Cholesterol-Lowering Supplements

If you have high blood cholesterol and you can’t lower it enough via diet and exercise, but don’t want to take a cholesterol-lowering drug, you may be tempted to try some of the many supplements that claim to lower cholesterol. This guide will help you.

Don’t assume these supplements are safe just because they are “natural” and available without a prescription. If they can affect blood cholesterol (and even if they can’t) they can also have other effects in the body. Many interact with medications, including cholesterol-lowering drugs. Optimal doses are not always known. Most have modest effects, if any.

Cholesterol-lowering drugs, on the other hand, have been carefully studied. They have impressive results, and their side effects, mostly rare, are known.

If you have high cholesterol and try one of the supplements, tell your doctor and have periodic blood tests to see if it is having the desired effect.

Supplement: Plant sterols or stanols (also called phytosterols)
What it does: Interfere with absorption of dietary cholesterol. Lower LDL (“bad”) cholesterol, but little or no effect on HDL (“good”) cholesterol or triglycerides. Used in FDA-approved margarines (Benecol and Take Control), which lower cholesterol by an average of 10% when eaten as directed.
Further details: A few other foods, such as a new orange juice, also contain sterols. Such foods are recommended in government cholesterol guidelines. Can be taken with cholesterol-lowering drugs. Effectiveness of various supplements containing stanols/sterols unknown; these vary in composition and ingredients. Many contain amounts too small to have any effect.
Potential side effects: Gastrointestinal problems such as cramping and diarrhea. May possibly reduce absorption of fat-soluble vitamins (A, D, K, and E) as well as carotenoids such as beta carotene.
Bottom line: The margarines and orange juice are worth trying, rather than the supplements.

Supplement: Psyllium (such as Metamucil)
What it does: A seed grain sold as a fiber supplement and laxative (powder or pill). Lowers total and LDL cholesterol by 4 to 7%.
Further details: Featured in the cholesterol-lowering Portfolio diet (Wellness Letter, November 2003). If you’re not accustomed to it, start with a low dose, then increase.
Potential side effects: Gas and bloating. May interact with some drugs. In rare cases, allergic reactions.
Bottom line: A good option, though the effect is modest compared to drugs.

Supplement: Beta glucan
What it does:
A soluble fiber found in oats and barley. Lowers total and LDL cholesterol. Also available in supplement form.
Further details: FDA allows fiber-rich oat products to make a heart-healthy claim. For a significant effect, you need 3 to 6 grams a day, the amount in 1.5 cups of cooked oatmeal.
Potential side effects: Gas and bloating.
Bottom line: Stick with oats and barley, not supplements.

Supplement: Niacin
What it does: Taken in massive doses, this B vitamin (also called nicotinic acid) is a proven way to lower LDL, boost HDL, and reduce triglycerides substantially. May have other beneficial effects as well. Other cholesterol-lowering drugs have less effect on HDL and triglycerides.
Further details: If you take it, you’ll need regular checkups and blood tests. Not a good choice for people with liver disease. One extended-release brand, Niaspan, is available only by prescription.
Potential side effects: Flushing and itching. Also nausea, blurred vision, dizziness, headache, rise in blood sugar, and liver damage. Extended-release versions, such as Niaspan, reduce flushing.
Bottom line: In therapeutic doses, this is a drug. Take only under medical supervision. May be prescribed along with another cholesterol-lowering drug.

Supplement: Guggul extract (guggulipid)
What it does: Gummy resin from a tree in India, where an extract called guggulipid is approved as a drug to lower LDL cholesterol and triglycerides.
Further details: Despite some positive research, a recent well-designed study at the University of Pennsylvania found no benefits. Do not take if you have liver disease, thyroid disorders, or inflammatory bowel disease.
Potential side effects: Rashes, nausea, headaches, vomiting, and diarrhea. May interfere with some heart and blood pressure drugs.
Bottom line: Effectiveness unknown.

Supplement: Red yeast rice extracts
What it does: Used for centuries in China as a heart remedy. Made by fermenting red yeast on rice; contains lovastatin, the same ingredient found in one of the statin drugs (Mevacor). Best-known brand in the U.S. was Cholestin.
Further details: Less predictable than statin drugs, since extracts also contain other substances. FDA considered Cholestin an unapproved drug and tried to block its sale. Manufacturer finally removed red yeast from Cholestin in the U.S. Other red yeast products are still available here.
Potential side effects: Bloating, gas. Rarely, muscle pain or liver problems. May interact with grapefruit juice. Do not take with other cholesterol-lowering drugs or levothyroxine (for thyroid problems).
Bottom line: If you need a statin, take one of the prescription drugs. If, however, you do take red yeast, you need medical supervision and periodic blood tests.

Supplement: Policosanol
What it does: Derived from sugar cane, yams, or beeswax. Now found in Cholestin.
Further details: Some studies suggest it can lower LDL cholesterol as much as 25%; others have found little or no effect. Don’t take with anti-clotting drugs.
Potential side effects: Gastrointestinal upset, rashes, headaches, insomnia, and weight loss. May inhibit blood clotting.
Bottom line: Promising, but more research needed. Often combined with many ingredients, so effect is unpredictable.

Supplement: Garlic
What it does: Probably the No.1 claim made for garlic supplements is lowering cholesterol. There are many types of garlic supplements, with different garlic components.
Further details: Most well-designed studies have found that supplements have only a small effect, if any. No one knows which garlic component is most important.
Potential side effects: High doses may cause nausea and heartburn; may increase risk of bleeding if taken with anti-clotting drugs.
Bottom line: Eat garlic, if you like it, but skip the supplements, which are ineffective.

Supplement: Fenugreek
What it does: These seeds, a traditional spice, are 40% soluble fiber (mostly mucilage). Contain other potential cholesterol-lowering compounds.
Further details: Minimal research. A few small studies have found it can lower cholesterol, but that you need at least half an ounce a day for a significant effect.
Potential side effects: Flatulence, nausea, and diarrhea. May interact with blood clotting medi-cation and other drugs.
Bottom line: Not recommended.

UC Berkeley Wellness Letter, February 2004