Cholesterol Busters

If you have high cholesterol and you can't lower it enough via diet and exercise and don't want to take a statin drug, you may be tempted to try supplements that claim to lower cholesterol. Don't assume such supplements are safe just because they are "natural" and available without a prescription. If they can affect blood cholesterol (and even if they can't), they can also have other effects in the body. Some can interact with medications, including cholesterol-lowering drugs. Optimal doses are usually not known. Most have modest effects, if any.

Cholesterol-lowering drugs, on the other hand, have been well studied. They have impressive results, and their side effects, mostly rare, are known. You can be sure of what's in the drug, in contrast to dietary supplements, which are unregulated.

If you have high cholesterol and try one of these supplements, tell your doctor, so the effects can be monitored. If you're already taking a statin, a few of these may help you stay on a lower dose of the drug. Our top rating is three stars; some get no stars.

Niacin

This B vitamin, taken in massive doses (1 to 3 grams a day), is actually a drug and is thus sold by prescription as well as over the counter. It's a proven way to lower LDL by up to 30%, and unlike statins, it also substantially boosts HDL ("good") cholesterol and reduces triglycerides (fats in the blood). A common side effect is flushing; it can also produce stomach upset and, in rare cases, liver damage. The extended-release versions reduce the flushing, but over-the-counter products may increase the risk of liver damage; prescription brands such as Niaspan are safer.

WL rating: *** Begin niacin therapy only under medical supervision. Niacin may be prescribed along with another cholesterol-lowering drug.

Sterols or stanols

These plant compounds, which resemble cholesterol, interfere with the absorption of dietary cholesterol. The standard dose (2 grams, or 2,000 milligrams, a day) lowers LDL ("bad") cholesterol by 9 to 20%. The government’s cholesterol guidelines and the American Heart Association recommend foods fortified with sterols/stanols, such as Benecol and Take Control margarines, Minute Maid Heart Wise orange juice, and Promise SuperShots yogurt drinks. There are also sterol and stanol supplements, which vary in composition and dosage. The FDA allows the labels on foods or supplements to claim they reduce the risk of heart disease if they supply at least 400 milligrams of sterols per serving or dose, for a daily total of at least 800 milligrams.

WL rating: **Worth trying.

Soluble fiber supplements

The government's cholesterol guidelines recommend fruit, vegetables, and grains rich in soluble fiber, including psyllium, a seed grain sold as a laxative and fiber supplement. Psyllium can lower LDL cholesterol by 5 to 15% and has other heart-healthy effects; you have to take the standard dose three times a day to get the greatest effect. It may cause gas and bloating, so start with a low dose; some people are allergic to it. Beta glucan, found in oats and barley, is another soluble fiber known to lower LDL cholesterol. The FDA allows fiber-rich oat and barley products to bear a heart-health claim, though you need to consume 3 to 6 grams a day, the amount in 1.5 cups of cooked oatmeal, to get a significant effect. Many supplements provide beta glucan or other soluble fibers, but have not been adequately studied.

WL rating: ** Psyllium is a good option, as part of a heart-healthy diet. Get other soluble fibers from foods, rather than supplements.

Red yeast rice extract

Long used in Asia as a heart remedy, the extract is made by fermenting red yeast on rice. It actually contains a statin compound, lovastatin (sold as a generic, or brand name Mevacor), so it does improve cholesterol levels. But the effect is less predictable, since the supplements are not standardized - that is, the amount of statin compounds varies (usually a low dose), and other substances (with unknown effects) are present. The extract can cause the same side effects as statin drugs.

WL rating: ** It may be effective, but it's safer to take a prescription-quality statin under medical supervision. A generic statin may not cost much more and is covered by insurance.