Complementary and Alternative

Therapies for Hyperlipide

miaDr. P.Naina Mohamed PhD

Pharmacologist

Introduction The therapies which could be combined with

conventional medicine is termed “Complementary Medicine”.

“Alternative Medicine” includes therapies that are used in place of conventional medicine.

“Complementary and Alternative Medicine” (CAM) refers to a wide range of clinical therapies outside the conventional medicine.

“Conventional Medicine” is a type of medicine practiced by medical doctors and by allied health professionals, such as physical therapists, psychologists, and registered nurses. It is also called Western or Allopathic medicine.

“Integrative Medicine” represents a combination of conventional medicine, CAM, and evidence-based medicine.

CAM Use An US study reported that the Complementary and

Alternative Medicine (CAM) use is high and continues to increase.

The most important reason cited by patients for the supplemental CAM use is the perception that CAM is harmless.

CAM use is highest in patients include Female Nonsmokers Physically active Having normal body mass index (BMI) Eating low-fat diets with a high fruit and vegetable content Individuals aged 35 to 54 years with a high level of education.

Types of CAM Practices

Mind-Body and Manipulative Practices

Traditional Medical Systems

"Modern" Medical Systems

Mind and BodyPractices

  Acupuncture and Acupressure Yoga Hypnosis Massage Meditation Reflexology Alexander technique Tai chi Spinal manipulation Therapeutic touch Guided imagery Rolfing/structural integration

Traditional Medical Systems

  •Ayurvedic medicine •Siddha medicine •Unani medicine •Native American medicine •Tibetan medicine •Traditional Chinese medicine •Curanderismo

"Modern" Medical Systems

  •Homeopathy •Naturopathy •Osteopathy •Chiropractic •Anthroposophic medicine

Hyperlipidemia Excessively elevated levels of lipids or lipoproteins in the blood is

termed Hyperlipidemia. Any fat-soluble molecules is known as Lipids and the

Lipoproteins are the capsules surrounding lipids and transporting them.

Cholesterol is one of the most common types of lipids. Elevated levels of cholesterol in the blood is referred as Hypercholesterolemia.

Triglycerides are the esters derived from glycerol and three fatty acids. Presence of high levels of Triglycerides in the blood is called Hypertriglyceridemia.

The risk factors of Hyperlipidemia include Obesity or Overweight, excessive Alcohol consumption, Physical inactivity, preexisting health conditions such as Diabetes, Hypothyroidism, or Kidney disease. 

CAM used for Hyperlipidemia

Dietary SupplementsOmega-3 Fatty AcidsPlant sterols and stanolsSoy proteinFlax seedRed yeast rice

Herbal SupplementsGingerGarlicGinseng

Mind – Body PracticesTranscendental MeditationYoga

Omega-3 Fatty Acids

Marine derived (Mackerel, Lake trout, Herring, Sardines, Albacore tuna, and Salmon) Omega-3 Fatty Acids such as Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA) and Plant derived (walnuts, flaxseeds and Canola) Omega-3 Fatty Acids like Alpha linolenic acid (ALA) are useful to reduce Triglyceride levels.

Two to four grams per day of EPA+DHA supplementation, can lower 20% to 40% triglycerides and may be useful in patients with hypertriglyceridemia.

The American Heart Association (AHA) recommends ≈1 g of EPA and DHA (combined) per day, for CHD patients.

The AHA recommends that all adults eat fish at least two times a week. The AHA also recommends eating plant-derived omega-3 fatty acids. http://atvb.ahajournals.org/content/23/2/151.full

Plant Sterols and Stanols

Approximate consumption of 2 g per day of plant sterol esters can decrease 9% to 20% of LDL cholesterol levels.

Significant reduction of serum total and LDL cholesterol levels found with the consumption of margarines providing 3.4 to 5.1 g a day of plant stanol esters.

Individuals with familial sitosterolemia should avoid stanol and sterol esters.

http://content.onlinejacc.org/article.aspx?articleid=1136740

Soy

Soybeans contain isoflavones which are similar to the structure female hormone estrogen. Traditionally soy products are used to treat menopausal symptoms, osteoporosis, memory

problems, high blood pressure, high cholesterol levels, breast cancer, and prostate cancer. Research suggests that daily intake of soy protein may slightly lower levels of LDL  cholesterol.http://www.ncbi.nlm.nih.gov/pubmed/17981741

Flax Seed (Linum Usitatissimum)

Flax seeds are rich in Alpha Linolenic Acid (Omega-3 fatty acid), dietary fiber, dietary lignans and natural antioxidants.

Dietary flaxseed can be recommended for CVD patients due to its antihyperlipidemic and antiplatelet actions.

http://jn.nutrition.org/content/early/2015/02/18/jn.114.204594.full.pdf

Red Yeast Rice (Monascus Purpureus)

Red yeast rice contains active constituents such as Monacolin K, Sterols (Betasitosterol, Campesterol, Stigmasterol, Sapogenin), Isoflavones and monounsaturated fatty acids.

Monacolin K has the same chemical structure as lovastatin. One study reported that some commercial red yeast rice

products elevated the levels of citrinin (Nephrotoxic mycotoxin).http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2823761/

Blond Psyllium

Patients who consume 10-12 grams of blond psyllium per day can decrease total cholesterol by 3-14% and LDL cholesterol by 5-10%.

The US Food and Drug Administration recently authorized the food products containing soluble fiber from psyllium to use health claims that their use is associated with a decreased risk of coronary heart disease.

http://ajcn.nutrition.org/content/71/2/472.long

Oat bran

Oat bran can reduce LDL cholesterol by up to 26% in some patients.

http://ajcn.nutrition.org/content/71/2/472.long

Whole Grain Foods

The FDA permits the foods containing at least 51% of whole grains (whole Wheat, whole Oats, Corn, Barley) to use health claims that they reduce the risk of coronary heart disease.

http://jama.jamanetwork.com/article.aspx?articleid=190211

Nuts

Nuts (Walnuts, Almonds, etc.) are high in arginine, magnesium, folate, plant sterols, and soluble fiber.

A Physicians’ Health Study demonstrated that consumption of nuts 2 or more times a week significantly reduced the risk of sudden cardiac death.

http://content.onlinejacc.org/article.aspx?articleid=1136740

Ginger (Zingiber officinale )

Ginger (Zingiber officinale) is one of the most commonly used dietary condiments in the world.

Gingerols are the major constituents of fresh ginger and Shogaols found abundantly in dry ginger.

Evidences are available for ginger's beneficial effect on hyperlipidemia, platelet aggregation, hypertension, inflammation and free radicals.

http://www.sciencedirect.com/science/article/pii/S0167527307016853

Garlic (Allium Sativum)

Traditionally, Garlic is used frequently as a dietary supplement for the treatment of Hyperlipidemia, Heart disease, Hypertension, Diabetes, etc.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103721/

Ginseng

Major constituents of Ginseng (Ginsenosides), are thought to possess antineoplastic, antistress, vasorelaxation, anti-inflammation and antioxidant effects.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213864/

Transcendental Meditation

http://archinte.jamanetwork.com/article.aspx?articleid=410453

Yoga

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860602/

General Nutritional Recommendations

Limit foods high in calories such as soft drinks and candy. Avoid foods high in saturated and trans fats, such as red meat,

whole milk products, and pastries. Eat a variety of fruits, vegetables, legumes, nuts, soy products,

low-fat dairy products, and whole grain breads, cereals, and pastas.

Eat baked or broiled fish at least twice per week. Choose oils and margarines low in saturated and trans fat and

high in omega-3 fat, such as canola, soybean, walnut, and flaxseed oils.

Eat less than 6 g of salt or less than 2,400 mg of sodium per day. Get atleast 30 min of exercise daily. Achieve and maintain ideal body weight.http://content.onlinejacc.org/article.aspx?articleid=1136740

Conclusion

Before considering any dietary supplement, consult with a health care provider.

Do not replace scientifically proven antihyperlipidemics with unproven health products or practices.

Read and follow the label instructions for the safe use of dietary supplements.

Always remember that dietary supplements may interact with medications or other dietary supplements.

Discuss with the health care providers about the current use of any CAM approaches.

References Hurst's The Heart, 13e

Valentin Fuster, Richard A. Walsh, Robert A. Harrington Harrison's Online

Featuring the complete contents of Harrison's Principles ofInternal Medicine, 18e Dan L. Longo, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, J. Larry Jameson, Joseph Loscalzo, Eds.

CURRENT Medical Diagnosis & Treatment 2013Maxine A. Papadakis, Stephen J. McPhee, Eds. Michael W. Rabow, Associate Ed.

Textbook of Complementary and Alternative Medicine Chun-Su Yuan, Eric J. Bieber

Evidence Based Guide to Complementary and Alternative Medicine Bradly P. Jacobs, Katherine Gundling

References https://nccih.nih.gov/health/providers/

digest/cholesterol http://circ.ahajournals.org/content/

103/16/2038.full http://www.hindawi.com/journals/

ecam/2013/672097/ http://www.ncbi.nlm.nih.gov/pmc/

articles/PMC2823761/ http://www.ncbi.nlm.nih.gov/

pubmedhealth/PMH0024707/