is often called "good cholesterol". They are the "good" lipoproteins that help carry excess cholesterol back to the liver. The liver then processes and gets rid of the excess cholesterol.
note: When we say high cholesterol, we normally means high LDL levels.
There is actually another type of lipoprotein called Very Low Density Lipoprotein. Like LDL, it is also considered a "bad" cholesterol because it too contributes to the hardening of your blood vessels. However, VLDL is different from LDL in the sense that it carries Triglyceride whereas LDL carries cholesterol.
Another non-cholesterol lipid that you will often see on your lipid analysis result is triglyceride. Triglycerides are another type of fat found in the blood. Unlike cholesterol (which is used by the body to build cell membranes and hormones), triglycerides are fats that help store unused calories and provide body with energy when required. A high triglyceride level normally means you are taking in more calories than you are burning away.
Generally, high triglyceride is bad for your body and can also contribute to the hardening of your blood vessels. This is why we include triglyceride levels in the calculation of the total cholesterol levels.
Total cholesterol = HDL + LDL + (TG/2.2)
note: the unit of measurement is mmol/L note: You can also see in the formula, total cholesterol doesn't really take into account the ratio between good and bad cholesterol. Theoretically, one can have low HDL "good" cholesterol and high LDL "bad" cholesterol and still shows an "okay" total cholesterol levels
According to the National Heart, lung and blood institute,
|Total Cholesterol||HDL Cholesterol||LDL Cholesterol||Triglyceride|
|Good||< 200||40 or higher||< 100||< 149|
|Borderline||200 - 239||n/a||130 - 159||150 - 199|
|High||240 or higher||n/a||160 or higher||200 or higher|
*All values are in mg/dL
Here's another table with the units converted to mmol/L
|Total Cholesterol||HDL Cholesterol||LDL Cholesterol||Triglyceride|
|Good||< 5.0||1.0 or higher||< 2.5||< 1.7|
|Borderline||5.0 - 6.0||n/a||3.3 - 4.0||1.7 - 2.2|
|High||6.0 or higher||n/a||4.0 or higher||2.2 or higher|
|Low||n/a||less than 1.0||n/a||n/a|
Please note: This is only a general guideline for most people without any other risks. If you have family history of heart disease, and/or have other conditions such as high blood pressure, diabetes etc, you should aim for a lower ldl and total cholesterol levels.
If there is too much cholesterol in the blood, some of the excess can become trapped in artery walls. Over time, this builds up and is called plaque. The plaque can narrow vessels and make them less flexible, a condition we sometimes refer to as atherosclerosis or “hardening of the arteries.”
This process can happen to blood vessels anywhere in the body.
This can cause chest pain, or angina.
Some cholesterol-rich plaques are unstable—they can burst and release cholesterol and fat into the bloodstream. The release can cause blood clots that block blood flow to the heart and cause a heart attack.
if it affected the blood vessels supplying to the brain, it can cause a stroke attack.
and if it affects the arteries supplying to the legs, it causes claudication. Claudication is a condition where the legs do not get enough oxygen supply during exercise, and pain occurs. Sometimes plaques release blood clots, which then travels to other smaller vessels causing blockade and cell death around that area due to insufficient oxygen supply.
Red yeast rice is a traditional chinese medicine used to lower cholesterol. It is extracted from rice that has been fermented with a type of yeast called Monascus purpureus.
note: Red Yeast Rice is a very popular culinary ingredient used in fu chow dish: red wine mi sua
Red yeast rice contains a few ingredients that are beneficial for cholesterol reduction. The list includes several types of monacolin, sterols, isoflavones and monosaturated fatty acids (“good” fats). Amongst these ingredients, monacolin K has the most effect on cholesterol lowering.
Monacolin K is also known as Lovastatin, which is a cholesterol lowering drug (brand name “Lestric”).
According to this study published in 1999, red yeast rice was proven to be able to significantly reduce total cholesterol and LDL Cholesterol. Similarly, a study done on animals also found that red yeast rice is effective both to prevent increase in cholesterol levels as well as to lower the cholesterol levels.
Another study published in 1997 also presented some very positive results on the effectiveness of red yeast rice. According to this study, not only did red yeast rice reduce the total cholesterol and LDL-cholesterol, it also significantyly increased the level of HDL-cholesterol.
We therefore highly recommend the use of red yeast rice for cholesterol reduction. If you want to try a food supplement before going on medication and if you are not pregnant, breastfeeding or using any other medications – you could consider taking red yeast rice.
Due to its similarity to prescription drug lovastatin, it is recommended that you seek for doctor’s or pharmacist’s advice before taking it, especially if you are on other medications.
There are plenty of evidence to support the use of oatmeal products for cholesterol reduction. In 1997, FDA in the U.S even gave the status of “health claim” to oatmeal products. This allows manufacturers to advertise the heart-healthy benefits on boxes of oatmeal products.
It’s not entirely sure how high fibre products can lower cholesterol yet. One widely accepted explanation is that when we digest fibre, it becomes sticky and sticks to cholesterol and stops it from being absorbed.
Another study also found that oatbran products lower blood cholesterol at least in part by changing how the liver processes cholesterol.
In other words, oat products can help reduce cholesterol absorbed from food as well as cholesterol produced in the body.
There are plenty of oatmeal products available on the market. (For e.g. Quick cook oats, instant oats, oatbran powders, psyllium husks etc.) How do you choose the right one?
Short answer is: check out the Beta-Glucan content.
The cholesterol lowering effect of oats comes mainly from this active ingredient: Beta-Glucan. In other words, the higher the Beta-Glucan content, the more powerful its cholesterol lowering effect.
*Most Beta-Glucan Oat bran powder in Malaysia have 20% Beta-glucan only. Due to regulatory restrictions, products that contain more than 20% of the active ingredient need to be registered as health supplements instead of health foods. (Stricter requirements will be implied on health supplements). Remember to always check the content label on the can before buying the oatbran powder. Kordel’s active oat-35 might not necessarily be better than Oats BG-22, as they both contain 20% beta-glucan only (Despite the name 35 and 22 respectively)
Plant sterols (also called phytosterols), phytostanols and their fatty acid esters are cholesterol-like substances that occur naturally at low levels in fruits, vegetables, nuts and cereals.
To the body, they actually look a lot like cholesterol. When ingested, they get absorbed by the body and hence prevent the absorption of "real" cholesterol in the intestines.
Plant sterols can be found in a variety of foods, including:
All of these foods however, contain only very low levels of plant sterols.
An easier way to get enough plant sterols to lower your cholesterol level is through eating fortified foods. Plant sterols are added to certain foods, including some kinds of orange juice, yogurt, and margarine.
To reap the cholesterol-lowering benefits, you need to consume at least 2 grams of plant sterols per day. This equals about two 8-ounce glasses of sterol-fortified orange juice per day.
In terms of its efficacy, this study here compared people with cholesterol problems who used margarine fortified with plant sterols instead of regular margarine, and found that people were able to reduce their LDL-levels by up to 14 percent in one year with plant sterols.
A study in The American Journal of Cardiology showed that getting 2 to 2.5 grams of sterols a day could lower LDL levels by 10 to 14 percent in some people.
Garlic is a plant closely related to onion and it's actually used since the ancient times for medicinal purpose. It provides a lot of health benefits and is widely accepted as one of the healthiest herbs in the world.
Most of the health benefits provided by garlic comes from the sulfur compounds that are formed when a garlic clove is chopped, crushed or chewed. These sulfur compounds can help kill germs and improve body's immunity, as well as act as natural anti-inflammatory and antioxidants.
For people with cholesterol problems, adding garlic to your supplement regimen might be a good idea.
Garlic is proven in a few studies to be able to lower total and LDL-cholesterol. In this meta-analysis of sixteen studies, garlic was found to significantly lower the subjects' total cholesterol levels by about 12%.
Another study published in 2018 found that garlic was not just beneficial for cholesterol reduction, it can also help with reducing the Body Mass Index (BMI) and blood pressure.
Furthermore, another meta-analysis of 33 studies also concluded that Garlic significantly improved the lipid profile and blood sugar paramaters.
Conclusion: Garlic is just a good supplement to have for general heart health. Not only it helps with cholesterol, it also helps improve blood sugar control and improve blood pressure. All of which are common problems suffered by people with high cholesterol.
Omega-3 supplements (fish oil, krill oil or flaxseed oil)are perhaps one of the most popular supplements you can get here in Malaysia. Omega-3s are an important essential nutrient which is required by our body but cannot be produced by our body.
Omega-3s offer a lot of beneficial health benefits:
But the question today is:
Can omega-3 help with cholesterol reduction?
Several studies have been conducted over the years to examine the effect of fish oil on reduction of LDL-cholesterol. The results have been mixed - reduction in people with already high cholesterol, and slight increase in normal people.
Some studies also found that omega-3 supplementation slightly increased the HDL levels of the subjects
There are however an extensive list of studies which showed that omega-3s are effective in lowering the triglyceride levels. Some studies also found that omega-3 supplementation slightly increased the HDL levels of the subjects
Conclusion: The efficacy of fish oil in LDL-reduction has been inconclusive - with a slight possibility that it might even increase the LDL-cholesterol.
For people with high triglyceride, omega-3 supplement would be highly recommended as it's proven to help reduce triglycerides.
Our stand: We actually think everyone should be using fish oil supplement, regardless of their cholesterol levels - not for its cholesterol-reducing effect but for its many other health benefits
So, which supplement should you get if you have high cholesterol?
A quick summary:
For people with high LDL-cholesterol and not on medications for cholesterol, GO for red yeast rice supplement plus oatbran powder.
For people with high LDL-cholesterol and are on medications, get oatbran powder. Oatbran can be taken with other supplements.
For people who have high cholesterol due to eating high fat foods, plant sterols supplementation would be beneficial.(Plant sterols can be taken together with other supplements)
For people with cholesterol problem as well as heart disease or blood pressure problems, garlic would be a good supplement choice.
And finally for everyone with or without cholesterol problems, and especially people with high triglyceride, Omega-3 fatty acids like fish oil or krill oil is highly recommended!
So there you go, five supplements for cholesterol reduction. Which one would you start taking and why? Do you have any other supplements for cholesterol reduction you would like us to include?
Comment below and let us know.