Which supplements lower cholesterol?
Plant sterols, which cut bad cholesterol by 6 to 12% in about a month. Psyllium fibre helps a little. But one supplement can match a statin, because it holds a statin’s own ingredient.
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What is the best supplement to lower cholesterol?
Plant sterols and stanols have the best evidence. Up to 3.3 g a day cut bad (LDL) cholesterol by 6 to 12% after about four weeks.
| Supplement | What trials found | Verdict |
|---|---|---|
| Plant sterols or stanols | Up to 3.3 g a day cut LDL by 6 to 12%. | Best evidence, best taken in food. |
| Psyllium husk (fibre) | About 10 g a day cut LDL by 0.33 mmol/L. | Helps a little. |
| Oat fibre (beta-glucan) | 3.5 g a day cut LDL by 4.2%. | Helps a little. |
| Red yeast rice | About the same fall as a statin. Strength varies. | Not recommended. |
| Omega-3 (fish oil) | Doesn’t lower cholesterol. May lower triglycerides, another blood fat. | Not for cholesterol. |
| Garlic | Mixed. A six-month trial found no effect. | Unproven. |
| Niacin (vitamin B3) | Works in some people, only at prescribed doses. | Not recommended as a supplement. |
| Nattokinase | In 6 trials, cholesterol came out higher, not lower. | No sign it helps. |
| Policosanol | Little reliable evidence outside Cuban studies. | Unproven. |
Sources: BHF; BDA; Psyllium review; Nattokinase review
A lower number is a good sign, like slower traffic on a busy road. But for sterols, no trial yet shows fewer crashes: heart attacks and strokes. Statins help reduce the risk of both.
So no supplement replaces a statin you’ve been prescribed. Never stop or change a prescribed medicine without your prescriber.
Want to try one? Start with sterols in food.
Do plant sterols lower cholesterol?
Yes, if you get about 2 g a day. Normal food gives less than 600 mg, so you need foods with sterols added.
Sterols look like cholesterol. They’re thought to cut how much cholesterol your gut takes in, so more leaves in your poo.
| Choose one | How much a day |
|---|---|
| Fortified mini yoghurt drink | 1 bottle |
| Fortified yoghurt | 1 pot |
| Foods with at least 0.8 g added | 2 to 3 portions, such as 2 teaspoons (10 g) of spread, a yoghurt or a 250 ml glass of milk |
Source: BDA
Have them every day, with meals. If you stop, the benefit stops too.
Sterol pills exist, but there’s less evidence for them than for foods. Sterols don’t help if your cholesterol is normal. Skip them if you’re pregnant or breastfeeding, and don’t give them to children under 5.
On a statin? Sterols lower bad cholesterol further. But NICE doesn’t advise them to prevent heart disease or strokes.
More in plant sterols and your LDL.
Does fibre like psyllium or oats lower cholesterol?
A little. Psyllium husk is a fibre supplement you stir into water. Across 28 trials, about 10 g a day cut LDL by 0.33 mmol/L.
Oats give you a fibre called beta-glucan. It forms a gel in your gut that can stop some cholesterol being absorbed. In trials in middle-aged people, 3.5 g a day cut bad cholesterol by 4.2%.
A 40 g bowl of porridge oats gives 2 g. There’s no research linking oats to fewer heart attacks or strokes.
Try a daily bowl of porridge first, with other oat foods to get closer to 3.5 g. For more, see psyllium husk for cholesterol and high-fibre foods.
Does red yeast rice work like a statin?
That pill is red yeast rice. It holds monacolin K, which is already an ingredient in a statin called lovastatin.
In a review of 20 trials, it cut bad cholesterol about as much as a statin. It works because it contains a statin’s ingredient.
The catch: the amount of that ingredient can vary between products. Its long-term safety hasn’t been studied enough, so the BHF doesn’t recommend it.
Already on a statin? NICE says some supplements may interfere with statins. Ask a pharmacist or your prescriber before you add one.
Do vitamins, fish oil or nattokinase lower cholesterol?
Niacin (vitamin B3) can, but it’s not advised. It lowers bad cholesterol in some people, but only at higher prescribed doses. As a supplement it can cause intense skin flushing.
Fish oil isn’t the answer either. Omega-3 doesn’t lower cholesterol, though it can lower triglycerides. In one large review, more than 2 g a day raised bad cholesterol.
Nattokinase is an enzyme from fermented soya beans. In a review of 6 trials with 546 people, cholesterol came out higher, not lower. It may also raise bleeding risk with blood thinners or daily aspirin.
Use any supplement on top of the food changes below, not instead of them.
Six steps to lower cholesterol, supplements last
- Swap butter, lard and ghee for olive or rapeseed oil, or spreads made from them.
- Have oily fish, like mackerel or salmon, in place of pies, sausages or fatty meat.
- Choose wholegrain bread, brown rice and wholewheat pasta.
- Do at least 150 minutes of moderate exercise a week, such as brisk walking, or 75 minutes of vigorous exercise.
- If you add a supplement, have about 2 g of plant sterols a day in food, with meals.
- On a statin? Ask a pharmacist or your prescriber before you take any supplement.
Sources: NHS; BDA; NICE NG238
More detail in niacin and cholesterol, nattokinase and how to lower cholesterol.
When to speak to a GP
High cholesterol does not usually cause symptoms. Only a blood test can show it. Speak to a GP if:
- Your cholesterol hasn’t gone down after changing your diet and lifestyle. You might need medicine.
- Your total cholesterol is more than 9 mmol/L, or your non-HDL is more than 7.5 mmol/L. NICE advises a specialist check.
- You take a statin and want to add red yeast rice or another supplement.
- You take a blood thinner or daily aspirin and are thinking about nattokinase.
Call 999 if you have chest pain that feels tight or squeezing, or that spreads to your arms, neck or jaw. Also call if you’re gasping, choking or can’t get words out, or your lips or skin turn pale, blue or grey. Call if someone has passed out and is not responding normally.
Not sure what your numbers mean? See cholesterol results explained.