There are natural ways to effectively reduce your heart attack risk.

As the controversial new guidelines on statins begin to kick into use in doctors’ offices around the country, the number of Americans for whom these drugs will be recommended is expected to double. But plenty of people don’t like to take any type of prescription medication if they can avoid it.

Most integrative physicians, who prescribe natural therapies (and drugs when needed), agree that the majority of people who take statins—and most of those who will be recommended to do so under the new guidelines—could get many of the same benefits, such as lower cholesterol and inflammation levels, with fewer risks, by relying on targeted food choices (see examples in box) and supplements. Exercise—ideally, about 30 minutes at least five days a week—should also be part of a healthy-heart regimen.*

The natural regimen that I’ve fine-tuned over the past 25 years for my patients…

THE BEST CHOLESTEROL-LOWERING SUPPLEMENTS

Fish oil (typical daily dose: 1,000 mg total of EPA and DHA) fights inflammation, lowers LDL “bad” cholesterol and is part of most good heart-protective regimens.** In addition, I recommend using the first supplement below and adding the other three supplements if total cholesterol levels don’t drop below 200 mg/dL…

  • Red yeast rice. You have probably heard of this rice, which is fermented to produce monacolins, chemical compounds with statinlike effects. It can lower LDL cholesterol by roughly 30%.

    • Red yeast rice can be a good alternative for people who can’t tolerate statins due to side effects such as muscle aches and increased risk for diabetes. Red yeast rice also has other natural protective substances, such as isoflavones, fatty acids and sterols, not found in statins.

    Typical dosage: 1.2 g to 2.4 g daily. I advise starting with 1.2 g daily. The dose can be increased as needed, based on your physician’s advice.

    What I tell my patients: Unfortunately, red yeast rice has gotten a bad rap because of the way some products were labeled. The supplements that I recommend are manufactured with high standards of quality control and contain therapeutic levels of active ingredients. Good products: Choleast by Thorne Research, Thorne.com…and High Performance Formulas’ Cholestene, HPFonline.com.

    When taking red yeast rice, some people have heartburn, gastrointestinal (GI) upset or mild headache—these effects usually are eliminated by taking the supplement with food.

  • Niacin. Few doctors recommend niacin routinely even though it’s one of the most effective cholesterol remedies. Although a recent study questioned the effectiveness of niacin, most research finds it beneficial. It may lower LDL by about 10% and increase HDL “good” cholesterol by 15% to 35%. It can lower levels of triglycerides and Lp(a), a sticky cholesterol particle that causes atherosclerosis.

    • Typical dosage: 1 g to 3 g of time-released niacin daily, divided into two doses and taken with food.

    What I tell my patients: Start with 250 mg daily, and increase the dose by 250 mg every two weeks until you are taking the amount recommended by your doctor. People who take high doses of niacin too quickly often have uncomfortable facial flushing and sometimes stomach upset or other GI disturbances. “Flush-free” niacin is available, but it doesn’t lower cholesterol as effectively as the regular version.

  • Pantethine. You may not be familiar with this supplement, a form of pantothenic acid (vitamin B-5). Recent studies show that it raises HDL cholesterol—and it prevents LDL from oxidizing, the process that causes it to cling to arteries.

    • Typical dosage: 900 mg, divided into two or three doses daily. Good pantethine products are made by Jarrow, Jarrow.com…and NOW Foods, NOWFoods.com.

    What I tell my patients: Take pantethine with meals to reduce the risk for indigestion and to aid absorption.

  • Sterols and stanols. These cholesterol-lowering plant compounds are found in small amounts in many fruits, vegetables and grains. But sterol and stanol supplements are much more powerful. In supplement form, the plant compounds reduce LDL by about 14% and cause no side effects.

    • Typical dosage: Take 3 g of a sterol/stanol supplement daily. Pure Encapsulations makes a good product, PureEncapsulations.com.

    Most integrative physicians are very knowledgeable about natural remedies. To find one in your area, consult the American College for Advancement in Medicine at ACAM.org.

    Yummy Cholesterol Fighters

    For years, oat bran and oatmeal were touted as the best foods for high cholesterol. Rich in soluble fiber, these foods help prevent cholesterol from getting into the bloodstream. A daily serving of oats, for example, can lower LDL by 20%. Other good foods rich in soluble fiber include barley, beans, pears and prunes. But research has now gone beyond these old standby food choices. Here are some other fiber-rich foods that have been found to give cholesterol the heave-ho…

  • All nuts. Walnuts and almonds are great cholesterol fighters, but so are pistachios, peanuts, pecans, hazelnuts and other nuts, according to recent research. Eat a handful (1.5 ounces) of nuts daily.
  • Popcorn actually contains more fiber per ounce than whole-wheat bread. Just go easy on the salt and butter, and stay away from store-bought microwave popcorn (it can contain harmful chemicals). Smart idea: Put one-quarter cup of organic plain popcorn in a lunch-size brown paper bag, and pop in the microwave. It’s delicious—and there’s no cleanup.

*Talk to your doctor before taking any of these supplements—they may interact with medications or affect certain chronic health conditions.

**A recent study linking fish oil to increased risk for prostate cancer is not supported by other medical research, so most men can take fish oil supplements under a doctor’s supervision.