This B vitamin, taken in very large doses (1 to 3 grams a day), is actually a drug and is sold by prescription as well as over the counter (OTC). It lowers LDL (“bad”) cholesterol by up to 30 percent, but unlike statins, it also substantially boosts HDL (“good”) cholesterol and reduces triglycerides. A common side effect is flushing; in rare cases, it can cause liver damage. The extended-release versions reduce the flushing, but OTC products may increase the risk of liver damage. Our rating: ★ ★ ★ Recommended primarily for people with low HDL and/or elevated triglycerides. Use under medical supervision.
These plant compounds interfere with absorption of dietary cholesterol. Two daily grams lowers LDL (“bad”) cholesterol by 9 to 20 percent. Government cholesterol guidelines and the American Heart Association recommend foods fortified with sterols/stanols. There are also supplements, which vary in composition and dosage. The Food and Drug Administration (FDA) allows food and supplement labels to claim they reduce the heart disease risks if they supply at least 400 milligrams of sterols per serving/dose, for a daily total of 800 milligrams. Our rating: ★ ★ Worth trying.
Used in Asia as a heart remedy, the extract is made by fermenting red yeast on rice. Its main compound, monacolin K, lowers cholesterol production in the liver. It is marketed in purified form as the drug lovastatin. The effect of supplements is unpredictable. The amount of compound can vary greatly and other substances with unknown effects are present. Our rating: ★ ★ Brands may or may not be effective. If you take it, have your blood tested regularly to make sure it is working and not having adverse effects.
Guidelines recommend produce and grains rich in soluble fiber. One is psyllium, sold as a laxative and fiber supplement, which can lower LDL cholesterol 5 to 15 percent and has other heart-healthy effects. Another is beta glucan, in oats and barley, which lowers LDL cholesterol. Fiber-rich oat and barley products can bear a heart-health claim, but you need 3 to 6 daily grams for significant effect. Many supplements provide beta glucan or other soluble fibers, but need more study. Our rating: ★ ★ Psyllium is a good option as part of a heart-healthy diet. Get other soluble fibers from foods.
The cardiovascular benefits of omega-3 supplements are now questionable, but one thing is clear: they do not lower cholesterol. In fact, they may raise both LDL and HDL slightly. They do help lower triglycerides, though it takes very high doses. Our rating: ★ Not recommended for cholesterol control.
Usually derived from sugar cane or beeswax, policosanol has been studied mostly in Cuba, where much of it is made. Though Cuban studies have found it improves cholesterol levels, independent studies from Germany and Italy found it ineffective. Potential side effects include gastrointestinal upset and rashes; it can affect blood-clotting medication. It’s often combined with a laundry list of ingredients, making the effect especially unpredictable. Our rating: Not recommended.
Studies have yielded inconsistent results. There are many types of supplements, with different amounts of garlic components. In 2007 a well-designed study from Stanford University found no benefit from two popular supplements or raw garlic. More recently, two analyses concluded that clinical trials have not shown consistent or significant improvements in cholesterol, while a Chinese review from 2012 found only very modest reductions. Our rating: Supplements are not recommended; if there is an effect, it’s small. Eat garlic if you like it, not to lower cholesterol.
Guggul is a gummy resin from a tree in India, where an extract called guggulipid is used as a drug to lower cholesterol and triglycerides. Despite some positive research from India, two well-designed studies (from the U.S. and Norway) found no lowering of LDL, but did note frequent side effects, mostly gastrointestinal. It can interfere with certain drugs. Long-term safety is unknown.
Our rating: Not recommended.
Some early research suggested cholesterol-reducing effects. But a 2009 review by the Cochrane Collaboration looked at three clinical trials and concluded that the extract had only a small effect on lowering cholesterol and that better research is needed.
Our rating: Not recommended.
Grape polyphenols, tea catechins, buckwheat, hawthorn fruit and a variety of other plant compounds have been shown to have some cholesterol-lowering effects, mostly in animal or test-tube studies. The few human studies have been small, short and/or poorly designed. Our rating: Not recommended.
If you have high cholesterol and try one of these supplements, tell your doctor, so he or she can monitor effects. If you’re already taking a statin, a few of these may help you stay on a lower dose of the drug. Don’t assume that such supplements are safe 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. Some can interact with medications, including cholesterol-lowering medication. Optimal doses are usually not known. Most have modest effects, if any.