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Cholesterol-Lowering Supplements: What Works, What Doesn’t

    If you want to lower your cholesterol naturally, in addition to managing what you eat and exercising, there are a number of dietary supplements on the market that promise to help. Each year, a new alternative remedy—garlic, ginseng, or red yeast rice, for example—seems to emerge as the next greatest thing for lowering cholesterol.

    However, just because your Uncle Jack swears by a vitamin and claims it helped him lower his cholesterol doesn’t guarantee it will help you. In fact, it’s possible that his achievement was owing to a placebo effect or a diet change that he didn’t reveal.

    Scientific studies are the greatest approach to see if nonprescription therapies work, even if they aren’t always ideal. We look down what the evidence says about the advantages of the most popular alternative cures for lowering cholesterol—and what it doesn’t say.

    Artichoke leaf extract

    • What it is: The dried extract of the artichoke leaf is also known as Cynara scolymus.

    • The evidence: In 2000, German researchers conducted a randomised, double-blind, placebo-controlled experiment with approximately 150 adults who had total cholesterol levels above 280, which is considered “high risk” by the American Heart Association (AHA). Participants who took an artichoke supplement for six weeks had their low-density lipoprotein (LDL), or bad cholesterol, levels drop by 23% on average, compared to only 6% in the placebo group.

    These are encouraging figures, but they have yet to be verified. A more recent three-month trial of a similar design indicated that ingesting artichoke leaf extract reduced total cholesterol by 4% on average, but had no effect on LDL or high-density lipoprotein (HDL), also known as good cholesterol, according to the researchers. They stated that the gap between the outcomes of the two investigations could be explained by differences in the health of the participants and the potency of the supplements (the patients in the second study received a dose that was around 30% lower).

    • The bottom line: Artichoke leaf extract has been studied in a limited number of high-quality research, and the conflicting results suggest that more evidence is needed to validate its cholesterol-lowering effects. If you take artichoke supplements, don’t anticipate your LDL to drop.


    • What it is: Fenugreek is a seed (typically pounded into a powder) that has been utilised in Egypt since the time of the Pharaohs and is now accessible in capsule form.

    • The evidence: Several studies from the 1990s found that large doses of various fenugreek seed formulations can significantly cut total cholesterol and LDL. (One study found a 38 percent reduction in LDL cholesterol.) Almost all of the studies, however, were small and of poor quality, raising questions about the validity of the findings.

    Fenugreek has a high quantity of dietary fibre (ranging from 20% to 50%, according to studies), and some experts believe that the reported cholesterol-lowering effect of fenugreek is due in part to its fibre content.

    • The bottom line: Despite research claiming fenugreek’s capacity to decrease cholesterol, there is insufficient data to recommend its use.


    • What is it? Soluble fibre is a form of dietary fibre that can be found in foods such as oats, barley, bran, peas, and citrus fruits, as well as dietary supplements. (Insoluble fibre, while beneficial to the heart in various ways, has no effect on blood cholesterol.)

    • The proof: In 1999, a group of Harvard Medical School researchers did a meta-analysis of over 70 clinical trials that looked at the impact of soluble fibre on cholesterol levels. In 60 to 70 percent of the studies they looked at, high soluble fibre intake was linked to lower LDL and total cholesterol levels. The participants in the various studies reduced their LDL levels by around 2 points for every gramme of soluble fibre added to their daily diet. (An average of seven weeks was used.)

    The amount of fibre you’d have to consume to considerably lower your LDL is quite large. Most people consume significantly less than the 25 grammes of dietary fibre suggested by most health organisations, and soluble fibre accounts for just around 20% of total fibre consumption. (According to Harvard researchers, three bowls of oatmeal a day only provide about 3 grammes of soluble fibre.) Daily fibre supplements can assist, but they can produce gastrointestinal adverse effects and interfere with some prescription medications if taken on a regular basis.

    • The bottom line: Eating a diet rich in soluble fibre can help you lower your LDL cholesterol. However, the effect is likely to be minor, and supplementing with soluble fibre may be impractical.

    Fish oil

    • What it is: Fish is high in EPA and DPA, two heart-healthy omega-3 fatty acids. These fatty acids are the major constituents of fish oil supplements, which are normally sold as gel capsules in concentrated form.

    • The evidence: Fish oil has been demonstrated to lower triglyceride levels—the third component of your total cholesterol number—by roughly 10% to 30% in clinical trials using relatively high dosages (3 grammes or more). (The more successful it is, the higher your triglyceride levels are.) Fish oil, on the other hand, has no effect on LDL cholesterol levels. The supplements do cause a little increase in LDL, but the form that this extra LDL takes is regarded to be less harmful to the arteries.

    Although high triglyceride levels are linked to an increased risk of coronary heart disease, reducing them is less significant than lowering LDL. In fact, some specialists believe that triglycerides are a marker of heart disease risk rather than a cause.

    • The bottom line: Fish oil helps to decrease triglycerides, especially in patients who have high levels. According to the American Heart Association, people who need to lower their triglycerides should take 2 to 4 grammes of fish oil per day, in consultation with their doctor; people with heart disease should consume about 1 gramme of EPA and DPA (combined) per day, preferably by eating fatty fish like salmon.


    • What is garlic? Garlic is a member of the onion family that comes in oil, extract, and tablet form (in addition to its natural state).

    • The evidence: The federal Agency for Healthcare Research and Quality reported in a 2000 assessment on garlic’s impact on cardiovascular risk factors that garlic induced a tiny but measurable decline in both LDL and total cholesterol, but only in the short term (three months).

    However, further study has not proven encouraging. Over a six-month period, a high-quality 2007 study published in the Archives of Internal Medicine compared raw garlic to commercial garlic supplements and found no detectable effects of the various garlic forms on total cholesterol, LDL, HDL, or triglyceride levels compared to placebo. Garlic has no effect on cholesterol, according to a meta-analysis that included only randomised, placebo-controlled trials the following year.

    • The bottom line: While garlic may temporarily lower LDL, its capacity to influence cholesterol levels in a meaningful way is dubious at best.


    • What it is: Ginseng is an Asian herb that has long been used in traditional medicine and is now available in tablet form.

    • The evidence: The research on ginseng and cholesterol is contradictory at best. A team of Harvard Medical School researchers highlighted in a comprehensive 2005 analysis that multiple studies had indicated ginseng to have a positive effect on one or more cholesterol components. However, the majority of the trials were small, few were randomised, and none of them were blinded or placebo-controlled. Researchers discovered a 45 percent drop in LDL levels and a 44 percent increase in HDL in one trial, although it wasn’t controlled, only included eight participants, and was funded by a Korean ginseng product producer.

    • The bottom line: While the findings of nonrandomized studies cannot be discounted, there is insufficient data to support the use of ginseng for cholesterol reduction.


    • What exactly is it? Guggul is a tree-resin extract that contains plant sterols (guggulsterones) and is accessible in pill form in Ayurvedic medicine.

    • The evidence: Similar to ginseng, there is little study on guggul and cholesterol. Early studies claimed a 10% or greater reduction in total cholesterol, LDL, and triglycerides, although the majority of the trials were tiny and faulty. Then, in 2003, researchers at the University of Pennsylvania published the first guggul study in the United States, a randomised controlled trial of more than 100 persons with high cholesterol in the Journal of the American Medical Association. They discovered that guggul had no effect on total cholesterol, HDL, or triglycerides, but did induce a 5-percent increase in LDL. (The placebo group’s LDL levels dropped by about the same amount.)

    • The bottom line: Guggul’s image was tarnished by the 2003 JAMA report. More research is needed, however there is currently insufficient data to support the use of guggul to decrease cholesterol. Furthermore, according to certain studies, up to 20% of Ayurvedic medications may be tainted with lead or other poisons.


    • What it is: Niacin (also known as nicotinic acid) is a B vitamin found in meat, fish, and dairy products. It’s also available in the form of a capsule.

    • The evidence: For decades, experts have known that niacin can help lower cholesterol levels. Niacin has been shown to lower total cholesterol, LDL cholesterol, and triglycerides in large studies, the most recent of which was a six-year study of over 1,100 persons done in the 1970s. But it has the most noticeable effect on HDL: studies show that niacin can increase HDL levels by up to 35%. (This is one of the reasons why niacin is frequently used in conjunction with statins, which lower LDL.)

    The problem is that it only works at large doses of 2 to 3 grammes per day, which is what you’d get from an extended-release prescription medicine (such as Niaspan). Niacin is available as an over-the-counter vitamin in 500 milligramme or higher extended-release doses, however taking significant levels of niacin on a regular basis can cause negative effects ranging from skin flushing to liver damage.

    • The bottom line: Niacin raises HDL levels, but it should not be taken without first visiting a physician. The American Heart Association warns that niacin supplements should not be used instead of a prescription because of the risk of major side effects.

    rice with red yeast

    • What it is: Red yeast rice is a fungus that grows on rice and includes trace quantities of lovastatin, a type of statin available in both prescription and over-the-counter drugs.

    • The evidence: When compared to most dietary supplements, the evidence for red yeast rice’s efficacy is quite strong—which isn’t unexpected given that red yeast rice is essentially a low-dose statin. Various red yeast rice preparations have been reported to decrease LDL by roughly 20% to 30% in tests over the years (including numerous high-quality trials), comparable to a prescription statin.

    These findings have been supported up by further subsequent research. Red yeast rice pills decreased total cholesterol and LDL by 15% and 21%, respectively, in the most recent trial, a 2009 study of patients who had discontinued using statins due to muscle pain (compared to 5 percent and 9 percent for placebo).

    • The bottom line: Red yeast rice has the ability to reduce cholesterol levels, but its potency has some specialists concerned—and suspicious. According to an investigation conducted by a consumer watchdog group, the amount of lovastatin in red yeast rice pills varies substantially between manufacturers, to the point where certain versions appear to be spiked with lovastatin. Because of the risk of inadvertently swallowing too much statin (which can induce muscle soreness), specialists advise against buying off-the-shelf red yeast rice.

    Protein derived from soy

    • What it is: Soy protein is found in tofu, edamame, and soy milk, among other soy foods. It’s also available as a powder in health food stores.

    • The evidence: Ten years ago, the US Food and Drug Administration began allowing labelling on select soy-containing foods, claiming that soy protein was low in saturated fat and dietary cholesterol, and that it could help lower LDL cholesterol and thereby lessen the risk of heart disease.

    Soy usage in the United States has risen, however study has indicated that soy protein has a minor influence on LDL cholesterol. A 2006 evaluation by the American Heart Association’s nutrition committee found that consuming 50 grammes of soy protein per day—twice the amount recommended by the FDA to minimise the risk of heart disease—only resulted in a 3% reduction in LDL cholesterol. Soy consumption did not result in a substantial increase in HDL values.

    • The bottom line: Soy protein does reduce LDL cholesterol, but only little. The magnitude of the effect appears to have been exaggerated.

    Learn more: Health Benefits of Flax Seeds