What Is the Best Supplement To Lower Cholesterol?

Following a healthy diet, exercising, and not smoking are the most commonly recommended natural ways to manage cholesterol. Natural supplements like berberine, flaxseed, omega-3 fatty acids, and psyllium can also lower cholesterol.

Cholesterol is a fat-like substance in every cell vital for your body to function properly. Some cholesterol is needed, but high levels—particularly of LDL ("bad") cholesterol—can increase the risk of heart disease. High LDL cholesterol levels cause plaque to build up in the arteries, narrowing them and slowing blood flow.

1. Berberine

Berberine is a dietary supplement that's been used in traditional Chinese medicine. It's harvested from parts of certain plants, such as goldenseal, and made into an edible substance.

Berberine has been shown to reduce LDL cholesterol and triglycerides. The exact way that berberine works inside the body is not well understood.

You can take goldenseal in supplement form, but your body would absorb only a small amount of berberine this way. Any research on the benefits of berberine wouldn't necessarily apply to goldenseal itself.

Side effects tend to be related to the digestive system. You may experience diarrhea, constipation, and bloating.

2. Beta-Glucans

Beta-glucans are a type of plant fiber usually found in barley and oats. Some evidence suggests that beta-glucan supplements can lower LDL and total cholesterol levels. Beta-glucans bind to cholesterol in the gut, which prevents the body from absorbing it in the blood.

Research has shown that beta-glucan supplements are an inexpensive option for lowering cholesterol. They also cause little to no side effects.

3. Flaxseed

Flaxseed and flaxseed oil have been shown to lower cholesterol and triglyceride levels. Flaxseed is a source of soluble fiber, which binds to cholesterol in the gut.

A study published in 2015 found that 10 g of flaxseed oil per day lowered LDL cholesterol levels by 25.8% after four weeks. The participants saw a 21.2% total decrease after 12 weeks.

Flaxseed is generally well-tolerated, but it's important to take supplements with water. Taking too much fiber without water can cause constipation, diarrhea, or, in severe cases, an intestinal blockage.

Talk to a healthcare provider before taking flaxseed if you're pregnant or breastfeeding. Flaxseed may increase the risk of premature birth if you take supplements during the second or third trimester.

4. Garlic

Garlic is often considered one of the oldest dietary supplements. It's believed to help with blood pressure and cholesterol levels. You can use garlic in many forms, including raw, cooked, or powdered. Garlic oil can also be extracted and consumed as a supplement.

There's been some conflicting evidence, but garlic may be effective in lowering cholesterol. Research has shown garlic can lower overall cholesterol between 7.4 to 29.8 milligrams per deciliter (mg/dL). Garlic also helps lower LDL cholesterol levels—anywhere from 5% to 10%—but it doesn't seem to change HDL ("good") cholesterol levels.

Risks and side effects of garlic include:

• Allergic reaction
• Body odor or foul-smelling breath
• Increased risk of bleeding, especially if you're taking a blood thinner
• Strong smell and odor
• Upset stomach or other digestive issues

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

5. Omega-3 Fatty Acids

Fish are a source of omega-3 fatty acids, which can improve overall cholesterol levels. High doses of omega-3s may reduce triglyceride levels in some people.

A study published in 2017 compared fish oil supplements to dietary fresh fish. Both groups had significantly lower total cholesterol, non-HDL cholesterol, and triglyceride levels. The dietary fish group had more improvements than the supplement group.

Eating seafood is generally more effective than taking fish oil supplements. The Food and Drug Administration (FDA) doesn't regulate fish oil, so the specific oils and doses can vary widely.

Fish oil is generally well-tolerated, but some people may have an unpleasant taste or an upset stomach. It's important to talk to a healthcare provider if you have allergies to seafood or shellfish or take blood thinners. Blood thinners or other drugs that affect blood clotting may interact with fish oils.

6. Phytosterols

Phytosterols include sterols and stanols, which are naturally occurring in plants. Sterol and stanol supplements have been shown to reduce cholesterol levels, especially if you take them with meals.

Sterols and stanols have a similar structure to cholesterol. This allows them to replace cholesterol in the gut, keeping the body from absorbing cholesterol in the blood.

Phytosterols are typically well-tolerated. You may develop side effects, such as diarrhea or fat in the stool. People with sitosterolemia may need to avoid sterol and stanol supplements. This rare disorder causes dietary fats to build up in the arteries.

7. Psyllium

Eating adequate amounts of fiber as part of a healthy diet can manage cholesterol. Adding additional fiber with soluble fiber supplements like psyllium may help lower cholesterol in some people. Research has shown that psyllium can reduce LDL cholesterol levels by around 7%.

Soluble fiber absorbs water and forms a gel-like substance that slows digestion. It attaches to the cholesterol you've eaten, helping pass it in stool without it entering the blood. Soluble fiber also slows stomach emptying, increases feelings of fullness, and reduces cholesterol production by the liver.

Increasing fiber intake can cause some mild digestive system symptoms. Soluble fiber supplements like psyllium function primarily as a bulk-forming laxative. Drug-related interactions are rare.

8. Red Yeast Rice

Red yeast rice is a supplement that's been used in traditional Chinese food dishes. The yeast may produce a substance called monacolin K. Monacolin K is a naturally occurring form of lovastatin. This drug lowers cholesterol.

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

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

Regulations limit the amount of monacolin K that can be in red yeast rice products. The FDA will categorize the product as an unapproved medication if there is any amount more than trace amounts.

Red yeast rice may have multiple drug interactions. Drugs that lower cholesterol, antibiotics, and HIV treatments are among those that may interact negatively.

Why Is It Important To Lower Cholesterol?

Your body can produce cholesterol all by itself, but it may also be in the foods you eat. It's important to have your cholesterol in healthy ranges to support overall health.

A healthcare provider will give you ways to reduce your cholesterol levels if they're too high. High levels of LDL cholesterol may cause fatty substances known as plaque to clog and narrow the arteries. Untreated high cholesterol can lead to complications like stroke or heart attack.

Healthcare providers can test your blood and measure the levels of different kinds of cholesterol. Several cholesterol levels are checked using a test called a lipid profile:

• HDL cholesterol: At or above 40 mg/dL in men and 50 in women
• LDL cholesterol: About 100 mg/dL
• Total cholesterol: About 150 mg/dL
• Triglycerides: Below 150 mg/dL

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

Risks and Side Effects

The FDA minimally regulates dietary supplements. The effects of supplements depend on the type, dosage, frequency of use, and interactions with current medications. Please speak with a healthcare provider or pharmacist before starting any supplements.

The International Lipid Expert Panel reviewed supplements that research has suggested might help lower cholesterol in 2017. The panel determined that the following are ineffective and may be harmful:

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

A Quick Review

High cholesterol is known to be a risk factor for severe complications like stroke and heart attack. A healthcare provider may recommend multiple approaches to manage cholesterol levels. There are some potentially promising dietary supplements that may help with cholesterol.

It can be difficult to find high-quality research that shows these supplements are safe and effective. Remember, the manufacturers are not required to show testing for the claims about their usefulness. Speak with a healthcare provider about any supplements and medications you're taking and treatments you are following.