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BLOG: August 2007

Alternatives to statins

Statins - Benefits - Side effects - Real problem - Alternatives

The fact that cholesterol imbalance (particularly high "bad", and low "good" cholesterol) is only a part of the problem - actually, part of body's attempt to remedy oxidative/inflammatory damage to the cells and tissues - implies that alternative (and better) treatments for primary and secondary cardiovascular disease prevention are available. It also makes it easier to understand the "mysterious" power of the Mediterranean-type diet, high in fruits and vegetables, rich in monounsaturated fatty acids (olive oil), and high in Omega-3 essential fatty acids, to significantly reduce heart attack incidence, both fatal and non-fatal,

That was the conclusion of the Lyon Diet Heart Study, a secondary prevention study in which, after 27-month study period, those on the Mediterranean-type diet had

76% lower incidence of fatal and non-fatal heart attacks
than folks in the control group

Researchers conducting the study believe that it is primarily due to Omega-3 fatty acids intake provided by the diet. Omega-3 fatty acids do have anti-inflammatory properties, coming from their important role in functioning of the cell membrane; they also exert anti-coagulating action and assist in moving around cholesterol molecules. These properties make them an important factor in preventing arterial plaque.

Since the Omega-3 showed the ability to cut the incidence of sudden cardiac death in half (GISSI Prevenzione Trial), they apparently also have antiarrhytmic effect (with arrhythmia being the most common cause of the SCD).

However, it is certain that

nutrient-rich diet as a whole deserves the credit.

Omega-3 fatty acids can never do as much alone, as when combined with other important nutrients. This is clearly indicated by a small 1-year secondary prevention study (Indian Experiment of Infarct Survival), which used Omega-3 fatty acid supplementation alone, and had total heart attacks (fatal and non-fatal) reduced only by 25%.

Another nutrient with multiple mode of action, proven to benefit in lowering cholesterol and cardiovascular disease prevention, is vitamin B3 (Niacin). It has multiple action, as an antioxidant, vasodilator (dilates blood vessels by stimulating nitric oxide production), as well as an activator for two enzymes needed for fats/cholesterol metabolism. Its big advantage is that it also lowers lipoprotein(a), a high-risk factor for developing cardiovascular disease.

However, as with most single agent treatments, high doses are needed for efficacy, which often results in side effects. With the regular form of niacin (also called niacinamide, or nicotinamide), the most frequent acute side effect is skin flushing; longer term, niacin can cause liver damage, although usually reversible. But there is better alternative to it: flushing is nearly eliminated, blood glucose effect insignificant, and risk of liver liver complications reduced to negligible with the B3/inositol compound, inositol hexaniacinate.

Niacin is the only nutrient for the secondary treatment of high LDL cholesterol - as a risk factor for heart disease - listed by the National Guideline Clearinghouse (NGC). While it is undoubtedly among the most important nutrients in this respect, the NGC folks have some serious catching up to do when it comes to the importance of nutrition in general, as well as other specific nutrients, for healthy blood cholesterol levels.

Agents clinically proven to reduce cholesterol also include pantethine, the stable form of vitamin B5, and gugulipid. The former acts by activating the key enzyme controlling fat metabolism. The latter improves the liver cholesterol metabolism. While not quite as effective as vitamin B3, they have no known serious side effects.

Although it is nearly impossible to directly compare different clinical studies, due to differences in critical factors such as size, duration, dosage, administration, participants' profile (diet, lifestyle, overall health, etc.), support, counseling and others, it is illustrative to put together a comparison table showing the level of effectiveness associated with statins vs. main natural alternatives.

Cholesterol-lowering agents comparison table


Daily dose












- liver
- muscle tissue
- nerves







- liver















Lp|a|=lipoprotein(a),  TG=triglycerides,  *purified form

Other natural agents are also effective in controlling cholesterol. Garlic lowers "bad" LDL and elevates "good" HDL cholesterol, while also significantly lowering triglycerides. Vitamin C lowers the LDL, increases HDL (especially in woman) and significantly lowers the most dangerous lipoprotein(a).

A little known role of another mineral - silicon - is that it is, similarly to vitamin C, needed for elasticity and strength of blood vessels. It makes them less vulnerable to damage and inflammation. Moreover, by forming sort of a non-sticky coating along the inner blood vessel lining, it can significantly reduce the rate of atherosclerotic plaque formation. It has shown spectacular protective effects against plaque build-up in animals; in a human study, its arterial content correlates inversely with the degree of (aorta) damage and plaque build-up12.

Dietary fiber reduces cholesterol by inhibiting its re-absorption. There is a drug for inhibiting cholesterol re-absorption from the intestine - Ezetimibe - but you are better off with a fiber-rich diet, also likely to contain significant amount of plant sterols - especially beta sitosterol - proven to reduce LDL cholesterol by competing to cholesterol for re-absorption from the intestine.

Those whose blood cholesterol level is affected by dietary cholesterol, will benefit from avoiding animal fats. Most everyone will benefit from avoiding excess of saturated fats, refined sugars and starches, which all promote cholesterol production.

Excess of oils rich in polyunsaturated Omega-6 fatty acids (sunflower, safflower, corn, soybean, canola), even when unprocessed, has inflammatory effect, and also promotes clot formation, especially if Omega-3 oils are deficient.

Neither of the above is associated with highly mono-unsaturated olive oil, whose only disadvantage seems to be the lack of essential fatty acids.

Non-dietary factors that help lower cholesterol include regular physical activity, which burns excess glucose before the body turns it into fats (cholesterol and triglycerides), as well as avoiding smoking, alcohol and coffee. Stress-free life minimizes demand for stress hormones, which require cholesterol for their synthesis, thus stimulate its production.

What also helps is proper thyroid function. Hypothyroidism lowers "good" HDL, and elevates "bad" LDL cholesterol, which indicates that it causes cholesterol build-up in the body. It also elevates lipoprotein(a), a sticky LDL cholesterol cousin, shown to increase the risk of cardiovascular disease ten times more than "bad" LDL cholesterol.

To sum it up, viable natural alternatives to statin treatment are Omega-3 fatty acids, niacin, pantethine, gugulipid and garlic. Also, any of the major antioxidants, or nutrients needed for their synthesis and activity, either alone or, better, combined. Longer tem, nutrient-rich natural-food diet is much preferred to drug treatment, both with respect to safety and overall efficacy.

The bottom line is that

lowering your cholesterol should not be your primary goal.

It would not free you from the risks of cardiovascular disease. There is no agent, medication or therapy that can compensate for ill effects of poor diet and unhealthy lifestyle. No one can live without cholesterol, and it will keep narrowing your arteries as long as there is free radical damage and inflammation in them.

Needless to say, any of the host of other diseases is more likely to strike you as well.

Check your CRP (C-reactive protein) levels for the sign of hidden internal inflammation, and your ADMA (asymmetrical dimethyl arginine, inhibiting nitric oxide synthesis) level, to make sure your blood vessels can dilate when needed. The former will indicate how urgent it is for you to switch to a healthy diet, antioxidant supplementation and, possibly, one of the safe cholesterol-lowering protocols.

The latter, if even mildly elevated, presents significant risk factor for developing cardiovascular, as well as other serious diseases. Luckily, you can easily correct insufficient nitric oxide production with arginine supplementation12.

After reading this, you may find drug-propaganda headlines like "Statin Users Risk Heart Attacks By Dropping Treatment Or Taking Low Doses" (Science Daily) not so scary anymore. You know better now about the healing power of a healthy diet and lifestyle, as well as safer, natural alternatives to statin drugs. Talk with your doctor about them; if it is not a part of his expertise, find one that can do more for a patient than pushing pills down his, or her throat.