* Naturopathic medicine uses the water-soluble fibre and bulk-forming agent psyllium (Ispaghula or Plantago ovata psyllium, also known as flea seed). Naturopathic physicians will also attempt to correct any existing imbalance in the bacterial flora of the gut and put patients on a low-fat diet. A meta-analysis of eight randomised clinical trials showed this to be a successful strategy. In all, 384 patients received psyllium (10.2 g daily) while 272 received cellulose as a placebo. All of the patients were following a low-fat diet at the same time. Compared with the placebo, psyllium lowered total cholesterol by 4 per cent and LDL (the ‘bad’ cholesterol) by 7 per cent (Am J Nutr, 2000; 71: 472-9).

Oat fibre, an important part of any diet proposed by a naturopath, has repeatedly been shown to reduce total and LDL cholesterol (JAMA, 1992; 267: 3317-25).

Plant-derived phytosterols, such as campesterol and sitosterol, are also used in naturopathic medicine. A meta-analysis of 16 clinical studies showed that this supplementation lowered cholesterol by 10 per cent and LDL by 13 per cent (Am J Med, 1999; 107: 588-94).

* Oriental medicine uses red yeast rice for stagnant qi (energy) and blood flow. Red yeast rice is fermented rice on which red yeast (Monascus purpuraeus) has been grown. It is now sold in the EU and the US as a food supplement. In a multicentre randomised clinical trial, it was shown to lower total cholesterol (Curr Ther Res, 1997; 58: 964-78). In a later study, 83 subjects were given either 2.4 g/day of red yeast rice or a placebo for 12 weeks. Mean total cholesterol decreased from 6.57 mmol/L to 5.38 mmol/L, and comparable positive results were also recorded for levels of LDL and triglycerides (Am J Clin Nutr, 1999; 69: 231-6).

* Herbal medicine advocates the seed powder of Trigonella foenum graecum (fenugreek) to reduce cardiovascular risk. In one study, 100 g/day of fenugreek seed powder was taken by patients with high cholesterol and insulin-dependent diabetes. A fall in fasting blood glucose, total and LDL cholesterol, and triglycerides was noted (Eur J Clin Nutr, 1990; 44: 301-6).

Medical herbalists may recommend including Medicago sativa (lucerne or alfalfa) into the diet because it is rich in saponins, which are capable of binding to cholesterol and bile salts in the gut to prevent their absorption (Am J Clin Nutr, 1984; 39: 917-29).

Guar gum is a dietary fibre product derived from Cyamopsis tetragonolobus used by herbalists for its cholesterol-lowering properties. In a double-blind, placebo-controlled, randomised clinical trial, patients took 5 g of granulated guar gum or a placebo three times daily for 24 months. At 12 and 24 months, there were statistically significant reductions of total (average: 21.07 mmol/L) and LDL (average: 21.10 mmol/L) cholesterol.

Gamma-oryzanol is a mixture of ferulic acid derivatives found in rice bran that, in one study, resulted in a 10 per cent decrease in LDL levels when it was tested on 67 patients who took 300 mg/day of gamma-oryzanol for three months (Curr Ther Res, 1989; 45: 543-52).

* Nutritional medicine prescribes 60-mg tablets of coenzyme Q10 twice daily for treating cholesterol. In one study, this was given for 28 days to 47 patients with coronary heart disease and elevated levels of lipoproteins. While this regime did not much alter levels of total cholesterol, it did increase high-density lipoprotein (HDL, the ‘good’ cholesterol) and lower LDL, driving the HDL-to-total cholesterol ratio up into the acceptable range (Int J Cardiol, 1999; 68: 23-9).