July 2010 Issue

Curb Cholesterol — Evidence on Achieving Better Levels With Dietary Supplements
By Sharon Palmer, RD
Today’s Dietitian
Vol. 12 No. 7 P. 8

Keeping cholesterol levels in check is at the top of many boomers’ wellness agenda. After all, controlling cholesterol is one of the most well-known prevention measures in the country. Boomers realize that as they age, high blood cholesterol levels can lead to buildup in the arteries, possibly resulting in a heart attack. According to the American Heart Association, an estimated 102.2 million U.S. adults have total blood cholesterol values of 200 mg/dL and higher and, of these, about 35.7 million have levels of 240 or above. The National Cholesterol Education Program advises strategies such as lifestyle changes and cholesterol-lowering drug therapy to reduce LDL and raise HDL levels. But boomers are often on the lookout for other treatments. 

A More ‘Natural’ Approach
Supplements aimed at lowering cholesterol are among the best-selling ones for the boomer population.

“Boomers have long had a profound interest in health and fitness. Nutritional supplements, including cholesterol-lowering supplements, are a desirable addition to the wellness regimen of many middle-aged Americans,” explains Janet Bond Brill, PhD, RD, LDN, author of Cholesterol Down and the upcoming The Heart Disease Reversal Plan. “Some otherwise healthy individuals with high cholesterol are averse to taking prescription drugs and want a more ‘natural’ approach to taming risk factors. Others are not quite ready to get on the statin merry-go-round, where the prescription drug must be taken daily for a lifetime. Then there are those who have been prescribed and tried a prescription cholesterol-lowering drug and simply cannot tolerate the side effects. And lastly, there are those already taking a prescription cholesterol-lowering drug [who] prefer to take the ‘lowest dose that will do the job.’ In this case, cholesterol-lowering supplements offer a highly effective adjunctive therapeutic option for boosting the cholesterol-lowering power of prescription medications so the patient can take a lower dose and still achieve [his or her] cholesterol goal.”

Health food stores and the Internet are rife with dietary supplements for heart health with dubious claims such as “contains bioenergized arterial cleansing formula” or “unclogs arteries.” While it’s important to warn people against the possible risks or side effects of some supplements, Brill advises dietitians to keep an open mind, especially when it comes to recommending supplements such as phytosterols, which have been proven to lower LDL cholesterol.

Review the evidence in the following list of cholesterol-lowering supplements to stay informed.


Fish Oil (DHA and EPA)
A body of science points out that fish oil (DHA and EPA) can help reduce the number of deaths from heart disease. Fish oil does not appear to alter total, HDL, or LDL cholesterol, but it can reduce triglyceride levels. It is considered safe but could theoretically cause blood-thinning problems at high doses (3 g or more). As little as 1 g daily of EPA + DHA may be adequate for reducing the risk of a recurrent heart attack.

A number of randomized trials showed that garlic led to small but statistically significant reductions in total cholesterol; however, a 2009 study by Khoo et al, published in the Journal of Clinical Pharmacy and Therapeutics, showed little benefit. Typical doses are roughly one clove of garlic (about 4 g), which yields 3,600 to 5,400 mcg of allicin. Garlic supplements are generally safe but may thin the blood or interact with drugs used for treating HIV infection.

Originating from the gum resin of the mukul myrrh tree, this traditional Indian herb is marketed to reduce LDL cholesterol and triglycerides, though current evidence does not consistently support its efficacy. A 2003 study by Szapary et al, published in The Journal of the American Medical Association, found that it increased LDL levels. A typical dosage is 75 to 100 mg divided into three doses per day. Guggulsterone may cause skin rash and other mild side effects, although one case report included potential muscle breakdown, according to Natural Standard, an international research collaboration that aggregates and synthesizes data on complementary and alternative therapies.

Niacin taken in high doses (1 to 4 g per day) can raise HDL cholesterol by about 35%, decrease LDL cholesterol by about 10%, and decrease triglycerides by about 25%. But when taken at this dosage, it can have side effects such as skin tingling and potentially dangerous liver inflammation.

Some research suggests that pantethine, or pantothenic acid, modestly decreases total and LDL cholesterol and triglycerides, with a rise in HDL cholesterol. A typical dosage is 300 mg three to four times daily. Side effects include a possible increased risk of bleeding due to decreased platelet aggregation.

Derived from sugarcane, policosanol supplements appeared to significantly lower total and LDL cholesterol in some studies conducted in Cuba. Interestingly, all the studies conducted outside of Cuba did not report this finding. Other forms of policosanol (found in rice bran wax) have not been found to be effective. The typical dosage is 5 to 10 mg taken twice per day. Reported side effects include blood thinning. 

Red Yeast Rice
Made by fermenting rice with a species of yeast, red yeast rice contains naturally occurring lovastatin, a prescription drug used to lower cholesterol, as well as other related, potentially active chemicals. Red yeast rice appears to lower total and LDL cholesterol and triglycerides, with no effect on HDL levels. It is thought to have the same serious risks as statin drugs, but a 2009 study by Becker et al, published in the Annals of Internal Medicine, found that only 7% of statin-intolerant people reported muscle pain when they switched to red yeast rice. It should not be used in conjunction with statins, niacin, or drugs in the fibrate family. Red yeast rice is no longer marketed with standardized lovastatin levels in the United States due to legal issues.

The majority of studies on soy reported small-to-moderate positive effects on total, LDL, and HDL cholesterol and triglycerides. Across the research, higher doses of soy protein are associated with greater LDL reduction among people with elevated LDL levels but not with HDL levels or triglycerides. Doses used in studies average about 80 mg of soy isoflavones per day and 36 g of daily soy protein intake. Soy is considered safe when consumed as a food, but concentrated extracts may cause hormonal effects, particularly in postmenopausal women.

Naturally occurring plant substances, sterols and stanols interfere with cholesterol absorption. A number of studies found that these substances can reduce total and LDL cholesterol by about 10% to 15%, but they do not have much effect on HDL cholesterol or triglycerides. Typical dosages of sterols/stanols that show benefits range from 2.7 to 5.1 g per day, and they have been found to be generally safe.

This proprietary blend of citrus polymethoxylated flavones and palm tocotrienols has been shown to reduce total cholesterol by 20% to 30%, LDL cholesterol by 19% to 27%, and triglycerides by 24% to 34%, according to preliminary studies. A typical dosage is 300 mg per day, and the supplement is generally well tolerated.

— Sharon Palmer, RD, is a contributing editor at Today’s Dietitian and freelance food and nutrition writer in southern California.