Which supplements or foods can help lower cholesterol and keep my heart healthy?

Heart disease remains the leading cause of death for both women and men in the U.S. Some supplements may help keep your heart healthy, but others may potentially contribute to heart disease.

Interestingly, a study at the Cleveland Clinic (Laffin, JACC 2022) that compared a low-dose statin (5 mg of rosuvastatin; brand name Crestor, by AstraZeneca, the study’s sponsor) to five types of dietary supplements taken daily for 28 days (by people with a range of total cholesterol levels, but averaging 206.5 mg/dL) found a reduction of 35.2% in LDL cholesterol with the statin drug while no supplement was better than placebo. However, ConsumerLab believes that the choice of some low-quality or inappropriate products, as well as how they were given, may have negatively skewed results: 3 of the 5 products had failed to pass recent ConsumerLab reviews. If better quality and more appropriate products had been used in the study and/or given correctly, greater benefits may have been reported. Below are the supplements used in the study along with the results of ConsumerLab’s tests of their quality:

• Arazo Nutrition red yeast rice 2,400 mg – Failed CL testing in 2020 for containing no detectable statin compounds normally found in red yeast rice and which are known to lower cholesterol. In contrast, CL's Top Pick for red yeast rice contained 7.5 mg of lovastatin per 2-pill (1,200 mg) serving, to be taken twice daily.

• Nature Made fish oil 2,400 mg – Not tested by CL, but this is not a highly concentrated fish oil: Only highly concentrated fish oil, at a high dose, has been shown to lower triglycerides. Very highly concentrated fish oil supplements, identified by CL, would be much more likely to have achieved a reduction in triglycerides.

• Nutriflair cinnamon 2,400 mg – Nutriflair does not appear to sell a "2,400 mg" cinnamon product, although its 1,200 mg Ceylon cinnamon failed CL testing in 2020. Cinnamon is not known to lower cholesterol levels, other than, possibly, in people with diabetes, as shown in one study using cassia cinnamon.

• Garlique garlic with 5,000 mcg of allicin – Failed CL review in 2020 for insufficient label information. As noted below, garlic may slightly reduce total cholesterol by reducing and triglycerides. In the study, the garlic group showed a small decrease in triglycerides but this was not significant, while rosuvastatin showed a much larger, significant reduction in triglycerides. Garlic is not known to lower LDL cholesterol but, concerningly, the study showed a 7.8% increase in LDL in the garlic group compared to placebo and this was statistically significant.

• BioSchwartz turmeric curcumin with bioperine 4,500 mg – BioSchwartz does not appear to sell a "4,500 mg" product, but its 1,500 mg product failed CL testing in 2020. The evidence is mixed on whether turmeric and curcumin can lower cholesterol.

• Nature Made CholestOff Plus with 1,600 mg of plant sterols – ConsumerLab did not find problems with the quality of this product (tested in 2020) but, to be effective, it should be taken with meals. It is not clear that participants were given this important instruction in the study. A decrease in HDL (which has been referred to as "good") cholesterol occurred in this group during the study, although it was not statistically significant and this has not been reported in other studies.

Supplements That May Help

There is strong evidence that sterol esters (such as the phytosterol beta-sitosterol) and stanol esters, available in supplements and in some "heart healthy" margarines and spreads, can significantly lower LDL cholesterol. (There is also some evidence that taking curcumin may increase the cholesterol-lowering effects of phytosterols.) You can get more information about this, plus our tests and reviews of products in the Cholesterol-Lowering Supplements Review.

Psyllium, a source of soluble fiber, may modestly lower total and LDL cholesterol, as discussed in our Psyllium Supplements Review, which includes our Top Picks for psyllium. Be aware that, unlike the soluble fiber in oats, which is fermentable and may also lower cholesterol (see below), the soluble fiber in psyllium in nonfermentable and, consequently, it can have a laxative effect.

Garlic has been shown to slightly reduce total cholesterol by reducing triglycerides (it does not lower LDL cholesterol), and may slow the development of atherosclerosis. One brand of garlic supplement in particular has been shown to lower triglycerides more than others. You can get more information about these, including our tests and reviews of products in the Garlic Supplements Review.

Red yeast rice can significantly lower cholesterol, but products vary widely in their amounts of natural, active statin compounds. You can get more information and our tests and comparisons of products in the Red Yeast Rice Supplements Review.

High-dose niacin has been shown to lower LDL cholesterol. However, it should not be taken with statin-containing supplements (red yeast rice), or with statin drugs, which could increase the risk of serious events like stroke. You can get more information about niacin, including our tests and reviews of products in the B Vitamin Supplements Review.

Some, but not all studies suggest that pantethine (which is not a B vitamin but is often included as an ingredient in B vitamin supplements) may help to lower LDL cholesterol.

CoQ10 has been shown to significantly reduce the risk of adverse cardiovascular events by 50% in people with moderate to severe heart failure, and may be helpful in reducing some of the side-effects of cholesterol-lowering statin drugs. You can get more information about CoQ10 (and ubiquinol, a related compound), including our tests and reviews of products, in the CoQ10 and Ubiquinol Supplements Review.

Vitamin D may lower the risk of cardiovascular disease in those with low blood levels of vitamin D but not be of benefit for people who do not have a vitamin D deficiency. You can get more information about vitamin D, including our tests and reviews of products in the Vitamin D Supplements Review.

Similarly, improving magnesium to adequate levels can slightly reduce blood pressure, and magnesium blood levels in the mid to high normal range have been associated with a lower risk of death from cardiovascular disease, as noted in the Magnesium Supplements Review.

Supplementation with cocoa extract decreased the risk of cardiovascular death among older adults without a history of heart attack or stroke in a large, long-term trial. Smaller, shorter trials and observational studies also suggest possible, modest benefit in people with peripheral artery disease, atrial fibrillation and other heart conditions, but more research is needed.

Berberine may help to reduce blood pressure, triglycerides and total and LDL cholesterol (as well as blood sugar) in people with type 2 diabetes; however, be aware that it may interact with several cholesterol-lowering medications, potentially increasing blood levels (and the risk of side effects) of these drugs.

Some, but not all studies suggest that extracts of citrus bergamot (Citrus bergamia) fruit may help to lower cholesterol levels in people with high cholesterol. It has been proposed that certain flavonoids in bergamot, including neoeriocitrin, naringin and neohesperidin, may, like statin medications, act on an enzyme involved in cholesterol synthesis (HMG-CoA reductase), or may influence an enzyme that plays a role in the metabolism of energy in cells (AMP-activated protein kinase or AMPK), although this remains to be proven (Nauman, Integr Food Nutr Metab 2019). In several small clinical trials, bergamot extract taken in daily dosages ranging from 150 mg to 1,500 mg daily (most studies used between 500 mg and 1000 mg of extract), alone or along with statin medication for one to six months, was generally well-tolerated and decreased total cholesterol levels by about 12 % to 31% , "bad" LDL cholesterol by 7% to 40% and triglycerides by about 11% to 39% in people with high cholesterol, metabolic syndrome or coronary artery disease compared to baseline or a control group (Lamiquiz-Moneo, Crit Rev Food Sci Nutr 2020).

Although the exact composition of the extracts used was not always provided, one trial that found modest reductions in total and LDL cholesterol compared to baseline in adults with high cholesterol levels used a branded extract (Bergavit) at a daily dosage of 150 mg of flavonoids standardized to contain 16% neoeriocitrin, 47% neohesperidin, and 37% naringin (Toth, Front Pharmacol 2015). However, not all studies have found a benefit, and, due to the limited size of these trials and wide variations in formulations, more research is needed. Few side effects other than heartburn have been reported in clinical trials, although longer-term studies are needed. Due to a potential blood-sugar lowering effect of bergamot extract (Mollace, Fitoterapia 2011), caution should be used in people taking blood-sugar lowering medications. Also be aware that bergapten, a compound in bergamot, may block potassium from entering nerve cells. This could cause hyperexcitability of nerve cells, resulting in involuntary muscle contractions and cramps if bergamot is consumed in large quantities. This was reported in a 44-year-old man who consumed approximately 4 quarts of Earl Grey tea daily (which is traditionally flavored with bergamot) for three weeks. His symptoms resolved after reducing consumption of the tea (Finsterer, Lancet 2002).

Artichoke leaf extract may modestly lower total and, possibly, LDL cholesterol levels in people with high cholesterol, according to small-short-term studies, although larger, long-term studies are needed to confirm this. It does not appear to improve HDL cholesterol or triglyceride levels. One study among 73 people with high cholesterol showed that taking 320 mg of artichoke leaf extract (Cynara Artichoke from Lichtwer Pharma, which partially funded the study) four times daily for 12 weeks reduced total cholesterol by 4.2% compared to an increase of 1.9% in the placebo group. The extract was standardized to at least 2.5% total caffeoyl-quinic acids and at least 0.1% luteolin-7-O-glucuronide (Bundy, Phytomedicine 2008). A study among 141 people with high total cholesterol found that 900 mg of artichoke dry extract (Valverde Artischocke, Novartis Consumer Health GmbH) twice daily for 6 weeks reduced total cholesterol levels by about 18% versus 9% with placebo and LDL cholesterols by 23% compared to 6% (Englisch, Arzneimittelforschung 2000). Laboratory research suggests several mechanisms by which artichoke may lower cholesterol, including increasing the flow of bile into the gut from the liver (thereby increasing cholesterol elimination), blocking the production of cholesterol by the liver (due to its constituent luteolin), and possibly by inhibiting HMG-CoA reductase (Kraft, Phytomedicine 1997).

Licorice may help lower high levels of cholesterol, according to small studies, but larger studies are needed to confirm this, and there are heart-related safety concerns with some forms of licorice. A study in Israel among 94 people with high cholesterol showed that taking 200 mg of deglycyrrhizinated (DGL) licorice root extract daily for 12 months reduced total cholesterol by about 8% (from 284 mg/dL to 262 mg/dL) and low-density lipoprotein by about 5% (from 183 mg/dL to 174 mg/dL) compared to baseline — although it was not indicated if these were statistically significant compared to the placebo group. High-density lipoprotein was not affected (Fogelman, Food Nutr Res 2016). Similar improvements were found in an earlier study in which participants with high cholesterol were given 100 mg of DGL root extract daily for one month (Fuhrman, Nutrition 2002), but this latter study did not include a suitable placebo-control. In both studies, participants taking licorice root extract also showed 9% to 10% reduction in systolic blood pressure, but the effect on diastolic blood pressure was conflicting, with only the one-year study showing benefit. Be aware that licorice that contains glycyrrhizin can cause serious side effects, including increased blood pressure and abnormal heart rhythms, and many experts recommend that to be safe, people with high blood pressure, as well as heart or kidney failure, avoid any form of licorice.

Supplements That May Not Help

Although getting sufficient calcium may decrease your risk of dying from cardiovascular disease, too much may be harmful. A study found that calcium (800 mg) given once daily to postmenopausal women with high cholesterol caused a significant increase in serum cholesterol (up by about 50 mg/dL) and an increase in the thickness of lining of the carotid artery - changes associated with heart disease. Only if you don't get enough calcium should you consider a supplement, and it generally recommended that calcium supplementation not exceed 500 mg per dose, or more than 900 mg per day. You can get more information about these supplements, including our tests and reviews of products, in the Calcium Supplements Review.

Despite the fact that omega-3 fatty acids in fish oil have been linked to some heart healthy effects, it seems that the benefits come from consumption of fish, and not supplements. Only if you don't eat fish might fish oil supplements provide some heart benefit — although very concentrated fish oil, at high dose, can lower high triglyceride levels. Because fish oil supplements can have a blood-thinning effect, they should be used with caution in people taking other blood-thinning supplements or medications. You can get more information about these supplements, including our tests and reviews of products, in the Fish/Marine Oil Supplements Review.

Multivitamins have not been found to reduce (nor increase) the risk of heart attack, stroke or death from cardiovascular disease. You can get more information about these supplements, including our tests and reviews of products, in the Multivitamin and Multimineral Supplements Review.

Although there is some evidence from several studies from Cuba suggesting a cholesterol-lowering effect of policosanol, other studies have failed to find this effect, as noted in our Cholesterol-Lowering Supplements Review.

Certain probiotics may modestly lower systolic and diastolic blood pressure, and "bad" LDL cholesterol — although they do not appear to increase "good" HDL cholesterol. There is mixed evidence as to whether probiotics reduce triglyceride levels. More information, plus our tests of popular products, is found in the Probiotic Supplements and Kefirs Review.

Diatomaceous earth, a silica-rich powder (from fossilized remains of microorganisms or "diatoms"), has been promoted to lower cholesterol, although there is only weak evidence to support this use. A single, preliminary study among 19 men and women (ages 35 to 67) with moderately high cholesterol found that 250 mg of diatomaceous earth taken three times daily for two months modestly decreased average blood levels of total cholesterol (from 285 mg/dL to 248 mg/dL) as well as "bad" LDL cholesterol and triglycerides, compared to baseline (Wachter, Eur J Med Res 1998). However, placebo-controlled trials are needed to prove a benefit. The side effects and long-term safety diatomaceous earth supplementation is unknown and inhalation can causing coughing and shortness of breath. Chronic exposure to large amounts of inhaled diatomaceous earth through industrial use has been linked with lung cancer. Topical exposure can cause skin dryness, irritation and rash (Akhoundi, J Insect Sci 2013).

Supplements That May Be Harmful

Vitamin E supplements, once touted for heart health, have not been found to provide a benefit for people with cardiovascular disease, and could actually be harmful for some heart disease patients, since they could reduce the effectiveness of cholesterol-lowering agents.

There is reason to believe that L-carnitine and lecithin could actually contribute to atherosclerosis in certain people, and it may be wise to avoid long-term supplementation with either one.

Unlike artichoke leaf extract, drinking artichoke juice does not appear to be beneficial and may actually worsen triglyceride levels. A small study among people with high cholesterol or high triglyceride levels showed that drinking 20 mL of frozen artichoke juice daily along with dieting for 6 weeks did not improve total, LDL, or HDL cholesterol compared to dieting alone, and those in the artichoke group actually showed about a 6% increase in triglyceride levels compared to baseline (Lupattelli, Life Sci 2004).

Foods

As noted above, cocoa powders and dark chocolate rich in flavanols may have some cardiovascular benefit, although more research is needed. You can get more information and see our tests and reviews of products in the Cocoa Powders, Extracts, Nibs, Supplements, and Chocolates Review.

Replacing some saturated fat in the diet with olive oil may help lower risk factors for heart disease, such as high blood pressure and high cholesterol. You can get more information about extra virgin olive oil and see our Top Picks among products in the Extra Virgin Olive Oil Review.

Oats and oat-based cereals can be a good source of soluble fiber (mainly beta-glucan), which can help to lower cholesterol and reduce the risk of heart disease. See our Oat Cereals Review for the clinical evidence, including how much you need to consume in order to significantly reduce cholesterol.

Although there are other foods sources of beta-glucans (such as from fungi/mushrooms), be aware that not all sources have been shown to lower cholesterol, likely because they are different chemical forms of beta-glucan. For instance, mushrooms contain beta-glucan, but a clinical study (of people with pre-diabetes) with oyster mushrooms did not find them to lower triglycerides, and a study (of people with diabetes) with reishi mushrooms did not show them to be effective in lowering LDL cholesterol. In addition, many beta-glucan supplements contain beta-glucan derived from brewer's yeast (Saccharomyces cerevisiae), but this differs in structure from that in cereals such as oats or barley and, consequently, it is insoluble while cereal-based beta-glucan is soluble. One small study among obese individuals with high cholesterol suggested that supplementing with 7.5 grams of yeast-derived beta-glucan fiber twice daily for 8 weeks reduced total cholesterol by 6% compared to baseline. However, there was no placebo-control, which is needed to prove a benefit, and the supplement did not improve LDL and HDL cholesterol levels (Nicolosi, Am J Clin Nutr 1999). (Yeast-derived beta-glucan may, however, have immune benefits (Ciecierska, Rocz Panstw Zakl Hig 2019)).

There mixed evidence for whether soy can lower cholesterol. Although the FDA currently allows companies to make the claim that "25 grams of soy protein daily, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease," the agency has proposed revoking this health claim due to inconsistent findings (a final decision has not yet been made). In addition, a specific protein peptide isolated from soy, called lunasin, is sometimes promoted to lower cholesterol, but it was not shown to be beneficial in a clinical trial.

Eating walnuts as part of a usual diet may lower "bad" cholesterol in older people, although it doesn't seem to increase "good" cholesterol or lower triglyceride levels. A study among 628 healthy elderly people (average age 69), about one-third of whom were taking statins, found that eating 30 to 60 grams (1 to 2 oz) of walnuts — about 14 to 28 walnut halves — daily as part of their usual diet for 2 years modestly reduced total cholesterol by 8.5 mg/dL (4.4%), low-density lipoprotein (LDL or "bad") cholesterol by 4.3 mg/dL (3.6%), and intermediate-density lipoprotein cholesterol (a precursor to LDL cholesterol and risk factor for heart disease) by 1.3 mg/dL (16.8%) compared to baseline. These improvements were significant compared to a control group of people who did not eat walnuts. Eating walnuts also decreased the number of small LDL particles, which are linked with atherosclerosis, by 6.1%. Levels of triglycerides and high-density lipoprotein (HDL or "good") cholesterol were not affected. This study was funded by the California Walnut Commission, an industry organization (Rajaram, Circulation 2021).