June 20, 2013
View as List Cholesterol-Lowering Supplements
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If you have high cholesterol and you can’t lower it enough via diet and exercise and don’t want to take a statin drug, you may be tempted to try supplements that claim to lower cholesterol. Here’s a rundown of some of them, which are sold on their own and in countless “heart-health” formulas. We chose some good ones and some questionable ones and awarded stars to those that merited it. Some get no stars and our top rating is ★ ★ ★.
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Niacin
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. -
Sterols or Stanols
These plant compounds, which resemble cholesterol, interfere with absorption of dietary cholesterol. Two grams a day lowers LDL (“bad”) cholesterol by about 10 percent. Government cholesterol guidelines and the American Heart Association recommend foods fortified with sterols/stanols, such as Benecol margarine. There are also sterol and stanol supplements, which vary in composition and dosage. The FDA allows food and supplement labels to claim they reduce the risk of heart disease if they supply at least 400 milligrams of sterols per serving or dose, for a daily total of 800 milligrams.
Our rating: ★ ★ Worth trying. -
Red Yeast Rice Extract
Long 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 and 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—as you would with a statin—to make sure it is working and not having adverse effects. -
Soluble Fiber Supplements
Government guidelines recommend fruit, vegetables and grains rich in soluble fiber, including psyllium, a seed grain sold as a laxative and fiber supplement. Psyllium can lower LDL cholesterol by 5 to 15 percent and has other heart-healthy effects. Beta glucan, found in oats and barley, is another soluble fiber known to lower LDL cholesterol. Many supplements provide beta glucan or other soluble fibers, but have not been adequately studied.
Our rating: ★ ★ Psyllium is a good option as part of a heart-healthy diet. Get other soluble fibers from foods, not supplements. -
Fish Oil Supplements
The omega-3 fats in fish offer up a variety of potential cardiovascular benefits, but 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: ★ If you have heart disease or high triglycerides, talk to your doctor about omega-3 supplements, but don’t take them to lower your cholesterol. -
Policosanol
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. -
Garlic
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.
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 Extract (Guggulipid)
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. -
Artichoke Leaf Extract
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. -
Other Supplements
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. -
The Bottom Line
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.
