Cholesterol-lowering Supplements: What Works, What Doesn't

Cholesterol is a fat-like substance in every cell that is vital for your body to function properly. While some cholesterol is needed, high levels—particularly of low-density lipoprotein (LDL), which is sometimes referred to as "bad" cholesterol—can have negative effects on your health.¹

If your cholesterol is too high, your healthcare provider may recommend medication or lifestyle changes to lower your cholesterol levels.² But you may also be interested in cholesterol-lowering supplements that can help you reach your cholesterol goal.

Why Would Cholesterol Need to Be Lowered?

Your body can produce cholesterol all by itself, but it may also be in the foods you eat.¹ It is important to have your cholesterol in the right range for your best health.

Cholesterol is needed to make hormones and vitamin D. But high levels of LDL cholesterol may cause the development of fatty deposits known as plaque, leading to clogged arteries.¹ Untreated high cholesterol can thus lead to complications like stroke or heart attack.³

Healthcare providers may test your blood and measure the levels of different kinds of cholesterol. Cholesterol levels are measured in milligrams per deciliter (mg/dL). Normally, several cholesterol levels are checked using a test called a lipid profile⁴:

• LDL is sometimes called "bad" cholesterol because it can lead to fatty clogs in your arteries. The Centers for Disease Control and Prevention (CDC) says LDL should be about 100 mg/dL.
• HDL is the abbreviation for high-density lipoproteins. This is sometimes called "good" cholesterol because it can help clear out LDL. Appropriate HDL levels can reduce your risk of stroke or heart attack. The CDC recommends HDL levels at or above 40 mg/dL in men and 50 in women.
• Triglycerides are a kind of fat in the blood the body uses for energy. They are different from cholesterol, but having high levels of triglycerides in combination with low HDL cholesterol or high LDL cholesterol levels can increase the risk of heart attack and stroke. The CDC recommends triglyceride levels below 150 mg/dL.
• Total cholesterol measures all the different kinds of fat (lipids) in your bloodstream. This includes LDL, HDL, triglycerides, and some less common substances. The CDC recommends a total cholesterol level of about 150 mg/dL.

These ranges are general guidelines for cholesterol. Your healthcare provider may recommend different goals depending on your family history, lifestyle, and overall health.

If it's determined that your cholesterol is too high, your provider will give you ways to reduce your levels.

Supplements That Can Help Lower Cholesterol

Following a healthy diet, exercising, and not smoking are the most commonly recommended natural ways to manage cholesterol.⁵ There are also some supplements that may assist in lowering cholesterol.

The Food and Drug Administration (FDA) describes a supplement as a product taken by mouth that has ingredients meant to add to your diet. Supplements are not medications, so they are not regulated to the same level as drugs and are not approved by the FDA for safety and effectiveness.⁶ Be sure to check with your healthcare provider about adding any supplements to your routine.

Red Yeast Rice

Red yeast rice is a food supplement that has been used in traditional Chinese food dishes. Depending on how it is grown, the yeast may produce a substance called monacolin K. Monacolin K is a naturally occurring form of the cholesterol-lowering drug lovastatin.⁷

Red yeast rice extract has been shown to decrease LDL cholesterol between 15% and 25% in about two months. However, the effect is dependent on the amount of monacolin K in the supplement.⁸

There are safety concerns about red yeast rice products. Some red yeast rice supplements have been found to contain a contaminant called citrinin that can cause kidney failure in some people. Red yeast rice products may also produce side effects in the muscles similar to those of lovastatin, such as pain, weakness, and breakdown.⁷

Since 1998, FDA regulations have limited the amount of monacolin K that can be in red yeast rice products. They can now contain only a trace amount of monacolin K. Any amount more and the FDA would categorize the product not as a supplement but as an unapproved medication.⁷

Red yeast rice may have multiple drug interactions. Cholesterol-lowering medications, antibiotics, and treatments for HIV infection are among the types of medications that may interact negatively with red yeast rice.⁷

Berberine

Berberine is a dietary supplement that has been used in traditional Chinese medicine. It is harvested from parts of certain plants, such as goldenseal, and made into an edible substance.⁹ Goldenseal itself can be taken in supplement form, but the body would absorb only a small amount of berberine this way. That means any research on the benefits of berberine wouldn't necessarily apply to goldenseal itself.¹⁰

Berberine has been shown to reduce not only LDL but also triglycerides.¹¹ The exact way that berberine works inside the body is not well understood.⁹

Overall, side effects tend to be related to the digestive system. They include diarrhea, constipation, and bloating.¹¹

Fish Oil/Omega-3 Fatty Acids

Fish are often a source of omega-3 fatty acids, which are believed to help improve overall cholesterol levels.¹² This has led some supplement manufacturers to create fish oil capsules.¹³ Fish liver oil and krill oil are also available as liquid oils (similar to cooking oil) to be added for flavor or as a dietary supplement.¹⁴

High doses of omega-3 fatty acids may help reduce triglyceride levels for some people.¹⁴ A 2017 study compared fish oil supplements to dietary fresh fish. Both groups had significantly lower total cholesterol, non-HDL cholesterol, and triglyceride levels. However, the dietary fish group had more improvements than the supplement group.¹²

Eating seafood is generally more effective than taking fish oil supplements.¹⁴ As a supplement, fish oil is not regulated by the FDA, so the specific oils and doses in these can vary widely.⁶

Fish oil is generally well tolerated, though some people may experience an unpleasant taste or an upset stomach.¹¹ People with allergies to seafood or shellfish should talk with their healthcare provider before consuming a possible allergen.¹⁴

Blood-thinning medications or other drugs that affect blood clotting may interact with fish oils,¹⁴ so discuss with your provider any supplements you are considering before you start taking them.

Garlic

Garlic is often considered one of the oldest dietary supplements and is believed to help with not only blood pressure but also cholesterol levels.¹⁵

Garlic can be used in many forms, including raw, cooked, or powdered. Garlic oil can also be extracted and consumed.¹⁵

While there has been some conflicting evidence, most of the evidence shows garlic to be effective in lowering cholesterol.¹⁵ A 2016 literature review looked at multiple research studies about garlic. Garlic seems to help lower overall cholesterol between 7.4–29.8 mg/dL.¹⁶ There is some evidence that garlic also helps to lower LDL levels—anywhere from 5% to 10%—but it does not seem to change HDL levels.¹⁷

Garlic may have different effects depending on sex, age, and other health factors. The effect may also depend on the specific kind of supplement and its doses.¹⁷

As for drawbacks, some people might find garlic to have a strong smell and odor. It may cause body odor or unpleasant-smelling breath. Some people may experience an upset stomach or other digestive issues. It's also possible to be allergic to garlic. Garlic supplements may also increase the risk of bleeding, especially if you are taking a blood thinner.¹⁵

Soluble Fiber

As part of a healthy diet, eating adequate amounts of fiber may help with cholesterol.¹⁸ Adding additional fiber with soluble fiber supplements like psyllium may be helpful in lowering cholesterol for some people.¹⁹

Soluble fiber is found in foods like fruits and vegetables. It can also be taken in supplement form. Soluble fiber absorbs water and forms a gel-like substance that slows down the digestive system.¹⁸

Soluble fibers attach to the cholesterol you have eaten, helping to pass out the cholesterol in stool without it entering the bloodstream. Soluble fiber also slows down stomach emptying, increases feelings of fullness when eating, and reduces cholesterol production by the liver.¹⁹

Soluble fiber has many subtypes. Psyllium is available as a supplement and has been shown to reduce LDL levels by around 7%. It's recommended that soluble fiber supplements be considered as a possible option, with the caveat that there is no full agreement on their effectiveness.¹⁹

As for potential negative effects, increasing fiber intake can cause some mild digestive system symptoms.²⁰ Soluble fiber supplements like psyllium function primarily as a bulk-forming laxative. Drug-related interactions are rare.

Supplements That Are Not as Promising

In 2017, the International Lipid Expert Panel reviewed supplements that research had suggested might help in lowering cholesterol. The panel determined that several were not effective at lowering cholesterol and might even be harmful. The committee recommended against using the following supplements as a way to reduce cholesterol²¹:

• Policosanols: These are alcohols from sugarcane wax. They are generally well tolerated, but more research is needed to nail down their true lipid-lowering benefits before they are recommended.
• Silymarin: This is extracted from the seeds of milk thistle. It doesn't absorb well in the body, and more information about its safety is still needed.
• Conjugated linoleic acid: This is made from the fat and milk of certain animals. It has been shown to negatively affect vascular function.

Remember that the FDA does not study the claims made by supplement manufacturers. It is important to make sure your healthcare team knows about any dietary supplements and medications you are taking.

Summary

High cholesterol is known to be a risk factor for serious health complications like stroke and heart attack. Your healthcare provider may recommend multiple approaches for managing your cholesterol levels to reduce your risk for these serious outcomes.

While there are some potentially promising dietary supplements that may help with cholesterol, it can be difficult to find high-quality research showing these supplements to be safe and effective. When considering cholesterol-lowering dietary supplements, remember that the manufacturers are not required to show testing for the claims about their usefulness.

Speak with your healthcare provider about any supplements and medications you are taking and treatments you are following. If lifestyle approaches and natural approaches do not have an adequate effect, your provider may recommend prescription medications to address issues with your cholesterol.

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