If you don’t want to take statin drugs to reduce your cholesterol, and diet alone isn’t enough, it can be tempting to shop online or at a health food store for over-the-counter cholesterol-lowering supplements. Some of these products can reduce your cholesterol and triglycerides, but you’ve got to shop smart. Here’s a guide to those that work best, so you get the most for your money.
Plant sterols such as beta-sitosterol are added to foods like margarines and sold as supplements. These compounds are safe and effective. The U.S. Food and Drug Administration allows sterol-containing products to make the claim for lowering the risk of heart disease. They have a chemical structure similar to cholesterol, and so, stop cholesterol absorption in the intestines. A typical dose is 800 to 6,000mg a day in divided doses, taken before meals. Sterols need to mix with food as it is digested to be effective.
Stanols are also plant compounds, similar to sterols, and used in margarines, chews, yogurt and some supplements. Stanols alone can reduce cholesterol 10 to 15 percent. When added to a statin, stanol reduces total cholesterol by an additional 3 to 11 percent and LDL cholesterol by another 7 to 16 percent. It usually takes 2 to 3 weeks of taking stanols before you see cholesterol drop much. The best dose: about 2,000mg a day in divided doses. Higher doses do not offer additional benefits. Like sterols, stanols need to be consumed with a meal.
Niacin, a B vitamin,is available over-the-counter in low doses and, in higher dosages, as a prescription drug. It can increase HDL by 15 to 35 percent and decrease triglycerides by 20 to 50 percent. It can lower LDL by about 5 to 25 percent. It is commonly added to other cholesterol-lowering drugs when they aren’t working well enough, or used alone to raise HDL. Doses of 1,000-3,000mg a day are needed. Flushing is a common side effect, and liver function should be monitored. So it is best to take high-dose niacin only with medical supervision. Lower doses (50mg a day) are safe, and may raise HDL slightly, but don’t lower triglycerides or LDL cholesterol.
Psyllium seed, the same soluble fiber found in bulk laxatives like Metamucil and Konsyl, is in some cholesterol-lowering supplements, sometimes along with other soluble fibers such as guar gum and pectin. All these fibers lower cholesterol–they prevent your body from absorbing it in your intestines–but psyllium has the best evidence to support its use. Results vary, but expect about a 10 percent drop in LDL cholesterol if you get 10 grams (about 3 servings) of psyllium a day.
Fish oil in large doses (1 to 5 grams a day) can reduce triglycerides by as much as 20 to 50 percent, but it doesn’t lower LDL cholesterol. Some people have a slight increase in HDL cholesterol when they take fish oil.
Artichoke extract seems to reduce LDL cholesterol by 20 to 25 percent and has “GRAS” (Generally Regarded as Safe) status as a food additive. A compound in the extract, cynarin, is thought to reduce the body’s cholesterol production. Artichoke extract also increases bile acid secretion in the intestine, which makes it a good match for a bile acid-binding product such as psyllium. A typical dose is 1,800mg a day in two to three divided doses. If you are allergic to ragweed, don’t take this cholesterol-lowering supplement.
Red yeast rice supplements do lower LDL cholesterol. That’s because they are, essentially, low-dose statin drugs. But they have similar side effects as statin drugs, including the potential for muscle and liver damage. So it’s best to use them only with medical supervision, if at all. One problem with red yeast rice products is that their content is not standardized, so you may get too much or too little of its active ingredients from batch to batch. And some may contain contaminants that can damage the kidneys. Consider, instead, taking a low-dose statin drug, which, by law, must have a consistent dosage and be free of contaminants.