Several natural supplements can lower cholesterol levels and improve the balance between ‘bad’ LDL-cholesterol and ‘good’ HDL-cholesterol. The best cholesterol lowering supplements are plant sterols, beta-glucans, bergamot orange, garlic, lycopene, glucomannan, green tea polyphenols, olive leaf extracts and, in some countries, red yeast rice extracts. These supplements can usually be taken together with a statin, to boost its effects, but check with your doctor first before combining them with any prescribed medication.
Plant sterol supplements lower cholesterol
If you are unable or unwilling to take a statin, or if your statin is not working as well as your doctor would like, then plant sterols are the best cholesterol-lowering supplement. Plant sterols are the equivalent of cholesterol in the vegetable world. Their structure is so similar to human cholesterol that they can block the absorption of cholesterol in the intestines without being significantly absorbed themselves.
Plant sterols reduce the uptake of pre-formed cholesterol from your diet (which is typically limited to no more than 300mg cholesterol per day on a low cholesterol diet). Plant sterols also block absorption of the much larger amount of cholesterol (around 800mg per day) which is made in your liver and squirted into your intestines in the bile.
By blocking cholesterol absorption into the circulation, more is voided via the bowel, along with most of the plant sterols. Plant sterols and stanols (which have a similar effect) are added to some spreads and yogurts designed to help maintain normal blood cholesterol levels, and the way they work is shown in the following clip.
Within the EU, there are authorised health claims that plant sterol supplements can lower blood cholesterol levels:
- by 7% to 10% at a daily intake of 1.5g to 2.4g plant sterols per day
- by 10% to 12% with a daily intake of 2.5g to 3g per day.
Supplements tend to provide 800mg plant sterols per tablet, and taking 3 tablets a day can have a significant cholesterol-lowering effect within 2 to 3 weeks.
Olive oil supplements lower cholesterol
Olive oil is a natural source of plant sterols that block the absorption of cholesterol in the gut. Extra virgin olive oil, with a high level of polyphenols, also have an additional effect on the liver to increase HDL-cholesterol production and improve cholesterol balance.
Olive Leaf Extracts contain 30 times more of the beneficial polyphenols supplied by extra virgin olive oil and are used to help lower blood pressure, reduce unwanted blood clotting and improve circulation.
If you have a raised cholesterol, use olive oil for cooking and drizzling on salads.
Garlic supplements lower cholesterol
Garlic contains powerful sulfur-based antioxidants, such as allicin which gives crushed garlic its characteristic smell.
Allicin both reduces cholesterol production in the liver and acts on cell receptors to reduce the uptake of cholesterol. Data from 39 clinical trials, involving 2300 adults, showed that garlic extracts can lower total and LDL-cholesterol by 10% if taken for at least two months. Garlic extracts also lower triglycerides – another type of circulating fat – by up to 27%.
Garlic extracts have the additional advantage of lowering blood pressure. The results from 20 trials involving 970 people suggest that, on average, garlic extracts lower blood pressure by 5.1/2.5mmHg and, in people with hypertension, can lower blood pressure by 8.7/6.1 mmHg compared with placebo.
Garlic also reduces blood stickiness, dilates blood vessels and can reduce the risk of hardening and furring up of the arteries up to a quarter. Link (more good news garlic)
If you need to both lower your cholesterol and reduce your blood pressure, garlic extracts are an excellent option. Add lots of garlic to your meals too, adding it towards the end of cooking for maximum benefits.
Betaglucan supplements lower cholesterol
Eating oats or barley can lower cholesterol in two ways. Oats and barley contain betaglucans, a type of soluble fibre that acts on the liver to reduce your own natural cholesterol production.
Oats and barley also contain insoluble fibre which acts like a sponge to bind cholesterol and slow its absorption in the intestines.
Oat and barley betaglucans are added to foods designed to lower cholesterol, and are also available in supplement form.
A daily intake of at least 3g oat betaglucan can lower total cholesterol and LDL-cholesterol by 5% to 10%.
Betaglucans also have an immune-boosting action, and many supplements highlight this aspect rather than the cholesterol-lowering action.
As with most cholesterol-lowering supplements, betaglucans can be used with or without statin medication but check with your doctor first. Eat oats (eg porridge, unsweetened muesli) and barley products, too.
Bergamot orange supplements lower cholesterol
Citrus fruits contain pectin, a soluble fibre that lowers cholesterol levels. Some citrus fruits also contain bitter polyphenols which have cholesterol-lowering properties. Drinking grapefruit juice daily can lower LDL-cholesterol by 7% to 15%, for example, with red grapefruit having the more powerful effect.
Grapefruit polyphenols can interact with some prescribed medications, however. Taking one particular statin, lovastatin, with a glass of grapefruit juice was found to produce the same blood levels of the drug as when taking 12 tablets with water! The effect, which is irreversible, lasts for at least 24 hours after drinking grapefruit juice or eating grapefruit segments, and can potentially lead to symptoms of overdose. Read the in-pack patient information leaflet, and check with a doctor or pharmacist before taking grapefruit extracts (or eating/drinking grapefruit) if you are taking any prescribed medicines.
The juice of the bitter, bergamot orange contains polyphenols that block the absorption of cholesterol from the intestines, and has the advantage of both reducing ‘bad’ LDL-cholesterol and raising ‘good’ HDL-cholesterol to improve overall cholesterol balance.
A study involving 77 people with raised LDL cholesterol and triglycerides compared the effects of taking a statin alone (at low and high doses), a low dose statin plus bergamot polyphenols or bergamot extracts alone versus placebo.
After 30 days, total cholesterol fell by 31% in those taking bergamot extracts alone, compared with 30% in those taking a low dose statin. In people taking the low dose statin plus bergamot, total cholesterol fell by 38% – a result that was slightly better than in those taking a high dose statin (37%). Bergamot caused ‘good’ HDL-cholesterol to increase and ‘bad’ LDL-cholesterol to fall. There were no significant changes in those on placebo.
Lycopene supplements lower cholesterol
Lycopene is a red, carotenoid plant pigment which lowers cholesterol and reduces hardening and furring up of the arteries.
Lycopene is found in tomato skins, where it is locked away inside cells. Cooking tomatoes releases the lycopene so it becomes five times more bioavailable than in raw tomatoes. Tinned tomatoes provide around 3mg lycopene per 100g, for example, compared while tomato ketchup supplies around 17mg/100g.
Lycopene is also found in pink guava, watermelon, red and pink grapefruit, tangerines (where lycopene is present in a form that is 8.5 times more bioavailable than even tomato juice ) and papaya, where lycopene is stored in a liquid, crystal form that is also readily absorbed.
Results from 12 trials suggests that taking lycopene in doses of at least 25mg per daily reduces LDL-cholesterol by around 10%.
Konjac glucomannan supplements lower cholesterol
Glucomannan is a soluble fibre derived from the root of the konjac plant, or elephant yam.
Glucomannan fibre swells in the intestines on contact with water, an effect that aids satiety and weight loss, promotes regular bowel movements and also slows or reduces the absorption of cholesterol, dietary fats and glucose from the intestines.
As a soluble fibre, glucomannan acts like a sponge to bind cholesterol in the gut. This helps to lower cholesterol absorption – both of the cholesterol in your food, and the cholesterol secreted into your intestines from the liver via your bile.
Data from 12 studies, involving 370 people, found that konjac glucomannan at intakes of 3 grams per day, lowered LDL cholesterol by around 10%.
Within the EU there are authorised health claims that:
- In the context of an energy restricted diet, konjac glucomannan contributes to weight loss at doses of 1g, three times a day, taken together with 1 or 2 glasses of water before a meal
- Konjac glucomannan contributes to the maintenance of normal blood cholesterol levels at a daily dose of 4g per day.
There is a warning to take care to drink plenty of water to ensure the fibre reaches the stomach, otherwise chocking could occur – especially for people with swallowing difficulties.
If you need to both lower your cholesterol and lose weight,konjac glucomannan is a good option to consider.
Red yeast rice supplements lower cholesterol
Red yeast rice is produced when a yeast, Monascus purpureus, ferments wet rice. The yeast turns the rice dark red on the outside and a bright red in the centre. The red yeast rice can be eaten as a delicacy, or dried and ground to a powder or paste to colour Asian dishes such as Peking duck.
Red yeast rice contains a substance, monacolin K, which is identical to one of the statin drugs, lovastatin. Red yeast monacolin K works on the liver in exactly the same way as statin drugs to inhibit the enzyme, HMG-CoA, and block cholesterol production.
The results of 21 clinical trials containing 4558 people, show that, not surprisingly, red yeast rice significantly lowers total cholesterol and LDL-cholesterol. There were no significant effects on blood pressure, triglycerides or HDL-cholesterol compared with placebo, however.
Ten trials, involving 905 people, which compared red yeast rice extracts against statins found no significant differences in any of the outcomes measured.
In the EU, there is an authorised health claim that red yeast rice, which supplies a daily intake of 10mg monacolin K contributes to the maintenance of normal blood cholesterol levels. However, some countries consider red yeast rice is a medicine at doses of at least 5mg per day (Germany), or more than 10mg per day (Belgium). In the UK, whether or not a red yeast rice supplement is a medicine is considered on a case by case basis.
Although red yeast rice extracts sold as food supplements in some countries have their statin content removed, the other ingredients present still have a useful cholesterol-lowering action.
NB if you are intolerant of statins, you could be intolerant to red yeast rice extracts, too. If you decide to take a red yeast rice supplement that has not had its monacolin K removed, then consider also taking co-enzyme Q10 supplements and vitamin D to help reduce any potential statin-like side effects.
Green tea supplements lower cholesterol
Over 30% of the dry weight of green tea leaves consists of powerful flavonoid antioxidants such as epicatechins. Researchers have found that green tea epicatechins block cholesterol absorption and increase liver excretion of cholesterol-containing bile salts and fatty acids.
Green tea antioxidants also increase the breakdown of triglyceride fats, as well as having a beneficial effect on blood pressure. Compared with non-tea drinkers, having 4 cups of tea per day appears to halve the risk of a heart attack, while the incidence of stroke is halved in people drinking at least 5 cups green tea daily, compared with those drinking less.
Results from 20 clinical trials, involving 1536 people, found that green tea extracts reduced total cholesterol by moderate amounts of around 5% to 8%.
Green tea extracts are also popular for their metabolism boosting effects to aid weight loss.
If you don’t want the caffeine kick that accompanies green tea, then decaffeinated supplements are available.
What are the target cholesterol levels?
What represents an ideal cholesterol level is not clear-cut, and acceptable limits are revised regularly – usually in a downward direction. The following cholesterol levels are currently considered desirable for otherwise healthy adults.
There is now a move away from measuring LDL-cholesterol, however, towards measuring all non-HDL-cholesterol as this is a more accurate way or predicting future heart disease risk:
- 5mmol/l or less in the UK
- 200mg/dl or less in the US
Low-density lipoprotein (LDL) cholesterol
- 3mmol/l or less in the UK
- 100mg/dl or less in the US
High-density lipoprotein (HDL) cholesterol
- Above 1mmol/l for men (40mg/dl or above in the US)
- Above 1.2 mmol/l for women (50mg/dl or above in the US).
- UK guidelines: less than 4 mmol/L
- US guidelines: your non-HDL cholesterol level goal should be 30 mg/dL higher than your LDL cholesterol level goal so, if your target LDL cholesterol is 100 mg/dL, your non-HDL goal is 130 mg/dL.
If you have diabetes, a history of heart attack or are at high risk for cardiovascular disease, a lower total cholesterol target (eg 4mmol/l) and a lower LDL-cholesterol target (eg 2mmol/l) may apply. Your doctor can tell you what target cholesterol levels are right for you.
Total cholesterol / HDL-cholesterol ratio
The ratio of your total cholesterol to your HDL- cholesterol is an important factor in assessing your risk of cardiovascular disease, as this takes your non-HDL cholesterol into account.
Your ratio of total cholesterol divided by HDL-cholesterol should ideally be less than 4.
For example, if your total cholesterol is 4.5 mmol/ and your HDL is 1.2 mmol/l, your ratio is 4.5/1.2 = 3.75.
A ratio above 4.0 is considered a risk factor for cardiovascular disease.
This total/HDL ratio is used to estimate your cardiovascular risk, along with other health and lifestyle risk factors to assess your qrisk2 score. Based on this calculation, your doctor may offer a statin drug if your risk of having a heart attack or stroke over the next 10-years is 10% or greater.
Image credits: pixaby; amawasri_pakdara/shutterstock; fotoosvanrobin/wikimedia;