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NCCIH Clinical Digest

for health professionals

High Cholesterol and Natural Products

February 2024
Cholesterol Label
© iStockphoto

Conventional treatment for high cholesterol levels consists of therapeutic lifestyle and, if necessary, cholesterol-lowering medicine. Natural products have also been studied for their possible effects on cholesterol levels. This issue provides information on “what the science says” about the effectiveness and safety of several dietary supplements reportedly used by people with high cholesterol, including soy, red clover, red yeast rice, sterols/stanols, flaxseed and flaxseed oil, garlic, bergamot, and green tea.

Natural Product and Summary of Current Evidence

The use of foods containing added plant stanols or sterols is an option in conventional treatment for high cholesterol levels. Stanols and sterols are also available in dietary supplements. The evidence for the effectiveness of the supplements is less extensive than the evidence for foods containing stanols or sterols, but in general, studies show that stanol or sterol supplements, taken with meals, can reduce cholesterol levels. Some foods and dietary supplements that contain stanols or sterols are permitted to carry a health claim, approved by the U.S. Food and Drug Administration (FDA), saying that they may reduce the risk of heart disease when consumed in appropriate amounts.

Read more about research on stanols or sterols in dietary supplements

Some soy products can have a small cholesterol-lowering effect. However, results from studies indicate that soy foods have more of a beneficial effect on cholesterol than soy protein supplements or isoflavones. 

Read more about research on soy

Studies of flaxseed preparations to lower cholesterol levels suggest possible beneficial effects for some types of flaxseed supplements, including whole flaxseed and flaxseed lignans but not flaxseed oil. The effects were stronger for women (especially postmenopausal women) than men and for people with higher initial cholesterol levels.

Read more about research on flaxseed

A recent review of the research on garlic supplements concluded that they can lower cholesterol if taken for more than 2 months, but their effect is modest in comparison with the effects of cholesterol-lowering drugs.

Read more about research on garlic

There is some limited evidence that suggests green tea may have a cholesterol-lowering effect.

Read more about research on green tea

The FDA has determined that red yeast rice that contains more than trace amounts of a substance called monacolin K is an unapproved new drug and cannot be sold legally as a dietary supplement. Monacolin K is chemically identical to the cholesterol-lowering drug lovastatin, and some red yeast rice contains substantial amounts of this substance. Red yeast rice that contains monacolin K may lower blood cholesterol levels, but it can also cause the same types of side effects and drug interactions as lovastatin.

Researchers have not reported results of any studies of red yeast rice products that contain little or no monacolin K, so whether these products have any effect on blood cholesterol is unknown.

Read more about research on red yeast rice

Studies on the effects of red clover on cholesterol levels have had inconsistent results.

Read more about research on red clover

There is some limited evidence suggesting that bergamot and bergamot-derived polyphenols may have lipid-lowering properties.

Read more about research on bergamot

Clinical Guidelines

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH website at NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.


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