Dr Jess says: If you have been diagnosed with high cholesterol, your doctor may have prescribed statins or other medicines for you to take. A healthy, balanced diet that is full of plant sterols can also help, as can avoiding fats such as palm oil and processed foods and adding exercise if you are sedentary. Reducing inflammation can transform cholesterol problems, so following our Refresh programme can help to reset your gut microbiome.
I would advise caution when looking at buying ‘cholesterol lowering’ foods from the supermarkets. In many cases, these are full of added sugars, chemicals and other undesirable ingredients, so it’s always preferable to use a healthy, balanced diet that is full of vegetables, meat and seafood and other natural ingredients to let Mother Nature do the hard work for you.
These supplements are some of my favourites for treating patients who come to me with high cholesterol and they see great results in most instances. Try to ensure you get your cholesterol regularly tested to see that you are making progress.
niacin (vitamin B3)
An excellent cholesterol support as well as being anti-inflammatory and anti-atherosclerotic. It has been shown to lower LDL cholesterol, lipoprotein a, VLDL, oxidised LDL and it raises HDL.1 It can be taken as a supplement, but can cause flushing, though this is not harmful and it usually settles over time. Many patients find it can be slowly increased to the maximum tolerated dose, with patients usually taking between 500mg-2000mg daily (although it is important not to take it in the niacinamide form, as this does not work on cholesterol). Niacin can cause heartburn and itchy skin. If you experience these side effects, lower your dosage until they resolve. Very rarely niacin can affect your liver enzymes or create blurred vision or flu-like symptoms, which stop when the supplement is stopped.2
A plant nutrient (see phytochemicals) with multiple anti-inflammatory, antioxidant, anti-ageing, heart and nerve protective and anti-cancer benefits. Studies also show it may lower LDL and can lower Lp(a).3 It has been shown to be extremely safe and can be taken up to doses of 5g daily, with only rare side effects of minor digestive symptoms.4
A natural fibre with many health benefits lowers LDL cholesterol when taken daily5 and can help maintain blood sugar. It can be taken as a capsule or added as a powder to smoothies or yoghurt.
Tocotrienols are a type of vitamin E (less commonly seen in supplements as they are extremely expensive, but are naturally high in certain foods like rice bran and barley). Evidence shows that they can lower LDL, raise HDL, improve atherosclerotic plaques, decrease blood sugar and measure glycated haemoglobin (HbA1c), as well as supporting fat loss and normalising blood pressure.6 Cytoplan offers a good quality mixed tocopherols and tocotrienols supplement.
green tea extract (EGCG)
As well as aiding weight loss and decreasing weight circumference, studies show that green tea can lower LDL.7,8 It has also been shown to improve blood sugar control and reduce diabetes risk.9 Although drinking tea has many health benefits (our favourite tea is Amber GABA oolong), to consume the amount used in clinical trials would be very difficult, so you may find a supplement a better choice. Lamberts have a good standardised green tea supplement.
A potent antioxidant and natural anti-inflammatory that helps support the liver and eliminating toxins (both Jess and Xandra take it daily). Small studies have shown it successfully reduces cholesterol and LDL and increases HDL, as well as improving fasting insulin and fasting blood sugar.10 It also likely protects against blood vessel damage and plaque formation and reduces homocysteine levels.11,12 It is safe and well-tolerated.13 Lamberts have a good N-Acetyl Cysteine supplement.
As mentioned above Coenzyme Q10 likely improves the side effects of statin use, but has also been shown to decrease total cholesterol and raise heart-protective HDL cholesterol.14 We prefer coenzyme Q10 in the form of ubiquinol. Lamberts sell a good quality supplement.
Magnesium is difficult to measure, and is a common mineral deficiency. Studies show that supplementation can improve fasting blood sugar, raise HDL cholesterol, lower LDL cholesterol, triglycerides and normalise blood pressure, especially in those with raised blood sugar or with low magnesium.15
red rice yeast extract
A traditional Chinese remedy, this is the most effective cholesterol-lowering supplement in Dr Jess’s experience. Multiple studies show that it lowers total and LDL cholesterol and can also lower hsCRP (a blood marker for inflammation that if raised shows an increased risk of heart disease). It is a natural statin (from a fermented culture of rice) and has a similar mechanism of action. It seems to be as effective without the same level of side effects found in statins.16,17 Cytoplan has an excellent form of this supplement, which Dr Jess uses regularly with her patients if cholesterol is not reduced by other methods.
Found in whole foods like fruit & vegetables, nuts and seeds although they can be taken as a supplement. They work by blocking the uptake of cholesterol by the gut to lower our total, LDL and VLDL cholesterol. They have very few side effects and can effectively lower LDL by 10-14%.18
other articles in this series:
- Julius U. Niacin as antidyslipidemic drug. Can J Physiol Pharmacol. 2015 Dec;93(12):1043-54. doi: 10.1139/cjpp-2014-0478. Epub 2015 Apr 28. PMID: 26370906.
- Pieper JA. Understanding niacin formulations. Am J Manag Care. 2002 Sep;8(12 Suppl):S308-14. PMID: 12240702.
- Momtazi-Borojeni AA, Katsiki N, Pirro M, Banach M, Rasadi KA, Sahebkar A. Dietary natural products as emerging lipoprotein(a)-lowering agents. J Cell Physiol. 2019 Aug;234(8):12581-12594. doi: 10.1002/jcp.28134. Epub 2019 Jan 13. PMID: 30637725.
- Ramírez-Garza SL, Laveriano-Santos EP, Marhuenda-Muñoz M, Storniolo CE, Tresserra-Rimbau A, Vallverdú-Queralt A, Lamuela-Raventós RM. Health Effects of Resveratrol: Results from Human Intervention Trials. Nutrients. 2018 Dec 3;10(12):1892. doi: 10.3390/nu10121892. PMID: 30513922; PMCID: PMC6317057.
- Davidson MH, Maki KC, Kong JC, Dugan LD, Torri SA, Hall HA, Drennan KB, Anderson SM, Fulgoni VL, Saldanha LG, Olson BH. Long-term effects of consuming foods containing psyllium seed husk on serum lipids in subjects with hypercholesterolemia. Am J Clin Nutr. 1998 Mar;67(3):367-76. doi: 10.1093/ajcn/67.3.367. Erratum in: Am J Clin Nutr 1998 Jun;67(6):1286. PMID: 9497178.
- Weng-Yew W, Brown L. Nutrapharmacology of tocotrienols for metabolic syndrome. Curr Pharm Des. 2011;17(21):2206-14. doi: 10.2174/138161211796957445. PMID: 21774781.
- Chen IJ, Liu CY, Chiu JP, Hsu CH. Therapeutic effect of high-dose green tea extract on weight reduction: A randomized, double-blind, placebo-controlled clinical trial. Clin Nutr. 2016 Jun;35(3):592-9. doi: 10.1016/j.clnu.2015.05.003. Epub 2015 May 29. PMID: 26093535.
- Huang LH, Liu CY, Wang LY, Huang CJ, Hsu CH. Effects of green tea extract on overweight and obese women with high levels of low density-lipoprotein-cholesterol (LDL-C): a randomised, double-blind, and cross-over placebo-controlled clinical trial. BMC Complement Altern Med. 2018 Nov 6;18(1):294. doi: 10.1186/s12906-018-2355-x. PMID: 30400924; PMCID: PMC6218972.
- Alves Ferreira M, Oliveira Gomes AP, Guimarães de Moraes AP, Ferreira Stringhini ML, Mota JF, Siqueira Guedes Coelho A, Borges Botelho P. Green tea extract outperforms metformin in lipid profile and glycaemic control in overweight women: A double-blind, placebo-controlled, randomized trial. Clin Nutr ESPEN. 2017 Dec;22:1-6. doi: 10.1016/j.clnesp.2017.08.008. Epub 2017 Aug 31. PMID: 29415825.
- Javanmanesh F, Kashanian M, Rahimi M, Sheikhansari N. A comparison between the effects of metformin and N-acetyl cysteine (NAC) on some metabolic and endocrine characteristics of women with polycystic ovary syndrome. Gynecol Endocrinol. 2016;32(4):285-9. doi: 10.3109/09513590.2015.1115974. Epub 2015 Dec 10. PMID: 26654154.
- De Mattia G, Bravi MC, Laurenti O, Cassone-Faldetta M, Proietti A, De Luca O, Armiento A, Ferri C. Reduction of oxidative stress by oral N-acetyl-L-cysteine treatment decreases plasma soluble vascular cell adhesion molecule-1 concentrations in non-obese, non-dyslipidaemic, normotensive, patients with non-insulin-dependent diabetes. Diabetologia. 1998 Nov;41(11):1392-6. doi: 10.1007/s001250051082. PMID: 9833950.
- Hildebrandt W, Sauer R, Bonaterra G, Dugi KA, Edler L, Kinscherf R. Oral N-acetylcysteine reduces plasma homocysteine concentrations regardless of lipid or smoking status. Am J Clin Nutr. 2015 Nov;102(5):1014-24. doi: 10.3945/ajcn.114.101964. Epub 2015 Oct 7. PMID: 26447155.
- Calverley P, Rogliani P, Papi A. Safety of N-Acetylcysteine at High Doses in Chronic Respiratory Diseases: A Review. Drug Saf. 2021 Mar;44(3):273-290. doi: 10.1007/s40264-020-01026-y. Epub 2020 Dec 16. PMID: 33326056; PMCID: PMC7892733.
- Jorat MV, Tabrizi R, Mirhosseini N, Lankarani KB, Akbari M, Heydari ST, Mottaghi R, Asemi Z. The effects of coenzyme Q10 supplementation on lipid profiles among patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials. Lipids Health Dis. 2018 Oct 9;17(1):230. doi: 10.1186/s12944-018-0876-4. PMID: 30296936; PMCID: PMC6176512.
- Verma H, Garg R. Effect of magnesium supplementation on type 2 diabetes associated cardiovascular risk factors: a systematic review and meta-analysis. J Hum Nutr Diet. 2017 Oct;30(5):621-633. doi: 10.1111/jhn.12454. Epub 2017 Feb 2. PMID: 28150351.
- Cicero AFG, Fogacci F, Banach M. Red Yeast Rice for Hypercholesterolemia. Methodist Debakey Cardiovasc J. 2019 Jul-Sep;15(3):192-199. doi: 10.14797/mdcj-15-3-192. PMID: 31687098; PMCID: PMC6822657.
- Gerards MC, Terlou RJ, Yu H, Koks CH, Gerdes VE. Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain – a systematic review and meta-analysis. Atherosclerosis. 2015 Jun;240(2):415-23. doi: 10.1016/j.atherosclerosis.2015.04.004. Epub 2015 Apr 12. PMID: 25897793.
- Plat J, Mensink RP. Plant stanol and sterol esters in the control of blood cholesterol levels: mechanism and safety aspects. Am J Cardiol. 2005 Jul 4;96(1A):15D-22D. doi: 10.1016/j.amjcard.2005.03.015. PMID: 15992511.