Therapeutic Foods

  • Sarah Sallee Jones


The National Cholesterol Education Program Adult Treatment Panel III (NCEP/ ATP III) recommends Therapeutic Lifestyle Changes as the cornerstone of treatment for dyslipidemia in all patients. In addition to diets for weight loss and weight maintenance, many patients can benefit from the addition of foods and supplements that directly lower serum cholesterol. In fact, many patients prefer the use of therapeutic foods over the use of pharmacologic agents because they see this as a more natural form of therapy.

It is crucial that physicians are informed about the broad range of therapeutic foods available as well as what evidence exists for the benefits or harms attributed to certain foods and supplements. This chapter explores many of the foods and supplements that are currently consumed by our patients to help control their cholesterol levels and reduce their cardiac risk. Foods that have more and generally beneficial effects are reviewed first; foods with less available...


Plant Sterol Soluble Fiber Dark Chocolate Plant Stanols Garlic Powder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Zarraga IG, Schwarz ER. Impact of dietary patterns and interventions on cardiovascular health. Circulation 2006;114(9):961–973.PubMedGoogle Scholar
  2. 2.
    Marinangeli CP, Varady KA, Jones PJ. Plant sterols combined with exercise for the treatment of hypercholesterolemia: overview of independent and synergistic mechanisms of action. J Nutr Biochem 2006;17(4):217–224.PubMedGoogle Scholar
  3. 3.
    Noakes M, Clifton PM, Doornbos AM, Trautwein EA. Plant sterol ester-enriched milk and yogurt effectively reduce serum cholesterol in modestly hypercholesterolemic subjects. Eur J Nutr 2005;44(4):214–222.PubMedGoogle Scholar
  4. 4.
    Volpe R, Niittynen L, Korpela R, Sirtori C, Bucci A, Fraone N, Pazzucconi F. Effects of yogurt enriched with plant sterols on serum lipids in patients with moderate hypercolesterolemia. Br J Nutr 2001;86(2):233–239.PubMedGoogle Scholar
  5. 5.
    Tikkanen MJ, Hogstrom P, Tuomilehto J, Keinanen-Kiukaanniemi S, Sundvall J, Karppanen H. Effect of a diet based on a low-fat foods enriched with nonesterified plant sterols and mineral nutrients on serum cholesterol. Am J Cardiol 2001;88(10):1157–1162.PubMedGoogle Scholar
  6. 6.
    Pouteau EB, Monnard IE, Piguet-Welsch C, Groux MJ, Sagalowicz L, Berger A. Non-esterified plant sterols solubilized in low fat milks inhibit cholesterol absorption—a stable isotope double-blind crossover study. Eur J Nutrition 2003;42(3):154–164.Google Scholar
  7. 7.
    Thomsen AB, Hansen HB, Christiansen C, Green H, Berger A. Effect of free plant sterols in low-fat milk on serum lipid profile in hypercholesterolemic subjects. Eur J Clin Nutr 2004;58(6):860–870.PubMedGoogle Scholar
  8. 8.
    Devaraj S, Jialal I, Vega-Lopez S. Plant sterol-fortified orange juice effectively lowers cholesterol levels in mildly hypercholesterolemic healthy individuals. Arterioscler Thromb Vasc Biol 2004;24(3):e-25–e-28.Google Scholar
  9. 9.
    Hendriks HFJ, Westrate JA, van Vliet T, Meijer GW. Spreads enriched with three different levels of vegetable oil sterols and the degree of cholesterol lowering in normocholesterolaemic and mildly hypercholesterolaemic subjects. Eur J Clin Nutr 1999;53:319–327.PubMedGoogle Scholar
  10. 10.
    Jones PJ, Ntanios FY, Raeini-Sarjaz M, Vanstone CA. Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men. Am J Clin Nutr 1999;69:1144–1150.PubMedGoogle Scholar
  11. 11.
    Miettinen TA, Puska P, Gylling H, Vanhanen H, Vartianinen E. Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N Engl J Med 1995;333:1308–1312.PubMedGoogle Scholar
  12. 12.
    Jones PJ, Raeini-Sarjaz M, Ntanios FY, Vanstone CA, Feng JY, Parsons WE. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. J Lipid Res 2000;41:697–705.PubMedGoogle Scholar
  13. 13.
    Gylling H, Miettinen TA. Cholesterol reduction by different plant stanol mixtures and with variable fat intake. Metabolism 1999;48:575–580.PubMedGoogle Scholar
  14. 14.
    Lichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association nutrition committee. Circulation 2006;113:82–96.Google Scholar
  15. 15.
    Amundsen AL, Ntanios F, Put N, Ose L. Long-term compliance and changes in plasma lipids, plant sterols and carotenoids in children and parents with FH consuming plant sterol ester-enriched spread. Eur J Clin Nutr 2004;58(12):1612–1620.PubMedGoogle Scholar
  16. 16.
    Sierksma A, Weststrate JA, Meijer GW. Spreads enriched with plant sterols, either esterified 4,4-dimethylsterols or free 4-desmethylsterols, and plasma total- and LDL-cholesterol concentrations. Br J Nutr 1999;82:273–282.PubMedGoogle Scholar
  17. 17.
    Christiansen LI, Lahteenmake PL, Mannelin MR, Seppanen-Laakso TE, Hiltunen RV, Yliruusi K. Cholesterol-lowering effect of spreads enriched with microcrystalline plant sterols in hypercholesterolemic subjects. Eur J Clin Nutr 2001;40(2):66–73.Google Scholar
  18. 18.
    Korpela R, Tuomilehto J, Hogstrom P, et al. Safety aspects and cholesterol-lowering efficacy of low fat dairy products containing plant sterols. Eur J Clin Nutr 2006;60(5):633–642.PubMedGoogle Scholar
  19. 19.
    Vau VW, Journoud M, Jones PJ. Plant sterols are efficacious in lowering plasma LDL and non-HDL cholesterol in hypercholesterolemic type 2 diabetic and nondiabetic persons. Am J Clin Nutr 2005;81(6):1351–1358.Google Scholar
  20. 20.
    de Jongh S, Vissers MN, Rol P, et al. Plant sterols lower LDL cholesterol without improving endothelial function in prepubertal children with familial hypercholesterolemia. J Inherit Metab Dis 2003;26(4):343–351.PubMedGoogle Scholar
  21. 21.
    Amundsen AL, Ntanios F, Put N, et al. Long-term compliance and changes in plasma lipids, plant sterols and carotenoids in children and parents with FH consuming plant sterol ester-enriched spread. Eur J Clin Nutr 2004;58(12):1612–1620.PubMedGoogle Scholar
  22. 22.
    Moruisi KG, Oosthuizen W, Opperman AM. Phytosterols/stanols lower cholesterol concentrations in familial hypercholesterolemic subjects: a systematic review with meta-analysis. J Am Coll Nutr 2006;25(1):41–48.PubMedGoogle Scholar
  23. 23.
    O’Neill FH, Brynes A, Mandeno R, et al. Comparison of the effects of dietary plant sterol and stanol esters on lipid metabolism. Nutr Metab Cardiovasc Dis 2004;14(3):133–142.PubMedGoogle Scholar
  24. 24.
    Miettinen TA, Gylling H. Plant stanol and sterol esters in prevention of cardiovascular diseases. Ann Med 2004;36(2):126–134.PubMedGoogle Scholar
  25. 25.
    Goldberg AC, Ostlund RE, Bateman JH, et al. Effect of plant stanol tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs. Am J Cardiol 2006;97(3): 376–379.PubMedGoogle Scholar
  26. 26.
    Thompson GR. Additive effects of plant sterol and stanol esters to statin therapy. Am J Cardiol 2005;96(1A):37D–39D.PubMedGoogle Scholar
  27. 27.
    Cater NM, Garcia-Garcia AB, Vega GL, et al. Responsiveness of plasma lipids and lipoproteins to plant stanol esters. Am J Cardiol 2005;96(1A):23D–28D.PubMedGoogle Scholar
  28. 28.
    Katan MB, Grundy SM, Jones P, et al. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clinic Proc 2003;78(8):965–978.Google Scholar
  29. 29.
    Jakulj L, Trip MD, Sudhop T, et al. Inhibition of cholesterol absorption by the combination of dietary plant sterols and ezetimibe: effects on plasma lipid levels. J Lipid Res 2005;46(12):2692–2698.PubMedGoogle Scholar
  30. 30.
    Grundy SM. Stanol esters as a component of maximal dietary therapy in the National Cholesterol Education Program Adult Treatment Panel III Report. Am J Cardiol 2005;96(1A): 47D–50D.PubMedGoogle Scholar
  31. 31.
    Patch CS, Tapsell LC, Williams PG. Plant sterol/stanol prescription is an effective treatment strategy for managing hypercholesterolemia in outpatient clinical practice. J Am Diet Assoc 2005;105(1):46–52.PubMedGoogle Scholar
  32. 32.
    Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico (GISSI)-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione Trial. Lancet 1999; 354: 447–455.Google Scholar
  33. 33.
    Marchioli R, Barzi F, Bomba E, et al., on behalf of the GISSI-Prevenzione Investigators. Early protection against sudden death by n-3 fatty acids after myocardial infarction: time course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico (GISSI)-Prevenzione. Circulation 2002;105:1897–1903.PubMedGoogle Scholar
  34. 34.
    Macchia A, Levantesi G, Franzosi MG, et al. Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n-3 polyunsaturated fatty acids. Eur J Heart Fail 2005;7:904–909.PubMedGoogle Scholar
  35. 35.
    Singh RB, Niaz MA, Sharma JP, et al. Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival. Cardiovasc Drugs Ther 1997;11:485–491.PubMedGoogle Scholar
  36. 36.
    Yokoyama M, Origasa H, for the JELIS Investigators. Effects of eicosapentaenoic acid on cardiovascular events in Japanese patients with hypercholesterolemia: rationale, design, and baseline characteristics of the Japan EPA Lipid Intervention Study (JELIS). Am Heart J 2003;146:613–620.PubMedGoogle Scholar
  37. 37.
    Jacobson TA. Secondary prevention of coronary artery disease with omega-3 fatty acids. Am J Cardiol 2006;98(suppl):61i–70i. Accessed from 6 Sep 06.Google Scholar
  38. 38.
    Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fiber intake on death and myocardial infarction: Diet and Reinfarction Trial (DART). Lancet 1989;334: 757–761.Google Scholar
  39. 39.
    Albert CM, Gaziano MJ, Willet WC, et al. Nut consumption and decreased risk of sudden cardiac death in the Physicians’ Health Study. Arch Intern Med 2002;162:1382–1387.PubMedGoogle Scholar
  40. 40.
    Studer M, Brief M, Leimenstoll B, et al. Effect of different antilipidemic agents and diets on mortality: a systematic review. Arch Intern Med 2005;165:725–730.PubMedGoogle Scholar
  41. 41.
    Bucher HC, Hengstler P, Schindler C, et al. n-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med 2002;112:298–304.PubMedGoogle Scholar
  42. 42.
    Nilsen DW, Albrektsen G, Landmark K, et al. Effects of a high-dose concentrate of n-3 fatty acids or corn oil introduced early after an acute myocardial infarction on serum triacylglycerol and HDL cholesterol. Am J Clin Nutr 2001;74:50–56.PubMedGoogle Scholar
  43. 43.
    Siscovick DS, Raghunathan T, King I, et al. Dietary intake of long-chain omega-3 polyunsaturated fatty acids and risk of primary cardiac arrest. Am J Clin Nutr 2000;71(suppl): 208S–212S.PubMedGoogle Scholar
  44. 44.
    Leaf A, Xiao YF, Kang JX, et al. Prevention of sudden cardiac death by omega-3 polyunsaturated fatty acids. Pharmacol Ther 2003;98:355–377.PubMedGoogle Scholar
  45. 45.
    Hooper L, Thompson RL, Harrison RA, et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ 2006;332:752–760.PubMedGoogle Scholar
  46. 46.
    Calo L, Bianconi L, Colivicchi F, et al. n-3 fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. J Am Coll Cardiol 2005;45:1723–1728.PubMedGoogle Scholar
  47. 47.
    Brouwer IA, Zock PL, Wever EF, et al. Rationale and design of a randomized controlled clinical trial on supplemental intake of omega-3 fatty acids and incidence of cardiac arrhythmia: SOFA. Eur J Clin Nutr 2003;57:1323–1330.PubMedGoogle Scholar
  48. 48.
    Leaf A, Albert CM, Josephson M, et al., for the Fatty Acid Antiarrhythmia Trial Investigators. Prevention of fatal arrhythmias in high-risk subjects by fish oil n-3 fatty acid intake. Circulation 2005;112:2762–2768.PubMedGoogle Scholar
  49. 49.
    Raitt MH, Connor WE, Morris C, et al. Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized controlled trial. JAMA 2005;293:2884–2891.PubMedGoogle Scholar
  50. 50.
    Leaf A, Kang JX, Xiao YF, et al. n-3 fatty acids in the prevention of cardiac arrhythmias. Lipids 1999;34(suppl):S187–S189.PubMedGoogle Scholar
  51. 51.
    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001; 285:2486–2497.Google Scholar
  52. 52.
    US Food and Drug Administration, Center for Food Safety and Applied Nutrition. Letter regarding dietary supplement health claim for omega-3 fatty acids and coronary heart disease. October 31, 2000. [∼dms/dr-ltr11.html.]
  53. 53.
    Kris-Etherton PM, Harris WS, Appel LJ, for the Nutrition Committee. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002;106:2747–2757.PubMedGoogle Scholar
  54. 54.
    Scandale S, Lee DT, Harris WS. Omega-3 fatty acids: fish oil use in primary care practice. Fam Pract Recert 2006;28:20–31.Google Scholar
  55. 55.
    Harris WS. Fish oil supplementation: evidence for health benefits. Clevel Clin J Med 2004;71:208–221.Google Scholar
  56. 56., accessed 6 October 2006.
  57. 57.
    Kris-Etherton PM, Derr JA, Mustad VA, Seligson FH, Pearson TA. Effects of a milk chocolate bar per day substituted for a high-carbohydrate snack in young men on an NCEP/AHA Step 1 Diet. Am J Clin Nutr 1994;60(6 suppl):1037S–1042S.PubMedGoogle Scholar
  58. 58.
    Wan Y, Vinson JA, Etherton TD, et al. Effects of coca powder and dark chocolate on LDL oxidative susceptibility and prostaglandin concentrations in humans. Am J Clin Nutr 2001;74(5):596–602.PubMedGoogle Scholar
  59. 59.
    De Graaf J, De Sauvage Nolting PR, Van Dam M, et al. Consumption of tall oil-derived phytosterols in a chocolate matrix significantly decreases plasma total and low-density lipoprotein-cholesterol levels. Br J Nutr 2002;88(5):479–488.PubMedGoogle Scholar
  60. 60.
    Mursu J, Voutilainen S, Nurmi T, et al. Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans. Free Radic Biol Med 2004;37(9):1351–1359.PubMedGoogle Scholar
  61. 61.
    Ding EL, Hutfless SM, Ding X, et al. Chocolate and prevention of cardiovascular disease: a systematic review. Nutr Metab 2006;3:1–12. Accessed from http://www. on 16 Sep 06.Google Scholar
  62. 62.
    Hirano R, Osakabe N, Iwamoto A, et al. Antioxidant effects of polyphenols in chocolate on low-density lipoprotein both in vitro and ex vivo. J Nutr Sci Vitaminol 2000;46(4):199–204.PubMedGoogle Scholar
  63. 63.
    Mensink RP, Zock PL, Kester AD, et al. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003;77:1146–1155.PubMedGoogle Scholar
  64. 64.
    Franco OH, Bonneux L, de Laet C, et al. The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75 percent. BMJ 2004;329:1447–1450.PubMedGoogle Scholar
  65. 65.
    Jenkins DJ, Kendall CW, Vuksan V, et al. Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial. Am J Clin Nutr 2002;75(5):834–839.PubMedGoogle Scholar
  66. 66.
    Brown L, Rosner B, Willett WW, et al. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 1999;69(1):30–42.PubMedGoogle Scholar
  67. 67.
    Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: a meta-analysis of 8 controlled trials. Am J Clin Nutr 2000;71(2):472–479.PubMedGoogle Scholar
  68. 68.
    Aller R, de Luis DA, Izaola O, et al. Effect of soluble fiber intake in lipid and glucose levels in healthy subjects: a randomized clinical trial. Diabetes Res Clin Pract 2004;65(1):7–11.PubMedGoogle Scholar
  69. 69.
    Olson BH, Anderson SM, Becker MP, et al. Psyllium-enriched cereals lower blood total cholesterol and LDL cholesterol, but not HDL cholesterol, in hypercholesterolemic adults: results of a meta-analysis. J Nutr 1997;127(10):1973–1980.PubMedGoogle Scholar
  70. 70.
    Bell LP, Hectorn KJ, Reynolds H, et al. Cholesterol-lowering effects of soluble fiber cereals as part of a prudent diet for patients with mild to moderate hypercholesterolemia. Am J Clin Nutr 1990;52(6):1020–1026.PubMedGoogle Scholar
  71. 71.
    Williams CL, Bollella M, Spark A, et al. Soluble fiber enhances the hypocholesterolemic effect of the step I diet in childhood. J Am Coll Nutr 1995;14(3):251–257.PubMedGoogle Scholar
  72. 72.
    Behall KM, Scholfield DJ, Hallfrisch J. Lipids significantly reduced by diets containing barley in moderately hypercholesterolemic men. J Am Coll Nutr 2004;23(1):55–62.PubMedGoogle Scholar
  73. 73.
    Behall KM, Scholfield DJ, Hallfrisch J. Diets containing barley significantly reduce lipids in mildly hypercholesterolemic men and women. Am J Nutr 2004;80(5):1185–1193.Google Scholar
  74. 74.
    Moreyra AE, Wilson AC, Koraym A. Effect of combining psyllium fiber with simvastatin in lowering cholesterol. Arch Intern Med 2005;165(10):1161–1166.PubMedGoogle Scholar
  75. 75.
    Karmally W, Montez MG, Palmas W, et al. Cholesterol-lowering benefits of oat-containing cereal in Hispanic Americans. J Am Diet Assoc 2005;105(6):967–970.PubMedGoogle Scholar
  76. 76.
    Chen J, He J, Wildman RP, et al. A randomized controlled trial of dietary fiber intake on serum lipids. Eur J Clin Nutr 2006;60(1):62–68.PubMedGoogle Scholar
  77. 77.
    Carmago CA, Stampher MJ, Glynn RJ, et al. Moderate alcohol consumption and risk for angina pectoris and myocardial infarction in male US physicians. Ann Intern Med 1997;126:372–375.Google Scholar
  78. 78.
    Renaud SC, Guegen R, Siest G, et al. Wine, beer, and mortality in middle-aged men for Eastern France. Arch Intern Med 1999;159:1865–1870.PubMedGoogle Scholar
  79. 79.
    Klatsky AL, Armstrong MA, Friedman GD. Alcohol and mortality. Ann Intern Med 1992;117:646–654.PubMedGoogle Scholar
  80. 80.
    Gronbaek M, Becker U, Johansen D, et al. Type of alcohol consumed and mortality from all causes, coronary disease and cancer. Ann Intern Med 2000;133:411–419.PubMedGoogle Scholar
  81. 81.
    Di Catelnuovo A, Rotondo S, Iacoviello L, et al. Meta-analysis of wine and beer consumption in relation to vascular risk. Circulation 2002;105:2836–2844.Google Scholar
  82. 82.
    St Leger AS, Cochrane AL, Moore F. Factors associated with cardiac mortality in developed countries with particular reference to consumption of wine. Lancet 1979;12:1017–1020.Google Scholar
  83. 83.
    Groenback M, Deis A, Sorensen T, et al. Mortality associated with moderate intakes of wine, beer or spirits. BMJ 1995;310:1165.Google Scholar
  84. 84.
    Goldfinger TM. Beyond the French Paradox: the impact of moderate alcohol and wine consumption in the prevention of cardiovascular disease. Cardiol Clin 2003;21:449–457.PubMedGoogle Scholar
  85. 85.
    Maxwell S, Cruickshank A, Thorpe G. Red wine and antioxidant activity in serum. Lancet 1994;344:193–194.PubMedGoogle Scholar
  86. 86.
    Erdman JW. Soy protein and cardiovascular disease: a statement for healthcare professionals from the nutrition committee of the AHA. Circulation 2000;102;2555–2559.PubMedGoogle Scholar
  87. 87.
    Protein Technologies International. Soy protein and health: discovering a role for soy protein in the fight against coronary heart disease. Houston, TX: Marimac Communications, 1996.Google Scholar
  88. 88.
    Carroll KK, Kurowska EM. Soy consumption and cholesterol reduction: review of animal and human studies. J Nutr 1995;125(suppl):594S–597S.PubMedGoogle Scholar
  89. 89.
    Potter SM. Soy protein and cardiovascular disease: the impact of bioactive components in soy. Nutr Rev 1998;56(8):231–235.PubMedGoogle Scholar
  90. 90.
    Anderson JW, Johnstone BM, Cook-Newell ME. Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med 1995;333:276–282.PubMedGoogle Scholar
  91. 91.
    Sacks FM, Lichtenstein A, Van Horn L, et al. Soy protein, isoflavones, and cardiovascular health: an American Heart Association science advisory for professionals from the Nutrition Committee. Circulation 2006;113:1034–1044.PubMedGoogle Scholar
  92. 92.
    Chait A, Brunzell JD, Denke MA, et al. Rationale of the diet–heart statement of the American Heart Association: report of the Nutrition Committee. Circulation 1993;88: 3008–3029.PubMedGoogle Scholar
  93. 93.
    Food and Drug Administration. Food labeling: health claims: soy protein and coronary heart disease. 21 CFR Part 101. Fed Reg 1999; 64:57700–57733.Google Scholar
  94. 94.
    Dewell A, Hollenbeck PL, Hollenbeck CB. Clinical review: a critical evaluation of the role of soy protein and isoflavone supplementation in the control of plasma cholesterol concentrations. J Clin Endocrinol Metab 2006;91(3):772–780.PubMedGoogle Scholar
  95. 95.
    Ma Y, Chiriboga D, Olendzki BC, et al. Effect of soy protein containing isoflavones on blood lipids in moderately hypercholesterolemic adults: a randomized controlled trial. J Am Coll Nutr 2005;24(4):275–285.PubMedGoogle Scholar
  96. 96.
    Hermansen K, Hansen B, Jacobsen R, et al. Effects of soy supplementation on blood lipids and arterial function in hypercholesterolemic subjects. Eur J Clin Nutr 2005;59(7):843–850.PubMedGoogle Scholar
  97. 97.
    West SG, Hilpert KF, Juturu V, et al. Effects of including soy protein in a blood cholesterol-lowering diet on markers of cardiac risk in men and in postmenopausal women with and without hormone replacement therapy. J Women’s Health 2005;14(3):253–262.Google Scholar
  98. 98.
    Cuevas AM, Irribarra VL, Castillo OA, Yanez MD, Germain AM. Isolated soy protein improves endothelial function in postmenopausal hypercholesterolemic women. Eur J Clin Nutr 2003;57(8):889–894.PubMedGoogle Scholar
  99. 99.
    Zhan S, Ho SC. Meta-analysis of the effects of soy protein containing isoflavones on the lipid profile. Am J Clin Nutr 2005;81:397–408.PubMedGoogle Scholar
  100. 100.
    Zhuo XG, Melby MK, Watanabe S. Soy isoflavone intake lowers serum LDL cholesterol: a meta-analysis of 8 randomized controlled trials in humans. J Nutr 2004;134(9):2395–2400.PubMedGoogle Scholar
  101. 101.
    Dunn AV. Incorporating soy protein into a low-fat, low-cholesterol diet. Clevel Clin J Med 2000;67(10):767–772.Google Scholar
  102. 102.
    Caron MF, White CM. Evaluation of the antihyperlipidemic properties of dietary supplements. Pharmacotherapy 2001;21(4):481–487.PubMedGoogle Scholar
  103. 103.
    Havel RJ. Dietary supplement or drug? The case of Cholestin. Am J Clin Nutr 1999;69: 175–176.PubMedGoogle Scholar
  104. 104.
    Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231–236.PubMedGoogle Scholar
  105. 105.
    Heber D, Lembertas A, Lu Q, et al. An analysis of nine proprietary Chinese red yeast rice dietary supplements: implications of variability in chemical profile and contents. J Altern Complement Med 2001;7(2):133-139.PubMedGoogle Scholar
  106. 106.
    Spigelski D, Jones PH. Efficacy of garlic supplementation in lowering serum cholesterol levels. Nutr Rev 2001;59:236–244.PubMedGoogle Scholar
  107. 107.
    Williams MJ, Sutherland WH, McCormick MP, Yeoman DJ, deJong SA. Aged garlic extract improves endothelial function in men with coronary artery disease. Phytother Res 2005;19(4):314–319.PubMedGoogle Scholar
  108. 108.
    Mader FH. Treatment of hyperlipidaemia with garlic-powder tablets. Evidence from the German Association of General Practitioners’ multicentric placebo-controlled double-blind study. Arzneim-Forsch 1990;40(10):1111–1116.Google Scholar
  109. 109.
    De ASOS, Grunwald J. Effect of garlic powder tablets on blood lipids and blood pressure—a six month placebo controlled, double-blind study. Br J Clin Res 1993;4:37–44.Google Scholar
  110. 110.
    Simons LA, Balasubramaniam S, von Konigsmark M, Parfitt A, Simons J, Peters W. On the effect of garlic on plasma lipids and lipoproteins in mild hypercholesterolemia. Atherosclerosis 1995;113(2):219–225.PubMedGoogle Scholar
  111. 111.
    Stevinson C, Pittler MH, Ernst E. Garlic for treating hypercholesterolemia. A meta-analysis of randomized clinical trials. Ann Intern Med 2000;133(6):420–429.PubMedGoogle Scholar
  112. 112.
    Superko HR, Krauss RM. Garlic powder, effect on plasma lipids, postprandial lipemia, low-density lipoprotein particle size, high-density lipoprotein subclass distribution and lipoprotein (a). J Am Coll Cardiol 2000;35(2):321–326.PubMedGoogle Scholar
  113. 113.
    Isaacsohn JL, Moser M, Stein EA, et al. Garlic powder and plasma lipids and lipoproteins: a multicenter, randomized, placebo-controlled trial. Arch Intern Med 1998;158(11): 1189–1194.PubMedGoogle Scholar
  114. 114.
    Berthold HK, Sudhop T, von Bergmann K. Effect of a garlic oil preparation on serum lipoproteins and cholesterol metabolism: a randomized controlled trial. JAMA 1998;279(23):1900–1902.PubMedGoogle Scholar
  115. 115.
    Peleg A, Hershcovici T, Lipa R, et al. Effect of garlic on lipid profile and psychopathologic parameters in people with mild to moderate hypercholesterolemia. Isr Med Assoc J 2003;5(9):637–640.PubMedGoogle Scholar
  116. 116.
    Jain AK, Vargas R, Gotzkowsky S, et al. Can garlic reduce levels of serum lipids? A controlled clinical study. Am J Med 1993;94(6):632–635.PubMedGoogle Scholar
  117. 117.
    Turner B, Molgaard C, Marckmann P. Effect of garlic (Allium sativum) powder tablets on serum lipids, blood pressure, and arterial stiffness in normolipidemic volunteers; a randomized, double-blind, placebo-controlled trial. Br J Nutr 2004;92(4):701–706.PubMedGoogle Scholar
  118. 118.
    Lau BH. Suppression of LDL oxidation by garlic. J Nutr 2001;131(3s):985S–988S.PubMedGoogle Scholar
  119. 119.
    Review: High-dose vitamin E supplementation is associated with increased all-cause mortality. ACP J Club 2005;143(1):1.Google Scholar
  120. 120.
    Vitamin E reduced the risk of cardiovascular events in coronary atherosclerosis. ACP J Club 1996;125:15.Google Scholar
  121. 121.
    Hodis HN, Mack WJ, LaBree L, et al. Alpha-tocopherol supplementation in healthy individuals reduces low-density lipoprotein oxidation but not atherosclerosis: the Vitamin E Atherosclerosis Prevention Study (VEAPS). Circulation 2002;106(12):1453–1459.PubMedGoogle Scholar
  122. 122.
    de Waart FG, Moser U, Kok FJ. Vitamin E supplementation in elderly lowers the oxidation rate of linoleic acid in LDL. Atherosclerosis 1997;133(2):255–263.PubMedGoogle Scholar
  123. 123.
    Stampfer MJ, Willett W, Castelli WP, Taylor JO, Fine J, Hennekens CH. Effect of vitamin E on lipids. Am J Clin Pathol 1983;79(6):714–716.PubMedGoogle Scholar
  124. 124.
    Meydani SN, Meydani M, Rall LC, Morrow F, Blumberg JB. Assessment of the safety of high-dose, short-term supplementation with vitamin E in healthy older adults. Am J Clin Nutr 1994;60(5):704–709.PubMedGoogle Scholar
  125. 125.
    Mensink RP, van Houwelingen AC, Kromhout D, Hornstra G. A vitamin E concentrate rich in tocotrienols had no effect on serum lipids, lipoproteins, or platelet function in men with mildly elevated serum lipid concentrations. Am J Clin Nutr 1999;69(2): 21321–21329.Google Scholar
  126. 126.
    Micheletta F, Natoli S, Misuraca M, et al. Vitamin E supplementation in patients with carotid atherosclerosis: reversal of altered oxidative stress status in plasma but not in plaque. Arterioscler Thromb Vasc Biol 2004;24(1):136–140.PubMedGoogle Scholar
  127. 127.
    Kris-Etherton PM, Lichtenstein AH, Howard BV, et al. AHA Scientific Advisory: antioxidant vitamin supplements and cardiovascular disease. Circulation 2004;110:637–641.PubMedGoogle Scholar
  128. 128.
    Bleske BE, Willis RA, Anthony M, Casselberry N, Datwani M, Uhley VE, Secontine SG, Shea MJ. The effect of pravastatin and atorvastatin on coenzyme Q10. Am Heart J 2001;142(2):E2.PubMedGoogle Scholar
  129. 129.
    Mortensen SA, Leth A, Agner E, et al. Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Aspects Med 1997;18(suppl): S137–S144.PubMedGoogle Scholar
  130. 130.
    Strey CH, Young JM, Molyneux SL, George PM, Florkowski CM, Scott RS, Framton CM. Endothelium-ameliorating effects of statin therapy and coenzyme Q10 reductions in chronic heart failure. Atherosclerosis 2005;179(1):201–206.PubMedGoogle Scholar
  131. 131.
    Human JA, Ubbink JB, Jerling JJ, et al. The effect of simvastatin on the plasma antioxidant concentrations in patients with hypercholesterolemia. Clin Chim Acta 1997;263(1):67–77.PubMedGoogle Scholar
  132. 132.
    Hargreaves IP. Ubiquinone: cholesterol’s reclusive cousin. Ann Clin Biochem 2003;40: 207–218.PubMedGoogle Scholar
  133. 133.
    Laaksonen R, Jokelainen K, Laakso J, et al. The effect of simvastatin treatment on natural antioxidants in low-density lipoproteins and high-energy phosphates and ubiquinone in skeletal muscle. Am J Cardiol 1996;77(1):851–854.PubMedGoogle Scholar
  134. 134.
    Palomaki A, Malminiemi K, Solakivi T, et al. Ubiquinone supplementation during lovastatin treatment: effect on LDL oxidation ex vivo. J Lipid Res 1998;39(7):1430–1437.PubMedGoogle Scholar
  135. 135.
    Singh RB, Niaz MA. Serum concentration of lipoprotein(a) decreased on treatment with hydrosoluble coenzyme Q10 in patients with coronary artery disease: discovery of a new role. Int J Cardiol 1999;68(1):23–29.PubMedGoogle Scholar
  136. 136.
    Singh RB, Niaz MA, Rastogi SS, et al. Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease. J Hum Hypertens 1999;13(3):203–208.PubMedGoogle Scholar
  137. 137.
    Cicero AF, Deorsa G, Miconi A, et al. Treatment of massive hypertriglyceridemia resistant to PFUA and fibrates: a possible role for the coenzyme Q10? Biofactors 2005;23(1):7–14.PubMedGoogle Scholar
  138. 138.
    Woo KS, Chook P, Lolin YI, et al. Folic acid improves arterial endothelial function in adults with hyperhomocystinemia. J Am Coll Cardiol 1999;34(7):2002–2006.PubMedGoogle Scholar
  139. 139.
    Liem A, Reynierse-Buitenwerf GH, Zwinderman AH, et al. Secondary prevention with folic acid: effects on clinical outcomes. J Am Coll Cardiol 2003;41(12):2105–2113.PubMedGoogle Scholar
  140. 140.
    Williams C, Kingwell BA, Burke K, et al. Folic acid supplementation for 3 weeks reduces pulse pressure and large artery stiffness independent of MTHFR (methylenentetrahydrofolate reductase) genotype. Am J Clin Nutr 2005;82(1):26–31.PubMedGoogle Scholar
  141. 141.
    Homocysteine Studies Collaboration. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA 2002;288:2015–2022.Google Scholar
  142. 142.
    Liem AH, van Boven AJ, Veeger NJ, et al. Efficacy of folic acid when added to statin therapy in patients with hypercholesterolemia following acute myocardial infarction: a randomized pilot trial. Int J Cardiol 2004;93(2-3):175–179.PubMedGoogle Scholar
  143. 143.
    Lekakis JP, Papamichael CM, Papaioannou TG, et al. Oral folic acid enhances endothelial function in patients with hypercholesterolemia receiving statins. Eur J Cardiovasc Prev Rehabil 2004;11(5):416–420.PubMedGoogle Scholar
  144. 144.
    The Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med 2006;354:1567–1577.Google Scholar
  145. 145.
    Bønaa KH, Njølstad I, Ueland PM, et al. Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med 2006;354:1778–1788.Google Scholar
  146. 146.
    Verhaar MC, Wever RM, Kastelein JJ, et al. Effects of oral folic acid supplementation on endothelial function in familial hypercholesterolemia. A randomized placebo-controlled trial. Circulation 1999;100(4):335–338.PubMedGoogle Scholar
  147. 147.
    Gupta A, Gupta R, Lal B. Effect of Trigonella foenum-graecum (fenugreek) seeds on glycemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study. J Assoc Phys India 2001;49:1057–1061.Google Scholar
  148. 148.
    Thompson C, Joanna S, Ernst E. Herbs for serum cholesterol reduction: a systematic review. J Fam Pract 2003;52(6):468–478.Google Scholar
  149. 149.
  150. 150.
    Pittler MH, Thompson Coon J, Ernst E. Artichoke leaf extract for treating hypercholesterolemia. Cochrane Database Syst Rev 2006;2.Google Scholar
  151. 151.
    Englisch W, Beckers C, Unkauf M, et al. Efficacy of artichoke dry extract in patients with hyperlipoproteinemia. Arzneim-Forsch 2000;50(3):260–265.Google Scholar
  152. 152.
    Lupattelli G, Marchesi S, Lombardini R, Roscini AR, Trinca F, Gemelli F, Vaudo G, Mannarino E. Artichoke juice improves endothelial function in hyperlipemia. Life Sci 2004;76(7):775–782.PubMedGoogle Scholar
  153. 153.
    Szapary PO, Wolfe ML, Bloedon LT, et al. Guggulipid for the treatment of hypercholesterolemia: a randomized controlled trial. JAMA 2003;290(6):765–772.PubMedGoogle Scholar
  154. 154.
    Ulbrict C, Basch E, Szapary P, et al. Guggul for hyperlipidemia: a review by the Natural Standard Research Collaboration. Complement Ther Med 2005;13(4):279–290.Google Scholar
  155. 155.
    Guimarae PR, Galvao AM, Batista CM, et al. Eggplant (Solanum melongena) infusion has a modest and transitory effect on hypercholesterolemic subjects. Braz J Med Biol Res 2000;33(9):1027–1036.Google Scholar
  156. 156.
    Silva GE, Takahashi MH, Eik Filho W, et al. Absence of hypolipidemic effect of Solanum melongena (eggplant) on hyperlipidemic patients. Arq Bras Endocrinol Metabol 2004;48(3):368–373.PubMedGoogle Scholar
  157. 157.
    Praca JM, Thomaz A, Caramelli B. Eggplant (Solanum melongena) extract does not alter serum lipid levels. Arq Bras Cardiol 2004;82(3):269–276.PubMedGoogle Scholar
  158. 158.
    Botanical Pathways. Downloaded on 16 Nov 06.Google Scholar
  159. 159.
    Agrawal P, Rai V, Singh RB. Randomized placebo-controlled, single blind trial of holy basil leaves in patients with noninsulin-dependent diabetes mellitus. Int J Clin Pharmacol Ther 1996;34:406–409.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Sarah Sallee Jones
    • 1
  1. 1.Associate Program Director, Family Medicine Residency, Department of Family MedicineDavid Grant Medical CenterCA

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