4 Natural Supplements to Support Healthy Cholesterol Levels

There are many supplements being touted on the market, but some may be more effective than others at helping you manage or maintain healthy cholesterol levels. In this article, we'll take a closer look at four natural supplements that support healthy cholesterol levels: red yeast rice, garlic, niacin, omega-3 fatty acids, soluble fiber.

Once you understand the relative merits of these natural remedies for high cholesterol, you'll be better equipped to discuss your options with your healthcare provider. Let's begin with reviewing what cholesterol is, and why unhealthy cholesterol levels may pose a problem.

Why It's Important to Know If Your Cholesterol Is Too High

Not all cholesterol is bad for you. Some of this waxy, fat-like substance is needed to make essential molecules like hormones, fat-soluble vitamins, and bile acids to help you digest your food. But the problem with cholesterol arises when you consume too much of the cholesterol that's in foods from animal sources, such as egg yolks, meat, and cheese, especially since your body already makes all the cholesterol it needs.

When more cholesterol is circulating in your blood than your body can use, the excess can form plaque and cause a condition known as atherosclerosis, which happens when plaque sticks to the walls of your arteries. Too much plaque narrows your coronary arteries, thereby reducing or blocking blood flow and potentially leading to coronary artery disease (CAD).

So how much cholesterol is too much? According to the Centers for Disease Control and Prevention (CDC), you should endeavor to maintain these cholesterol levels:

• LDL cholesterol (low-density lipoprotein, or "bad" cholesterol): less than 100 mg/dL

• HDL cholesterol (high-density lipoprotein, or "good" cholesterol): 60 mg/dL or higher

• Triglycerides: less than 150 mg/dL

Note that triglycerides are not cholesterol. Rather than being used to build cells and certain hormones, as cholesterol does, triglycerides store unused calories and provide your body with energy. Although different from cholesterol, triglycerides and cholesterol are often bundled together in blood tests that measure your cholesterol levels. The reason for this is that high triglycerides may combine with LDL and stiffen the arteries, or make the arterial walls thicker (called arteriosclerosis). Thus, high triglycerides, just like excess cholesterol, increases your risk of stroke, heart attack and heart disease.

Your total cholesterol (LDL plus HDL) should be less than 200 mg/dL. But too many of us have dangerously high cholesterol levels, raising the risk of the number one cause of death — heart disease — and the fifth ranking cause of death — stroke.

In 2015 to 2016, the CDC reported that among adults 20 years old or older:

• More than 12% had total cholesterol higher than 240 mg/dL.

• Nearly 29 million have total cholesterol levels higher than 240 mg/dL.

• More than 18% had HDL levels of less than 40 mg/dL.

The bottom line is that many millions of people have dangerously high cholesterol, which begs the question: "What can I do to support healthy cholesterol levels?"

For starters, you can work to improve your diet, maintain a healthy weight, exercise more regularly, quit smoking, limit alcohol, and consider cholesterol-lowering medication, recommends the CDC. If your cholesterol isn't dangerously high, and your doctor hasn't recommended medication, you might consider natural supplements for healthy cholesterol. While there's no magic supplement or quick fix, there may be some natural options to help you keep your cholesterol on track.

4 Natural Supplements for Healthy Cholesterol

1. Red Yeast Rice Extract

Red yeast rice is a substance made by fermenting rice with a species of yeast called Monascus purpureus. Fermented rice has been used as a food and traditional medicine in China since 800 AD. Red yeast rice contains a variety of natural compounds known as monacolins (or mevinic acids). Some of these monacolins are known to inhibit cholesterol production by inhibiting the enzyme HMG-CoA reductase that controls the metabolic pathway that produces cholesterol.

The cholesterol-blocking compound monacolins (principally, monacolin K) is the active ingredient in red yeast rice. According to the Mayo Clinic, using red yeast rice can reduce your total blood cholesterol and triglyceride levels.

Several human studies that found red yeast rice supplementation to be effective at reducing total cholesterol, LDL, and triglycerides:

• A September 2018 study of 1084 men and women showed that a daily dose of red yeast rice (containing 10 mg of lovastatin), 30 mg of CoQ10, in conjugation with dietary change in line with the Mediterranean diet, reduced total cholesterol by 17.2%, LDL by 21.8% and total cholesterol by 16%. (There was no change in HDL.).

• A July 2008 study reported a dramatic 42% decrease in LDL when a combination of lifestyle changes recommended by the American Heart Association (AHA), fish oil and red yeast rice were used.

Side Effects: While studies are promising, red yeast rice has some potential side effects, associated with it. A small minority of those using red yeast rice supplements experience various side-effects. Digestive disruption, heartburn, dizziness, and muscle aches are the primary ones reported. Additionally, there may also be some inconsistencies in the active ingredient monacolin K among products from mainstream retailers, so be sure to purchase your supplement from a reputable company.

2. Niacin (Vitamin B)

Niacin can reliably raise HDL levels by more than 30%. For that to happen, you need to consume between 1 to 4 grams per day, an amount likely to be difficult to consume from a full-flush product. Full-flush niacin, or niacin-induced flushing, occurs when this type of niacin causes the small blood vessels in your skin to dilate so more blood can rush through. This typically causes discomfort for most people and thereby may exclude full-flush niacin from being used.

Should you wish to try full-flush niacin:

• Increase the dose gradually as you become acclimated to its use.

• Take it with meals.

• If you're bothered by the flushing effect, take aspirin before the niacin to help minimize flushing.

Bear in mind that a no-flush formulation doesn't appear to carry the same benefits as its full-flush counterpart, as suggested by a medical review in Progress in Cardiovascular Disease. The bottom line on niacin: If you want the potential HDL-raising effect of niacin, use the full-flush version, but begin with a low dose, like 50 mg. Gradually increase your dose until you reach 1,000 mg.

Side effects: High doses of niacin may be associated with nauseas, vomiting, abdominal pain, diarrhea, gout, and more.

3. Omega-3 Fatty Acids (Fish Oil)

Omega-3 fatty acids include alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). This may be a good choice to be included amongst your natural supplements for cholesterol, given that the AHA recommends the consumption of EPA plus DHA for patients with coronary heart disease and hypertriglyceridemia (high triglycerides):

• For those with coronary heart disease (for which high cholesterol is a risk factor), the recommendation is approximately 1 gram of EPA plus DHA per day, either from eating oily fish (such as mackerel, salmon and herring), or from omega-3 supplements.

• For those with high triglycerides, the recommendation is 2 to 4 grams of EPA plus DHA per day, an amount that can potentially lower triglyceride 20% to 40%; however, obtain a physician's approval before consuming more than 3 grams of these fatty acids from supplements.

The best way to ingest omega-3 fatty acids is through foods like avocado, walnuts, and fish, such as mackerel, salmon, and herring. If you choose to use supplements, make sure you take a cholesterol test twice a year.

Side effects: Side effects of supplementing with omega-3 fatty acids can include nausea, loose stools, belching, fishy breath. An omega-3 supplement may have have blood-thinning properties, so talk to your doctor before use if you're taking a blood-thinning medication.

4. Soluble Fiber

There are several types of soluble fiber from which to choose, such as oats, psyllium, pectin, and guar gum. They all have been associated with lowering total cholesterol and LDL-C, but it appears that psyllium husk fiber is the best choice to mitigate possible digestive complaints. In a June 2000 study, consuming about 5 grams of psyllium twice daily produced significant net reductions in serum total and LDL concentrations of between 5% to 7% in men and women with primary hypercholesterolemia.

Side effects: Note that fiber can absorb the active compounds in vitamins and pharmaceuticals, thereby making them ineffective. Try to consume fiber either two hours before or after you take medications and supplements. Fiber may cause bloating, gas, and constipation in some people. Therefore, begin with a small dose, perhaps less than recommended on the label (with plenty of water), and gradually increase the amount as your body adjusts to it

Your Takeaway About Natural Supplements for Healthy Cholesterol Levels

Although there's no perfect set of natural cholesterol-supporting supplements, you do have options to consider. Evaluate the upside and downside of each of the four options presented, and talk to your doctor about them. Should you try one or more, carefully observe your reaction, and recheck your cholesterol twice a year (or as directed by your healthcare provider) until your combination of exercise, diet and supplements helps you maintain healthy levels of cholesterol and triglycerides.

References:

Ambizas, Emily M. PharmD. OTC Supplements for the Management of High Cholesterol. U.S. Pharmacist. February 16, 2007. US Pharm. 2017;42(2):8-11.

Anderson JW, Davidson MH, Blonde L, et al. Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia, The American Journal of Clinical Nutrition. June 2000; 71(6): 1433–1438, doi:10.1093/ajcn/71.6.1433

Becker DJ, Gordon RY, Morris PB, et al. Simvastatin vs therapeutic lifestyle changes and supplements: randomized primary prevention trial. Mayo Clin Proc. 2008;83(7):758–764. doi:10.4065/83.7.758

High Cholesterol Facts. Centers for Disease Control and Prevention website. https://www.cdc.gov/cholesterol/facts.htm

Houston MC, Fazio S, Chilton FH, et al. Nonpharmacologic treatment of dyslipidemia. Prog Cardiovasc Dis. 2009;52(2):61–94. doi:10.1016/j.pcad.2009.02.002

Kris-Etherton PM, Harris WS, Appel LJ. Omega-3 Fatty Acids and Cardiovascular Disease. Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:151–152. doi10.1161/01.ATV.0000057393.97337.AE

Mazzaa A, Lentib S, Schiavonc L, et al. Effect of Monacolin K and COQ10 supplementation in hypertensive and hypercholesterolemic subjects with metabolic syndrome. Biomed Pharmacother. 2018 September; 105: 992–996. doi:10.1016/j.biopha.2018.06.076

Miller M, Stone NJ, Ballantyne C, et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011;123(20):2292-2333. DOI: 10.1161/CIR.0b013e3182160726

Niacin to boost your HDL, 'good,' cholesterol. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/niacin/art-20046208

Preventing High Cholesterol. Centers for Disease Control and Prevention website. https://www.cdc.gov/cholesterol/prevention.htm

Red Yeast Rice. Mayo Clinic website. https://www.mayoclinic.org/drugs-supplements-red-yeast-rice/art-20363074