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Functional foods and dietary supplements for the management of dyslipidaemia

Key Points

  • Use of functional foods and dietary supplements is becoming increasingly prevalent among those individuals at risk of cardiovascular disease; however, limited clinical guidance is available for the use of safe and effective supplements

  • Evidence supports the use of products such as soy protein, green tea, plant sterols, probiotic yogurt, marine-derived omega-3 fatty acids and lovastatin-containing red yeast rice in patients with dyslipidaemia

  • Products such as seaweed, berberine, hawthorn and garlic might confer some limited lipid-lowering benefit in certain patient populations

  • Policosanol, guggulsterone and resveratrol are unlikely to have lipid-lowering effects

  • Functional foods and dietary supplements can be used in addition to pharmacotherapy to provide additional lipid lowering and could potentially reduce medication dose

  • Very few long-term studies have been conducted, which has led to a paucity of information on clinical end points such as mortality and cardiac events

Abstract

Dyslipidaemia is characterized by increased blood levels of total or LDL cholesterol and triglycerides, or decreased HDL cholesterol levels, and is a risk factor for cardiovascular disease. Dyslipidaemia has a high worldwide prevalence, and many patients are turning to alternatives to pharmacotherapy to manage their lipid levels. Lifestyle modification should be emphasized in all patients to reduce cardiovascular risk and can be initiated before pharmacotherapy in primary prevention of cardiovascular disease. Many functional foods and natural health products have been investigated for potential lipid-lowering properties. Those with good evidence for a biochemical effect on plasma lipid levels include soy protein, green tea, plant sterols, probiotic yogurt, marine-derived omega-3 fatty acids and red yeast rice. Other products such as seaweed, berberine, hawthorn and garlic might confer some limited benefit in certain patient groups. Although none of these products can reduce lipid levels to the same extent as statins, most are safe to use in addition to other lifestyle modifications and pharmacotherapy. Natural health products marketed at individuals with dyslipidaemia, such as policosanol, guggulsterone and resveratrol, have minimal definitive evidence of a biochemical benefit. Additional research is required in this field, which should include large, high-quality randomized controlled trials with long follow-up periods to investigate associations with cardiovascular end points.

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Figure 1: Intestinal action of functional foods and supplements.
Figure 2: Hepatic action of functional foods and supplements.

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Acknowledgements

R.A.H. is supported by the Jacob J. Wolfe Distinguished Medical Research Chair, the Edith Schulich Vinet Research Chair in Human Genetics and the Martha G. Blackburn Chair in Cardiovascular Research. He has received operating grants from the Canadian Institutes of Health Research (Foundation Grant), the Heart and Stroke Foundation of Ontario (T-000353) and Genome Canada through Genome Quebec (award 4530).

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P.M.H. and R.A.H. researched data for the article, contributed to discussion of the content, wrote the article and reviewed and/or edited the manuscript before submission.

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Hunter, P., Hegele, R. Functional foods and dietary supplements for the management of dyslipidaemia. Nat Rev Endocrinol 13, 278–288 (2017). https://doi.org/10.1038/nrendo.2016.210

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