How to reduce your cholesterol in a natural way
Cholesterol is an essential lipid for life It is essential for the maintenance of cell structure and is the essential component of plasma membranes that regulate the entry and exit of substances into and out of the cell. In addition, it acts as a precursor in the synthesis of vitamin D, sex hormones (estrogens, progesterone and testosterone) and adrenal hormones (cortisol and aldosterone). It also participates in the synthesis of bile acids helping the digestion of fatty foods.1
Cholesterol circulates in the bloodstream bound to lipoproteins. There are mainly two types of cholesterol-transporting lipoproteins: LDL (Low Density Lipoprotein) whose function is to transport cholesterol from the liver to the tissues where its function is required and HDL (High Density Lipoprotein), also known as “good cholesterol” whose function is to collect excess cholesterol and transport it back to the liver for metabolism.
When there is an excess of circulating cholesterol in the blood, LDL (which occupy more volume than HDL) cause “bad cholesterol” to tend to be deposited on the arterial walls, generating what is known as “atheroma plaques”. These plaques become thicker and thicker, making the blood vessels more rigid and causing them to become progressively obstructed. This phenomenon is one of the main causes of the development of cardiovascular diseases.2 In Spain it is estimated that around 50% of the adult population suffers from hypercholesterolemia and most of them do not know it.
Maintaining healthy blood cholesterol levels is vital for the proper functioning of the heart. In this sense, there are several strategies to reduce hypercholesterolemia, such as: modifying eating habits, regular exercise or treatment with drugs, usually statins. These drugs are effective, although, if are taken for long periods of time can produce adverse side effects such as muscle pain, digestive problems or liver damage.3 In addition, it is estimated that between 10% and 15% of patients are intolerant to statins, even at low doses.
Fortunately, there are several plants and natural supplements that can help us control and reduce the levels of “bad cholesterol” effectively and without the side effects of drugs. Among these natural components are red yeast rice, berberine, guggul, coenzyme Q10 and some vitamins and minerals, among others.
The lipid-lowering properties of these nutrients are detailed below:
Guggul (Commiphora mukul Engl.)
According to the EFSA (European Food Safety Authority), guggul (Commiphora mukul) helps maintain normal blood lipid levels and maintains healthy cholesterol levels in the human body.
In mammals, cholesterol homeostasis is regulated by the farnesoid X receptor (FXR) in the liver for metabolism and by phospholipase A2 (PLA2) in the intestine for absorption.
The lipid-lowering activity of guggul is mainly due to the guggulsterones present in the resin, which act as FXR antagonists, thus regulating cholesterol metabolism in the liver. On the other hand, guggul cembranoids have been shown to reduce the rate of cholate-activated hydrolysis of human pancreatic phospholipase A2 IB (hPLA2), which controls gastrointestinal absorption of fat and cholesterol.4
Berberine (Berberis aristata)
According to the EFSA, Berberine (Berberis aristata) helps maintain normal cholesterol levels and helps reduce triglyceride levels in the blood.
Scientific studies have shown that this alkaloid has comparable effects to statins in terms of cholesterol-lowering efficacy, with the advantage that it does not have the adverse effects of these drugs. These studies show that the administration of berberine produces a significant reduction in the levels of total cholesterol, triglycerides (TG) and LDL-c and a notable increase in HDL-c.
There are several mechanisms of action where berberine acts effectively reducing cholesterol levels. On the one hand, it acts by inducing the activation of AMPK which in turn inactivates the liver enzyme HMG-CoA reductase. This enzyme is involved in the conversion of HMG-CoA to mevalonate, a key metabolite in cholesterol biosynthesis. In that sense, berberine blocks this pathway and causes less cholesterol to be synthesized.5 On the other hand, berberine also increases the expression and half-life of the low-density lipoprotein receptor (LDL-R) on the surface of hepatocytes and increases the transcriptional activity of the LDL-R promoter. This results in less LDL (“bad cholesterol”) circulating in the blood.6
Olive tree (Olea europaea L.)
Phenolic compounds derived from the olive plant (Olea europaea L.), in particular hydroxytyrosol and oleuropein, have many beneficial effects on cardiovascular health.7 As far as cholesterol is concerned, these polyphenols increase high-density lipoprotein (HDL) levels and act as powerful antioxidants, that is, they prevent the oxidation of low-density lipoprotein (LDL) cholesterol.8 The oxidation of LDL is one of the factors contributing to the formation of atheroma plaques. Preventing the oxidation of LDL promotes the outflow of cholesterol from cells, including lipid-laden macrophages in the arterial wall, leading to better prevention against coronary heart disease.
– Red fermented rice yeast (Monascus purpureus)
The active ingredient in red yeast is monacolin K, which comes from the fermentation of rice with a mixture of fungi of the Monascus genus, mainly Monascus purpureus, which gives it its characteristic red colour. The EFSA states that a daily intake of 10 mg of monacolin K helps to maintain normal blood cholesterol levels.
Monacolin K is identical in chemical structure and behaviour to the statin drug lovastatin. Although the mechanism of action is similar, it is estimated that a daily intake of 3 to 10 mg of monacolin K from red yeast carries minimal health risks and mild myalgias are observed only in the most statin-sensitive patients.9
Regarding the mechanism of action, monacolin K acts as a selective and competitive HMG-CoA reductase inhibitor. As a consequence, total and LDL cholesterol levels are reduced. On the other hand, the blockade of hepatic cholesterol synthesis produces an activation of the regulatory proteins SREBP ( sterol regulatory elements-binding proteins), which activate the transcription of proteins and, therefore, produce a greater expression of the LDL receptor gene and an increase in the amount of functional receptors in the hepatocyte. This causes the levels of free LDL-cholesterol in the blood to be reduced.10
Probiotic bacteria can reduce cholesterol levels by reducing cholesterol absorption by several mechanisms: by the action of the enzyme bile salt hydrolase (BHS), by trapping cholesterol in the bacterial membrane, by conversion of cholesterol to coprostanol, by inhibition of micelle formation and by selective fermentation of certain foods by the intestinal microbiota.11
Specifically, L. reuteri has been studied and its efficacy in reducing cholesterol levels has been proven in several clinical trials. In a study of 127 people treated with L. reuteri NCIMB 30242 and placebo, the results indicate that the group receiving probiotics reduced their cholesterol level by 9.1% compared to the control group. As for the mechanism of action, correlations between LDL reduction and bile measurements in the intestine suggest that L. reuteri activates the enzyme HSB, this is, facilitates the hydrolysis of bile salts.
Bile excretion is the main route of cholesterol elimination, as well as one of the main pathways of cholesterol metabolism. The role of bile salts is to emulsify lipids so that they can be absorbed. When conjugated bile salts are hydrolysed in the intestine, their solubility and emulsification capacity decreases, which causes them to be less soluble and their absorption in the intestinal wall is lower, which facilitates the excretion of cholesterol through the feces.13
Niacin (vitamin B3), when consumed in high doses, can help reduce LDL cholesterol and triglycerides in the blood. Its benefits in this regard are achieved mainly through the inhibition of the liver enzyme DGAT (diacylglycerol acyltransferase) necessary for the synthesis of new triglycerides and by decreasing the mobilization of fatty acids from lipid deposits in adipose tissue (lipolysis) into the blood.14
It is also known that a high intake of niacin increases HDL due to a reduction in the catabolism of apolipoprotein A1 (APOA1), the main component of these lipoproteins.
Sugar cane (Saccharum officinarum)
Policosanol is a natural mixture of fatty alcohols usually obtained from sugar cane. Due to its lipid-lowering properties it is commonly used as a dietary supplement to help lower LDL cholesterol levels and increase HDL cholesterol. It is also used as a preventive treatment for atherosclerosis. Its mechanism of action is not entirely clear but it appears to act by reducing cholesterol synthesis in the liver by inhibiting HMG-CoA reductase and in turn increasing hepatic reabsorption of LDL cholesterol by increasing the expression of the LDL receptor in the liver. In addition, policosanol stimulates cholesterol excretion by increasing the content of cholesterol and bile acids in the stool. 15
Coenzyme Q10 (CoQ10) is one of the most potent natural fat-soluble antioxidants available. Our body synthesizes it in the liver following the same biochemical pathway by which we produce cholesterol, this is, the mevalonate pathway. Statins are drugs that block mevalonate synthesis by inhibiting HMG-CoA reductase, so in addition to lowering cholesterol they also reduce endogenous synthesis of CoQ10. One of the most important roles of this coenzyme is energy transfer in skeletal muscle. Some people taking statins to lower cholesterol suffer from muscle cramps and pain and it is thought that these myopathies may be due to a CoQ10 deficiency caused by taking these drugs. For this reason, CoQ10 supplementation is often recommended for people taking statins. In addition, the antioxidant properties of CoQ10 and the fact that much of it is transported in plasma bound to LDL-cholesterol lipoproteins has led to research into whether CoQ10 has any clinically relevant role as an antioxidant in reducing cholesterol oxidation. 16
Chrome is involved in the metabolism of macronutrients (lipids, proteins and carbohydrates) and helps maintain normal blood glucose levels. Chromium picolinate is the best form of supply of this nutrient because picolinic acid acts as a chelator of chromium, that is, it acts as a transporter of chromium so that it can be integrated into cell membranes and thus improve insulin sensitivity and glucose metabolism. 17
Some studies suggest that chromium reduces triglycerides and LDL while increasing HDL levels, although more studies are needed to confirm its mechanism of action. Hypotheses suggest that chromium may improve acetyl-CoA conversion and decrease cholesterol formation. In addition, chromium may increase lecithin cholesterol acyltransferase (LCAT) activity and accelerate cholesterol esterification and excretion. On the other hand, studies seem to indicate that chromium produces an activation of the glucose transporter GLUT4, through a cholesterol-dependent mechanism, thus decreasing cholesterol levels. 18
- Maldonado Saavedra, Octavio et al . Colesterol: Función biológica e implicaciones médicas. Rev. mex. cienc. farm, Ciudad de México , v. 43, n. 2, p. 7-22, jun. 2012.
- Pedro-Botet J, Pintó X. LDL-cholesterol: The lower the better. Clin Investig Arterioscler. 2019 Dec; 31 Suppl 2:16-27.
- Pinal-Fernandez I et al. Statins: pros and cons. Med Clin (Barc). 2018 May 23; 150(10):398-402.
- Yu BZ, Kaimal R. et al. Effect of guggulsterone and cembranoids of Commiphora mukul on pancreatic phospholipase A(2): role in hypocholesterolemia. J Nat Prod. 2009 Jan; 72(1):24-8.
- Wu N, Sarna LK, Siow YL, O K. Regulation of hepatic cholesterol biosynthesis by berberine during hyperhomocysteinemia. Am J Physiol Regul Integr Comp Physiol. 2011 Mar; 300(3):R635-43.
- Kong W. et al. Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins. Nat Med. 2004 Dec;10(12):1344-51.
- Imed Hassen et al. Biological activities of the natural antioxidant oleuropein: Exceeding the expectation – A mini-review, Journal of Functional Foods, Volume 18, Part B, 2015, 926-940.
- Covas MI. Et al. EUROLIVE Study Group. The effect of polyphenols in olive oil on heart disease risk factors: a randomized trial. Ann Intern Med. 2006 Sep 5;145(5):333-41.
- Cicero AFG, Fogacci F, Banach M. Red Yeast Rice for Hypercholesterolemia. Methodist Debakey Cardiovasc J. 2019 Jul-Sep;15(3):192-199.
- Huang CH. et al. Monacolin K affects lipid metabolism through SIRT1/AMPK pathway in HepG2 cells. Arch Pharm Res. 2013 Dec;36(12):1541-51.
- ones ML. et al. Cholesterol lowering with bile salt hydrolase-active probiotic bacteria, mechanism of action, clinical evidence, and future direction for heart health applications. Expert Opin Biol Ther. 2013 May; 13(5):631-42.
- MacKay D, Hathcock J, Guarneri E. Niacin: chemical forms, bioavailability, and health effects. Nutr Rev. 2012 Jun;70(6):357-66.
- Nam DE, Yun JM, Kim D, Kim OK. Policosanol Attenuates Cholesterol Synthesis via AMPK Activation in Hypercholesterolemic Rats. J Med Food. 2019 Nov;22(11):1110-1117.
- Langsjoen PH, Langsjoen AM. Overview of the use of CoQ10 in cardiovascular disease. Biofactors. 1999;9(2-4):273-84.
- Alvarado-Gamez, Ana et al. El cromo como elemento esencial en los humanos. Rev. costarric. cienc. méd , San José, v. 23, n. 1-2, pág. 55-68, junio de 2002.
- Abraham AS, Brooks B.A, Eylath U. The effects of chromium supplementation on serum glucose and lipids in patients with and without non-insulin-dependent diabetes. Metabolism. 1992 Jul;41(7):768-71.