Let's start with the obvious.

DIET

If you start out with a healthy diet, which consists mostly of lean protein sources, vegetables that grow above the ground, and fruit, that will help. In addition to a basically healthy diet, to control cholesterol most experts counsel avoiding eating red meat and animal fat in general. For example, if you eat the breast of birds such as chickens and turkeys instead of the legs and thighs, you will eat less animal fat. You can also avoid animal fat by not eating the skin.

Now, if your cholesterol problems are diet based, eating a healthy diet will probably solve the problem. If not, then you might need to look into some sort of supplement to help you control your cholesterol levels.

I assume if you're reading this article, you've already ruled out statin drugs because they are carcinogenic and often have side effects such as muscle pain and weakness, nausea, insomnia, fatigue, slurred speech, balance problems, memory loss, liver problems, sexual dysfunction, personality changes and irritability.

Fortunately, there are less destructive and expensive alternatives available.

NIACIN

Niacin has been known to lower cholesterol since the 1950s. Of particular interest is a comparative study between Lovastatin (a popular statin drug) and Niacin. 136 patients with high cholesterol were randomly assigned either Lovastatin or Niacin over a 26 week period. Although the Lovastatin initial lowered LDL cholesterol more quickly than the Niacin, by the end of the study, there was not a whole lot of difference, with Lovastatin lowering LDL by 32% and Niacin lowering LDL by 23%.

But where Niacin really shines is in increasing HDL (the good cholesterol) and lowering Lp(a), a lipoprotein which is highly predictive of heart disease. By the end of the study, Niacin had increased HDL by 33% and lowered Lp(a) by 35%, compared to 7% and 0% for Lovastatin, respectively.

However, there are some problems with Niacin. It causes unpleasant flushing and can impair blood sugar control in diabetics. Worse, if using sustained-release Niacin, almost half of users develop liver toxicity, although it should be noted that if using regular Niacin, there is little danger of liver toxicity.

Fortunately, there is a form of niacin called inositol hexaniacinate, which has been used in Europe for many years to control cholesterol levels.

INOSITOL HEXANIACINATE

Inositol hexaniacinate's side effects are minimal and it works even better than regular niacin, according to a study comparing the effect of niacin and inositol hexaniacinate on hyperlipidemic Buscat rabbits (The role of nicotinic acid and inositol hexaniacinate as anticholesterolemic and antilipemic agents. Nutr Reports Int 1983;28:899-911). The inositol hexaniacinate caused a 79.5 % reduction in cholesterol while niacin caused a 74.9% reduction. Better yet, inositol hexaniacinate caused a 63.2% triglyceride reduction, compared to a 30.9% reduction for regular niacin.

This same correlation was found by Welsh and Ede (Inositol hexanicotinate for improved nicotinic acid therapy, Int Record Med 1961;174:9-15).

If you plan to take inositol hexaniacinate to lower your cholesterol, experts recommend that you start out with 500 mg, 3 times a day with meals for 2 weeks. If you tolerate that okay, they suggest upping the dosage to 1000 mg, 3 times a day with meals. Although inositol hexaniacinate appears to have little in the way of side effects, it might still be prudent to have your doctor test your cholesterol levels and liver enzymes with a frequency of every 3 months, at the very least.

Like regular niacin, inositol hexaniacinate is not recommended for use by diabetics, because it can interfere with blood sugar metabolism.

Given inositol hexaniacinate's effectiveness, that's probably a good choice to try first. However, if you cannot tolerate inositol hexaniacinate, there are more options you can try.

PANTETHINE

Pantethine, a stable form of vitamin B5, inhibits the production of cholesterol by the liver. In a one-year clinical trial conducted with 24 patients, pantethine was shown to decrease LDL (the bad cholesterol) by 21% and increase HDL (the good cholesterol) by 23%, with virtually no toxicity (Effectiveness of long-term treatment with pantethine in patients with dyslipidemia, Clin Ther. 1986;8(5):537-45).

The dosage of pantethine usually recommended for cholesterol management by experts is 300 mg, 3 times a day.

VITAMIN C

It has been shown that the higher the level of vitamin C in the blood, the lower the total cholesterol count and the higher the HDL (the good cholesterol) is (High plasma vitamin C associated with high plasma HDL- and HDL2 cholesterol, American Journal of Clinical Nutrition, Vol 60, 100-105).

In particular, for every increase of .5 mg/dl in vitamin C plasma content, there was a corresponding increase in HDL of 2.1 mg/dl in men and 14.9 mg/dl in women.

Many experts recommend taking 2000 mg of vitamin C a day as general nutritional insurance. That should be plenty for cholesterol control purposes as well.

GARLIC

Believe it or not, garlic has a substantial effect on cholesterol levels, but you would need between 1 to 4 cloves of fresh garlic a day to achieve a significant therapeutic result. Fortunately, the compounds in garlic responsible for its therapeutic benefit can be isolated in pill form.

However, in order to be effective, the supplement must supply the equivalent of 4,000 mg of fresh garlic, not aged garlic. Aged garlic has been proven not to be as effective (A double-blind crossover study in moderately hypercholesterolemic men that compared the effect of aged garlic extract and placebo administration on blood lipids, Am J Clin Nutr. 1996 Dec;64(6):866-70).

On the other hand, a study done at the Clinical Research Center in New Orleans, Louisiana showed that treatment with standardized fresh garlic of 900 mg a day resulted in a drop of 11% in LDL (the bad cholesterol) (Can garlic reduce levels of serum lipids? A controlled clinical study, Am J Med. 1993 Jun;94(6):632-5).

So, if you wanted similar results, you could either take 900 mg a day of a standardized fresh garlic supplement or 1 to 4 cloves or fresh garlic a day.

GUGULIPID

Gugulipid is extracted from the mukul myrrh tree, which is native to India. It appears to get it's cholesterol lowering effects from increasing the liver's metabolism of LDL (the bad cholesterol).

In a double blind study of 125 patients comparing the effect of gugulipid with the cholesterol lowering drug clofibrate over a period of 12 weeks, the gugulipid group lowered their LDL (the bad cholesterol) by 11% and the clofibrate group by 10% (Clinical trials with gugulipid. A new hypolipidaemic agent, J Assoc Physicians India. 1989 May;37(5):323-8). While HDL (the good cholesterol) was unchanged in the clofibrate group, the gugulipid group typically increased HDL levels by between 16%-20%.

With purified gugulipid preparations, there are no significant side effects. Experts recommend a standardized extract of gugulipid containing 25 mg of guggulsterone per 500 mg tablet, 3 times a day for elevated cholesterol.