The October, 2015 issue of the American Diabetes Association journal Diabetes Care featured an article which reveals a reduction in low-density lipoprotein (LDL) cholesterol levels among users of metformin, a commonly used antidiabetic drug that has been associated with other health benefits.

Rui Wang-Sattler of Helmholtz Zentrum München and colleagues utilized fasting serum samples collected from over 1,800 subjects, including 151 type 2 diabetics treated with metformin, enrolled in the Health Research in the Region of Augsburg (KORA) cohort. The current study evaluated genetic factors and 131 metabolites, as well as serum lipids.

In association with a decline in three metabolites, the researchers observed a relationship between metformin use and lower LDL cholesterol in type 2 diabetics treated with the drug in comparison with those who were not using oral glucose-lowering medications. "We speculate that metformin intake affects the levels of LDL cholesterol via AMPK, leading to a down-regulation of the genes FADS1 and 2," stated Dr Wang-Sattler, of the Research Unit of Molecular Epidemiology at the Institute of Epidemiology II of the Helmholtz Zentrum München.. "This is also supported by the fact that three lipid metabolites, which are dependent on FADS, are decreased. Presumably, this is the mechanism how the production of LDL cholesterol is repressed by metformin."

"Our study suggests that metformin might indeed have an additional beneficial effect with regards to cardiovascular diseases among the diabetes patients," first author Tao Xu concluded.

There are several nutrients that have been identified as potential agents for promoting a favorable lipid profile; many of them work by the same principles as conventional therapies (such as reducing cholesterol synthesis, or interfering with cholesterol absorption in the gut). Several also have additional activities (antihypertensive, inhibition of LDL-oxidation, anti-inflammatory) that complement their cholesterol-lowering activity and lend to their overall reductions in fatal and non-fatal cardiovascular events.

Indian gooseberry (Amla; Emblica officinalis) has been used traditionally as a nutrient-dense food in Indian regions, and in Ayurvedic medicine for treating a variety of conditions. Modern scientific inquiry has revealed considerable evidence in support of the medicinal use of this nutritional powerhouse. Analytical studies on extracts of Indian gooseberry highlight its potent antioxidant properties; animal studies carry these findings forward by showing that orally administered amla extract significantly reduce levels of oxidized LDL. In human studies, extracts of amla have been shown to attenuate elevations in LDL, total cholesterol, and triglycerides, and boost levels of protective HDL.

Prebiotics, a subset of soluble fiber, have gained attention in recent years in their ability to be selectively fermented by gut flora for a diversity of potential health-promoting benefits. The fermentation of prebiotic fibers into short-chain fatty acids such as acetate, butyrate, or propionate may inhibit cholesterol synthesis in the liver.