What Supplements Lower Cholesterol and When Do They Make Sense?

Suppose your lab results show your LDL cholesterol is higher than last year.

Are you concerned about taking medication to control your cholesterol? Should you consider taking a dietary supplement to improve your numbers? Do you wonder what supplements lower cholesterol?

If your doctor prescribes a statin to help control lower cholesterol levels, it may be a perfectly good choice for you. But if your levels aren’t severely elevated and you prefer not to take a statin, you may be able to partner with your doctor to explore other means of lowering cholesterol safely, including diet and lifestyle changes combined with one of a small number of supplements.

Rarely, however, should you combine a statin with a cholesterol-lowering supplement. Keep in mind that no one piece of advice regarding prescription drugs or supplements applies to every unique person when it comes to high cholesterol.

So, do your homework. Research the supplement you’re interested in, then bring your findings to your integrative medicine doctor or primary care physician.

An integrative medicine specialist will work with you to develop a personalized holistic program to help control your cholesterol, including medication, supplements, diet, and exercise. A physician or pharmacist can help determine whether a supplement is appropriate and safe for you.

Again, it’s rarely a good idea to mix prescription statins with cholesterol-lowering supplements. More is not always better.

Dispelling Misconceptions

Cholesterol is a fatty substance manufactured by the liver and found in the blood. It helps the body produce hormones and maintain cell membranes.

Our cholesterol levels may increase as we age, with cardiovascular risk compounded by factors including family history, smoking, unhealthy diet, sedentary lifestyle, and more. Unfortunately, many misconceptions exist about what causes cholesterol levels to rise, the risks associated with high cholesterol, and how best to manage them. Let’s debunk a few:

Misconception #1

“Cholesterol is the main risk factor for high blood pressure, heart attack, and stroke.”

Fact: Cholesterol is only one factor doctors consider when evaluating cardiovascular risk. Other key contributors are:

• Hypertension
• Excess body weight and obesity
• Diabetes
• Smoking
• Level of physical activity
• Family history

Misconception #2

“Prescription medication is the only effective treatment for abnormally elevated cholesterol.”

Fact: Most people with mild to moderate high cholesterol may be able to bring the levels down through appropriate increases in physical activity and a more plant-based diet, perhaps with the addition of a specific supplement. If levels are high or if a person is at increased risk for cardiovascular disease when compared with the general population, a prescription aid, in conjunction with diet and lifestyle changes, is usually the best way to go.

Misconception #3

“Statins cause various ills, ranging from memory loss to cataracts to diabetes.”

Fact: Statins may have occasional side effects, but not everyone with elevated cholesterol needs them. Statins effectively lower cholesterol and reduce inflammation, reducing cardiovascular disease risk. They’re also easy to take in a single daily dose.

Misconception #4

“When we talk about cholesterol, we only refer to LDL (the ‘bad’ cholesterol) and HDL (the ‘good’ cholesterol).”

Fact: At Signature Healthcare, we investigate a patient’s cholesterol levels by requesting advanced lipid testing. The expanded lipid profile includes information about LDL particle size and quantity, apolipoprotein A, and lipoprotein B. This deeper data sheds greater light on cardiovascular health and risk beyond the basic information in standard lipid markers.

Do Supplements Hold Promise?

With a few exceptions, there is limited evidence about supplements’ cholesterol-lowering effectiveness and safety.

Studies show that statins and other prescription aids reduce the risk of heart attack and stroke. Most supplements have not been adequately studied this way, even though they may lower cholesterol levels.

There are a number of prescription medications associated with good evidence for lowering cholesterol and reducing cardiovascular risk, including?PCSK9 inhibitors, fibrates, ezetimibe, and bile acid resins.

With some precautions, the following supplements show promise in reducing LDL levels. Work with your doctor to determine what serves your needs:

• Red yeast rice. Many patients turn to red yeast rice to help lower cholesterol. Our advice: Ensure it’s a high-quality product free from citrinin, a kidney toxin sometimes found in poorly manufactured red yeast rice products. Red yeast rice can work very well in uncomplicated cases of mild to moderate high cholesterol, but it needs to be taken twice daily.
• Plant sterols and stanols. Also known as phytosterols, these natural compounds inhibit cholesterol production at the gut level. Phytosterols are found in plant-based foods and are available as supplements.
• Garlic. The evidence of its cholesterol-lowering benefits isn’t as strong as other supplements.
• Green tea. Green tea can lower cholesterol levels slightly. However, supplements are not recommended. Drinking green tea is preferable.
• Fish oil (or omega-3). These supplements are better for lowering triglycerides but may help lower cholesterol slightly. However, fish oil supplements can thin the blood, a potential concern for a patient already on blood thinners. Studies suggest that high doses of fish oil taken over a long period of time may increase atrial fibrillation risk in some patients. In place of fish oil supplements, try eating more cold-water fish.
• Citrus bergamot. Clinical trials suggest bergamot reduces total cholesterol and LDL.
• Niacin. Work with your doctor. The data surrounding niacin and its cholesterol-lowering capacity is contradictory and complex.

The Role of Exercise and Nutrition

While some interesting research exists around supplements and their ability to lower cholesterol, lifestyle changes are also significant. For many, high cholesterol goes down in response to regular exercise and a healthy plant-based diet.

Exercise

Although exercise must be individualized to the patient’s physical condition, any form of exercise — whether tai chi or easy walking — is better than no physical activity. Your doctor can advise you on how to safely get started.

Nutrition

Many people with high cholesterol believe they must watch their animal protein intake, especially saturated fats, and that may be true. However, strong evidence suggests that high intakes of refined and processed carbohydrates also pose significant health risks.

We advise people with elevated cholesterol levels to follow a Mediterranean eating pattern:

• Eat more fish and less red meat.
• Consume healthy fats like extra-virgin olive oil.
• Add more vegetables and fruits to your menu.
• Include more high-fiber foods in your diet, and have a small handful of nuts (walnuts or almonds) every other day.

A Final Word on Supplements

Many people with high cholesterol feel their only recourse is prescription medication.

You may gain added control over high cholesterol by following healthy diet and lifestyle recommendations and perhaps using carefully chosen supplements. Working with a well-trained integrative medicine practitioner or your well-informed primary care doctor can ensure you make safe, effective choices.

At Signature Healthcare, we empower you through offerings around diet and lifestyle habits, the safe use of select supplements where appropriate, and the optimal use of prescription medications when indicated. Get in touch with us today!