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. It lowers LDL (“bad”) cholesterol by up to 30 percent, but unlike statins, it also boosts HDL (“good”) cholesterol and reduces triglycerides. However, some major studies have called niacin’s efficacy and safety into question, and updated cholesterol guidelines no longer recommend it except perhaps for people who can’t tolerate statins. A common side effect is flushing. Our rating: ★★★ Recommended mainly for people with low HDL or elevated triglycerides. Use under medical supervision.
These plant compounds interfere with the absorption of dietary cholesterol. Two daily grams lower LDL (“bad”) cholesterol by 9 to 20 percent. The American Heart Association has recommended foods fortified with sterols/stanols, such as Benecol margarine and Minute Maid Heart Wise orange juice. There are also supplements, which vary in composition and dosage. The FDA allows labels on foods and supplements 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 at least 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.
Psyllium, sold as a laxative and fiber supplement, can lower LDL cholesterol 5 to 15 percent and has other heart-healthy effects. Another soluble fiber, beta glucan, is found in oats and barley and also lowers LDL. The FDA allows fiber-rich oat and barley products to 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 being questioned, 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 an Australian review from 2013 found only modest reductions. The supplements may interact with some medications for diabetes, HIV, hypertension, and cancer. Our rating: Supplements are not recommended. 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 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.
Some promising early research suggested that this antioxidant mineral may lower cholesterol and help prevent heart disease, but more recent research has been less kind. For a report in the Cochrane Review, for example, researchers looked at 12 trials on the effects of selenium supplementation, involving nearly 20,000 people, and found no link between selenium and a reduced risk of cardiovascular disease. And supplemental selenium may increase the risk of type 2 diabetes. Our rating: Not recommended. Americans generally get enough selenium from foods.
Rich in fiber and flavonoids, this member of the legume family is often sold as a dietary supplement, in capsules, tablets, tinctures, and powders. Lab and animal studies have shown that fenugreek might lower cholesterol by increasing bile secretion and inhibiting absorption of dietary cholesterol in the intestine. But the few studies that have been done involving people have come up with inconsistent results. In theory, fenugreek supplements could interact with blood thinners or cause gastrointestinal symptoms. Our rating: Supplements are not recommended. Limit your use of fenugreek to cooking.
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, 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.