What supplements can increase cholesterol levels?

Supplements That Can Increase Cholesterol Levels

Plant stanols/sterols, high-dose iron supplements, and certain antioxidant supplements can increase cholesterol levels, with plant stanols/sterols specifically raising LDL cholesterol by 9-20% at doses of 2-3g daily. 1, 2

Plant Stanols/Sterols

Plant stanols/sterols are the most well-documented supplements that can increase cholesterol levels:

• Plant stanols/sterols compete with cholesterol for absorption, decreasing absorption efficacy 1
• Intake of 2-3g of plant sterols daily can increase total and LDL cholesterol levels by 9-20% 1
• The American Heart Association (AHA) notes considerable variability in individual responses 1
• These compounds have minimal effect on HDL cholesterol or triglyceride levels 1
• Plant sterols are currently isolated from soybean and tall oils 1

Clinical Application:

• Plant stanols/sterols can be considered for adults requiring LDL cholesterol reduction due to hypercholesterolemia 1
• Available in various foods, drinks, and soft gel capsules 1
• Daily consumption is required to sustain cholesterol effects 1
• Maximum effects observed at 2g daily intake 1

Caution:

• Recent concerns about decreased plasma carotenoid and vitamin E levels with plant sterol consumption 1
• Long-term studies on safety are lacking; use should be reserved for adults requiring cholesterol management 1
• Plant sterol-containing foods may decrease plasma α-plus β-carotene, α-tocopherol, and/or lycopene levels 1

Iron Supplements

High-dose iron supplementation can increase cholesterol levels:

• Dietary iron elevates LDL-cholesterol concentrations 2
• Increasing dietary iron increases plasma lipid hydroperoxide levels 2
• Iron supplementation decreases plasma antioxidants including α-tocopherol and retinol 2
• The effect appears to be dose-dependent with higher iron intake leading to greater cholesterol elevation 2

Antioxidant Supplements

Certain antioxidant supplements may adversely affect cholesterol:

• High doses of commonly used antioxidant vitamins may downregulate HDL cholesterol levels 3
• Antioxidant supplements like vitamin E and beta carotene have shown no cardiovascular benefit and may interfere with beneficial effects of statin therapy 1
• Some antioxidants have been associated with increased risk of hemorrhagic strokes 1

Other Supplements That May Affect Cholesterol

• Niacin (vitamin B3): While prescribed to improve cholesterol profiles, over-the-counter niacin supplements should only be used if approved and monitored by a physician 1
• Vitamin D: May have beneficial effects on lipid profiles, particularly in vitamin D-deficient individuals 4
• Soy protein: Consuming 25g daily can reduce LDL cholesterol by 4-8% 5
• Black seed extracts and phytosterols: May increase HDL cholesterol levels 3
• Cholic acid: May downregulate HDL cholesterol levels 3

Clinical Recommendations

1. Avoid recommending plant stanols/sterols for general use due to their cholesterol-raising effects and potential long-term safety concerns 1

2. Monitor iron supplementation carefully, especially in patients at risk for cardiovascular disease 2

3. Exercise caution with antioxidant supplements in patients with cardiovascular risk factors 1

4. Consider soy protein as an alternative for patients needing cholesterol management (25-50g daily) 5

5. Vitamin D supplementation may be beneficial for hypercholesterolemic patients with vitamin D deficiency 4

The evidence suggests that while some supplements are marketed for cardiovascular health, many have limited efficacy, and some may actually worsen cholesterol profiles. Dietary approaches focusing on foods naturally low in saturated fat and high in fiber remain the cornerstone of cholesterol management.