The Best & WORST Supplements to Lower Cholesterol | A Dietitian's Recommendations

In this article, I reveal the top 3 supplements for lowering cholesterol—and the ones to ignore. Save your money for something else!

NOW Remember, it's food first, followed by supplements. That is why they are called supplements.

“A supplement is a product that you can take to ADD (not replace) extra nutrients or other substances to your diet for better health or specific purposes.”

As a dietitian, many would think that I would be very against supplements. However, I firmly believe we really need them in many cases. In fact some supplements have a lot of strong evidence behind them. But its important to point out that the supplement industry makes a lot of money and is very poorly regulated. So always consult your doctor or your personal Registered Dietitian before taking any supplement.

This post is all about the best and worst supplements to lower your cholesterol.

Fibre Supplements

So, let’s start by looking at fibre supplements. If you read my previous article, "The No.1 food to lower your cholesterol," you will know that fibre is an amazing secret weapon when it comes to cholesterol-lowering—fibre from food, that is! Not all the benefits of diets high in fibre can be achieved through supplementation—if only it were that easy.

There is now a huge market for fibre supplements, and in theory, you would think these would also be great for lowering cholesterol...

However, when it comes to fibre, there are over 100 different types, and they all offer benefits in their own unique way. Just like if you had 100 different people in a room, everyone would have their own unique skill.

Broadly speaking, there are two main types of fibre incorporated into fibre supplements: soluble and non-soluble fibre. Soluble fibre can be further divided into two types: nonviscous and viscous.

We want to focus on viscous soluble fibre, which becomes a thick gel when it comes in contact with liquids in your gut. Due to this characteristic, it can bind to cholesterol in the small intestine, preventing its absorption into the bloodstream and sweeping it through your digestive tract so it can be eliminated in your stool.

Insoluble fibre and nonviscous soluble fibre do not possess the ability to bind to cholesterol like this.

So when we are looking at fibre, it’s the high viscosity, gel-forming fibres, which include (beta-glucans, psyllium and guar gum, that have been shown to lower cholesterol levels. So, you will want to read the label of any fibre supplement to see which type of fibre it includes.

My recommendation is that if you are looking for a fibre supplement to lower your cholesterol, start with psyllium as there is a lot of research supporting its use to reduce LDL cholesterol.

Psyllium For Cholesterol Lowering

Psyllium: comes from the husks of seeds from the psyllium plant. It is found in a variety of whole-grain foods as well as fibre supplements such as Konsyl, Metamucil, and other store-brand versions.

Psyllium has been the most extensively studied soluble fibre, either administered alone as a supplement or in various grains. Studies have shown that doses anywhere between 6 and 15 grams per day are able to lower LDL levels between 6% and 24%.

Psyllium is also non-gas forming, so it's suitable for those with IBS.

Other soluble fibre supplements are on the market; however, no studies support their use in lowering cholesterol levels.

How To Take Fibre Supplements:

Follow the directions on the packaging. Fibre supplements should be taken with a whole glass of water for them to work most efficiently. You don’t want to end up like a blocked kitchen sink. They can result in some GI side effects (like cramping and bloating), so it’s often best to divide the dose throughout the day. Generally, you should not take fibre supplements around the same time as you take certain vitamins and other medications as the fibre may lower its effectiveness.

Plant Stanols and Sterols

These are usually available as fortified food products like yoghurt drinks and spreads, but they are also available as dietary supplements.

There is very good research behind them; however, there is less evidence for them in dietary supplement form than for the food product.

What are they?

Plant sterols and stanols are substances found naturally in plants with a chemical structure similar to that of cholesterol. They work by partially blocking cholesterol from being absorbed into the bloodstream from the gut. Normally, about 50% of cholesterol is absorbed, but when plant stanols are taken, it drops to just 20%.

If taken in large quantities, they are clinically proven to lower cholesterol. But they are only found naturally in plants in small quantities. For context, you would need to eat 7500g of broccoli to come close to the therapeutic dose. And 30 buckets of broccoli every day for three weeks might be a challenge!

So, food companies have taken other foods, such as yogurt drinks, spreads, and milk, and added big doses of these sterols and stanols, and they can sell them as “clinically proven to lower cholesterol.” Benecol and Flora Pro-activ are examples of products that contain added plant stanols, and there are many own-brand products now, too.

In people with high blood cholesterol, a daily intake of 1.5-2.4g of plant stanols lowers LDL cholesterol by an average of 7-10% within two to three weeks.

These products can be really effective when it comes to cholesterol lowering. As a dietitian, I often recommend these to my clients. However, rather than taking them in pill form, I encourage the food products because that’s where we have the most solid evidence for their efficacy. Now, they are expensive, so taking them isn’t a decision to be taken lightly.

Omega-3 Supplements

Oily fish is the best source of omega-3s in our diet. More than any other food, fish is linked with a healthy heart. We have known for many years that people who eat lots of fish have less heart disease and stroke compared to people who never eat fish. One study found that eating fish once a week reduced fatal heart attacks by 50%.

Fish has many benefits, but the main heart health benefit comes from its omega-3 fats. Omega-3 fats are a special type of fat that prevents blood from clotting (which can trigger a heart attack), reduces inflammation, and maintains a healthy heart rhythm.

So, you would like to think that people who don’t eat fish should instead take an omega-3 supplement for heart health benefits.

Unfortunately, a large analysis showed there was no effect on total HDL or LDL cholesterol with 3.25 grams of fish oil a day, and that's quite a large dose compared to what you tend to get in your pharmacy or the kind of usual omega-3 three capsules. However, if you are someone who has high triglycerides, there have been studies that show a reduction in triglyceride levels with omega-3 supplements. So, if you do have hypertriglyceridemia, speak with your doctor, and they will discuss with you the best omega-3 supplement for taking to help with this.

If you don’t eat at least one serving of oily fish a week, I would still consider taking an omega-3 supplement for general health, even if it may not help with your cholesterol. You can get plant sources of omega 3 from flaxseeds and walnuts, but the plant sources are not as effective as the fish. So, you ideally want to look for a supplement with 450-500mg of EPA and DHA combined. I don’t recommend choosing fish liver oils, as they tend to have less omega 3 than fish oils and too much vitamin A. If you are vegan, you can try to find one that's derived from algae because it has the EPA and DHA.

Multivitamins

A recent study has revealed that most of the more commonly used vitamin and mineral supplements (like a general multivitamin, vitamin D, calcium, and vitamin C) showed no advantage or added risk in the prevention of heart disease, heart attack, or stroke, except for folic acid. Now, you may want or need to take them for other aspects of health, but they are not going to directly work on improving cholesterol levels.

Red Yeast Rice and Cholesterol

“Red yeast rice” is a type of fermented rice produced using a specific species of mould. Although it has only been on pharmacy shelves for the last few decades, it has been prized for its powerful medicinal properties for hundreds of years.

Do these supplements work? In theory, yes. But whether or not you should take them is a little more complex.

They contain the compound monacolin K — the same active ingredient found in prescription cholesterol-lowering medications like lovastatin.

Because it's chemically identical to a statin, it does work, and it’s often used as a cost-effective alternative to pricey medications to help reduce cholesterol levels. However, because it's similar to statins, it can also have the same side effects as a statin and can interact with other medications, so it’s important to tell your doctor if you are taking something like this.

Now, I don’t recommend these to my clients. Because the supplement industry is poorly regulated and is a bit of a "Wild West". Whereas drugs are much better regulated. And often, it’s difficult to know if you’re even getting bang for your buck. The labels on these products usually just state the amount of red yeast rice or Monascus purpureus (the mould), not the amount of monacolin k. So you might be getting none of this monacolin K (and just some mouldy rice), or you could be getting a really high dose that might be higher than the dose that your doctor would have prescribed to you starting off in the first place.

There is no standardization as there is with normal-regulated drugs. So, if you decide to take it, please let your healthcare provider know so they can monitor your cholesterol and your symptoms.

Conclusion

Supplements worth considering include:

psyllium
plant stanols and sterols
and omega-3s if you don't eat oily fish

I would pass on the red yeast rice. If you want to take a multivitamin, it's often better to find out exactly what vitamins and minerals you need rather than just taking something for the sake of it.

This article definitely shows how powerful plants can be, so one of the best things you can do for your cholesterol is increase your intake of plant foods.

Try your best to get in a variety of:

Fruits
Vegetables
Nuts & seeds
Wholegrains
Legumes

Your diet doesn’t have to be plant-only, but increasing your intake of these foods will be a big help. I recommend reading my post on the four best cholesterol-lowering foods to strengthen your cholesterol-lowering toolkit even further.

This post was all about the best and worst supplements to lower cholesterol.

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More about the author:

Hi there! My name is Maria, and I am a Registered Dietitian practising in Ireland and Bermuda. I have extensive experience in helping clients improve their health through the power of good nutrition. I hope you enjoyed this article. If you have any questions or concerns, please do not hesitate to contact me. Additionally, if there are nutrition topics or recipes you would like me to make in future posts, please let me know. I would be more than happy to help.

Stay happy and healthy 💚

Your Registered Dietitian

Maria xox

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The Best & WORST Supplements to Lower Cholesterol | A Dietitian's Recommendations