Cholesterol Supplements

Reality Check:
Which Cholesterol Supplements Work?
Which Don’t?
Are they Safe?

If you are a “Do it Yourself” person, deciding about cholesterol supplements is a great time to ask for some help. Preventing heart disease and stroke is too important to guess wrong and take a supplement that does not do much more than make the manufacturer happy. A holistic medicine approach in my view must be as careful about natural supplements as it is prescription medicines, so allow me to take a few minutes to review some of the natural remedies for lowering cholesterol I am often asked about in practice and in public seminars.

The one that tops the list is fish oil . Of all the cholesterol supplements, this is the one with the broadest application. Almost anyone can take it, it is very safe, and it has great benefits in other areas of health in addition to heart health. But it does NOT lower total cholesterol. It DOES lower triglycerides (that’s important) and can raise HDL (the good cholesterol). It will not lower LDL cholesterol. The effect on lowering triglycerides is especially important for diabetic patients, and the fish oil can also help prevent some of the complications of diabetes.


It’s also really good news that a high dose of a B-vitamin, specificallyNiacin , is a one of the most powerful cholesterol supplements. You can get Niacin in low doses over the counter, but I prefer a prescription form of an extremely high dose of slow release Niacin. This lowers LDL cholesterol, raises HDL cholesterol (good), and also lowers one of the advanced cardiac risk markers called Lipoprotein(a). Because these high doses of Niacin can harm the liver in a few people, I like to monitor this prescription with lab tests for the first few months.

If you come to my office with heart issues, you are likely to leave with a recommendation for a supplement called CoQ10 (Coenzyme Q-10). It is extremely important in maintaining healthy heart muscle cells, and there is some evidence that supplementing with CoQ10 improves function in people with heart failure. It is especially important to be taking CoQ10 if you are on a prescription statin medication to lower cholesterol, since these medications also decrease the body’s natural production of CoQ10. This also is true for patients taking Red Yeast Rice, a natural supplement which works in the body in a similar way to statin prescriptions. The dose of CoQ10 I recommend routinely is from 60 to 100 mg per day.

What about Red Yeast Rice? My own experience with Red Yeast Rice clinically has been excellent. I have seen reductions of up to 40-50% in LDL cholesterol on doses of 1200 mg twice daily. This is an old Chinese herbal formula which has recently been discovered to work in the same way as statin drugs like lovastatin for example. So why bother taking a natural supplement instead of a prescription? There’s probably in my opinion not a lot of difference, but I tend to trust herbal and natural remedies which have stood the test of time rather than new pharmacologic inventions. So I prescribe statin drugs and often do, but if a patient prefers natural therapies, I know that I can depend on Red Yeast Rice. Just two cautions: one is to take the CoQ10 (see above paragraph). The other is that some brands of Red Yeast Rice have been contaminated with a compound called citrinin which damages the kidneys. This was reported by Consumer Lab in summer 2008, so be careful to choose a reliable brand.

I had great hopes several years ago that policosanol was going to be an effective natural cholesterol supplement; unfortunately time has not supported my hopes. Policosanol does not now seem very effective in lowering cholesterol.

On the other hand I have great faith in garlic, the bulb of the allium sativum plant. Garlic’s effect is modest, not nearly as much as a statin drug or red yeast rice, but it is an important part of a natural lipid management program. It has the added benefits of decreasing blood pressure and making blood clots less likely. And because it is a food and has additional health benefits (such as its anti-cancer and anti-microbial effects) this herbal medication is one of my most frequent recommendations in my holistic medicine practice. Warning: if you are scheduled for surgery, make sure to stop garlic about 1 week ahead of time to avoid excess bleeding during surgery. 

Olive Leaf Capsules are a very promising herbal medication for cardiovascular health. They may serve as a first line defense against high blood pressure while at the same time lowering triglycerides and LDL cholesterol. 

I know this is a brief introduction, but this overview gives you a sense of how I approach natural cholesterol supplements in clinical practice. If we have the opportunity to consult in my office, we would tailor a program more specifically designed to your needs.



To your health,



Robert Pendergrast, MD 
(medical practice website to learn more about office consultation) 

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