High Cholesterol

Health Condition

High Cholesterol

  • Artichoke

    Artichoke leaf extract has been found to lower total and LDL-cholesterol levels and may increase HDL-cholesterol levels.

    Dose:

    500–1,000 mg daily
    Artichoke
    ×
    Artichoke (Cynara scolymus) leaf extract has been shown to reduce total and LDL-cholesterol levels, as well as triglyceride levels, and this effect may be related to artichoke flavonoids.8 A meta-analysis of findings from nine randomized controlled trials with a combined total of 702 participants found artichoke leaf extract reduced total and LDL-cholesterol levels and triglyceride levels, without impacting HDL-cholesterol levels.9 Nevertheless, in an uncontrolled clinical trial in 20 people with depressed HDL-cholesterol levels and moderately elevated total cholesterol levels, 250 mg of artichoke leaf extract twice daily for 60 days increased HDL-cholesterol levels.10 A trial with 92 overweight subjects with mildly elevated cholesterol levels found 500 mg artichoke leaf extract twice daily for eight weeks reduced total and LDL-cholesterol and increased HDL-cholesterol levels compared with placebo.11 Another placebo controlled trial with 55 participants found artichoke leaf extract, at 600 mg per day for eight weeks, improved lipid levels as well as glucose metabolism in overweight individuals with high blood glucose levels.12

  • Berberine

    Berberine, a compound found in herbs such as goldenseal, barberry, goldthread, and Oregon grape, has been found to lower total and LDL-cholesterol levels and raise HDL-cholesterol levels.

    Dose:

    500 mg two to three times per day
    Berberine
    ×
    Berberine, an alkaloid compound found in herbs such as goldenseal, barberry, goldthread, and Oregon grape, has been found to improve lipid profiles in numerous clinical trials. In a meta-analysis of findings from 18 controlled trials, berberine was found to improve multiple aspects of metabolic syndrome: berberine reduced total and LDL-cholesterol levels, increased HDL-cholesterol levels, and improved markers of insulin resistance.13 Similarly, a meta-analysis that included data from 16 randomized controlled trials with a total of 2,147 participants with abnormal lipid profiles found treatment with berberine led to reductions in total and LDL-cholesterol and triglyceride levels, and an increase in HDL-cholesterol levels.14 Berberine has also been found to be as effective as the cholesterol-lowering drug simvastatin (Zocor) and may enhance its effects when used adjunctively.15,16 Several trials have further shown the use of berberine in combinations containing red yeast rice extract and/or sylimarin (from milk thistle) can be effective for lowering cholesterol levels.17,18,19

  • Beta-Glucan

    Beta-glucans are a type of soluble fiber that has been shown in multiple clinical trials to lower elevated total and LDL-cholesterol levels.

    Dose:

    3 grams or more daily
    Beta-Glucan
    ×
    Beta-glucans are a type of soluble fiber found in oats and barley, and mushrooms, as well as yeasts, bacteria, and algae. Beta-glucans are a key factor in the cholesterol-lowering effect of oats. As with other soluble fibers, beta-glucans lower circulating cholesterol levels by binding to dietary cholesterol, reducing its absorption, and by altering cholesterol metabolism, partly through effects on the gut microbiome.20,21 A meta-analysis of results from 21 controlled trials that included a combined total of 1,120 participants with mildly elevated cholesterol levels found supplementing with a minimum of 3 grams per day of beta-glucan for at least three weeks led to reductions in total and LDL-cholesterol levels.22 In one placebo-controlled trial that included 191 subjects with borderline to very high LDL-cholesterol levels, taking 3 grams of beta-glucan daily for four weeks reduced LDL-cholesterol levels by 6% and cardiovascular risk scores by 8%.23 A placebo-controlled crossover trial that had 83 participants with moderately high cholesterol levels found LDL-cholesterol levels dropped 15.1%, total cholesterol levels decreased 8.9%, and non-HDL-cholesterol levels fell 12.1% after eight weeks of supplementing with 3 grams of beta-glucan daily.24

  • Beta-Sitosterol

    More than 50 years of research has shown consumption of sitostanol and beta-sitosterol, plant compounds known as phytosterols, lowers cholesterol levels.

    Dose:

    2 to 3 grams daily
    Beta-Sitosterol
    ×
    Beta-sitosterol and sitostanol are examples of phytosterols, plant compounds related to cholesterol. Phytosterols reduce dietary cholesterol absorption and alter cholesterol metabolism, and numerous clinical trials and meta-analyses have found dietary and supplemental phytosterols, especially sitosterols and sitostanols, lower cholesterol levels.25 In particular, clinical trials using margarine and other foods enriched with highly-absorbable sitostanol esters have noted substantial improvements in lipid profiles with an intake of 2–3 grams of sitostanol esters daily.26 Findings from research reviews indicate long-term use of 2 grams of sitostanols and sitosterols daily can reduce LDL-cholesterol levels by as much as 10–20%.27,28 Supplementation with beta-sitosterol or sitostanol has also been shown to enhance the cholesterol-lowering effect of statin drugs.29 In addition to improving lipid levels, beta-sitosterol has demonstrated anti-inflammatory, antioxidant, anti-diabetic, immune-modulating, liver-protective, and anti-anxiety properties that may add to its health-promoting effects.30

  • Chitosan

    Chitosan is a fiber-like polysaccharide that has been shown to improve cholesterol levels in a number of clinical trials.

    Dose:

    1 to 3 grams daily
    Chitosan
    ×
    The fiber-like polysaccharide chitosan is found in the exoskeletons of insects, crabs, and shrimp, as well as the cell walls of fungi and yeast.31 Chitosan has properties similar to viscous fibers and is believed to reduce the absorption of dietary cholesterol and inhibit cholesterol synthesis. In one placebo-controlled trial, 116 subjects with obesity taking 3.2 grams of chitosan daily for 12 weeks resulted in a 4.7% drop in LDL-cholesterol levels relative to placebo; the effect could not be fully explained by shifts in cholesterol absorption and metabolism, suggesting an unknown mechanism may contribute to its benefits.32 Furthermore, chitosan was found to be effective for lowering total and LDL-cholesterol levels in a meta-analysis of 14 randomized controlled trials.33 Another meta-analysis included data from 14 randomized controlled trials in subjects with overweight and obesity and found treatment with chitosan, at doses of 1–3 grams per day for an average of 17 weeks, lowered total and LDL-cholesterol levels, increased HDL-cholesterol levels, and reduced triglyceride levels.34

  • Fenugreek

    Fenugreek seed powder has been found to substantially lower blood levels of total and LDL-cholesterol.

    Dose:

    10 to 30 grams two to three times per day
    Fenugreek
    ×
    Fenugreek (Trigonella foenum-graecum) seeds contain soluble fiber as well as compounds known as steroidal saponins that inhibit cholesterol production by the liver and accelerate cholesterol breakdown.35 A meta-analysis that included findings from 12 placebo-controlled trials found fenugreek lowered total and LDL-cholesterol levels,36 while another meta-analysis that included 12 randomized controlled trials found fenugreek not only reduced total and LDL-cholesterol but also raised HDL-cholesterol levels.37 In one controlled trial, 114 newly diagnosed type 2 diabetic patients were randomly assigned to treatment with 25 grams (almost two tablespoons) of fenugreek seed powder twice daily or no treatment for one month. Total cholesterol levels fell 13.6% and LDL-cholesterol levels dropped 23.4% in those receiving fenugreek but were unchanged in the no-treatment group.38

  • Garlic

    Taking garlic can improve cholesterol levels and help prevent heart disease.

    Dose:

    300 to 900 mg a day of garlic powder
    Garlic
    ×
    Numerous randomized controlled trials and meta-analyses have found garlic can reduce total and LDL-cholesterol levels and raise HDL-cholesterol levels.39 A meta-analysis of 14 randomized controlled trials noted garlic had positive effects on all types of cholesterol levels.40 Similarly, a meta-analysis that included data from 29 randomized controlled trials with a total of almost 2,300 participants found treatment with garlic for two months or longer reduced total cholesterol by 8% and LDL-cholesterol by 10%, although HDL-cholesterol levels were only slightly improved.41 One meta-analysis concluded garlic improved lipid profiles in people with type 2 diabetes after pooling findings from 39 randomized controlled trials.42 The majority of clinical trials in these meta-analyses used garlic powder at doses of 300–900 mg per day, but some used garlic oil, aged garlic extract, or raw garlic. In addition to inhibiting cholesterol synthesis in the liver, garlic has been found to reduce oxidation of LDL-cholesterol, lower blood pressure, and decrease the risk of blood clots, lowering the risks of atherosclerosis and cardiovascular events.43

  • Glucomannan

    Glucomannan is a viscous, soluble dietary fiber that has been shown to improve metabolism and reduce LDL-cholesterol and non-HDL-cholesterol levels.

    Dose:

    3 grams daily
    Glucomannan
    ×
    Glucomannan is a viscous, soluble dietary fiber that is derived from konjac root. Clinical trials have shown glucomannan has positive impacts on glucose and lipid metabolism.44 A meta-analysis of 12 randomized controlled trials including 370 participants found that supplementing with 3 grams of glucomannan daily for three weeks or longer reduced LDL-cholesterol levels by 10% and non-HDL-cholesterol levels by 7%.45

  • Green Tea

    Green tea has been shown to lower total and LDL-cholesterol levels and improve cardiovascular health. Though uncommon, liver injury can occur with long-term use of green tea extract or EGCG.

    Dose:

    green tea extract providing 107–856 mg of EGCG daily in smaller divided doses and with food
    Green Tea
    ×
    Green tea has been shown to lower total and LDL-cholesterol levels in a number of randomized controlled trials. Some research further shows green tea can lower blood pressure, promote weight loss, and reduce the risk of cardiovascular events.46 Its benefits on heart health have largely been attributed to its polyphenols, including catechins such as epigallocatechin gallate (EGCG). A meta-analysis of results from 31 randomized controlled trials with a combined total of 3,216 subjects found green tea supplementation reduced total and LDL-cholesterol levels.47 In other large meta-analyses, green tea extract was found to reduce total cholesterol levels, as well as triglyceride levels, in type 2 diabetics,48 and decrease total and LDL-cholesterol levels in individuals with overweight and obesity.49 A research review indicated green tea extract providing 107–856 mg of EGCG could induce significant reductions in LDL-cholesterol levels.50 EGCG, with its powerful antioxidant and anti-inflammatory effects, has also been linked to reduced risks of atherosclerosis and heart attack.51

  • Pantothenic Acid

    Pantethine, a byproduct of vitamin B5 metabolism, may help reduce the amount of cholesterol made by the body.

    Dose:

    300 mg pantethine taken two to four times per day
    Pantothenic Acid
    ×
    Pantethine, a byproduct of vitamin B5 (pantothenic acid) metabolism with a critical role in converting fatty acids into energy, may reduce cholesterol levels by inhibiting cholesterol synthesis in the body.52  In a randomized placebo-controlled trial that included 32 subjects with low to moderate heart disease risk participating in a healthy lifestyle intervention program, treatment with pantethine, at a dose of 600 mg per day for eight weeks followed by 900 mg per day for another eight weeks, resulted in an 11% reduction in LDL-cholesterol levels, while placebo resulted in no significant change. In addition, 6% and 8% reductions in total and non-HDL-cholesterol levels, respectively, were seen in the pantethine group, but no significant changes were seen in the placebo group.53In a similar trial conducted by the same research group that included 120 participants with low to moderate heart disease risk, the 16-week pantethine treatment protocol reduced total cholesterol levels by 3% and LDL-cholesterol levels by 4% relative to placebo.54 Several uncontrolled trials have also found that pantethine, at doses of 300 mg two to four times per day, improved cholesterol levels.55,56,57 A meta-analysis of findings from 28 clinical trials including 646 participants with high cholesterol levels found pantethine, when taken in doses of 600–1,200 mg daily, reduced total and LDL-cholesterol levels and increased HDL-cholesterol levels; in addition, the analysis suggested beneficial effects on lipid levels may not be fully realized until 16 weeks of treatment with pantethine.58 Common pantothenic acid has not been reported to have any effect on high blood cholesterol.

  • Psyllium

    Psyllium husk has been shown to be effective at lowering total and LDL-cholesterol levels.

    Dose:

    2 to 20 grams (about ½–4 teaspoons) per day with meals
    Psyllium
    ×
    Psyllium husk is rich in viscous soluble fiber and is used as a supplement to lower high cholesterol levels, as well as improve digestive function. Psyllium has been shown in multiple clinical trials and meta-analyses to lower high total, LDL-, and non-HDL-cholesterol levels.59,60 One meta-analysis included data from 28 randomized controlled trials with a combined total of 1,924 participants and found psyllium, at doses ranging from about 2.4–20.4 grams per day for at least three weeks, lowered LDL- and non-HDL-cholesterol levels in both those with high and normal baseline cholesterol levels.61 In another meta-analysis that examined data from eight randomized controlled trials with a total of 395 subjects with type 2 diabetes, psyllium use was found to lower LDL-cholesterol and triglyceride levels.62 In a meta-analysis of three trials, psyllium was further found to enhance the cholesterol-lowering effects of statin drugs to a degree comparable to doubling the medication dose.63 Psyllium has even been found to be safe and effective for treating children and adolescents with high cholesterol levels.64,65

  • Red Yeast Rice

    Red yeast rice contains a compound that is well known to inhibit production of cholesterol in the liver.

    Dose:

    600 to 1,200 mg with 2.5 to 5 mg of monacolin K twice daily
    Red Yeast Rice
    ×

    Red yeast rice contains a compound called monacolin K (also known as lovastatin) that reduces production of cholesterol by inhibiting HMG-CoA reductase, a key enzyme in cholesterol synthesis.66 Multiple clinical trials have shown red yeast rice can effectively lower high total, LDL-, and non-HDL-cholesterol levels. In fact, six to eight weeks of treatment with red yeast rice extract has been found to reduce LDL-cholesterol levels by 15–25%.67

    Lovastatin (Mevacor)and several of its analogs, collectively called statins, are used as prescription drugs used to treat high cholesterol.66 However, a typical daily dose of red yeast rice extract provides 10 mg or less monacolin K, while a common dose of lovastatin is 20 to 40 mg per day.67 It has been suggested that other compounds, including other monacolins, present in red yeast rice work together with monacolin K to produce a greater cholesterol-lowering effect than would be expected from the small amount of monacolin K alone.66 Nevertheless, monacolins in red yeast rice products vary widely and are often not accurately quantified on labels, and red yeast rice has demonstrated a similar adverse side effect profile to lovastatin.71,72 Because HMG-CoA reductase also plays a role in synthesis of coenzyme Q10, an antioxidant needed for mitochondrial energy production, a small amount of coenzyme Q10 is sometimes included in red yeast rice supplements.73

    A randomized controlled trial comparing a monacolin K-containing red yeast rice product and a monacolin K-free red yeast rice product to placebo found only the monacolin K-containing supplement lowered cholesterol levels.74 An uncontrolled clinical trial in 25 subjects with low to moderate cardiovascular risk found supplementing with red yeast rice providing 3 mg monacolin K plus 30 mg of coenzyme Q10 daily for one year reduced total, LDL-, and non-HDL-cholesterol, as well as triglyceride and high-sensitivity C-reactive protein (hs-CRP, a marker of vascular inflammation) levels. In addition, vascular characteristics had improved at the end of the trial.75 In a controlled trial that included 104 participants with high cholesterol levels enrolled in a diet and lifestyle program, those additionally treated with a red yeast rice supplement providing 10 mg monacolin K and 30 mg coenzyme Q10 per day had greater reductions in total and LDL-cholesterol levels, as well as blood pressure, than those receiving no supplements.76

  • Sitostanol

    More than 50 years of research has shown consumption of sitostanol and beta-sitosterol, plant compounds known as phytosterols, lowers cholesterol levels.

    Dose:

    2 to 3 grams daily
    Sitostanol
    ×
    Beta-sitosterol and sitostanol are examples of phytosterols, plant compounds related to cholesterol. Phytosterols reduce dietary cholesterol absorption and alter cholesterol metabolism, and numerous clinical trials and meta-analyses have found dietary and supplemental phytosterols, especially sitosterols and sitostanols, lower cholesterol levels.74 In particular, clinical trials using margarine and other foods enriched with highly-absorbable sitostanol esters have noted substantial improvements in lipid profiles with an intake of 2–3 grams of sitostanol esters daily.75 Findings from research reviews indicate long-term use of 2 grams of sitostanols and sitosterols daily can reduce LDL-cholesterol levels by as much as 10–20%.76,77 Supplementation with beta-sitosterol or sitostanol has also been shown to enhance the cholesterol-lowering effect of statin drugs.78 In addition to improving lipid levels, beta-sitosterol has demonstrated anti-inflammatory, antioxidant, anti-diabetic, immune-modulating, liver-protective, and anti-anxiety properties that may add to its health-promoting effects.79

  • Soy

    Soy supplementation has been shown to lower cholesterol. Soy contains isoflavones, which are believed to be soy’s main cholesterol-lowering ingredients.

    Dose:

    25 grams soy protein per day
    Soy
    ×

    Soy supplementation has been shown to lower cholesterol in humans.80 Soy is available in foods such as tofu, miso, and tempeh and as a supplemental protein powder. Soy contains isoflavones, naturally occurring plant components that are believed to be soy’s main cholesterol-lowering ingredients. A controlled trial showed that soy preparations containing high amounts of isoflavones effectively lowered total cholesterol and LDL (“bad”) cholesterol, whereas low-isoflavone preparations (less than 27 mg per day) did not.81 However, supplementation with either soy82 or non-soy isoflavones (from red clover)83 in pill form failed to reduce cholesterol levels in a group of healthy volunteers, suggesting that isoflavone may not be responsible for the cholesterol-lowering effects of soy. Further trials of isoflavone supplements in people with elevated cholesterol, are needed to resolve these conflicting results. In a study of people with high cholesterol levels, a soy preparation that contained soy protein, soy fiber, and soy phospholipids lowered cholesterol levels more effectively than isolated soy protein.84

  • Calcium

    Some trials have shown that supplementing with calcium reduces cholesterol levels, and co-supplementing with vitamin D may add to this effect.

    Dose:

    500 to 1,000 mg daily
    Calcium
    ×

    Calcium can inhibit cholesterol absorption and synthesis, and some research shows calcium supplements can lower high cholesterol levels.85,86 A meta-analysis of results from 22 randomized controlled trials with a total of 4,071 participants found calcium supplementation, with or without vitamin D, decreased LDL-cholesterol and increased HDL-cholesterol levels, though the effects were small.87 In a placebo-controlled trial in 36,282 women aged 50 years and older, taking 1,000 mg calcium plus 400 IU vitamin D daily led to a small reduction in LDL-cholesterol levels compared with placebo after six years of monitoring.88 However, a two-year placebo-controlled trial in 190 premenopausal and 182 postmenopausal women with high cholesterol levels found long-term supplementation with 800 mg calcium daily increased cholesterol levels and resulted in detrimental changes in carotid artery structure, suggesting increased atherosclerosis in postmenopausal participants, but had no impact on these parameters in premenopausal participants.89

    Although many studies have examined the relationship between calcium supplementation and cardiovascular outcomes, this topic remains controversial. One recent review of trials and meta-analyses concluded modest calcium supplementation may have a small protective effect against heart attack, stroke, and cardiovascular death, especially in women.90 However, a meta-analysis of 13 randomized controlled trials with more than 42,000 participants found 1,000 mg per day of supplemental calcium, as well as high dietary calcium intake, can substantially increase cardiovascular risk in healthy postmenopausal women.91 Yet another large analysis found no cardiovascular benefits or harms from calcium supplementation.92

    Some research suggests vitamin D may increase the beneficial effects of calcium. In a randomized controlled trial in 45 women with obesity, those who received 1,200 mg calcium per day plus 50,000 IU vitamin D per week had greater reduction in cholesterol levels than those who received calcium alone or no supplements after three months.93

  • Charcoal

    Activated charcoal can bind to cholesterol and cholesterol-containing bile acids in the intestine, preventing their absorption.

    Dose:

    4 to 32 grams per day
    Charcoal
    ×
    Activated charcoal has the ability to adsorb, or bind to, cholesterol and cholesterol-rich bile acids present in the intestine, preventing their absorption.94 Reducing the absorption of bile acids results in increased cholesterol use in new bile acid synthesis by the liver.95 In a set of controlled trials lasting three weeks, activated charcoal reduced total- and LDL-cholesterol levels when given in amounts from 4 to 32 grams per day. The greatest effect (29% reduction in total cholesterol and 41% reduction in LDL-cholesterol levels) was seen in those given 32 grams daily and was comparable to that of cholestyramine (Questran), a bile acid-binding medication.96 Similar results were reported in another controlled trial using 40 grams per day for three weeks and an uncontrolled trial using 32 grams per day for four weeks.97,98 However, one small placebo-controlled trial found no effect of either 15 or 30 grams per day in patients with high cholesterol levels.99 Activated charcoal can cause black stools, digestive upset, and constipation, limiting its usefulness.

  • Chondroitin Sulfate

    Chondroitin sulfate appears to sequester cholesterol, lowering circulating cholesterol levels and reducing atherosclerosis.

    Dose:

    500 mg three times daily
    Chondroitin Sulfate
    ×
    Chondroitin sulfate is a large structural polysaccharide found in connective tissues including in blood vessel walls, where it appears to form complexes with cholesterol that contribute to atherosclerosis.100 Clinical trials performed in the 1960s and 1970s reported supplemental chondroitin sulfate had cholesterol-lowering effects and could slow atherosclerosis progression.101 For example, in one controlled trial that included 48 elderly participants with atherosclerosis, those given 4.5 grams of chondroitin sulfate daily had lower cholesterol levels, slower clotting times, and a lower mortality rate after 64 months.102 Another trial found chondroitin sulfate reduced the risk of coronary events (heart attack or serious episode of low blood flow to the heart) seven-fold during six years of monitoring.103 More recently, a trial in 48 subjects with obesity and knee osteoarthritis found eight weeks of supplementation with 600 mg of chondroitin sulfate daily not only reduced knee pain and dysfunction but also lowered total cholesterol levels and improved markers of inflammation and glucose metabolism relative to placebo.104 Some evidence suggests chondroitin sulfate interacts with LDL-cholesterol, reduces cholesterol accumulation in vessel walls, and decreases lipoprotein oxidation.105,106,107

  • Chromium

    Some controlled trials have found chromium supplementation can reduce total cholesterol and increase HDL-cholesterol levels, especially in people with type 2 diabetes, but the effects are small.

    Dose:

    up to 200 mcg daily
    Chromium
    ×
    Chromium is best known for its ability to improve blood glucose regulation in people with type 2 diabetes. Observational studies have correlated poor chromium status with low HDL-cholesterol108 and high total cholesterol109 levels. A meta-analysis of findings from 38 randomized controlled trial with a combined total of 7,605 participants found chromium supplementation reduced total cholesterol levels slightly. The analysis further noted better results were achieved in trials that used chromium picolinate, used daily doses under 200 micrograms, and lasted less than 12 weeks, as well as in subjects with type 2 diabetes and those under 54 years old.110 In a meta-analysis of 24 trials that only enrolled subjects with type 2 diabetes, chromium was similarly found reduce total cholesterol levels as well as raise HDL-cholesterol levels, but its impacts were small.111 However, a meta-analysis of ten trials that included 509 diabetic subjects found chromium had no effect on lipid levels.112

  • Cranberry

    Some, but not all, clinical trials show cranberry extract may improve cholesterol profiles.

    Dose:

    500 mg three times per day after meals
    Cranberry
    ×
    Cranberries are rich in flavonoid antioxidants that have demonstrated multiple beneficial effects.113 Randomized controlled trials have shown cranberry extract can increase HDL-cholesterol levels in people under 50 years old.114 In a placebo-controlled trial in 78 adults with overweight or obesity, taking 450 ml (about 15 ounces) of a high-polyphenol/low-calorie cranberry extract beverage daily increased HDL-cholesterol levels after eight weeks.115 In a placebo-controlled trial in 30 subjects being treated for type 2 diabetes, 500 mg of cranberry extract three times per day for 12 weeks lowered LDL-cholesterol levels as well as the ratio of total to HDL-cholesterol levels.116 On the other hand, in another placebo-controlled trial, 56 participants received either 480 ml (16 ounces) per day of a cranberry extract drink providing 173 mg of phenolic compounds or a low-phenolic cranberry drink; after eight weeks, those receiving the high-phenolic cranberry drink had reduced triglyceride levels but no changes in cholesterol levels occurred.117

  • Creatine

    Clinical trials examining the effect of creatine on cholesterol metabolism have yielded mixed results.

    Dose:

    20 grams per day as a loading dose and 10 grams per day as an ongoing dose
    Creatine
    ×
    Creatine is a peptide often used as a supplement to support muscle growth. In a preliminary trial, 40 physically active men who took 20 grams of creatine monohydrate daily for one week were found to have significantly decreased levels of total and LDL-cholesterol levels.118 A placebo-controlled trial in 30 men found 20 grams per day of creatine for five days followed by 10 grams per day for 23 days in conjunction with a strength training program lowered total cholesterol more than strength training plus placebo or creatine alone.119 However, in a placebo-controlled trial in 22 healthy men in an exercise training program, creatine, at a dose of 20 grams per day for one week followed by 10 grams per day for eleven weeks, did not lower cholesterol levels more than placebo.120 In addition, 25 grams of creatine daily for a week followed by 5 grams daily for eleven weeks did not lower cholesterol levels more than placebo in a controlled trial in 19 men participating in a strength training program.121 One placebo-controlled trial examined the effect of creatine supplementation in 34 adult men and women with high cholesterol levels and found creatine, at 20 grams per day for five days followed by 10 grams per day for 51 days, lowered total cholesterol levels relative to placebo after four and eight weeks, but the effect disappeared by week 12.122

  • Guggul

    Findings regarding the ability of guggul extracts to lower cholesterol levels are mixed.

    Dose:

    500 to 2,000 mg three times per day
    Guggul
    ×
    Guggulsterones are compounds from guggul (also known as guggulipid), a gum resin from Commiphora wightii (a plant native to India) that has been used for centuries as a traditional Ayurvedic medicine to treat a wide range of ailments.123 Guggulsterones have been found to bind to receptors involved in cholesterol metabolism, and some clinical research suggests it can lower cholesterol levels.124 However, results of controlled trials using guggul have been mixed. One publication described two controlled crossover trials: one included 205 participants and compared guggulipid to placebo and the other with 233 participants compared guggulipid to the cholesterol-lowering drug clofibrate (Atromid-S). Treatment with 500 mg of guggulipid three times daily for 12 weeks resulted in an 11% drop in total cholesterol levels and was more likely to raise HDL-cholesterol levels than clofibrate.123,126 Other early trials had similarly positive findings,127 but more recent research has been disappointing. For example, a randomized, double-blind, placebo-controlled trial in 103 participants with high cholesterol levels found supplementation with 1–2 grams of guggulipid three times daily for eight weeks had no effect on total or HDL-cholesterol levels but significantly increased LDL-cholesterol levels by 4–5% compared with placebo.128 In another randomized controlled trial with 34 subjects, 2.16 grams of guggul daily for 12 weeks decreased total and HDL-cholesterol levels and had no effect on LDL-cholesterol levels.129

  • HMB

    Supplementing with HMB, or beta-hydroxy-beta-methylbutyrate, has been reported to lower total and LDL-cholesterol levels.

    Dose:

    3 grams daily
    HMB
    ×
    Beta-hydroxy-beta-methylbutyrate, or HMB, is a by-product of breakdown of the amino acid leucine and has been studied mainly for its effects on protein metabolism and muscle growth. HMB appears to exert its effects on muscle by modifying cholesterol metabolism.129 One report on nine clinical studies concluded 3 grams of HMB per day for three to eight weeks resulted in an average drop in total cholesterol levels of 3.7% and a drop in LDL-cholesterol levels of 5.7%.130

  • Krill Oil

    Supplementing with krill oil is likely to help lower high triglyceride levels, but findings regarding its ability to improve cholesterol levels are mixed.

    Dose:

    0.5 to 4 grams krill oil daily
    Krill Oil
    ×
    Krill oil is high in the same omega-3 fatty acids (EPA and DHA) as fish oil. Unlike fish oil, however, the fatty acids in krill oil are mainly in the form of phospholipids that are readily absorbed and used.131 Krill oil has been shown to lower high triglyceride levels in clinical trials, but trials examining the effects of krill oil, and fish omega-3 fatty acids more generally, on cholesterol levels have yielded mixed results, with some trials indicating neutral or negative effects and others noting beneficial effects.132,131 A meta-analysis of results from seven randomized controlled trials with a total of 662 participants showed krill oil, at doses ranging from 0.5–4 grams per day, lowered both triglyceride and LDL-cholesterol levels, particularly when used for 12 weeks or longer.134 However, an analysis comparing data from 64 randomized controlled trials found krill oil raised HDL-cholesterol levels without affecting LDL- or total cholesterol levels, and found no significant difference between the effects of krill oil and fish oil on cholesterol levels.131

  • L-Carnitine

    L-carnitine has been found in some, but not all, clinical trials to reduce high cholesterol levels.

    Dose:

    2 to 3 grams per day
    L-Carnitine
    ×
    L-carnitine is needed by cells, including heart muscle cells, to metabolize fat into energy, and numerous clinical trials show L-carnitine helps regulate cholesterol levels. A meta-analysis that included findings from 67 randomized controlled trials found L-carnitine appeared to lower total and LDL-cholesterol, increase HDL-cholesterol, and reduce triglyceride levels; however, these benefits disappeared when age, health status, and other parameters of trials and their participants were considered.134 Another meta-analysis that included 55 randomized controlled trials found only doses of L-carnitine higher than 2 grams per day improved total, LDL-, and HDL-cholesterol levels.135 Using results from eight randomized controlled trials in a combined total of 508 participants with type 2 diabetes, another meta-analysis found L-carnitine supplementation, at doses of 2–3 grams per day for at least 12 weeks, lowered total and LDL-cholesterol levels.136

  • Lecithin (Phosphatidyl Choline)

    Taking lecithin supplements may be a useful way to lower cholesterol.

    Dose:

    500 mg per day
    Lecithin (Phosphatidyl Choline)
    ×
    Lecithin is a phospholipid-rich compound from plants that often contains large amounts of phosphatidylcholine. Soy-derived lecithin is widely used in the food industry as an emulsifier. Some research shows lecithin from plant oils, such as soy and sunflower oils, may reduce cholesterol levels by decreasing absorption and increasing excretion of cholesterol.137 In a placebo-controlled trial in 30 people with high cholesterol levels, those given 500 mg of soy lecithin daily had a 42% reduction in total and 56% reduction in LDL-cholesterol levels while those given placebo had no significant reductions in cholesterol levels after two months.138 However, another placebo-controlled trial in 20 men with high cholesterol levels found 20 grams of lecithin daily for four weeks had no impact on cholesterol levels.139

  • Royal Jelly

    Supplementing with royal jelly may improve cholesterol levels.

    Dose:

    150 to 6,000 mg daily
    Royal Jelly
    ×
    Royal jelly contains various sugars, proteins, and medium-chain fatty acids and has demonstrated antioxidant and anti-inflammatory properties. Royal jelly was found to lower total, LDL-, and non-HDL cholesterol levels in subjects with type 2 diabetes in a meta-analysis of findings from 12 randomized controlled trials.140 In a placebo-controlled trial in 40 subjects with mildly elevated cholesterol levels, 3,150 mg royal jelly daily resulted in an 11.5% reduction in total cholesterol levels and a 4.8% reduction in LDL-cholesterol levels.141 In an eight-week placebo-controlled trial with 60 healthy overweight participants, 666 mg of royal jelly per day was found to lower total cholesterol levels and improve antioxidant status.142 A small controlled trial in 15 healthy volunteers found 6 grams of royal jelly per day for four weeks reduced total and LDL-cholesterol levels.143 In an uncontrolled trial, 36 healthy postmenopausal women received 150 mg of a high-potency royal jelly product daily for three months; at the end of the trial, HDL-cholesterol levels had increased by 7.7%, total cholesterol levels had decreased by 3.09 %, and LDL-cholesterol levels had decreased by 4.1%.144

  • Tocotrienols

    Tocotrienols may increase HDL-cholesterol levels.

    Dose:

    200 mg daily
    Tocotrienols
    ×
    Tocotrienols are lipid-soluble antioxidant molecules that are closely related to tocopherols. Together, tocotrienols and tocopherols make up the family of compounds referred to as vitamin E. These compounds have a critical role in preventing LDL particle oxidation, thus reducing oxidative damage to blood vessels.145 Some clinical trials have found tocotrienols lowered cholesterol levels, but evidence is conflicting. A meta-analysis of 15 clinical trials found tocotrienol supplementation may increase HDL-cholesterol levels, but is unlikely to reduce total or LDL-cholesterol levels.146

  • Vitamin E

    It is unclear whether supplementing with vitamin E can improve cholesterol levels.

    Dose:

    Refer to label instructions
    Vitamin E
    ×
    Vitamin E, made up of tocopherols and tocotrienols, is important for its role in protecting lipid molecules in the body from free radical damage, and may reduce the risk of atherosclerosis and heart disease.147 Its potential as a cholesterol-lowering agent is controversial. One comprehensive analysis of the clinical findings concluded vitamin E had no effect on cholesterol levels in patients with type 2 diabetes.148 However, a meta-analysis of results from eight trials in patients with non-alcoholic fatty liver disease (NAFLD) found vitamin E supplementation lowered LDL-cholesterol levels, in addition to improving liver health and function.149 Other meta-analyses have found co-supplementation with vitamin E and omega-3 fatty acids had no effect on lipid profiles overall150 but lowered LDL-cholesterol levels in trials in people with metabolic syndrome.151

  • Achillea species

    In one clinical trial, people who took a tincture of Achillea wilhelmsii had significant reductions in total cholesterol, LDL-cholesterol, and triglyceride levels and an increase in HDL-cholesterol levels.

    Dose:

    15 to 20 drops of tincture twice per day for six months
    Achillea species
    ×
    In a placebo-controlled trial, people with moderately high cholesterol levels took a tincture of Achillea wilhelmsii, a tradition medicinal herb native to Iran and closely related to North American yarrow (Achillea millefolium). Participants in the trial used 15 to 20 drops of the tincture twice daily for six months. At the end of the trial, participants had reductions in total cholesterol, LDL-cholesterol and triglyceride levels, and an increase in HDL-cholesterol levels compared to those who took placebo.152 More recently, several compounds from this plant demonstrating lipid-lowering effects have been identified.153

  • Astaxanthin

    Astaxanthin has antioxidant and other properties that may help improve cholesterol metabolism and protect vascular health.

    Dose:

    6 to 12 mg daily
    Astaxanthin
    ×
    Astaxanthin is a red carotenoid pigment found in microalgae as well as some seafood such as salmon, shrimp, and trout.154 Astaxanthin is an antioxidant and has demonstrated an ability to improve cholesterol metabolism and protect vascular health.155,156,154 One randomized controlled trial in 61 people with high blood triglycerides found 6 mg and 12 mg of astaxanthin daily for 12 weeks increased HDL-cholesterol levels, but 18 mg per day did not.158 In another placebo-controlled trial that included 27 overweight participants, LDL-cholesterol levels decreased in those who received 20 mg of astaxanthin per day for 12 weeks, while no change was seen in those who received placebo, although the difference between the two groups was not statistically significant (possibly due to the small size of the trial).159 However, a meta-analysis that pooled findings from seven randomized controlled trials found astaxanthin had no beneficial effect on lipid profiles.160

  • Copper

    Copper deficiency has been linked to high cholesterol levels, but supplementation does not appear to have a cholesterol-lowering effect.

    Dose:

    2 to 4 mg daily
    Copper
    ×
    The trace mineral copper plays an important role in cellular energy production, and low copper status has been linked to low HDL-cholesterol levels, as well as other aspects of metabolic syndrome.160,161,162 However, a meta-analysis of findings from five randomized controlled trials with a total of 176 participants found copper supplementation had no impact on lipid levels.163 In fact, copper supplementation at doses of 2– 8 mg daily has not been found to have an effect on cholesterol levels in healthy adults.164,165,166

  • Fo-Ti

    Animal and laboratory research suggests the herb fo-ti may lower high cholesterol levels; however, this herb should be used with caution due to its unpredictable potential to cause liver damage.

    Dose:

    Refer to label instructions
    Fo-Ti
    ×
    Fo-ti (Polygonium multiflorum) is an herb used in traditional Chinese medicine to slow aging and treat constipation and skin disorders. Research in animals and other laboratory models has indicated fo-ti may improve lipid metabolism and lower cholesterol levels by inhibiting cholesterol synthesis.167,168,169 Cases of liver toxicity related to the use of fo-ti have been reported, but the mechanism of liver injury remains unknown.170

  • Inositol Hexaniacinate (Vitamin B3)

    Inositol hexaniacinate, a special form of niacin, does not appear to improve cholesterol levels.

    Dose:

    400 to 500 mg of inositol hexaniacinate three to four times daily
    Inositol Hexaniacinate (Vitamin B3)
    ×
    In an attempt to avoid the side effects of niacin (vitamin B3), inositol hexaniacinate (also called inositol hexanicotinate) is sometimes recommended instead of niacin. This special compound contains six molecules of niacin bound to a single molecule of inositol, and the niacin in this compound is released slowly. Early reports suggested inositol hexaniacinate could lower serum cholesterol without toxic effects.171,172 However, in a placebo-controlled trial in 120 participants with mildly to moderately elevated cholesterol levels, 1,500 mg of inositol hexaniacinate for six weeks had no impact on lipid levels.173 Similarly, a crossover trial also found inositol hexaniacinate had no significant effect on cholesterol levels.174

  • Magnesium

    Magnesium supplementation can be beneficial in reducing cardiovascular risk but is unlikely to lower high cholesterol levels.

    Dose:

    300 to 600 mg daily
    Magnesium
    ×
    Magnesium plays an important role in cholesterol synthesis and metabolism, and some research has correlated low magnesium status with high cholesterol levels.175 Magnesium supplementation has been found to have beneficial effects on several aspects of metabolic syndrome and reduce the risks of cardiovascular disease and metabolic disorders, particularly in those with poor magnesium status.176 A meta-analysis that included findings from 12 randomized controlled trials in type 2 diabetic subjects found magnesium supplementation lowered LDL-cholesterol levels, as well as total cholesterol levels, when used for more than 12 weeks.177 However, another meta-analysis that included 18 trials found no effect for magnesium on cholesterol levels in either diabetic or non-diabetic individuals.178

  • Maitake

    Maitake mushroom polysaccharides have been found to improve lipid levels in animal studies.

    Dose:

    Refer to label instructions
    Maitake
    ×
    A number of animal studies suggest that extracts from maitake mushroom may lower cholesterol and triglyceride levels in the blood.179,180,181 Animal research further suggests maitake may inhibit development of atherosclerosis.182 This research is requires confirmation in clinical trials.

  • Pine Bark Extract (Pycnogenol)

    Pycnogenol appears unlikely to impact cholesterol levels.

    Dose:

    50 to 450 mg per day
    Pine Bark Extract (Pycnogenol)
    ×
    A patented extract from French maritime pine bark known as Pycnogenol has demonstrated strong antioxidant properties and clinical trials have examined its effects on cholesterol levels. However, a meta-analysis of results from seven controlled trials with a total of 422 participants failed to find a cholesterol-lowering effect for pycnogenol.183

  • Policosanol

    An older body of evidence that has not been reproduced outside of Cuba suggests policosanol may have cholesterol-lowering effects.

    Dose:

    Refer to label instructions
    Policosanol
    ×
    Policosanol is a mixture of lipid-soluble compounds from sugar cane wax and early clinical trials indicated it may be useful in lowering high cholesterol levels.184,185,186 Nevertheless, questions related to fact that these clinical findings have not been reproduced by researchers outside of Cuba remain unanswered.187,188 More recently, policosanol has been used in a combination supplement that also contains red yeast rice, berberine, folic acid, astaxanthin, and coenzyme Q10. Several randomized controlled trials have shown this combination can improve lipid levels similarly to statin medications.189

  • Sea Buckthorn

    Sea buckthorn contains flavonoids and essential fatty acids that may reduce high cholesterol levels, but little supportive evidence exists.

    Dose:

    0.75 ml sea buckthorn oil daily
    Sea Buckthorn
    ×
    Sea buckthorn (Hippophae rhamnoides) contains flavonoids and essential fatty acids that may have cardiovascular benefits.190 However, clinical trials examining the cholesterol-lowering effect of sea buckthorn preparations have yielded mixed results. An uncontrolled trial in 111 people with high cholesterol levels found taking 90 ml of sea buckthorn berry puree daily for 90 days had no impact on lipid levels.191 In a placebo-controlled trial, people with normal blood cholesterol levels who consumed 28 grams per day of pureed sea buckthorn berries for three months experienced no change in their blood cholesterol.192 Sea buckthorn berry juice was found to increase HDL-cholesterol levels by 20% after eight weeks, though this effect was not statistically significant, in a placebo-controlled trial in 20 healthy men.193 In 80 overweight women participating in a crossover trial, sea buckthorn oil, but not other sea buckthorn preparations, reduced total and LDL-cholesterol levels after 30 days, but the effect was not statistically significant.194 On the other hand, a placebo-controlled trial in 106 adults found 0.75 ml of sea buckthorn oil daily for 30 days reduced total cholesterol levels in those with high cholesterol and high blood pressure, but had a smaller effect in those with normal lipid levels and blood pressures.195

  • Selenium

    Selenium does not appear to have substantial cholesterol-lowering effects.

    Dose:

    200 micrograms per day
    Selenium
    ×
    A meta-analysis of data from eleven randomized controlled trials with a combined total of 1,221 participants found selenium supplementation reduced total cholesterol levels without significantly impacting LDL-, HDL-, or non-HDL-cholesterol levels.196 Another meta-analysis that included findings from five trials in participants with diseases related to metabolic syndrome also found selenium had no effect on lipid profiles.197 Nevertheless, a research review suggested supplementing with 200 micrograms daily may have some cholesterol-lowering benefits in those with high baseline cholesterol levels.198

  • Vitamin B3 (Niacin)

    High amounts (several grams per day) of niacin, a form of vitamin B3, have been shown to raise HDL-cholesterol and lower LDL-cholesterol levels; however, niacin therapy has not been found to reduce the incidence of cardiovascular events and has substantial toxicity.

    Dose:

    1,500 to 3,000 mg daily under a doctor's supervision
    Vitamin B3 (Niacin)
    ×
    Niacin, or nicotinic acid, is a form of vitamin B3. High amounts of niacin, such as 1.5–3 grams per day, have been shown to improve lipid profiles, mainly by raising HDL-cholesterol levels.199 A review of clinical trials found 3 grams per day of niacin can lower total cholesterol levels by 12.6%, lower LDL-cholesterol levels by 15.4%, and raise HDL-cholesterol levels by 22.5%.200 Niacin was widely used as a prescription medication for treating high cholesterol before the introduction and success of statin drugs, but more recent research has shown niacin therapy and other treatments that increase low HDL-cholesterol levels have little impact on cardiovascular outcomes and its use is generally no longer recommended.199,202,203 Another challenge with niacin therapy is toxicity: acute flushing, headache, and stomachache from high-dose niacin limit its tolerability, and chronic toxic effects, such as liver toxicity and musculoskeletal damage, can be severe.203 Serious toxic events are more common with sustained release formulations.205 Therefore, high intakes of niacin must only be taken under the supervision of a doctor. Importantly, another form of vitamin B3 called niacinamide (also nicotinamide) has no effect on cholesterol levels and does not have the same toxic effects.

  • Vitamin C

    Vitamin C appears to protect LDL cholesterol from oxidative damage and may protect cardiovascular health, but has been found to have little impact on cholesterol levels.

    Dose:

    500 to 2,000 mg daily
    Vitamin C
    ×
    Vitamin C appears to protect LDL cholesterol from oxidative damage and its possible role in cardiovascular protection remains uncertain.204,205,206 Some research suggests vitamin C may reduce LDL-cholesterol levels.207 However, a meta-analysis of randomized controlled trials found vitamin C had no general effect on lipid levels, but decreased total cholesterol levels in younger participants, lowered LDL-cholesterol levels in healthy people, and increased HDL-cholesterol levels in type 2 diabetics, with stronger effects in those with more disturbed levels.208 Other meta-analyses have not found a statistically significant effect for vitamin C on lipid levels in those with type 2 diabetes.209,210,211

  • Wild Yam

    Wild yam does not appear to impact lipid profiles.

    Dose:

    Refer to label instructions
    Wild Yam
    ×
    Although eating yams has been found to lower cholesterol levels in health postmenopausal women,212 taking a wild yam (Dioscorea villosa) supplements was not found to have a similar effect.213
What Are Star Ratings
×
Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

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