Alternative Therapies for Hypercholesterolemia

Therapy	Best Evidence *	Probably Useful †	Least Evidence ‡
Herbals		Artichoke 320 mg of std extract t.i.d.; avocado; barley; evening primrose oil; flax seeds 20 g/day, 1 T flaxseed oil daily; glucomannan; pectin; plantain.	Fenugreek 5–20 g with meals t.i.d. or 15–90 g once daily with a meal; fo-ti 3–5 g/day as tea t.i.d., 500-mg tabs, up to 5 tabs t.i.d.; ginseng; proanthocyanidins (grape seed extract, pine bark); wild yam 2–3 ml tincture t.i.d., 1–2 tabs t.i.d.; yogurt.
		Garlic 1–4 cloves/day, tabs 300 mg t.i.d. (4000–5000 µg of allicin), tincture 2–4 ml t.i.d.; Guggul 500 mg tab t.i.d. (5–10% guggelsterones or total of 25 mg t.i.d.); psyllium 5–10 g/day; Chinese red yeast rice (cholestin) (Monascus purpureus), two 600-mg capsules b.i.d..
Diet and Nutrition/Lifestyle	Exercise; 5–7 servings/day fruits and vegetables (source of bioflavonoids and beta carotene); fiber; Mediterranean diet; quit smoking; soy protein 30 g/day; vegetarian diet; very low-fat diet (Ornish); vitamin B 3 (niacin) up to 3 g/day (potential hepatoxicity); weight loss.	Calcium 800–1000 mg/day; coenzyme Q10 100–200 mg/day; fish intake (EPA/DHA omega-3 oils); inositol hexaniacinate 500–1000 mg t.i.d.; olive and canola oil; Pritikin program; reduce intake of refined sugars; reduce caffeine intake; red wine or other form of alcohol 1–2 drinks/day; selenium 200 mg/day; vitamin B 5 (pantothenic acid) 300 mg b.i.d.–t.i.d. esp. for diabetics, hypertriglyceridemia; vitamin C 100–1000 mg/day; vitamin E 100–800 IU/day.	Beta-sitosterol; brewer's yeast 2 T/day carnitine 1–4 g/day; chitosan 3–6 g/day; chromium 200 mg/day; green tea 3C/day; lecithin; magnesium 400 mg/day; mushrooms: shiitake, maitake; oats; octacosanol; vitamins B 6 (pyridoxine) 50 mg/day; B 9 (folic acid) 400 mg/day; B 12 (cyanocobalamin) 1000 mg/day (may lower homocysteine levels, alone or together); quercetin 35 mg/day (apples, onion, black tea); safflower oil.
Mind-Body Interventions		Modifying type A behavior, stress reduction, reducing hostility, time urgency, competitiveness; reducing chronic arousal; improving sleep pattern; relaxation therapy.	Meditation; qi gong.
Pharmacological and Biological Treatments			Chelation therapy.
Alternative Systems of Care		Ayurveda; traditional Chinese medicine.

^*Therapies with the highest degree of scientific support for efficacy and safety.
^†Therapies that are often helpful but that do not have the highest degree of supporting evidence for efficacy and safety.
^‡Therapies that may be useful but that have limited scientific evidence for efficacy and safety.
NOTE: C denotes the number of times that a substance is diluted at a ratio of 1:100.
SOURCE: Sierpina, VS: Integrative Health Care: Complementary and Alternative Therapies for the Whole Person, F.A. Davis, Philadelphia, 2000.