12 PAID CONTENT Understanding phytosterols, alternatives to cholesterol- lowering drugs Phytosterols are compounds naturally found in the cell membranes of foods from certain plants, and they have a chemical structure that’s similar to cholesterol. Because of that, they can compete with cholesterol for absorption in your gut, which may help lower LDL (bad) cholesterol in your bloodstream. You consume small amounts of phytosterols when you eat vegetable oils, nuts, seeds and whole grains. Typical daily intake of phytosterols from foods ranges between 167 to 437 milligrams. Foods containing at least 0.65 grams (650 mg) per serving of plant sterol esters, eaten twice a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease by lowering cholesterol levels. Phytosterol supplements can help you reach that daily goal. Studies have shown that, on average, phytosterol supplementation produces an average decrease in LDL cholesterol of 5 percent to 15 percent, with greater decreases shown with higher doses (2 grams per day). Notably, there is also individual variation in how much people respond to phytosterols. Genetics and other factors may play a role. For maximum benefit, it’s generally advised to take phytosterol supplements with meals and split your daily dose so you take the supplement two or three times a day. HAWTHORN BERRY This herb helps support healthy blood pressure and heart rate, as well as supporting healthy pumping function of the heart and circulation. “This is a key herb for heart health, but it should really be taken under the guidance of a doctor knowledgeable about it,” Fratellone says. “It can interact with other blood pressure medications, including beta blockers. That could result in lowering your blood pressure too much.” B VITAMINS Three B vitamins—vitamin B6, vitamin B12 and folate—help promote a healthy homocysteine level. “Homocysteine is a harmful amino acid derived from methionine in foods like eggs, meat and nuts,” Fratellone says. “To convert homocysteine into harmless products, you need enough vitamin B6, B12 and folate. If you’re deficient in any of those vitamins, your homocysteine level will be too high. Homocysteine can cause premature damage to arteries, especially the carotid arteries of the neck. That can increase stroke risk.” Fortunately, you can ask your doctor to check your homocysteine level with a simple blood test. COENZYME Q10 (COQ10) CoQ10 is a natural compound made by your body and has antioxidant actions. That’s not all. “CoQ10 is an energy generator that enhances your heart’s pumping ability,” Fratellone says. Your body naturally makes some CoQ10, but it makes a limited amount. CoQ10 is especially important to take if you’re on a statin drug. “It’s been known since the 1970s that when you take a statin drug to lower cholesterol, you deplete CoQ10,” Fratellone says. Still, some doctors may not be aware of this or don’t address this with a supplement. RED YEAST RICE This is a fermented rice supplement produced by growing red yeast (Monascus purpureus) on white rice. “Red yeast rice contains a small amount of a naturally occurring statin that lowers cholesterol,” Fratellone says. “So, it works like a statin drug by blocking an enzyme that is involved in making cholesterol.” Fratellone cautions that if you’ve had side effects from taking a statin drug, such as muscle aches and weakness, you should be cautious with red yeast rice, especially high doses (such as 2,400 mg), as you may experience side effects from the supplement, too. He encourages people to ask their doctor for a genetic test to determine their tendency for statin-induced myopathy. This will tell you if you’re more likely to have side effects from statins and red yeast rice. If you do take red yeast rice, it’s a good idea to also take CoQ10 because statins lower this important compound.