Alternative answers to hyperlipidaemia
FIRST-LINE management of hyperlipidaemia must always include lifestyle changes, particularly weight loss when required.
Reducing saturated fatty acid intake to less than 7% of energy and cholesterol intake to less than 200mg per day reduces LDL-C by 9% to 12%. In conjunction with a 3–6kg weight loss, LDL-C can be reduced by 16% if necessary. Also exercise, added soluble fibre (e.g. β-glucan, pectin, guar gum, glucomannan and psyllium) and phytosterols (e.g. stanols and sterols) play a role.
Vitamin B3 (niacin or nicotinic acid) has long been valued as playing a role in lowering LDL-cholesterol and triglyceride levels and raising HDL-cholesterol, even when combined with statins.
The main side effect of niacin includes flushing due to vasodilatation effects which wears off after two weeks of continued use, and there have been several case reports of hepatotoxicity associated with extended release forms.
Garlic extract or powder may reduce cholesterol although meta-analyses have found conflicting results with no significant benefits.
A meta-analysis of 26 studies demonstrated that garlic powder and aged garlic extract significantly lowered total cholesterol levels whilst garlic oil reduced serum triglyceride when compared with placebo.
Fish oils are well recognised in lowering triglyceride levels (not cholesterol) which is dose dependent. The recommended dose is 1–2 grams daily. Side-effects include gastrointestinal upset, reflux, burping, allergic reactions in people with seafood allergy, and blood thinning in very high doses (>9 gram daily). A meta-analysis found a marine source of omega-3 fatty acid not derived from fish (median dose of algal DHA 1.68g/d) may reduce serum triglycerides and increase HDL-cholesterol and LDL-cholesterol in persons without coronary heart disease.
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