Cholesterol-Lowering Supplements: What Works, What Doesn’t

If you’re looking for an all-natural way to lower your cholesterol—in addition to watching what you eat and exercising—there are plenty of dietary supplements on the market that claim to do the trick. Each year seems to bring a new alternative remedy—garlic, ginseng, or red yeast rice, for example—that users tout as the next best thing to get cholesterol under control.

But just because your Uncle Jack says a supplement worked miracles on his cholesterol doesn’t mean it will work for you. In fact, his success may be due to a placebo effect or a diet overhaul he neglected to mention.

Though not always perfect, scientific studies are the best way to determine if nonprescription remedies really work. Below, we break down what the research does—and doesn’t—say about the benefits of the most popular alternative remedies for lowering cholesterol.

To see what these supplements look like, view this slideshow.

Artichoke leaf extract

• What it is: The dried extract of the artichoke leaf is also known as Cynara scolymus.

• The evidence: In 2000, German researchers performed a randomized, double-blind, placebo-controlled trial using nearly 150 adults with total cholesterol over 280—well into what the American Heart Association (AHA) considers “high risk” territory. The participants who took an artichoke supplement for six weeks saw their levels of low-density lipoprotein (LDL), or bad cholesterol, fall by 23%, on average, compared to just 6% in the placebo group.

These are promising numbers, but they haven’t been replicated. A more recent, three-month trial of similar design found that total cholesterol fell by an average of 4% among participants taking artichoke leaf extract, but the researchers found no measurable impact on either LDL or high-density lipoprotein (HDL), also known as good cholesterol. They suggested that differences in the health of the participants and the potency of the supplements—the patients in the second study received a dose about 30% smaller—could explain the discrepancy between the results of the two studies.

• The bottom line: There have been very few quality studies conducted on artichoke leaf extract, and the mixed results suggest that more evidence is needed to confirm its effect on cholesterol. Don’t expect your LDL to plummet if you take artichoke supplements.

Fenugreek

• What it is: Fenugreek is a seed (often ground into a powder) that has been used since the days of ancient Egypt and is available in capsule form.

• The evidence: Several studies from the 1990s have reported that, in high doses, various fenugreek seed preparations can lower total cholesterol and LDL, in some cases dramatically. (One study recorded an LDL drop of 38%.) Almost without exception, however, the studies have been small and of poor quality, which casts some doubt on the validity of the results.

Fenugreek contains a significant amount of dietary fiber (anywhere from 20% to 50%, analyses have shown), and some experts speculate that the purported cholesterol-lowering effect of fenugreek may in fact be attributed largely to its fiber content.

• The bottom line: Despite the studies frequently cited as proof of fenugreek’s ability to lower cholesterol, there is not enough evidence to support its use.

Fiber

• What it is: Soluble fiber is a type of dietary fiber found in oats, barley, bran, peas, and citrus fruits, as well as in dietary supplements. (Though it is good for the heart in other ways, insoluble fiber does not affect blood cholesterol.)

• The evidence: In 1999, a team of Harvard Medical School researchers conducted a meta-analysis of nearly 70 clinical trials that examined the effect of soluble fiber on cholesterol levels. High soluble fiber intake was associated with reductions in both LDL and total cholesterol in 60% to 70% of the studies they examined. For each gram of soluble fiber that the participants of the various studies added to their daily diet, their LDL levels fell by about 2 points. (The average time frame was seven weeks.)

The amount of fiber you’d need to eat to significantly lower your LDL is a bit unwieldy. Most people eat far less than the 25 grams of dietary fiber recommended as a minimum by most health organizations—and only about 20% of your total fiber intake is likely to be soluble. (Eating three bowls of oatmeal a day will only yield about 3 grams of soluble fiber, according to the Harvard researchers.) Taking daily fiber supplements can help, but they can cause some gastrointestinal side effects if taken regularly and can interfere with some prescription medications.

• The bottom line: A diet high in soluble fiber can lower your LDL. The effect is likely to be relatively modest, however, and loading up on soluble fiber may be impractical.

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Breast Cancer During Pregnancy: What You Need to Know

You may not recognize the name Kerryn McCann, but it's all over the news this week. McCann was an award-winning Australian runner, age 41, who died Monday from breast cancer that spread to her liver and brain. Sadly, about 1.3 million women will be diagnosed with breast cancer worldwide this year, and 465,000 women will die from it—McCann is just one of many. The twist on the story is that she discovered her breast lump while pregnant, and initially she thought it was nothing.

Breasts can do all sorts of strange things during pregnancy: They blow up, they get tender and lumpy, they squirt mysterious substances. For many women, pregnancy boobs are a downright strange experience. When I was pregnant, it was the first time I had a generous bosom, and I poked my boobs every now and then to see if they were real. What I didn't do was check them to make sure they were healthy.

Like McCann, I figured breast changes during pregnancy were normal. And they usually are. Breast cancer during pregnancy is quite rare. In the United States, just 1 in 3,000 pregnant women is diagnosed with breast cancer.

But you still need to be vigilant. That means doing routine breast self-exams and reporting anything suspicious to your doctor immediately. Breast tenderness is normal during pregnancy, but hard lumps are not. It's really important to take action quickly: The average reported delay in reporting a lump or other symptom detected during pregnancy is 5 to 15 months, a factor that may contribute to less promising outcomes.

Have you checked your breasts during pregnancy?If you and your doctor do find an abnormality, there are ways to perform diagnostic tests, such as ultrasound and mammography, without exposing the fetus to radiation. Sometimes babies are induced early (as was the case with Kerryn McCann's baby) so that the mother can start chemotherapy or another treatment as soon as possible.

There are lots of lessons to take away from Kerryn McCann: She was an inspirational athlete and mother of three and, whether you are pregnant or not, her story is a call to check your breasts—now.

Read Anne's previous posts:
How Blogging Is Good for Your Breasts
Good News: My Migraines May Be Good for My Breasts
The Survivor Files: Amazing Women Share Their Breast Cancer Journeys

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Nearly Half of Breast Cancer Survivors Have Lingering Pain

TUESDAY, Nov. 10, 2009 (Health.com) — Almost half of women who have breast cancer surgery still have pain or numbness two to three years later, according to a new study. Women younger than 40 who receive lumpectomies are at the greatest risk.

In general, women are most likely to have pain or a loss of sensation in the breast region, followed by the armpit, the arm, and their sides. However, 40% of women with lingering symptoms have pain in parts of the body not affected by treatment, according to a report in the Journal of the American Medical Association.

“This is a very well-done study by very well-respected surgeons in Denmark,” says Allen Burton, MD, a professor and the chair of the department of pain medicine in the division of anesthesiology and critical care at M.D. Anderson Cancer Center, in Houston.

“This is a known phenomenon,” says Dr. Burton, who wasn’t involved in the study. “These women have pain and huge numb patches in their chest, underarm, down their arm, and in their back that never feels normal again.”

None of the women in the study had reconstructive breast surgery, which is commonplace in the United States. “It would be interesting to see if that changes the outcome,” Dr. Burton says. “Would they have more pain? Less pain? Different kinds of pain?”

In the study of 3,754 breast cancer survivors ages 18 to 70, 47% had pain in one or more area, and 58% reported problems in the treated breast, including burning and a loss of sensation for one to three years after their surgery. Overall, 13% of women with lingering problems said their pain was severe, 39% said it was moderate, and 48% reported light pain. And 76% of patients with severe pain said they ached every day.

Women at the greatest risk for chronic pain were ages 18 to 39 and had undergone breast-conserving surgery, or lumpectomy, in which doctors remove only the tumor and some surrounding tissue. Other risk factors for persistent pain included radiation therapy, which is directed at the breast area to destroy any remaining cancer cells after surgery.

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Products That May Reduce Your Risk of Breast Cancer

There is no proven link between breast cancer and household products, whether they be soap or water bottles. But many consumers, activists, and experts are concerned that a variety of goods contain hormone disruptors, chemicals that when absorbed into the body can mimic or interfere with hormones such as estrogen. Some researchers believe that chemicals with estrogenic characteristics can cause normal breast cells to divide.

"Each time they divide, they have the risk of copying DNA incorrectly and creating mutations in key genes, which may lead to increased breast cancer risk," says Suzanne Snedeker, PhD, the associate director for translational research for the Program on Breast Cancer and Environmental Risk Factors at Cornell University. Chemicals that mimic estrogen might also enable an existing breast tumor to keep growing, because most tumors depend on estrogen to grow.

Individual products contain only small amounts of these questionable chemicals, if they do at all. But there is growing concern that the ubiquity of such agents in cosmetics, household products, and certain plastics, may have a cumulative estrogenic effect. "We are not saying if you use a certain product with estrogenic ingredients it will cause breast cancer," Snedeker says. "But the science suggests your risk may be reduced if you avoid these ingredients." Here are a few ways to play it safe.

View the slideshow

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Panel Says Women Should Start Mammograms at 50, Not 40

Women should have a mammogram every two years starting at age 50—not 40, according to an expert panel’s new breast cancer screening guidelines, which are sure to cause confusion among women, particularly those in their 40s who routinely schedule a mammogram each year.

However, a number of prominent groups say they strongly disagree with the new advice, which was issued by the U.S. Preventive Services Task Force (USPSTF) on Monday.

The USPSTF panel has backed off a 2002 statement advising women to have a routine mammogram every year or two beginning at age 40. The panel now recommends that women undergo mammography screening every two years starting at age 50 and continue being screened through age 74.

The USPSTF concluded that the benefit gained by starting screening at 40 versus 50 is “small” and that the decision to start screening before 50 should be an individual one.

The new guidelines would seem to reopen a debate that raged in the 1990s, but seemed to have been settled years ago. The American Cancer Society (ACS) now recommends that women get an annual mammogram and have a clinical breast examination beginning at age 40.

Otis W. Brawley, MD, the chief medical officer of the ACS, said in a statement that the ACS would stick to its current guidelines.

Mammograms are the “one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member,” Dr. Brawley said. The USPSTF is an independent panel, sponsored by the federal Agency for Healthcare Research and Quality, whose members make recommendations about preventive-care services and published the new recommendations in the Annals of Internal Medicine.

The panel’s recommendations are based, in part, on a review of the latest scientific evidence on the benefits and harms of breast cancer screening. The pooled data show that mammography screening does reduce breast cancer death—by 15% for women ages 39 to 49. To prevent one cancer death in this group, 1,904 women would have to be screened. Among women 50 to 59, one death is avoided per 1,339 screenings.

Because breast cancer risk increases with age, younger women are at a somewhat lower risk of developing the disease, explains George W. Sledge Jr., MD, a professor of oncology at Indiana University’s Melvin and Bren Simon Cancer Center, in Indianapolis, and president-elect of the American Society of Clinical Oncology.

They’re also somewhat more likely to have a false-positive mammogram—a test result that triggers a biopsy or other tests, but turns out not to be cancer—because they tend to have denser breasts, he says.

“No one is saying, or no one should say, that screening mammography has no value for younger women,” he says.

What the task force is saying is that the absolute reduction in breast cancer deaths is much greater in an older population.

But the American Cancer Society’s Dr. Brawley reasoned that “the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.”

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Breast Cancer Risk and Estrogen Alternatives

Taking estrogen may increase a woman's risk of getting breast cancer.Getting relief from menopause symptoms doesn’t need to mean estrogen-only treatments or combined hormone therapy (HT), which may increase your risk of breast cancer. If you can, consider nondrug remedies first, says JoAnn Manson, MD, a professor of medicine at Harvard Medical School and the author of Hot Flashes, Hormones & Your Health.

Dr. Manson has several suggestions for managing hot flashes and night sweats:

Wear layered clothing.Lower the thermostat.Use portable fans.Avoid dietary triggers such as caffeine, spicy foods, and alcohol.Avoid tobacco.Increase your intake of soy-based foods.Consider trying the herb black cohosh.A low dose of a selective serotonin-reuptake inhibitor (SSRI) or the antiseizure medication gabapentin may also be useful, according to Kala Visvanathan, MBBS, assistant professor of epidemiology and oncology at Johns Hopkins Bloomberg School of Public Health, in Baltimore. Alternative Therapy for Side EffectsMore than 80% of breast cancer patients have tried complementary therapies.  Read more"If a woman has only vaginal dryness and discomfort with intercourse and no other symptoms, she can use a topical estrogen or a vaginal estrogen ring, which have a much lower absorption of estrogen," adds Dr. Manson, who notes that relaxation and breathing techniques have worked for some women as well. "I would encourage women to try lifestyle modifications before going with estrogen, especially if they have mild symptoms," she says.

Dr. Visvanathan agrees: "You definitely want to try simple things first, then go to [HT] if you need to. It used to be that hormones were the first thing you tried, but the paradigm is changing because we’ve determined the long-term breast cancer and cardiovascular risk associated with HT, and because the benefits of HT have been shown to be less effective than previously thought. Women with modest menopausal symptoms can often treat their symptoms effectively with nonmedical therapies."

Have you tried estrogen alternatives for hot flashes?If you end up needing estrogen or combination HT, though, and you want to keep your breast cancer risk low while still keeping menopause symptoms in check, ask your doctor about transdermal patches, gels, and sprays, which deliver low doses of estrogen through the skin and may have fewer risks than pills. "Transdermal estrogen may be less likely to cause blood clots and gallbladder disease," Dr. Manson explains. "And lower doses may be less likely to increase the risk of breast cancer or other cancers."

The bottom line: Consider alternative approaches to see if one or several together can control your menopause symptoms before turning to oral estrogen or combination HT.

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Can Twitter and Facebook Help Fight Breast Cancer?

Twitter and other social media sites are often perceived as the ultimate navel-gazing tools. Seemingly a narcissist’s dream, many think that Facebook status updates and the 140-character Twitter messages (known as “tweets”) are really just boring play-by-plays of daily life—I had granola for breakfast! I’m stuck in traffic!

But Laurie Brosius, 31, isn’t buying it. Brosius, a business analyst in Dallas, used Twitter to raise $6,000 for a walk for breast cancer research in 2008. “Fifty percent of that came from online strangers,” she says. She was able to reach those people in part because her Twitter followers re-tweeted her messages.

In 2004, Brosius started blogging about her upcoming wedding. But after she married, she felt a key person was missing from the happy picture—her husband’s mother, who had died of breast cancer at age 48 when her husband was 20 years old. “I felt like I missed out on having her in my life,” says Brosius. “I felt cheated.”

She wanted to raise money for breast cancer research, so she participated in a three-day walk and fund-raiser, but felt she could do more. She had used Twitter to raise a small sum for that first walk, but for the second walk she relied mainly on tweets to direct people to the donation website.

(Anyone can see breast cancer–related tweets by typing #breastcancer into Twitter’s search field.)

Brosius still blogs and says that breast cancer organizations’ websites are great places to donate. However, Brosius says, they only reach a specific crowd—those already interested in the topic.

“[Social media sites] are reaching people who might not be specifically looking for that kind of information,” she explains. “They’re reaching everyone.”

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