Supplements for Lowering LDL Cholesterol and Cortisol
Direct Answer for LDL Cholesterol
Plant stanols/sterols at 2-3 grams daily are the only evidence-based supplement proven to lower LDL cholesterol, reducing levels by 9-20%. 1, 2
Evidence-Based Supplement for LDL Cholesterol Lowering
Plant Stanols/Sterols (Primary Recommendation)
- Consume 2-3 grams daily with meals to achieve 9-20% LDL cholesterol reduction. 1, 2
- The American Heart Association and American College of Cardiology both recommend plant stanols/sterols as a reasonable adjunctive approach to lower LDL cholesterol. 1, 2
- Maximum effectiveness occurs at 2-3 grams daily; doses above 3 grams provide no additional benefit. 1, 2
- Plant stanols/sterols work by blocking intestinal absorption of both dietary and biliary cholesterol. 3, 4
Practical Implementation
- Take plant stanols/sterols with meals, divided into two doses daily (e.g., 1-1.5 grams twice daily). 2
- Available forms include fortified margarines, spreads, orange juice, beverages, and soft gel capsules. 1
- Choose low-calorie delivery vehicles (fortified beverages or capsules) if weight management is a concern. 1
- Effects are additive with statin therapy—adding plant stanols/sterols to statins is more effective than doubling the statin dose. 5
Important Clinical Caveats
- Separate plant stanol/sterol consumption from bile acid sequestrants by 2-4 hours to avoid binding in the gut. 2
- Contraindicated in patients with phytosterolemia (sitosterolemia), a rare genetic disorder. 2
- May decrease fat-soluble vitamin and carotenoid absorption, particularly beta-carotene; ensure adequate fruit and vegetable intake. 2, 6
- Reassess LDL levels after 6-12 weeks to determine effectiveness. 2
Adjunctive Fiber Supplementation
- Add 10-25 grams of soluble/viscous fiber daily to enhance LDL lowering by an additional 5-10%. 7, 2
- Psyllium fiber supplements are FDA-approved for cholesterol lowering. 2
Supplements NOT Recommended for LDL Cholesterol
- Omega-3 fatty acids (EPA/DHA) do NOT lower LDL cholesterol and are not recommended for this purpose. 7
- Omega-3 supplements did not improve glycemic control or reduce cardiovascular events in multiple randomized controlled trials. 7
- Antioxidant vitamins (vitamin E, beta-carotene, selenium) should not be used due to lack of benefit and potential harm. 2
- Soy protein has minimal LDL-lowering effect. 2
- B vitamins (folate, B6, B12) are not recommended for cardiovascular risk reduction. 2
Supplements for Cortisol Lowering
No supplements are supported by clinical guidelines or high-quality evidence for lowering cortisol levels in healthy adults. The provided evidence focuses exclusively on cholesterol management in diabetes and cardiovascular disease, with no guideline-level recommendations addressing cortisol reduction through supplementation.
Critical Distinction
The evidence base for plant stanols/sterols in LDL cholesterol reduction is robust, with multiple professional society endorsements and consistent trial data. 1, 2, 5 In contrast, cortisol-lowering supplements lack this level of evidence and guideline support for use in generally healthy adults.