What dietary supplements can help reduce hypercholesterolemia (high cholesterol)?

From the Guidelines

To reduce cholesterol levels, I strongly recommend taking plant sterols and stanols at a dose of 2-3g daily, as they have been shown to modestly reduce total and LDL cholesterol by blocking cholesterol absorption. This recommendation is based on the most recent and highest quality study available, which suggests that plant sterols and stanols can be an effective addition to a heart-healthy diet and lifestyle modification for individuals with elevated LDL cholesterol levels 1.

Some key points to consider when taking plant sterols and stanols include:

• They can be found in enriched foods or supplement form
• Maximum effects are observed at intakes of 2-3g per day
• They should be consumed daily to sustain LDL cholesterol reductions
• They may have beneficial effects on total, LDL cholesterol, and non-HDL cholesterol, particularly in individuals with diabetes

It's also important to note that while other supplements, such as soluble fiber, fish oil, and red yeast rice, may have some benefits for cholesterol reduction, the evidence for plant sterols and stanols is particularly strong and consistent across multiple studies 1.

When considering any supplement regimen, it's essential to consult with a healthcare provider, especially if you have existing health conditions or take medications. Additionally, a heart-healthy diet low in saturated fats, regular exercise, weight management, and avoiding smoking are all crucial components of a comprehensive approach to reducing cholesterol levels and promoting overall cardiovascular health 1.

From the Research

Supplements to Reduce Cholesterol

• Plant sterols and stanols are naturally occurring constituents of plants that can help reduce low-density lipoprotein cholesterol (LDL-C) concentrations 2.
• Consuming approximately 2.5 g of plant sterols or stanols per day can lower serum LDL-C concentrations by up to 10% 2.
• Higher intakes of plant sterols and stanols, up to 9 g/d, can reduce LDL-C concentrations by up to 17% 2.
• A meta-analysis of randomised controlled studies found that plant sterols and stanols can lower LDL-cholesterol concentrations, with the effect increasing up to intakes of approximately 3 g/d 3.
• Plant sterol/stanol supplements can decrease LDL-cholesterol concentrations by 12 mg/dL (0.31 mmol/L) compared to placebo, with no significant difference in efficacy between supplements and food-based approaches 4.

Factors Influencing Efficacy

• The efficacy of plant sterols and stanols can be influenced by factors such as food format, intake frequency, and time of day 5.
• Consuming plant sterols and stanols with a meal, especially a main meal, can lead to optimal LDL-C lowering efficacy 5.
• Intake frequency and occasion, such as with or without a meal, can also impact efficacy 5.
• Age and gender may not have a significant impact on the LDL-C lowering effect of plant sterols and stanols, although some studies suggest greater reductions in men than women 5.

Safety and Cardiovascular Outcomes

• The long-term safety and cardiovascular efficacy of plant sterol/stanol supplementation have not been extensively investigated in randomized trials 6.
• Experimental and human observational studies have demonstrated controversial results regarding the association of phytosterol supplementation with markers of atherosclerosis and ASCVD events 6.
• Recent genetic studies have linked elevated plasma concentrations of circulating plant sterols with ASCVD presence, raising concerns about the safety of phytosterol supplementation 6.