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High Cholesterol

Uses

  • Hypercholesterolemia
  • Hyperlipidemia
Cholesterol is a type of fat in the blood. Too much of this fat can add to a build-up of plaque in the blood vessels. It can raise your risk of stroke and heart disease.
Changes to diet, activity level, and medicine may help to lower levels. Some look to natural treatments to further lower their cholesterol.

Natural Therapies

Likely Effective

These therapies are likely effective:
  • Berberine is a chemical found in some plants. C27
  • Calcium is a mineral found in the body that can also be taken as a supplement. D2
  • Chocolate is a food product that comes from the cacao tree. E6
  • Coenzyme Q10 is a protein in the body that helps make energy. E7, E8
  • Glucomannan is thought to bind cholesterol in the intestine and remove it from the body. C2-C4, C16, C21, C22, C33
  • Green tea A2-A4, A12
  • Lipoic acid is a compound found in the body that acts as an antioxidant to help slow damage to cells. E14
  • Psyllium is thought to bind cholesterol in the intestine and remove it from the body. C34, C38, C39
  • Red yeast rice is a traditional Chinese medicine that may lower cholesterol. C10, C23, C27, C29, C31, C34, C40
  • Rice bran oil comes from the outer brown layer of rice. A10
  • Stanols/sterols are substances found in many plant foods. A1, A5, A6, A8, A11

May Be Effective

These therapies may be effective:

Unlikely to Be Effective

These therapies are unlikely to lower cholesterol levels:

Not Enough Data to Assess

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.
Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Herbs and Supplements to Be Used With Caution

Talk to your doctor about all herbs or supplements you are taking. Some may interact with your treatment plan or health conditions.
Niacin in large amounts may cause liver problems, gout, ulcers, problems seeing, high blood sugar, irregular heartbeat, and other health problems. It may also increase your risk of diabetes.

References


. Dietary Changes
REFA1
Scholle JM, Baker WL, et al. The effect of adding plant sterols or stanols to statin therapy in hypercholesterolemic patients: systematic review and meta-analysis. J Am Coll Nutr. 2009 Oct;28(5):517-524.
REFA2
Zheng XX, Xu YL, et al. Green tea intake lowers fasting serum total and LDL cholesterol in adults: a meta-analysis of 14 randomized controlled trials. Am J Clin Nutr. 2011 Aug;94(2):601-610.
REFA3
Kim A, Chiu A, et al. Green tea catechins decrease total and low-density lipoprotein cholesterol: a systematic review and meta-analysis. J Am Diet Assoc. 2011 Nov;111(11):1720-1729.
REFA4
Wu AH, Spicer D, et al. Effect of 2-month controlled green tea intervention on lipoprotein cholesterol, glucose, and hormone levels in healthy postmenopausal women. Cancer Prev Res (Phila). 2012 Mar;5(3):393-402.
REFA5
Buyuktuncer Z, Fisunoglu M, et al. The cholesterol lowering efficacy of plant stanol ester yoghurt in a Turkish population: a double-blind, placebo-controlled trial. Lipids Health Dis. 2013 Jun 20;12:91.
REFA6
Vasquez-Trespalacios EM, Romero-Palacio J. Efficacy of yogurt drink with added plant stanol esters (Benecol®, Colanta) in reducing total and LDL cholesterol in subjects with moderate hypercholesterolemia: a randomized placebo-controlled crossover trial NCT01461798. Lipids Health Dis. 2014 Aug 6;13:125.
REFA7
Wang D, Chen C, et al. Effect of black tea consumption on blood cholesterol: a meta-analysis of 15 randomized controlled trials. PLoS One. 2014 Sep 19;9(9):e107711.
REFA8
Parraga-Martinez I, Lopez-Torres-Hidalgo JD, et al. Long-term effects of plant stanols on the lipid profiles of patients with hypercholesterolemia. A randomized clinical trial. Rev Esp Cardiol (Engl Ed). 2015 Aug;68(8):665-671.
REFA9
Zhao Y, Asimi S, et al. Black tea consumption and serum cholesterol concentration: systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2015 Aug;34(4):612-619.
REFA10
Jolfaie NR, Rouhani MH, et al. Rice bran oil decreases total and LDL cholesterol in humans: a systematic review and meta-analysis of randomized controlled clinical trials. Horm Metab Res. 2016 Jul;48(7):417-426.
REFA11
Han S, Jiao J, et al. Effects of plant stanol or sterol-enriched diets on lipid profiles in patients treated with statins: systematic review and meta-analysis. Sci Rep. 2016 Aug 19;6:31337.
REFA12
Momose Y, Maeda-Yamamoto M, et al. Systematic review of green tea epigallocatechin gallate in reducing low-density lipoprotein cholesterol levels of humans. Int J Food Sci Nutr. 2016 Sep;67(6):606-613.
REFA13
Sahebkar A, Simental-Mendia LE, et al. Lipid profile changes after pomegranate consumption: a systematic review and meta-analysis of randomized controlled trials. Phytomedicine. 2016 Oct 15;23(11):1103-1112.

Herbs
REFB1
Khoo YS, Aziz Z. Garlic supplementation and serum cholesterol: a meta-analysis. J Clin Pharm Ther. 2009 Apr;34(2):133-145.
REFB2
Kianbakht S, Abasi B, et al. Antihyperlipidemic effects of salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomized double-blind placebo-controlled clinical trial. Phytother Res. 2011 Dec;25(12):1849-1853.
REFB3
Ried K. Garlic lowers blood pressure in hypertensive individuals, regulates serum cholesterol, and stimulates immunity: an updated meta-analysis and review. J Nutr. 2016 Feb/146(2):389S-396S.
REFB4
Posadzki P, AlBedah AM, et al. Complementary and alternative medicine for lowering blood lipid levels: A systematic review of systematic reviews. Complement Ther Med. 2016 Dec;29:141-151.
REFB5
Sun YE, Wang W, et al. Anti-hyperlipidemia of garlic by reducing the level of total cholesterol and low-density lipoprotein: a meta-analysis. Medicine (Baltimore). 2018 May;97(18):e0255.

Supplements
REFC1
Kim SW, Park SK, et al. Hypocholesterolemic property of Yucca schidigera and Quillaja Saponaria extracts in human body. Arch Pharm Res. 2003;26(12):1042-1046.
REFC2
Chen HL, Sheu WH, et al. Konjac supplement alleviated hypercholesterolemia and hyperglycemia in type 2 diabetic subjects--a randomized double-blind trial. J Am Coll Nutr. 2003 Feb;22(1):36-42.
REFC3
Martino F, Martino E, et al. Effect of dietary supplementation with glucomannan on plasma total cholesterol and low density lipoprotein cholesterol in hypercholesterolemic children. Nutr Metab Cardiovasc Dis. 2005 Jun;15(3):174-180.
REFC4
Yoshida M, Vanstone CA, et al. Effect of plant sterols and glucomannan on lipids in individuals with and without type II diabetes. Eur J Clin Nutr. 2006 Apr;60(4):529-537.
REFC5
Simons LA, Amansec SG, et al. Effect of Lactobacillus fermentum on serum lipids in subjects with elevated serum cholesterol. Nutr Metab Cardiovasc Dis. 2006 Dec;16(8):531-5. Epub 2006 Jan 18.
REFC6
Thakur G, Mitra A, et al. Effect of flaxseed gum on reduction of blood glucose and cholesterol in type 2 diabetic patients. Int J Food Sci Nutr. 2009;60 Suppl 6:126-136.
REFC7
Andrade S, Borges N. Effect of fermented milk containing Lactobacillus acidophilus and Bifidobacterium longum on plasma lipids of women with normal or moderately elevated cholesterol. J Dairy Res. 2009 Nov;76(4):469-474.
REFC8
Ataie-Jafari A, Larijani B, et al. Cholesterol-lowering effect of probiotic yogurt in comparison with ordinary yogurt in mildly to moderately hypercholesterolemic subjects. Ann Nutr Metab. 2009;54(1):22-7.
REFC9
Fukumitsu S, Aida K, et al. Flaxseed lignin lowers blood cholesterol and decreases liver disease risk factors in moderately hypercholesterolemic men. Nutr Res. 2010 Jul;30(7):441-6.
REFC10
Bogsrud MP, Ose L, et al. HypoCol (red yeast rice) lowers plasma cholesterol—a randomized placebo controlled study. Scan Cardiovasc J. 2010 Aug;44(4):197-200.
REFC11
Affuso F, Ruvolo A, et al. Effects of a nutraceutical combination (berberine, red yeast rice and policosanols) on lipid levels and endothelial function randomized, double-blind, placebo-controlled study. Nutr Metab Cardiovasc Dis. 2010 Nov;20(9):656-661.
REFC12
Susalit E, Agnus N, et al. Olive (Olea europaea) leaf extract effective in patients with stage-1 hypertension: comparison with Captopril. Phytomedicine. 2011;18(4):251-258.
REFC13
Liu ZL, Liu JP, et al. Chinese herbal medicines for hypercholesterolemia. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD008305.
REFC14
Marazzi G, Cacciotti L, et al. Long-term effects of nutraceuticals (berberine, red yeast rice, policosanol) in elderly hypercholesterolemic patients. Adv Ther. 2011 Dec;28(12):1105-1113.
REFC15
Jones ML, Martoni CJ, et al. Cholesterol-lowering efficacy of a microencapsulated bile salt hydrolase-active Lactobacillus reuteri NCIMB 30242 yoghurt formulation in hypercholesterolaemic adults. Br J Nutr. 2012 May;107(10):1505-1513.
REFC16
Liu S, Tan MY, et al. [Effect of policosanol on serum lipids and heme oxygenase-1 in patients with hyperlipidemia]. Zhonghua Xin Xue Guan Bing Za Zhi. 2012;40(10):840-843.
REFC17
Tang M, Wu SZ, et al. [Effects of policosanol combined with simvastatin on serum lipids and sex hormones in male patients with hyperlipidemia]. Zhonghua Xin Xue Guan Bing Za Zhi. 2013;41(6):488-492.
REFC18
Ogier N, Amiot MJ, et al. LDL-cholesterol-lowering effect of a dietary supplement with plant extracts in subjects with moderate hypercholesterolemia. Eur J Nutr. 2013 Mar;52(2):547-557.
REFC19
Wider B, Pittler MH, et al. Artichoke leaf extract for treating hypercholesterolaemia. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD003335.
REFC20
Fuentes MC, Lajo T, et al. Cholesterol-lowering efficacy of Lactobacillus plantarum CECT 7527, 7528 and 7529 in hypercholesterolaemic adults. Br J Nutr. 2013 May 28;109(10):1866-1872.
REFC21
Martino F, Puddu PE, et al. Low dose chromium-polynicotinate or policosanol is effective in hypercholesterolemic children only in combination with glucomannan. Atherosclerosis. 2013 May;228(1):198-202.
REFC22
Guardamagna O, Abello F, et al. Could dyslipidemic children benefit from glucomannan intake? Nutrition. 2013 Jul-Aug;29(7-8):1060-1065.
REFC23
Verhoeven V, Lopez Hartmann M, et al. Red yeast rice lowers cholesterol in physicians—a double blind, placebo controlled randomized trial. BMC Complement Altern Med. 2013 Jul 18;13:178.
REFC24
Barrat E, Zaïr Y, et al. A combined natural supplement lowers LDL cholesterol in subjects with moderate untreated hypercholesterolemia: a randomized placebo-controlled trial. Int J Food Sci Nutr. 2013 Nov;64(7):882-889.
REFC25
Barrat E, Zaïr Y, et al. Effect on LDL-cholesterol of a large dose of a dietary supplement with plant extracts in subjects with untreated moderate hypercholesterolaemia: a randomised, double-blind, placebo-controlled study. Eur J Nutr. 2013 Dec;52(8):1843-1852.
REFC26
Wong RH, Garg ML, Wood LG, Howe PR. Antihypertensive potential of combined extracts of olive leaf, green coffee bean and beetroot: a randomized, double-blind, placebo-controlled crossover trial. Nutrients. 2014 Nov 5;6(11):4881-4894.
REFC27
Lan J, Zhao Y, et al. Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension. J Ethnopharmacol. 2015 Feb 23;161:69-81.
REFC28
Edel AL, Rodriguez-Leyva D, et al. Dietary flaxseed independently lowers circulating cholesterol and lowers it beyond the effects of cholesterol-lowering medications alone in patients with peripheral artery disease. J Nutr. 2015 Apr;145(4):749-757.
REFC29
Gerards MC, Terlou RJ, et al. Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain—a systematic review and meta-analysis. Atherosclerosis. 2015 Jun;240(2):415-423.
REFC30
Serban MC, Sahebkar A, et al. A systematic review and meta-analysis of the impact of Spirulina supplementation on plasma lipid concentrations. Clin Nutr. 2016;35(4):842-851.
REFC31
Cavallini DC, Manzoni MS, et al. Probiotic Soy Product Supplemented with Isoflavones Improves the Lipid Profile of Moderately Hypercholesterolemic Men: A Randomized Controlled Trial. Nutrients. 2016 Jan 19;8(1). pii: E52.
REFC32
Lockyer S, Rowland I, et al. Impact of phenolic-rich olive leaf extract on blood pressure, plasma lipids and inflammatory markers: a randomized controlled trial. Eur J Nutr. 2017;56(4):1421-1432.
REFC33
Ho HVT, Jovanovski E, et al. A systematic review and meta-analysis of randomized controlled trials of the effect of konjac glucomannan, a viscous soluble fiber, on LDL cholesterol and the new lipid targets non-HDL cholesterol and apolipoprotein B. Am J Clin Nutr. 2017 May;105(5):1239-1247.
REFC34
Peng D, Fong A, et al. Original research: The effects of red yeast rice supplementation on cholesterol levels in adults. Am J Nurs. 2017 Aug;117(8):46-54.
REFC35
Qin S, Huang L, et al. Efficacy and safety of turmeric and curcumin in lowering blood lipid levels in patients with cardiovascular risk factors: a meta-analysis of randomized controlled trials. Nutr J. 2017 Oct 11;16(1):68.
REFC36
Costabile A, Buttarazzi I, et al. An in vivo assessment of the cholesterol-lowering efficacy of Lactobacillus plantarum ECGC 13110402 in normal to mildly hypercholesterolaemic adults. PLoS One. 2017 Dec 11;12(12):e0187964.
REFC37
Gong J, Qin X, et al. Efficacy and safety of sugarcane policosanol on dyslipidemia: A meta-analysis of randomized controlled trials. Mol Nut Food Res. 2018;62(1).
REFC38
Jovanovski E, Yashpal S, et al. Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2018 Sep 15.
REFC39
Brum J, Ramsey D, et al. Meta-analysis of usefulness of psyllium fiber as adjuvant antilipid therapy to enhance cholesterol lowering effects of statins. Am J Cardiol. 2018 Oct 1;122(7):1169-1174.
REFC40
Raschi E, Girardi A, et al. Adverse Events to Food Supplements Containing Red Yeast Rice: Comparative Analysis of FAERS and CAERS Reporting Systems. Drug Saf. 2018 Aug;41(8):745-752.

Vitamins
REFD1
Fazio S, Guyton JR, et al. Long-term safety and efficacy of triple combination ezetimibe/simvastatin plus extended-release niacin in patients with hyperlipidemia. Am J Cardiol. 2010 Feb 15;105(4):487-494.
REFD2
Chen C, Ge s, et al. The effects of dietary calcium supplements alone or with vitamin D on cholesterol metabolism: a meta-analysis of randomized controlled trials. J Cardiovasc Nurs. 2017 Sep/Oct;32(5):496-506.

Other Therapies
REFE1
Wang D, Chen C, et al. Effect of black tea consumption on blood cholesterol: a meta-analysis of 15 randomized controlled trials. PLoS One. 2014 Sep 19;9(9):e107711.
REFE2
Zhao Y, Asimi S, et al. Black tea consumption and serum cholesterol concentration: Systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2015;34(4):612-619.
REFE3
Troup R, Hayes JH, et al. Effect of black tea intake on blood cholesterol concentrations in individuals with mild hypercholesterolemia: a diet-controlled randomized trial. J Acad Nutr Diet. 2015 Feb;115(2):264-71.e2.
REFE4
Zunft HJ, Lüder W, et al. Carob pulp preparation rich in insoluble fibre lowers total and LDL cholesterol in hypercholesterolemic patients. Eur J Nutr. 2003 Oct;42(5):235-242.
REFE5
Ruiz-Roso B, Quintela JC, et al. Insoluble carob fiber rich in polyphenols lowers total and LDL cholesterol in hypercholesterolemic subjects. Plant Foods Hum Nutr. 2010;65(1):50-56.
REFE6
Tokede OA, Gaziano JM, et al. Effects of cocoa products/dark chocolate on serum lipids: a meta-analysis. Eur J Clin Nutr. 2011;65(8):879-886.
REFE7
Jorat MV, Tabrizi R, et al. The effects of coenzyme Q10 supplementation on lipid profiles among patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials. Lipids Health Dis. 2018;17(1):230.
REFE8
Samimi M, Zarezade Mehrizi M, et al. The effects of coenzyme Q10 supplementation on glucose metabolism and lipid profiles in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Clin Endocrinol (Oxf). 2017;86(4):560-566.
REFE9
Ferguson JJA, Stojanovski E, et al. Curcumin potentiates cholesterol-lowering effects of phytosterols in hypercholesterolaemic individuals. A randomised controlled trial. Metabolism. 2018 May;82:22-35.
REFE10
Pan A, Yu D, et al. Meta-analysis of the effects of flaxseed interventions on blood lipids. AM J Clin Nutr. 2009;90(2):288-297.
REFE11
Torkan M, Entezari MH, et al. Effect of flaxseed on blood lipid level in hyperlipidemic patients. Rec Recent Clin Trials. 2015;10(1):61-67.
REFE12
Qin Y, Niu K, et al. Isoflavones for hypercholesterolaemia in adults. Cochrane Database Syst Rev. 2013;(6):CD009518.
REFE13
Jandaghi P, Noroozi M, et al. Lemon balm: A promising herbal therapy for patients with borderline hyperlipidemia-A randomized double-blind placebo-controlled clinical trial. Complement Ther Med. 2016;26:136-140.
REFE14
Haghighatdoost F, Hariri M. Does alpha-lipoic acid affect lipid profile? A meta-analysis of and systematic review on randomized controlled trials. Eur J Pharmacol. 2019;847:1-10.
REFE15
Vashishtha V, Barwhal K, et al. Effect of seabuckthorn seed oil in reducing cardiovascular risk factors: A longitudinal trial on hypertensive subjects. Clin Nut. 2017;36(5):1231-1238.
REFE16
Qin Y, Niu K, et al. Isoflavones for hypercholesterolaemia in adults. Cochrane Database Syst Rev. 2013 Jun 6;(6):CD009518.
REFE17
Malhotra A, Shafiq N, et al. Dietary interventions (plant sterols, stanols, omega-3 fatty acids, soy protein and dietary fibers) for familial hypercholesterolaemia. Cochrane Database Syst Rev. 2014;(6):CD001918.
REFE18
Sahebkar A. Effects of resveratrol supplementation on plasma lipids: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev. 2013 Dec;71(12):822-835.
REFE19
Haghighatdoost F, Hariri M. Effect of resveratrol on lipid profile: An updated systematic review and meta-analysis on randomized clinical trials. Pharmacol Res. 2018;129:141-150.
REFE20
Zhang JW, Tong X, et al. Effect of whey protein on blood lipid profiles: a meta-analysis of randomized controlled trials. Eur J Clin Nutr. 2016;70(8):879-885.
REFE21
Venkatakrishnan K, Chiu HF, et al. Comparative studies on the hypolipidemic, antioxidant and hepatoprotective activities of catechin-enriched green and oolong tea in a double-blind clinical trial. Food Funct. 2018;9(2):1205-1213.

Revision Information

  • Reviewer: EBSCO NAT Review Board Eric Hurwitz, DC
  • Update Date: 11/16/2020