Dyslipidemia is a condition in which the amount of lipids in the blood is very high to abnormal levels. In technical terms, the elevation of plasma cholesterol, triglycerides (TGs), or both, causes the disease. It also caused by low HDL cholesterol level. In the majority of high-income countries, the condition is often due to lifestyle factors such as diet or level of exercise. Also, the elevation of insulin over a long period leads to the disease. The increase in the level of the enzyme O-GlcNAc transferase (OGT) is a known cause of the condition as well. With the changes in diet and lifestyle in the last few decades, the condition is now common, especially in developed counties and among the wealthy in low and middle-income countries. Dyslipidemia leads to atherosclerosis, in case of low HDL cholesterol level, which is a condition in which plaques form on arteries where they obstruct the free flow of blood (Alkazemi, Egeland, Vaya, Meltzer & Kubow, 2008).
Given the importance of the condition to poor health, it is vital to manage it. For patients, over-the-counter (OTC) medication can manage the disease. Some of the OTC agents are supplements with proven effect in lowering blood cholesterol levels. The first OTC agent is garlic, which contains an amino acid known as alliin. After crushing the agent, alliin converts to allicin, a compound that inhibits cholesterol synthesis (Burke, 2015). Recent data shows that when used over two months or so, the agent is beneficial in lowering cholesterol levels. However, garlic is known to interact with specific medication due to its antiplatelet effects. For such patients, the garlic might not be appropriate.
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Niacin or vitamin B 3 supplement is effective. Niacin is effective in raising HDL-C levels while reducing LDL-C and triglycerides. For the best results, the recommended dosage is 1 to 4 g per day (Mills et al., 2003). The downside of niacin is the potential to develop hyperglycemia, but the condition is easily treatable, and its effect is mild (Meyers, Carr, Park & Brunzell, 2003). It also induces flushing, but with the right dosage and guidance, most patients can tolerate it.
Omega-3 Fatty Acids/Fish Oils are the most used natural product to manage the condition. Studies have shown that eicosapentaenoic acid (EPA) is effective in lowering serum triglycerides, but the product can raise LDL-C and HDL-C. For most people, they can get most of the Omega-3 Fatty Acids/Fish Oils from consumption of food rich in certain fish species (Balu, Simko, Quimbo & Cziraky, 2009). However, supplements are available as well. However, for patients who want to consume more than 3 g per day, they need supervision from a physician. Most patients tolerate this product, but some patients complain of stomach upsets and excessive bleeding to its anticoagulant properties. Therefore, patients should use the product cautiously when using certain medications.
Red Yeast Rice (RYR) is commonly used as a food agent, but when fermented, it released monacolins, which inhibits cholesterol synthesis. The FDA approved drug lovastatin contains monacolin K. studies have shown that the product is effective in reducing cholesterol and other lipids in the blood. FDA restricts the sale of products with monacolin K, so the OTC option for most patients is to stick with fermented Red Yeast Rice (RYR). Many supplements on the market contain RYR, but their level of monacolin is often not disclosed.
Soluble fiber is also adequate OTC agent for the condition. Some of the soluble fibers are from oats, pectin, or guar gum, and they have shown effectiveness in lowering cholesterol and LDL-C. The most effective soluble fiber comes from psyllium husk. It also has the least negative effect. The recommended intake of dietary fiber per day is 25 to 38 g per day, but most people do not consume even half of that amount. For patients with dyslipidemia, their fiber consumption is even lower than average due to poor lifestyle choices.
References
Alkazemi, D., Egeland, G., Vaya, J., Meltzer, S., & Kubow, S. (2008). Oxysterol as a Marker of Atherogenic Dyslipidemia in Adolescence. The Journal of Clinical Endocrinology & Metabolism, 93 (11), 4282-4289. doi:10.1210/jc.2008-0586
Balu, S., Simko, R. J., Quimbo, R. M., & Cziraky, M. J. (2009). Impact of fixed-dose and multi-pill combination dyslipidemia therapies on medication adherence and the economic burden of sub-optimal adherence. Current Medical Research and Opinion, 25 (11), 2765-2775. doi:10.1185/03007990903297741
Burke, F. M. (2015). Red Yeast Rice for the Treatment of Dyslipidemia. Current Atherosclerosis Reports, 17 (4). doi:10.1007/s11883-015-0495-8
Meyers, C. D., Carr, M. C., Park, S., & Brunzell, J. D. (2003). Varying Cost and Free Nicotinic Acid Content in Over-the-Counter Niacin Preparations for Dyslipidemia. Annals of Internal Medicine, 139 (12), 996. doi:10.7326/0003-4819-139-12-200312160-00009
Mills, E., Prousky, J., Raskin, G., Gagnier, J., Rachlis, B., Montori, V. M., & Juurlink, D. (2003). The safety of over-the-counter niacin. A randomized placebo-controlled trial [ISRCTN18054903]. BMC Clinical Pharmacology, 3 (1). doi:10.1186/1472-6904-3-4
