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Colesterol Alto
Uses
Otros Tratamientos Naturales Propuestos
- Achillea wilhelmsii
- Alfalfa
- Ashwagandha
- Cimicifuga
- Caigua
- Calcio
- Quitosano
- Cromo
- Creatina
- Fenogreco
- Aceite de Pescado
- Semilla de Linaza
- Aceite de Linaza
- Gama Orizanol
- Ajo
- Genisteína
- Guggul
- He Shou Wu
- L-Carnitina
- Lecitina
- Cambios en su Estilo de Vida
- Gallina de los bosques
- Mesoglican
- Multivitamina/Mineral
- Pantetina
- Probióticos
- Espirulina
Uno de los descubrimientos más significativos en la medicina preventiva es que los elevados niveles de colesterol en la sangre aceleran la
aterosclerosis
, un padecimiento comúnmente conocido como endurecimiento de las arterias. Además de la
presión arterial alta
, la inactividad,
fumar
y la
diabetes
, el alto nivel de colesterol ha probado ser uno de los más importantes promotores de la
enfermedad cardiaca
,
apoplejías
y la
enfermedad vascular periférica
(bloqueo de la circulación a las extremidades, normalmente las piernas).
El colesterol no bloquea directamente las arterias como tubos bloqueados de grasa. La teoría actual es que los niveles elevados de colesterol irritan las paredes de los vasos sanguíneos y causan que estos sufran cambios perjudiciales. Debido a que la mayoría del colesterol es fabricado por el mismo cuerpo, las fuentes alimenticias de colesterol (tales como los huevos) normalmente no son el problema más importante. La proporción relativa de grasas no saturadas (de plantas) y grasas saturadas (principalmente de productos animales) en la dieta es más significativa.
Cuando al principio fueron investigadas las consecuencias del alto nivel de colesterol, la medida considerada sólo era la del colesterol total. Hoy en día, el
perfil de lípidos
general es tomado en cuenta. El colesterol LDL ("malo"), el colesterol HDL ("bueno") y los
triglicéridos
son las otras medidas más comunes relacionadas al colesterol. Las lipoproteínas A y el colesterol LDL oxidado también trazan una atención creciente.
Este cambio en énfasis ha lanzado algunas recomendaciones de mucho tiempo hacia la confusión. Por ejemplo, reducir la ingesta total de grasa generalmente reduce el colesterol total y sobre esta base las autoridades médicas desde hace tiempo adoptaron la política de recomendar dietas bajas en grasa. Sin embargo, cuando usted toma en cuenta otras medidas de lípidos, ahora está claro que reducir la ingesta de grasas no es la clara ventaja que al principio parecía ser. Reducir la grasa mejora los niveles de colesterol total y LDL, pero empeora los niveles de HDL y triglicéridos; el efecto neto no está claro. Cambiar a grasas saludables en vez de grasas saturadas puede ser más importante que reducir la ingesta total de grasa.
El incremento en el ejercicio y la mejoría en la dieta pueden producir progresos adecuados en el perfil de lípidos. Si tales cambios en su estilo de vida no son efectivos, sin embargo, existen muchos medicamentos altamente efectivos a elegir. Los medicamentos de la familia de las estatinas son los más efectivos y estos han sido probados en la prevención de ataques cardiacos y la reducción de la mortalidad. Otras opciones convencionales útiles incluyen medicamentos con fibratos y varias formas de la vitamina niacina (comentadas abajo).
Principales Tratamientos Naturales Propuestos
Existen varias hierbas y complementos que parecen ayudar a bajar los niveles de colesterol. Para algunos (tales como los estanoles, la vitamina B3, la fibra y la soya) la evidencia es suficientemente fuerte como para haber recibido aceptación generalizada.
Nota: Si su principal problema son los triglicéridos elevados, vea el artículo sobre
triglicéridos altos
.
Estanoles/Esteroles
Los estanoles son substancias que es presentan de manera natural en varias plantas. Sus efectos en la reducción del colesterol fueron observados primero en animales en la década de 1950. Desde entonces, una cantidad sustancial de investigación sugiere que los estanoles vegetales (normalmente modificados en estanoles ésteres) pueden ayudar a disminuir el colesterol en individuos con niveles de colesterol normales o leves a moderadamente elevados. Los estanoles están disponibles en la margarina para untar, aderezos para ensalada y tabletas de complementos alimenticios. Las substancias relacionadas llamadas esteroles vegetales parecen tener efectos equivalentes,
173
y en este artículo nos referiremos a las dos substancias de manera un tanto intercambiable.
Los estanoles vegetales ésteres reducen los niveles de suero del colesterol al inhibir la absorción del colesterol.
10
Debido a que son estructuralmente similares al colesterol, los estanoles (y esteroles) pueden desplazar el colesterol desde "paquetes" que entregan el colesterol para la absorción desde los intestinos hasta el torrente sanguíneo.
1
El colesterol desplazado no es absorbido y es evacuado del cuerpo; los estanoles por sí mismos a fin de cuentas tampoco son absorbidos.
Numerosos estudios
doble ciego, controlados por placebo
, en una escala de duración de 30 días a 12 meses, han encontrado a los ésteres estanoles y a sus químicos relativos efectivos para el mejoramiento de los niveles de colesterol.
2 - 15,167 - 169,174,175
Los resultados combinados sugieren que estas substancias pueden reducir el colesterol total y el colesterol LDL ("malo") por alrededor del 10 al 15%.
16
Los ésteres estanoles no tuvieron algún efecto significativo sobre el colesterol HDL ("bueno") o los triglicéridos en la mayoría de estos estudios.
Los individuos que toman medicamentos estatinas también pueden beneficiarse del uso de los estanoles/esteroles.
20,21,170
De acuerdo con un estudio, si usted está con estatinas y empieza a consumir margarina de éster de esterol, su colesterol mejorará a la misma extensión de su doble dosis de estatina.
170
Los estanoles y los esteroles también parecen mejorar los efectos de las dietas reductoras de colesterol.
17,174
Además, tres estudios descubrieron que los estanoles y los esteroles son útiles para bajar los niveles de colesterol en las personas con diabetes tipo 2 (de presencia en adultos).
18,19,175
Para más información, incluyendo dosis y cuestiones de seguridad, vea el artículo completo sobre los
estanoles
.
Niacina (Vitamina B 3 )
La vitamina común niacina, también llamada vitamina B
3
, es un tratamiento médico aceptado para el colesterol elevado con ciencia sólida detrás de él. Varios estudios doble ciego, controlados con placebo y bien diseñados han descubierto que la niacina redujo el colesterol LDL en aproximadamente 10% y los triglicéridos en un 25% y elevó los niveles de colesterol HDL en un 20 al 30%.
22 - 27
La niacina también baja los niveles de lipoproteína A - otro factor de riesgo para la aterosclerosis - por alrededor de un 35%. Además, el uso a largo plazo de la niacina ha probado reducir de manera significativa los índices de muerte por enfermedad cardiovascular.
28
La niacina parece ser un tratamiento seguro y efectivo también para el alto nivel de colesterol en personas con diabetes y (contrariamente a reportes previos) no parece elevar los niveles de azúcar en la sangre.
29
Desafortunadamente, la niacina, si se toma en cantidades suficientes puede causar reacciones molestas de ruborización y ocasionalmente inflamación del hígado.
30
La supervisión médica cercana es esencial cuando se usa la niacina para reducir el colesterol.
Combinar altas dosis de niacina con medicamentos estatinas (los medicamentos más efectivos para el colesterol) mejora posteriormente el perfil de lípidos al elevar el colesterol HDL ("bueno").
149 - 151
Desafortunadamente, existen preocupaciones reales de que esta terapia de combinación pueda causar una condición potencialmente fatal llamada rabdomiólisis.
Creciente evidencia, sin embargo, sugiere que el riesgo es relativamente leve en individuos con riñones saludables. Además, incluso dosis mucho menores de niacina que la dosis normal administrada para mejorar los niveles de colesterol (100 mg. contra los 1,000 mg. o más) pueden proporcionar un beneficio similar.
152
En esta dosis, el riesgo de rabdomiólisis deben ser disminuidos.
Sin embargo, no es seguro tratar esta combinación excepto bajo supervisión médica cercana. La rabdomiólisis puede ser fatal.
Para más información, incluyendo dosis y cuestiones de seguridad, vea el artículo completo sobre la
vitamina B
3
.
Fibra
Los complementos de fibra soluble en agua parecen reducir el colesterol y la FDA ha permitido que productos que contienen esta forma de fibra lleven una etiqueta de "saludable para el corazón."
31
Muchas formas están disponibles, variando desde el salvado de avena hasta productos de fibra caros vendidos a través de empresas comerciales de varios niveles. Una buena dosis de salvado de avena es de 5 a 10 gramos con cada alimento y a la hora de dormir y el psyllium es tomado a 10 gramos con cada alimento. Sin embargo, comer una dieta alta en frutas frescas, verduras y granos enteros puede ser incluso mejor debido a los muchos nutrientes saludables tales como los que contiene la dieta.
Proteína de Soya
Las proteína de soya parece reducir el colesterol total por cerca del 9%, el colesterol LDL ("malo") por 13% y los triglicéridos por 10%.
32
La FDA ha permitido que los alimentos que contienen proteína de soya hagan la afirmación "saludable para el corazón" en la etiqueta. Un estudio sugiere que sustituir tan poco como 20 gramos diariamente de proteína de soya en vez de proteína animal puede mejorar de manera significativa los niveles de colesterol.
33
Los
isoflavones
de soya son ampliamente considerados por ser un ingrediente activo en la disminución del colesterol en la proteína de soya,
34 - 36,159
pero varios estudios sugieren que esto no puede ser cierto.
37 - 41,153,158 - 161
Para más información, incluyendo dosis y cuestiones de seguridad, vea el artículo completo sobre la
soya
.
Policosanol
El policosanol es una mezcla de substancias serosas fabricadas a partir de la caña de azúcar. Este parece hacer más lenta la síntesis del colesterol en el hígado y también incrementar la reabsorción del hígado del colesterol LDL ("malo").
43,44
Éste está aprobado como un tratamiento para el colesterol alto en casi dos docenas de países, principalmente en América Latina.
154
Al menos 16 estudios doble ciego, controlados por placebo, involucrando un total de más de 1,500 personas y variando en duración desde 6 semanas hasta 12 meses, han descubierto que el policosanol fabricado de la caña de azúcar es efectivo para mejorar los niveles de colesterol.
42,45 - 58,171
De todos, uno de estos ensayos fue llevado a cabo en Cuba por un sólo grupo de investigación.
42
La acumulación de resultados sugiere que el tratamiento con policosanol puede reducir el colesterol LDL ("malo") por un 21 al 29% y el colesterol total por una cantidad ligeramente menor; además, el policonasol parece incrementar el colesterol HDL ("bueno") en un 8 a 15%.
172
Los niveles de triglicéridos no parecen ser afectados. De forma interesante, estos ensayos matricularon sólo a personas cuyos niveles de colesterol no habían mejorado previamente sólo con la dieta.
Otros siete estudios doble ciego que matricularon un total de casi 400 personas han comparado el policosanol contra los medicamentos estándar, incluyendo la pravastatina, la simvastatina, la fluvastatina, la lovastatina y el acipimox y los encontraron igualmente efectivos.
59 - 65
Los estudios han encontrado el policosanol seguro y efectivo para reducir los niveles de colesterol en personas con diabetes tipo 2 (de presencia en adultos).
66,67
Sin embargo, las personas con alguna forma de diabetes deben buscar consejo médico antes de tomar policosanol.
Note que la forma de "policosonol" más ampliamante disponible en los Estados Unidos está hecha de cera de abeja en vez de caña de azúcar y es posible que no sea efectiva.
176
Para más información incluyendo dosis y cuestiones de seguridad, vea el artículo completo sobre el
policosanol
.
Hoja de Alcachofa
Aunque usada principalmente para estimular la función de la vesícula biliar, la hoja de alcachofa también puede ser útil para el colesterol alto.
De acuerdo a un estudio doble ciego, controlado con placebo de 143 individuos con colesterol elevado, el extracto de hoja de alcachofa mejoró de manera significativa las lecturas de colesterol.
81
El colesterol total cayó un 18.5% al compararlo con el 8.6% en el grupo del placebo; el colesterol LDL bajó un 23% contra 6%; y la proporción LDL a HDL se redujo en un 20% contra 7%.
La hoja de alchachofa puede funcionar por medio de interferir con la síntesis del colesterol.
82
Un componente de la alchachofa llamado luteolina puede desempeñar una función en la reducción del colesterol.
83
Para más información, incluyendo dosis y cuestiones de seguridad, consulte artículo completo de la
alcachofa
.
Otros Tratamientos Naturales Propuestos
Existen muchos otros tratamientos alternativos para el colesterol alto. Los enfoques que específicamente disminuyen los triglicéridos son discutidos en el artículo
triglicéridos altos
.
En un estudio de 12 meses de 223 mujeres posmenopáusicas, los suplementos de
calcio
(citrato de calcio a una dosis de 1 gramo diario) mejoró de manera significativa la proporción entre el colesterol HDL ("bueno") con el colesterol LDL ("malo").
155
Esto parecer haber sido debido principalmente a un significativo aumento en los niveles de HDL.
Pero no todos los estudios sugieren que el quitosano, un tipo de fibra derivado de las conchas de crustáceos, pueda disminuir los niveles de colesterol.
84 - 92,147,148,187
Sin embargo, el más reciente y mejor diseñado de estos estudios, un ensayo doble ciego de 90 mujeres con alto nivel de colesterol de leve a moderado, no encontró más que modestos beneficios. Vea el artículo completo sobre el
quitosano
para información sobre las preocupaciones de seguridad con este suplemento.
Ensayos preliminares doble ciego sugieren que los beneficios con la hierba iraní
Achillea wilhelmsii
,
93
la hierba peruana Caigua (
Cyclanterha pedata
),
94
y la
Ipomoea batatus
(batatas).
162
Existe alguna evidencia de que
linaza
pueden reducir el colesterol LDL y en general, hacer más lenta la
aterosclerosis
.
95,96,98 - 100,157
El extracto de aceite de linaza también puede ser útil.
97,184
Un creciente cúmulo de evidencia sugiere que el incremento en el consumo de nueces secas como las almendras, nueces de nogal, pacanas y nuez de macadamia puede mejorar el perfil de lípidos y reducir el riesgo de una enfermedad cardiaca.
101 - 109, 163
Guggul
, la resina de goma pegajosa de la mirra de árbol mukul, ha sido ampliamente comercializada como una hierba reductora del colesterol. Sin embargo, mientras la evidencia preliminar encuentra evidencia de beneficio,
77 - 80
todas ellas han sufrido de significativos defectos de diseño; un estudio bien diseñado no encontró al guggul efectivo.
186
Escasa evidencia preliminar sugiere evidencia potencial con la
alfalfa
,
132 - 146beta-hidroxi-beta-metilbutirato (HMB por sus siglas en inglés)
,
164ácido linoléico conjugado (CLA por sus siglas en inglés)
,
165L-carnitina
,
185mesoglican
,
110 - 112
y
espirulina
.
129 - 131
Algunos pero no todos los estudios sugieren que unas bacterias "amigables" (
probióticos
) podrían ser capaces de reducir los niveles de colesterol.
123 - 128
Los estudios sobre si el cromo puede mejorar los niveles de colesterol también han emitido resultados contradictorios.
113 - 121
Sin embargo, este mineral puede ofrecer beneficios para las personas que toman medicamentos de la familia de los
bloqueadores beta
. Estos medicamentos, usados para la presión arterial alta y otros padecimientos, algunas veces reducen los niveles de colesterol HDL. Los complementos de cromo pueden contrarrestar este efecto secundario.
122
Un estudio proporciona evidencia preliminar de que la cimicifuga puede mejorar el perfil de lípidos en la mujeres posmenopáusicas.
156
Como otros aceites vegetales, el aceite de salvado de arroz parece cambiar de manera favorable el perfil de lípidos así como reducir el riesgo de una enfermedad cardiaca de otras maneras.
166
Evidencia aún menos convincente sugiere que el
gama orizanol
, una substancia hecha del aceite de salvado de arroz, también puede mejorar el perfil de lípidos.
Otras hierbas y complementos algunas veces recomendados para los altos niveles de colesterol incluyen la
ashwagandha
,
fenogreco
,
He shou wu
y
gallina de los bosques
, pero todavía no hay una evidencia real de que estos realmente funcionen.
Las substancias relacionadas con la vitamina E llamadas tocotrienoles son algunas veces promovidos para mejorar los niveles de colesterol, pero la evidencia en relación a si estos realmente funcionan permanece inconsistente en el mejor de los casos.
177
Un número de estudios publicados en los 80s y en los 90s descubrió evidencia que las preparaciones de
ajo
pueden disminuir el colesterol.
68,69
Sin embargo, varios estudios más recientes y generalmente mejor diseñados han encontrado que si algunos beneficios existen, estos son tan pequeños que son de poca ayuda en la vida real.
70 - 76
Aunque la
lecitina
comúnmente es considerada por reducir los niveles de colesterol, la evidencia indica que ésta no funciona.
178 - 182
Un estudio fracasó al encontrar grasas especiales llamadas
MCT (siglas en inglés de triacilgliceroles de cadena media)
más efectivos para la reducción del colesterol que las grasas no saturadas ordinarias.
183
Hierbas y Complementos para Usar Sólo con Precaución
Varias hierbas y complementos pueden interactuar de manera adversa con medicamentos usados para tratar el colesterol alto. Para más información sobre este riesgo potencial, vea el artículo individual sobre el medicamento en la sección de esta de base de datos sobre
Interacciones con Medicamentos
.
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18
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19
Gylling H, Miettinen TA. Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholesterolaemic NIDDM patients before and during sitostanol ester-margarine treatment. Diabetologia . 1994;37:773 - 780.
Gylling H, Miettinen TA. Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholesterolaemic NIDDM patients before and during sitostanol ester-margarine treatment. Diabetologia . 1994;37:773 - 780.
20
Gylling H, Miettinen TA. Effects of inhibiting cholesterol absorption and synthesis on cholesterol and lipoprotein metabolism in hypercholesterolemic non-insulin-dependent diabetic men. J Lipid Res . 1996;37:1776 - 1785.
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