Probiotics
Mixed high dose probiotics at 60 to 100 billion organisms per day reduce TC 9%, LDL-C 8% and TG 10%.[179–182] Probiotics precipitate bile salts, deconjugate bile salts with bile salt hydrolyase and are incorporated into cell membranes, as well as being assimilated into cholesterol itself.
Berberine HCL
Berberine HCL is an alkaloid present in roots, rhizomes and stem barks of selected plants.[183–185] In a study of 32 dyslipidemic patients, 500 mg per day of berberine HCL decreased TC 29%, LDL-C 25% and TG 35% in 3 months.[184] Berberine increases hepatic LDL-R and suppresses PCSK9 expression that increases hepatic LDL excretion and is additive to statins in its lipid-lowering effect.[183,184] The recommended dose is 500 mg q.d. to b.i.d. Berberine has additive LDL-lowering effects with statins[183] and ezetimibe.[185] A meta-analysis of berberine that included eleven randomized trials of 874 subjects showed significant reduction in TC, LDL, TG and increase in HDL without any serious adverse effects.[186] Berberine is more effective and has fewer adverse effects compared with ezetimibe monotherapy.[185]
Combinations
A prospective open-label human clinical trial of 30 patients for 2 months showed significant improvement in serum lipids using a proprietary product with a combination of pantethine, plant sterols, EGCG, γ/δ tocotrienols and phytolens.[187] The TC fell 14%, LDL decreased 14%, VLDL dropped 20% and small dense LDL particles fell 25% (type III and IV).[187] In another study using the same proprietary product with RYR 2400 mg per day and niacin 500 mg per day, the TC fell 34%, LDL decreased by 34%, LDL particle number fell 35%, VLDL dropped 27% and HDL increased 10% [Houston MC, Unpublished Data]. Studies indicate a relative risk reduction of CVD mortality with omega 3 fatty acids of 0.68, with resins of 0.70 and with statins of 0.78.[188,189] Combining statins with omega 3 fatty acids (EFA) decreases CHD 19% more.[114] The combination of γ/δ tocotrienols and a statin reduces LDL cholesterol an additional 10%.[135] Plant sterols with omega 3 fatty acids have synergistic lipid-lowering and anti-inflammatory effects.[118] A combination of red yeast rice, bitter gourd, chlorella, soy protein and licorice resulted in significant reductions in TC, TG and LDL, as well as BP in 228 subjects in a controlled clinical trial.[190] Aged garlic alone or in combination with B vitamins, folate, arginine, coenzyme Q 10 or statins improves lipids and other markers of endothelial function, vascular elasticity, NO, inflammation, HS CRP, CAC and plaque regression.[5,55,147–151] Future studies are needed to evaluate various other combinations on serum lipids, surrogate vascular end points and CHD and CVD morbidity and mortality.
Clin Lipidology. 2014;9(3):333-354. © 2014 Future Medicine Ltd.
