PHYTOTHERAPY FOR LIPID DISORDERS

Oktavia Rahayu A, S.Farm., M.Biomed

Departemen Farmasi Bahan Alam Program Studi Farmasi FKUB 2017
Learning Outcome
• Mahasiswa mampu memahami pengaruh gangguan lipid pada sistem
kardiovaskuler
• Mahasiswa mampu memahami jenis dan mekanisme kerja OT yang
digunakan untuk gangguan lipid
• Mahasiswa mampu memahami ESO yang potensial terjadi pada
penggunaan OT untuk gangguan lipid
• Mahasiswa mampu mengaplikasikan fitoterapi pada penyakit
gangguan lipid
 BIOSYNTHESIS OF CHOLESTEROL

How do
Isoprene unit

statins
work?
C5

C10

C15

C30

steroid
 Potentially
proinflammatory

Composition
of lipoprotein
complexes
Lipoproteins of the blood
LIPID
METABOLIS
M
Major lipid
trials:
LDL-c levels vs rate of
coronary events
Development of
Atherosclerosis
 suatu
respons
inflamasi
kronik
terhadap
deposisi
lipoprotein
pada dinding
arteri
Development of
Atherosclerosis
Initial Development of Fatty
Streak
OxLDL-LOX-1
Signaling
Pathway
Chronic
Heart
Disease/
Coronary Artery
Disease
Carotic
Artery
Disease
Lipid lowering
drugs
Selected herbal therapies
Herbs Lipid Disorders Grades
Alfafa Atherosclerosis, hyperlipidemia C
Ashwagandha Hypercholesterolemia C
Astragalus Coronary heart disease C
Avocado Hypercholesterolemia B
Barley Hyperlipidemia B
Beet Hyperlipidemia C
Beta-glucan Hyperlipidemia A
Beta-sitosterol, Sitosterol Hypercholesterolemia A
Borage Hyperlipidemia C
Carob Hypercholesterolemia B
Chia CVD prevention/ atheroclerosis B
Cordyceps Hyperlipidemia B
Selected herbal therapies
Herbs Lipid Disorders Grades
Elder Hypercholesterolemia C
Fenugreek Hyperlipidemia C
Flax Atheroclerosis/ CAD, hyperlipidemia C
Garlic Hyperlipidemia B
Familial hyperlipidemia, atherosclerosis C
Ginseng CAD, Hyperlipidemia C
Globe artichoke Hyperlipidemia B
Goldenseal Hypercholesterolemia C
Grapefruit Heart disease C
Grape seed Hypercholesterolemia C
Guggul Hyperlipidemia C
Gymnema Hyperlipidemia C
Selected herbal therapies
Herbs Lipid Disorders Grades
Lemongrass Atheroclerosis/ hyperlipidemia C
Milk thistle Hyperlipidemia C
Nopal Hyperlipidemia C
Omega-3 fatty acid, ALA Hyperlipidemia C
Hypercholesterolemia D
Policosanol Hypercholesterolemia A
Psyllium Hypercholesterolemia A
Pycnogenus Hypercholesterolemia C
Red clover Hypercholesterolemia C
Red yeast rice Hypercholesterolemia A
CHD C
Reishi mushroom CHD C
Selected herbal therapies
Herbs Lipid Disorders Grades
Rhubarb Hypercholesterolemia C
Safflower Familial hyperlipidemia, C
hypercholesterolemia, atherosclerosis
Soy Hypercholesterolemia, CVD A
Spirulina Hypercholesterolemia C
Sweet almond Hypercholesterolemia B
Tea Hypercholesterolemia, hypertriglyceridemia C
Turmeric Hypercholesterolemia C
White horehound Hypercholesterolemia C
Wild yam Hypercholesterolemia C
Yucca Hypercholesterolemia C
SUMMARY
Red Yeast Rice
Grade A: Strong scientific evidence for hypercholesterolemia
Grade C: Unclear/conflicting scientific evidence for CHD
Dose
• 3,4-45 g/day in 2-3 divided doses for 8-12 weeks

Adverse effect
• Chocking  take psyllium w/ at least 8 ounces of water

Interaction
• Anticoagulants
• Antidepressant
• Oral agents
• Orlistat
• Vitamin B12  taken 1 h / 4 h after psyllium
 DIETARY
FIBER MAY

Psyllium (Plantago spp.)

Grade A: Strong scientific evidence for hypercholesterolemia
REDUCE
RISK OF CHD

Mechanism of action
• Proposed mechanism: “displacement” of dietary fat by soluble fiber  ↓ cholesterol available
for absorption
• ↑ Fecal excretion of bile acids & cholesterol, bind bile acids & cholesterol in intestines, allow
less circulation for reabsorption & cause the liver to use more cholesterol to make bilde acid
• Fatty acids proprionate & acetate are produced from soluble fiber by bacteria in the colon 
indirecty inhibit cholesterol biosynthesis on the liver

Scientific evidence

• Meta analysis (8 studies)  ↓ serum total cholesterol, LDL. Apo B:apo A-1 ratio; no effect on
serum HDL
• Approved by FDA as dietary fiber that may reduce the risk of coronary heart disease  not
recommended to px with severe/moderate hypercholesterolemia (compared w/ lovastatin)
β-sitosterol, Sitosterol
Grade A: Strong scientific evidence for hyperlipidemia
β-glucan
Grade A: Strong scientific evidence for hyperlipidemia
Soy (Glycine max)
Grade A: Strong scientific evidence for hypercholesterolemia, CVD
Avocado (Persea americana)
Grade B: Good scientific evidence for hypercholesterolemia
 DIETARY
FIBER MAY
Barley (Hordeum
Grade B: Good scientific evidence for hyperlipidemia
vulgare) REDUCE
RISK OF CHD
Soy (Glycine max)

Barley (Hordeum vulgare)

Reishi mushroom (Ganoderma
lucidum)
Grade C: Unclear/conflicting scientific evidence for CHD
Safflower (Cathamus tinctorius)
Grade C: Unclear/conflicting scientific evidence for familial hyperlipidemia, hypercholesterolemia,
atherosclerosis
ADJUNCT THERAPIES
INTEGRATIVE THERAPY PLAN
• Individuals age 20 and older should have their cholesterol levels measured at least once every 5
years.
• In general, prescription drugs should be taken 1 hour before or 2 hours after taking psyllium or
barlerly. Doses of 3.4 to 45 g daily of psyllium, in two to three divided doses for 8 to 12 weeks,
have been used in clinical trials.
• The FDA has approved a health claim stating that soy products (containing at least 6.25 g of soy
protein for serving, one fourth the effective level of 25 g daily) may reduce the risk of coronary
heart disease by lowering blood cholesterol levels. Caution is advised for women with hormone-
sensitive conditions, because soy contains phytoestrogen and may have estrogenic effects.
• Beta-sitosterol is one of the most prevalent diaetary phytosterols (plant sterols) found in plants,
as in fruits, vegetables, soybeans, breads, peanuts, and peanut product. Many human and animal
studies have demonstrated that supplementation with beta-sitosterol decrease total and LDL
cholesterol.
• Omega-3 fatty acids from fish or fish oil supplements significantly reduce blood triglyceride levels.
Review Questions
1. True or false: FDA has approved health claims that two dietary fibers (β-glucan
& psyllium) may reduce the risk of CHD
2. Which substances in red yeast rice are known to inhibit cholesterol synthesis?
a. Phenolic diterpenes
b. Polyphenols
c. Hydroxybenzenes
d. Monacolins
3. True or false: FDA approved a health claim that soy products may reduce the
risk of CHD by lowering blood cholesterol levels
Review Questions
4. Which of the following statements is true concerning the use of
psyllium or its constituents?
a. Psyllium should not be taken within 1 hour of taking medications
or other oral agents
b. Psyllium is systemically absorbed
c. Psyllium products are considered to be unsafe during all three
trimesters of pregnancy
d. There is nor enough evidence to support the use if psyllium in
reducing cholesterol levels
References
• Bone K, Mills S. 2013. Principles and Practice of Phytotherapy: Modern
Herbal Medicine, 2nd Edition. New York: Churchill Livingstone.
• Ulbricht C, Seamon E. 2010. Natural Standard Herbal
Pharmacotherapy: An Evidence-Based Approach. Canada: Mosby Inc.