High Cholesterol (Holistic)
About This Condition
- Reduce risk with fiber
Add whole grains, legumes, fruits, and vegetables to your meals to reduce heart disease risk
- Add soy protein to your diet
30 grams (about 1 ounce) a day of powdered soy protein added to food or drinks can help lower cholesterol
- Check out natural vegetable fats (plant sterols and stanols)
Take 1.6 grams a day as a supplement or in specially fortified margarines to help reduce cholesterol
- Get some supplemental garlic
600 to 900 mg a day of a standardized garlic extract may help lower cholesterol and prevent hardening of the arteries
- Raise “good” cholesterol with exercise
Start a regular exercise program to help raise HDL ("good") cholesterol
- Cut the bad fats
Foods that contain saturated fat, hydrogenated fat, and cholesterol (such as animal products, fried foods, and baked snacks) can raise cholesterol.
Cut the bad fats
Foods that contain saturated fat, hydrogenated fat, and cholesterol (such as animal products, fried foods, and baked snacks) can raise cholesterol
Pick a plant-based diet
Emphasize vegetarian meals whenever possible to reap the rewards of avoiding animal fats and increasing fiber and other cholesterol-stabilizing nutrients
- Get and stay trim
Aim for a healthy body weight to avoid problems with blood lipids and other heart disease risk factors
- Get moving
Use a regular program of aerobic exercise to maintain optimal blood lipid levels and lower heart disease risk
- Avoid the habit
Maintain healthy HDL (“good”) cholesterol levels and low heart disease risk by avoiding cigarette smoke
- Protect with antioxidants
Use at least 100 mg per day vitamin C and/or up to 400 IU vitamin E to protect LDL cholesterol from damage that can increase heart disease risk
About
About This Condition
Cholesterol is needed for normal cell membrane function and as a precursor to steroid hormones, bile acids, and vitamin D. Metabolism of cholesterol, which is both produced in the liver and obtained through diet, is carefully controlled in the body. In some circumstances, however, cholesterol metabolism becomes dysregulated, leading to high blood cholesterol levels, accumulation of cholesterol in tissues and immune cells, and increased risk of atherosclerosis and heart disease.1
Cholesterol circulates in several types of fatty complexes, which have different effects on vascular health and function. In simplest terms: very low-density lipoprotein (VLDL)-cholesterol is made in the liver and released into the bloodstream; VLDL is converted into low-density lipoprotein (LDL)-cholesterol, which delivers cholesterol to tissues and cells, promoting atherosclerotic plaque formation; high-density lipoprotein (HDL)-cholesterol retrieves excess cholesterol from circulation and from cells in the blood vessel lining and returns it to the liver for storage or excretion, possibly inhibiting plaque formation. The amounts of total cholesterol and each type of cholesterol are measured to assess cardiovascular risk. High levels of VLDL- and LDL-cholesterol (sometimes referred to as non-HDL cholesterol) and low levels of HDL-cholesterol are associated with heart disease.2, 3 Importantly, while LDL-cholesterol-lowering therapies have been shown to reduce cardiovascular events (like heart attack and stroke), therapies that raise HDL-cholesterol levels have so far failed to improve cardiovascular outcomes.4
The American Heart Association recommends total cholesterol levels should stay under 200 mg/dL, although the optimal level is likely to be closer to 150 mg/dL.5 They also recommend a target LDL-cholesterol level of 100 mg/dL or lower, and a target HDL-cholesterol level of 60 mg/dL or higher. Target cholesterol levels in individuals with a high cardiovascular risk or a history of a cardiovascular event, such as known cardiovascular disease, diabetes, or a previous heart attack, are more stringent, especially regarding LDL-cholesterol.6, 7 Healthy cholesterol levels, however, are not a guarantee of good heart health, as some people with lipid profiles considered to be healthy can still have atherosclerosis and an increased risk of heart attack.8, 9
The following discussion is limited to information about improving cholesterol levels using natural approaches. People with high cholesterol levels may also want to learn more about atherosclerosis and cardiovascular disease.
Healthy Lifestyle Tips
The body’s circadian clock plays a critical role in regulating metabolism, and disruption of natural rhythms has been associated with high cholesterol levels and other signs of poor metabolic health.10 Shift work and other causes of short nighttime sleep, as well as variability in sleep and activity patterns from day to day, have been found to correlate with higher cholesterol levels.11, 12 Observational evidence indicates those with a preference for evening activity, including eating, have worse metabolic health, including higher cholesterol levels.13, 14, 15
Compared with those who routinely skip breakfast, habitual breakfast eaters have been noted to have better lipid profiles and lower cardiovascular risk.16 In a crossover-design clinical trial, 12 healthy participants ate a controlled diet comprised of three meals and two snacks during two eight-week phases: in the first phase, eating was restricted to the hours of 8AM–7PM, but in the second phase, eating was delayed until noon and ended at 11PM. A number of other metabolic markers, including total cholesterol levels, improved after the daytime eating phase and worsened during the delayed eating phase of the trial.17 In addition, a habit of eating smaller amounts more frequently during the day has been associated with lower cholesterol levels.18
Exercise and a physically active lifestyle have been found in multiple randomized controlled trials to increase protective HDL-cholesterol while decreasing heart disease-related triglyceride, LDL-cholesterol, and total cholesterol levels.19, 20 Even low-intensity exercise such as walking and Tai Chi can raise HDL-cholesterol levels, while more rigorous exercise may be needed to lower LDL-cholesterol levels.21, 22, 23 Importantly, weight gain appears to nullify the positive effects of exercise on lipid levels.24 Some evidence suggests evening exercise is more effective than morning exercise for improving cholesterol levels.25 Physical activity has the additional advantage of lowering risks of heart disease, type 2 diabetes, depression, anxiety, cancer, and myriad other chronic conditions.26
Smoking impairs lipid metabolism and is linked to increased total, LDL-, and non-HDL-cholesterol levels, as well as lower HDL-cholesterol levels. Even secondhand smoke exposure has negative impacts on cholesterol levels, especially in children.27 Furthermore, smoking is a major contributor to heart disease. Quitting smoking can result in improvement in lipid levels and is an important strategy for decreasing cardiovascular risk in people with high cholesterol levels.28
Psychological factors such as anxiety, depression, distress, anger, and hostility have been shown to contribute to heart disease risk in both men and women.29 On the other hand, optimism, conscientiousness, openness to experience, and curiosity have been found to reduce cardiovascular risk.30 Some, but not all, research indicates yoga and mindfulness may improve markers of cardiovascular health, including cholesterol levels.31, 32, 33
Eating Right
The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.
| Recommendation | Why |
|---|---|
| Add some olive oil | Replacing foods high in trans and saturated fats with foods rich in high-quality polyunsaturated and monounsaturated fats, like those in fish, nuts and seeds, and olive oil, can help lower cholesterol levels and reduce cardiovascular risk. It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects. The most studied dietary monounsaturated fatty acid is the omega-9 fatty acid oleic acid. Oleic acid is found mainly in olive oil but is also present in avocado and nut and seed oils. Multiple clinical trials have shown replacing saturated and trans fats with high-oleic acid oils can lower total and LDL-cholesterol levels without affecting HDL-cholesterol levels, and a growing body of evidence shows high intake of olive oil is associated with lower risk of cardiovascular events and death. |
| Avoid sugar | Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels. Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention. High consumption of sugar-sweetened foods and beverages, as well as refined carbohydrates (which are rapidly converted into glucose in the body), is strongly correlated with heart disease, although evidence linking sugars to high cholesterol levels is limited. Observational data from studies with almost 30,000 US adult participants found high intake of sugar-sweetened beverages in particular were associated with higher LDL-cholesterol and triglyceride levels and lower HDL-cholesterol levels. A meta-analysis of findings from 13 observational studies in children and youth also show links between increased sugar-sweetened beverage intake and worsening lipid profiles in this age group. However, a randomized controlled trial in 203 high consumers of sugar-sweetened beverages found switching to artificially-sweetened beverages did not improve lipid levels. |
| Balance your fats with polyunsaturated fats | Replacing foods high in trans and saturated fats with foods rich in high-quality polyunsaturated and monounsaturated fats, like those in fish, nuts and seeds, and olive oil, can help lower cholesterol levels and reduce cardiovascular risk. It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects. The most important dietary PUFAs are categorized, based on their structure, as either omega-6 or omega-3 fatty acids. Major dietary omega-6 fats include arachidonic acid (mainly from animal fats) and linoleic acid (mainly from plant fats); major dietary omega-3 fats include eicosapentaenoic acid and docosahexaenoic acid (EPA and DHA, mainly from fish fats) and alpha-linolenic acid (mainly from plant fats, especially flaxseed, hemp seed, and canola oils). Increasing omega-6 PUFA intake, particularly in the form of linoleic acid, can reduce total and LDL-cholesterol levels. However, one meta-analysis of data from eleven randomized controlled trials found replacing saturated fats with mostly omega-6 PUFAs does not lower risk of cardiovascular events or death. Omega-3 fatty acids appear to have varied effects on cholesterol metabolism: both alpha-linolenic acid and EPA have been found to reduce LDL-cholesterol and have no impact on HDL-cholesterol levels, but DHA appears to cause an increase in both LDL- and HDL-cholesterol levels. Although the average US adult diet provides 20–50 times more omega-6 than omega-3 fatty acids, some research suggests a lower ratio of omega-6 to omega-3 fat intake, such as 4–5:1, may be associated with lower risks of cardiovascular and other chronic inflammatory conditions. |
| Curb the carbs | Low-carbohydrate diets appear to slightly increase LDL-cholesterol levels but have positive impacts on HDL-cholesterol and triglyceride levels. It is unclear how these effects influence cardiovascular outcomes. Various degrees of carbohydrate restriction are sometimes used to manage metabolic disorders like type 2 diabetes and obesity. These diets can also affect lipid levels, having in particular a positive effect on triglyceride levels. One meta-analysis of findings from eight randomized controlled trials comparing low-carbohydrate to low-fat diets found these diets had similar effects on LDL-cholesterol levels, but adherence to low-carbohydrate diets resulted in lower triglyceride and higher HDL-cholesterol levels. Another meta-analysis that included 12 randomized controlled trials found that adhering to a low-carbohydrate diet raised LDL-cholesterol levels slightly, but all of the effects of the diet on lipid levels and other markers of cardiovascular risk disappeared within two years of monitoring. Furthermore, an analysis of 121 clinical trials with a combined total of almost 22,000 participants found neither low-carbohydrate nor low-fat diets led to lasting changes in cardiovascular risk factors, including cholesterol levels. One analysis examined data from 37 clinical trials to compare the effects of diets with three different degrees of carbohydrate restriction: a very low-carbohydrate diet, in which less than 30% of daily calorie intake was from carbohydrates (a ketogenic diet); a low-carbohydrate diet, in which calories from carbohydrates ranged from 30% to less than 40% of total calories; and a moderately low-carbohydrate diet, in which carbohydrate calories ranged from 40% to less than 45% of daily calories. The analysis showed LDL-cholesterol and HDL-cholesterol levels increased more in those eating a very low-carbohydrate diet compared with those eating a moderately low-carbohydrate diet. The analysis also found substituting carbohydrate calories with saturated fat calories resulted in higher total and LDL-cholesterol levels. The effect of these differences on cardiovascular outcomes is still unknown, but some evidence has indicated a very low-carbohydrate diet, particularly one that includes high intake of animal (saturated) fat, may be associated with increased mortality. |
| Do the DASH | The DASH eating pattern has been shown to lower LDL-cholesterol levels and improve cardiovascular and metabolic health. The Dietary Approaches to Stop Hypertension (DASH) diet is predominantly plant based, is low in saturated fats and cholesterol, and emphasizes fruits, vegetables, whole grains, legumes, nuts, and low-fat dairy products. Although DASH was developed to lower high blood pressure, research has shown adherence to this dietary pattern also lowers non-HDL-cholesterol levels. One large review of 15 observational studies and 31 controlled trials found the DASH diet lowered LDL-cholesterol levels and improved other cardiovascular and metabolic health parameters. |
| Eat your veggies | Vegetarian diets are generally rich in soluble fiber, phytosterols, and soy protein, all of which have been shown to lower LDL-cholesterol levels. A vegetarian diet excludes meat, poultry, and fish, while a vegan diet also excludes eggs and dairy products. These diets are generally low in saturated fat and excess calories and high in heart-protective foods like legumes, soy foods, nuts, seeds, vegetables, fruits, and whole grains. In addition to soluble fiber, vegetarian and vegan diets are high in phytosterols, plant lipids similar in structure and function to cholesterol. Phytosterols are found in all plant foods but are especially abundant in unrefined vegetable, nut and seed, and olive oils. When consumed in amounts of 600–3,300 mg per day, phytosterols have been found to improve lipid profiles by inhibiting dietary cholesterol absorption and stimulating cholesterol excretion. In addition, consuming about 25 grams of soy protein per day has been shown to lower LDL-cholesterol levels by 3–4%. A large review that included findings from 20 meta-analyses of observational studies and clinical trials determined vegetarian diets were associated with lower total and LDL-cholesterol levels, but had negative impacts on HDL-cholesterol levels and vitamin B12 status. |
| Fight cholesterol 'mano a mono' | Replacing foods high in trans and saturated fats with foods rich in high-quality polyunsaturated and monounsaturated fats, like those in fish, nuts and seeds, and olive oil, can help lower cholesterol levels and reduce cardiovascular risk. It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects. The most studied dietary monounsaturated fatty acid is the omega-9 fatty acid oleic acid. Oleic acid is found mainly in olive oil but is also present in avocado and nut and seed oils. Multiple clinical trials have shown replacing saturated and trans fats with high-oleic acid oils can lower total and LDL-cholesterol levels without affecting HDL-cholesterol levels, and a growing body of evidence shows high intake of olive oil is associated with lower risk of cardiovascular events and death. |
| Get your garlic | Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels. Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention. According to a large analysis of findings from numerous controlled trials, adding garlic to the diet can lower cholesterol levels in as little as eight weeks. In one placebo-controlled trial with 80 participants with cardiovascular disease, 2 grams of garlic powder per day for 60 days lowered total and LDL-cholesterol and raised HDL-cholesterol levels. |
| Go nuts | Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels. Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention. People who eat nuts and seeds regularly have been found to have better lipid profiles and overall cardiovascular and metabolic health (including less overweight and obesity) than those who don’t eat nuts. In addition, a number of clinical trials have shown adding nuts and seeds to the diet is an effective strategy for lowering total, LDL-, and non-HDL cholesterol, as well as triglycerides. In particular, pecans, almonds, Brazil nuts, pistachios, hazelnuts, walnuts, and sunflower seeds have been found to improve cholesterol levels, while cashews have not shown these beneficial effects. Peanuts (which are technically in the legume family) have also failed to demonstrate beneficial effects on cholesterol levels. |
| Less turf, more surf | Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels. Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention. A meta-analysis of 14 controlled trials found oily fish consumption raised HDL-cholesterol levels but did not impact levels of other forms of cholesterol. In addition, fish consumption lowered triglyceride levels. |
| Make Mediterranean meals | A Mediterranean-style diet has been associated with lower cholesterol levels and better cardiovascular, metabolic, and overall health. The foundation of the Mediterranean diet is a healthy, plant-based diet, high in whole grains, vegetables and fruits, legumes, and nuts and seeds. It also includes modest amounts of fish, low-fat dairy products, lean poultry, and red wine, and highlights olive oil as its main fat source. It is the most studied dietary pattern to date, and has been associated with a wide range of health benefits, including lower risks of heart disease, obesity, type 2 diabetes, and Alzheimer disease. Adherence to a Mediterranean diet has been shown to be associated with healthy lipid levels and reduced cardiovascular risk. In a large meta-analysis that included data from 57 controlled trials, participants assigned to a Mediterranean eating pattern experienced a reduction in LDL-cholesterol and increase in HDL-cholesterol levels compared with those assigned to other dietary changes or no dietary intervention. Another meta-analysis of 121 randomized controlled trials found a reduction in LDL-cholesterol levels was maintained after 12 months in subjects receiving a Mediterranean diet intervention, but not those receiving a low-fat, low-carbohydrate, or DASH diet interventions. |
| Manage your portfolio | The portfolio diet emphasizes four dietary components that lower cholesterol levels: phytosterols, viscous soluble fiber, soy protein, and nuts. Some research suggests this diet can be as effective as a widely used cholesterol-lowering drug. A diet emphasizing a portfolio of foods with evidence supporting their cholesterol-lowering effects has been developed and compared with other diets and cholesterol-lowering drugs. The goals of the portfolio diet are to consume, per 1,000 calories of daily energy intake:
In a randomized controlled trial with 46 participants who had high cholesterol levels, a portfolio diet was as effective as lovastatin (Mevacor®) and more effective than a low saturated fat diet, lowering LDL-cholesterol levels by 28.6% after one month. In a six-month controlled trial, 345 participants with high cholesterol levels ate either a low saturated fat or portfolio diet. The portfolio diet group had a reduction in LDL-cholesterol of more than 13%, while the low saturated fat group had a 3% reduction; levels of fat-soluble nutrients did not change with either diet. A meta-analysis of findings from seven trials found the portfolio diet, added to the Step II dietary recommendations of the National Cholesterol Education Program, lowered LDL-cholesterol levels by 17%, as well as total and non-HDL-cholesterol levels and other markers of cardiovascular risk. Furthermore, a large observational study that used data collected from more than 123,000 participants in the Women’s Health Initiative from 1993 through 2017 found higher scores reflecting adherence to the portfolio diet were correlated with lower risks of cardiovascular disease, coronary artery disease, and heart failure. |
| Reduce risk with fiber | Eating fiber-rich foods like whole grains, legumes, fruits, and vegetables can help reduce cholesterol levels. Dietary fiber is categorized as soluble or insoluble. Soluble fiber interacts with water, often (but not always) forming a gel-like substance, and is fermentable by intestinal bacteria, while insoluble fiber does not interact with water and is usually not fermentable. Gel-forming soluble fiber (also called viscous fiber) sequesters dietary cholesterol (reducing its absorption) and alters the gut microbiome, leading to better cholesterol metabolism and lower cholesterol levels. Good sources of gel-forming soluble fiber include vegetables like sweet potatoes, carrots, artichokes, Brussels sprouts, broccoli, and other greens; fruits like apples, pears, berries, and bananas; legumes including lentils, peas, and beans; and whole grains like oats, rye, and barley. Psyllium husks and flaxseeds are functional foods with high gel-forming soluble fiber content and have been shown in multiple clinical trials and meta-analyses to lower high LDL- and non-HDL-cholesterol levels. Typical amounts used in clinical trials were equivalent to two to three tablespoons for flaxseeds and about two to three teaspoons for psyllium husk. Insoluble fiber, found in high amounts in vegetables, whole wheat and other grain brans, and nuts and seeds, has important impacts on digestive function but is not likely to contribute as much to cholesterol lowering as soluble fiber. Diets high in legume and whole-grain fiber (especially barley and oat) have been found in multiple studies to be associated with lower LDL-cholesterol levels. A meta-analysis of findings from 58 randomized controlled trials found beta-glucan from oats can reduce LDL- and non-HDL-cholesterol levels. One literature review determined that regular daily intake of 4–10 grams of soluble fiber can result in a 5–10% reduction in LDL-cholesterol. Furthermore, a growing body of evidence shows increasing dietary fiber intake, by increasing whole grains or adding psyllium husk for example, can enhance the effectiveness of widely used cholesterol-lowering drugs called statins. The recommended daily allowance (RDA) for total dietary fiber is 38 grams in healthy adult men up to age 50 and 25 grams in healthy adult women up to age 50, but most Americans do not consume this amount. In fact, the average daily fiber intake in 2015–16 among US adults was found to be 17.33 grams. Randomized controlled trials show getting a minimum of 25–40 grams of total fiber, including a minimum of 7–13 grams of soluble fiber, per day can lower LDL-cholesterol by at least 5–10%. Dietary fiber has benefits beyond lowering cholesterol: A meta-analysis of data from 17 studies found the risk of death from any cause was 16% lower in those with the highest, versus lowest, daily fiber intake. |
| Replace meat with soy | Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels. Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention. Soybeans are high in phytosterols and viscous soluble fiber, and have a relatively low ratio of omega-6 to omega-3 fatty acids, all of which may contribute to their cholesterol-lowering effects. Furthermore, soy protein fractions have been found to reduce dietary cholesterol absorption and cholesterol production by the liver. Soy proteins also decrease bile acid resorption, increasing the utilization of cholesterol to manufacture new bile acids. Preclinical and clinical trials show replacing animal protein with soy protein, and other plant-sourced proteins, substantially lowers total cholesterol, LDL-cholesterol, and non-HDL-cholesterol levels. |
| Seed change | Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels. Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention. People who eat nuts and seeds regularly have been found to have better lipid profiles and overall cardiovascular and metabolic health (including less overweight and obesity) than those who don’t eat nuts. In addition, a number of clinical trials have shown adding nuts and seeds to the diet is an effective strategy for lowering total, LDL-, and non-HDL cholesterol, as well as triglycerides. In particular, pecans, almonds, Brazil nuts, pistachios, hazelnuts, walnuts, and sunflower seeds have been found to improve cholesterol levels, while cashews have not shown these beneficial effects. Peanuts (which are technically in the legume family) have also failed to demonstrate beneficial effects on cholesterol levels. |
| Try vegan | Vegan diets are generally rich in soluble fiber, phytosterols, and soy protein, all of which have been shown to lower LDL-cholesterol levels. A vegetarian diet excludes meat, poultry, and fish, while a vegan diet also excludes eggs and dairy products. These diets are generally low in saturated fat and excess calories and high in heart-protective foods like legumes, soy foods, nuts, seeds, vegetables, fruits, and whole grains. In addition to soluble fiber, vegetarian and vegan diets are high in phytosterols, plant lipids similar in structure and function to cholesterol. Phytosterols are found in all plant foods but are especially abundant in unrefined vegetable, nut and seed, and olive oils. When consumed in amounts of 600–3,300 mg per day, phytosterols have been found to improve lipid profiles by inhibiting dietary cholesterol absorption and stimulating cholesterol excretion. In addition, consuming about 25 grams of soy protein per day has been shown to lower LDL-cholesterol levels by 3–4%. A large review that included findings from 20 meta-analyses of observational studies and clinical trials determined vegetarian diets were associated with lower total and LDL-cholesterol levels, but had negative impacts on HDL-cholesterol levels and vitamin B12 status. |
| Choose coffee carefully | Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels. Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention. While coffee consumption has been associated with decreased risks of cardiovascular disease, obesity, and diabetes, drinking coffee prepared without the use of a paper filter has been strongly linked to negative impacts on lipid profiles, including elevation of total and LDL-cholesterol levels. |
| Enjoy a drink | Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels. Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention. Regular light to moderate alcohol consumption is associated with increased HDL-cholesterol levels and decreased risk of atherosclerosis. Light to moderate alcohol intake is defined as a maximum of two drinks per day for men and one drink per day for women, with a drink being 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits. In fact, two alcoholic drinks per day has been found to raise HDL-cholesterol by 12%. |
| Focus on healthy fats, not dietary cholesterol | Replacing foods high in trans and saturated fats with those rich in high-quality fats, like omega-3 and omega-6 polyunsaturated and omega-9 monounsaturated fatty acids, can help lower cholesterol levels and reduce cardiovascular risk. It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects. While diets associated with lower cholesterol levels and cardiovascular risk are often inherently low in cholesterol, dietary cholesterol intake has not been correlated with cholesterol levels, and reducing cholesterol intake has not been shown to be an effective way to reduce high cholesterol levels. |
| Avoid saturated fats | Replacing foods high in trans and saturated fats with foods rich in high-quality polyunsaturated and monounsaturated fats, like those in fish, nuts and seeds, and olive oil, can help lower cholesterol levels and reduce cardiovascular risk. It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects. Saturated fats are mainly found in animal foods, but coconut and palm oils are also rich sources. Higher intakes of saturated fatty acids appear to be associated with higher combined risk of heart disease and stroke. According to one analysis, replacing 10% of dietary saturated fat with polyunsaturated fatty acids could reduce cardiovascular events by 27%. The saturated fatty acids in coconut and palm oil differ from those in animal fat such as butter, and some clinical trials have found coconut oil has less negative impact on cholesterol metabolism than butter. |
| Pass on the trans fat | Replacing foods high in trans and saturated fats with foods rich in high-quality polyunsaturated and monounsaturated fats, like those in fish, nuts and seeds, and olive oil, can help lower cholesterol levels and reduce cardiovascular risk. It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects. Trans fats are polyunsaturated fats that have been subjected to partial hydrogenation to increase their solid phase temperature range. Partially hydrogenated oils are used to make highly processed fat products such as shortening and margarine. Trans fats are also generated naturally as polyunsaturated fatty acids age but are found only in small amounts in unprocessed fats and oils. Trans fats are closely associated with cardiovascular disease and have been found to increase cholesterol synthesis in the liver. |
Supplements
Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.
For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.
3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.
2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
| Supplement | Why |
|---|---|
3 Stars Artichoke 500–1,000 mg daily | Artichoke leaf extract has been found to lower total and LDL-cholesterol levels and may increase HDL-cholesterol levels. 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. 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. 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. 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. 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. |
3 Stars Berberine 500 mg two to three times per day | 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. 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. 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. Berberine has also been found to be as effective as the cholesterol-lowering drug simvastatin (Zocor) and may enhance its effects when used adjunctively. 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. |
3 Stars Beta-Glucan 3 grams or more daily | Beta-glucans are a type of soluble fiber that has been shown in multiple clinical trials to lower elevated total and LDL-cholesterol levels. 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. 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. 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%. 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. |
3 Stars Beta-Sitosterol 2 to 3 grams daily | More than 50 years of research has shown consumption of sitostanol and beta-sitosterol, plant compounds known as phytosterols, lowers cholesterol levels. 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. 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. 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%. Supplementation with beta-sitosterol or sitostanol has also been shown to enhance the cholesterol-lowering effect of statin drugs. 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. |
3 Stars Chitosan 1 to 3 grams daily | Chitosan is a fiber-like polysaccharide that has been shown to improve cholesterol levels in a number of clinical trials. 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. 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. Furthermore, chitosan was found to be effective for lowering total and LDL-cholesterol levels in a meta-analysis of 14 randomized controlled trials. 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. |
3 Stars Fenugreek 10 to 30 grams two to three times per day | Fenugreek seed powder has been found to substantially lower blood levels of total and LDL-cholesterol. 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. A meta-analysis that included findings from 12 placebo-controlled trials found fenugreek lowered total and LDL-cholesterol levels, 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. 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. |
3 Stars Garlic 300 to 900 mg a day of garlic powder | Taking garlic can improve cholesterol levels and help prevent heart disease. Numerous randomized controlled trials and meta-analyses have found garlic can reduce total and LDL-cholesterol levels and raise HDL-cholesterol levels. A meta-analysis of 14 randomized controlled trials noted garlic had positive effects on all types of cholesterol levels. 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. One meta-analysis concluded garlic improved lipid profiles in people with type 2 diabetes after pooling findings from 39 randomized controlled trials. 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. |
3 Stars Glucomannan 3 grams daily | Glucomannan is a viscous, soluble dietary fiber that has been shown to improve metabolism and reduce LDL-cholesterol and non-HDL-cholesterol levels. 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. 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%. |
3 Stars Green Tea green tea extract providing 107–856 mg of EGCG daily in smaller divided doses and with food | 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. 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. 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. In other large meta-analyses, green tea extract was found to reduce total cholesterol levels, as well as triglyceride levels, in type 2 diabetics, and decrease total and LDL-cholesterol levels in individuals with overweight and obesity. A research review indicated green tea extract providing 107–856 mg of EGCG could induce significant reductions in LDL-cholesterol levels. EGCG, with its powerful antioxidant and anti-inflammatory effects, has also been linked to reduced risks of atherosclerosis and heart attack. |
3 Stars Pantothenic Acid 300 mg pantethine taken two to four times per day | Pantethine, a byproduct of vitamin B5 metabolism, may help reduce the amount of cholesterol made by the body. 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. 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.In 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. Several uncontrolled trials have also found that pantethine, at doses of 300 mg two to four times per day, improved cholesterol levels. 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. Common pantothenic acid has not been reported to have any effect on high blood cholesterol. |
3 Stars Psyllium 2 to 20 grams (about ½–4 teaspoons) per day with meals | Psyllium husk has been shown to be effective at lowering total and LDL-cholesterol levels. 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. 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. 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. 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. Psyllium has even been found to be safe and effective for treating children and adolescents with high cholesterol levels. |
3 Stars Red Yeast Rice 600 to 1,200 mg with 2.5 to 5 mg of monacolin K twice daily | Red yeast rice contains a compound that is well known to inhibit production of cholesterol in the liver. 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. 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%. Lovastatin (Mevacor)and several of its analogs, collectively called statins, are used as prescription drugs used to treat high cholesterol. 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. 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. 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. 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. 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. 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. 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. |
3 Stars Sitostanol 2 to 3 grams daily | More than 50 years of research has shown consumption of sitostanol and beta-sitosterol, plant compounds known as phytosterols, lowers cholesterol levels. 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. 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. 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%. Supplementation with beta-sitosterol or sitostanol has also been shown to enhance the cholesterol-lowering effect of statin drugs. 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. |
3 Stars Soy 25 grams soy protein per day | Soy supplementation has been shown to lower cholesterol. Soy contains isoflavones, which are believed to be soy’s main cholesterol-lowering ingredients. Soy supplementation has been shown to lower cholesterol in humans. 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. However, supplementation with either soy or non-soy isoflavones (from red clover) 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. |
2 Stars Berberine (Type 2 Diabetes) 500 mg two to three times daily | Berberine may improve blood glucose control and insulin sensitivity and decrease risks of cardiovascular and other complications in people with type 2 diabetes. Berberine is an alkaloid compound extracted from medicinal herbs such as goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), and Oregon grape (Mahonia aquifolium). Multiple clinical trials, research reviews, and meta-analyses of trials show berberine can improve blood glucose control and insulin sensitivity and decrease risks of cardiovascular and other complications in people with type 2 diabetes. Some evidence suggests it may also support healthy weight loss in people with diabetes. It has even been found to have comparable efficacy to conventional anti-diabetes drugs and to enhance the benefits these drugs when used in combination. Since it is poorly absorbed through the intestinal wall, some researchers have proposed berberine exerts its actions through positively impacting the gut microbiota. Researchers have typically used doses of 1–1.5 grams of berberine per day. |
2 Stars Calcium 500 to 1,000 mg daily | Some trials have shown that supplementing with calcium reduces cholesterol levels, and co-supplementing with vitamin D may add to this effect. Calcium can inhibit cholesterol absorption and synthesis, and some research shows calcium supplements can lower high cholesterol levels. 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. 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. 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. 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. 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. Yet another large analysis found no cardiovascular benefits or harms from calcium supplementation. 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. |
2 Stars Charcoal 4 to 32 grams per day | Activated charcoal can bind to cholesterol and cholesterol-containing bile acids in the intestine, preventing their absorption. Activated charcoal has the ability to adsorb, or bind to, cholesterol and cholesterol-rich bile acids present in the intestine, preventing their absorption. Reducing the absorption of bile acids results in increased cholesterol use in new bile acid synthesis by the liver. 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. 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. However, one small placebo-controlled trial found no effect of either 15 or 30 grams per day in patients with high cholesterol levels. Activated charcoal can cause black stools, digestive upset, and constipation, limiting its usefulness. |
2 Stars Chondroitin Sulfate 500 mg three times daily | Chondroitin sulfate appears to sequester cholesterol, lowering circulating cholesterol levels and reducing atherosclerosis. 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. Clinical trials performed in the 1960s and 1970s reported supplemental chondroitin sulfate had cholesterol-lowering effects and could slow atherosclerosis progression. 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. 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. 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. Some evidence suggests chondroitin sulfate interacts with LDL-cholesterol, reduces cholesterol accumulation in vessel walls, and decreases lipoprotein oxidation. |
2 Stars Chromium up to 200 mcg daily | 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. 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-cholesterol and high total cholesterol 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. 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. However, a meta-analysis of ten trials that included 509 diabetic subjects found chromium had no effect on lipid levels. |
2 Stars Cranberry 500 mg three times per day after meals | Some, but not all, clinical trials show cranberry extract may improve cholesterol profiles. Cranberries are rich in flavonoid antioxidants that have demonstrated multiple beneficial effects. Randomized controlled trials have shown cranberry extract can increase HDL-cholesterol levels in people under 50 years old. 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. 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. 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. |
2 Stars Creatine 20 grams per day as a loading dose and 10 grams per day as an ongoing dose | Clinical trials examining the effect of creatine on cholesterol metabolism have yielded mixed results. 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. 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. 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. 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. 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. |
2 Stars Guggul 500 to 2,000 mg three times per day | Findings regarding the ability of guggul extracts to lower cholesterol levels are mixed. 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. Guggulsterones have been found to bind to receptors involved in cholesterol metabolism, and some clinical research suggests it can lower cholesterol levels. 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. Other early trials had similarly positive findings, 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. 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. |
2 Stars HMB 3 grams daily | Supplementing with HMB, or beta-hydroxy-beta-methylbutyrate, has been reported to lower total and LDL-cholesterol levels. 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. 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%. |
2 Stars Krill Oil 0.5 to 4 grams krill oil daily | Supplementing with krill oil is likely to help lower high triglyceride levels, but findings regarding its ability to improve cholesterol levels are mixed. 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. 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. 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. 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. |
2 Stars L-Carnitine 2 to 3 grams per day | L-carnitine has been found in some, but not all, clinical trials to reduce high cholesterol levels. 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. 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. 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. |
2 Stars Lecithin (Phosphatidyl Choline) 500 mg per day | Taking lecithin supplements may be a useful way to lower cholesterol. 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. 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. 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. |
2 Stars Royal Jelly 150 to 6,000 mg daily | Supplementing with royal jelly may improve cholesterol levels. 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. 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. 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. 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. 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%. |
2 Stars Tocotrienols 200 mg daily | Tocotrienols may increase HDL-cholesterol levels. 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. 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. |
2 Stars Vitamin E Refer to label instructions | It is unclear whether supplementing with vitamin E can improve cholesterol levels. 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. 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. 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. Other meta-analyses have found co-supplementation with vitamin E and omega-3 fatty acids had no effect on lipid profiles overall but lowered LDL-cholesterol levels in trials in people with metabolic syndrome. |
1 Star Achillea species 15 to 20 drops of tincture twice per day for six months | 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. 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. More recently, several compounds from this plant demonstrating lipid-lowering effects have been identified. |
1 Star Astaxanthin 6 to 12 mg daily | Astaxanthin has antioxidant and other properties that may help improve cholesterol metabolism and protect vascular health. Astaxanthin is a red carotenoid pigment found in microalgae as well as some seafood such as salmon, shrimp, and trout. Astaxanthin is an antioxidant and has demonstrated an ability to improve cholesterol metabolism and protect vascular health. 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. 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). However, a meta-analysis that pooled findings from seven randomized controlled trials found astaxanthin had no beneficial effect on lipid profiles. |
1 Star Copper 2 to 4 mg daily | Copper deficiency has been linked to high cholesterol levels, but supplementation does not appear to have a cholesterol-lowering effect. 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. 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. 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. |
1 Star Fo-Ti Refer to label instructions | 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. 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. Cases of liver toxicity related to the use of fo-ti have been reported, but the mechanism of liver injury remains unknown. |
1 Star Inositol Hexaniacinate (Vitamin B3) 400 to 500 mg of inositol hexaniacinate three to four times daily | Inositol hexaniacinate, a special form of niacin, does not appear to improve cholesterol levels. 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. 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. Similarly, a crossover trial also found inositol hexaniacinate had no significant effect on cholesterol levels. |
1 Star Magnesium 300 to 600 mg daily | Magnesium supplementation can be beneficial in reducing cardiovascular risk but is unlikely to lower high cholesterol levels. Magnesium plays an important role in cholesterol synthesis and metabolism, and some research has correlated low magnesium status with high cholesterol levels. 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. 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. However, another meta-analysis that included 18 trials found no effect for magnesium on cholesterol levels in either diabetic or non-diabetic individuals. |
1 Star Maitake Refer to label instructions | Maitake mushroom polysaccharides have been found to improve lipid levels in animal studies. A number of animal studies suggest that extracts from maitake mushroom may lower cholesterol and triglyceride levels in the blood. Animal research further suggests maitake may inhibit development of atherosclerosis. This research is requires confirmation in clinical trials. |
1 Star Pine Bark Extract (Pycnogenol) 50 to 450 mg per day | Pycnogenol appears unlikely to impact cholesterol levels. 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. |
1 Star Policosanol Refer to label instructions | An older body of evidence that has not been reproduced outside of Cuba suggests policosanol may have cholesterol-lowering effects. 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. Nevertheless, questions related to fact that these clinical findings have not been reproduced by researchers outside of Cuba remain unanswered. 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. |
1 Star Sea Buckthorn 0.75 ml sea buckthorn oil daily | Sea buckthorn contains flavonoids and essential fatty acids that may reduce high cholesterol levels, but little supportive evidence exists. Sea buckthorn (Hippophae rhamnoides) contains flavonoids and essential fatty acids that may have cardiovascular benefits. 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. 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. 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. 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. 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. |
1 Star Selenium 200 micrograms per day | Selenium does not appear to have substantial cholesterol-lowering effects. 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. 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. Nevertheless, a research review suggested supplementing with 200 micrograms daily may have some cholesterol-lowering benefits in those with high baseline cholesterol levels. |
1 Star Vitamin B3 (Niacin) 1,500 to 3,000 mg daily under a doctor's supervision | 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. 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. 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%. 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. 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. Serious toxic events are more common with sustained release formulations. 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. |
1 Star Vitamin C 500 to 2,000 mg daily | 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. Vitamin C appears to protect LDL cholesterol from oxidative damage and its possible role in cardiovascular protection remains uncertain. Some research suggests vitamin C may reduce LDL-cholesterol levels. 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. Other meta-analyses have not found a statistically significant effect for vitamin C on lipid levels in those with type 2 diabetes. |
1 Star Wild Yam Refer to label instructions | Wild yam does not appear to impact lipid profiles. Although eating yams has been found to lower cholesterol levels in health postmenopausal women, taking a wild yam (Dioscorea villosa) supplements was not found to have a similar effect. |
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Last Review: 06-08-2015
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