Get full access to Outside Learn, our online education hub featuring in-depth nutrition, fitness and adventure courses, and more than 2,000 instructional videos when you sign up for Outside+..
Without question, statin drugs lower cholesterol, but many people can’t tolerate their side effects. The FDA requires warnings of these risks on drug labels: possible liver damage; memory loss, forgetfulness, or confusion; muscle damage, which can manifest as muscle weakness or fatigue;
and raised levels of blood sugar and risk for diabetes.
Ironically, statins deplete levels of CoQ10, a nutrient required by the heart and other muscles, and this is one reason why side effects occur. Taking CoQ10 supplements can help correct the problem, and is generally beneficial for the heart. Better still, there are drug-free options for lowering cholesterol.
Depending on your individual situation, natural remedies may be taken alone or,
if recommended by a health practitioner, along with a statin to reduce the required dose. As dietary supplements, each of these is available as a single-ingredient product, and some formulas combine two or more for a synergistic effect.
Once in a while, there’s a breakthrough in the world of natural remedies, and for cholesterol reduction, it’s bergamot extract. It comes from a citrus fruit that grows mostly in the Calabria region of southern Italy. Oil from bergamot rind is used to flavor Earl Grey tea, and in aromatherapy, to reduce anxiety, but neither will lower cholesterol. The therapeutic supplement is a bergamot extract from the juice of the fruit.
So far, human studies have tested bergamot extract on more than 400 people with elevated blood fats, including cholesterol and triglycerides, which increase risk for both heart disease and diabetes. These are some of the findings:
- An Italian study, published in the journal Fitoterapia, compared a placebo with either 500 or 1,000 mg of bergamot extract. After one month, for the lower and higher dosages, average reductions in harmful LDL cholesterol were 24 and 36 percent and for triglycerides, 30 and 39 percent, while beneficial HDL cholesterol increased by 22 and 40 percent and elevated blood sugar dropped by 15 and 25 percent.
- Another study, published in the International Journal of Cardiology, compared the effects of a placebo, a statin, 1,000 mg of bergamot, and a combination of the statin and bergamot during one month. All but the placebo effectively lowered cholesterol, and among those taking the drug-supplement combination, doctors cut the drug dosage in half without reducing its effectiveness.
- A study published in Advances in Biological Chemistry looked at the effect of 650 mg of bergamot extract, twice daily, on the liver. Researchers found that among people with non-alcoholic fatty liver disease and risk for heart disease and diabetes, bergamot improved levels of cholesterol, triglycerides, and blood sugar, and improved liver health.
Using bergamot extract: 500-1,000 mg daily has been the effective dose in studies. It’s preferable to take bergamot before or between meals, rather than with food.
Also known as vitamin B3, niacin has been used to lower cholesterol since the 1950s. Both the American College of Cardiology and the American Heart Association officially recognize it as an effective alternative to statins in cholesterol guidelines published in the Journal of the American College of Cardiology. As well as being a dietary supplement, niacin is also available by prescription (Niaspan and Niacor are some prescription brands).
Research with a total of several thousand participants shows that in daily doses of one gram (1,000 mg) or more, niacin can reduce harmful cholesterol by 10-20 percent, raise beneficial cholesterol by 20-35 percent, and reduce triglycerides by 30-70 percent. It also reduces levels of very small particles of harmful LDL, which are considered especially dangerous. But not all forms of the nutrient work equally well.
In supplements, the form of niacin may be niacinamide (also called nicotinamide) or nicotinic acid, the technical name for niacin. In small doses for general nutrition, such as in a multivitamin, both forms are beneficial, but they differ when used in higher, therapeutic amounts.
Niacin (nicotinic acid) lowers cholesterol and triglycerides, but also has a temporary flushing effect for up to an hour or so, which not everyone can tolerate. The niacinamide (or nicotinamide) form doesn’t have this side effect, but unfortunately, it doesn’t reduce cholesterol or triglycerides.
Some people are better able to tolerate time-released forms of niacin, sometimes described as slow-release or extended-release, which are designed to cause less flushing. One specific time-released form, inositol hexaniacinate, doesn’t cause any flushing, but studies of its cholesterol-lowering abilities have produced conflicting results, and perspectives of integrative physicians differ.
Using niacin: Look for niacin or nicotinic acid. According to a review of research published in the Mayo Clinic Proceedings, most people experience mild to moderate flushing which reduces over time, even with higher doses. If you try inositol hexaniacinate and don’t get results, try regular niacin.
Cholesterol guidelines recommend starting with 100 mg of immediate-release niacin (meaning products that are not time-released), three times daily with food, then very gradually increasing the dose. For time-released niacin, start with 500 mg daily with food, and increase amounts very gradually, not more than once per week, according to your individual needs. Medical guidelines recommend using high-dose niacin only under the supervision of a health professional, and getting liver enzymes, blood sugar, and uric acid levels tested regularly. For some people, the flushing reaction eventually ceases.
3 Plant Sterols and Stanols
Found in foods and supplements, these compounds reduce absorption of cholesterol and aid its elimination. In studies, approximately 2.5 grams daily reduced total and harmful LDL cholesterol by some 10-15 percent.
Soluble fibers help eliminate cholesterol and may lower levels by up to 10 percent. Some different types and daily amounts include 5-10 grams of oat bran, up to 15 grams of beta-glucan, or 10 grams of psyllium.
5 Red Yeast Rice
It contains a natural statin-like substance that effectively lowers harmful LDL and total cholesterol while raising protective beneficial HDL. Because it works much like a statin, it may deplete CoQ10. Most studies have used 1.2-2.4 grams daily of red yeast rice powder.
Multiple studies in Cuba found that 5-10 mg of a sugar-derived form of policosanol, taken daily in the evening, can significantly reduce harmful cholesterol. Higher doses should be split in two, with one being taken with a meal earlier in the day.
An ancient Ayurvedic remedy made from the sap of a myrrh tree native to India, guggul has effectively lowered cholesterol in most published studies since the 1980s. It helps eliminate cholesterol, rather than blocking its production in the liver as statins do. Product formulations vary, so follow label directions or advice from a health practitioner.
During the past 30 years, at least 13 studies have looked at Pantesin, a patented form of vitamin B5 (pantethine), in lab, animal, and human trials. In one study, published in Vascular Health and Risk Management, harmful LDL cholesterol dropped by 11 percent among those taking 600 mg of Pantesin daily, for four weeks. It may enhance blood flow and favorably alter gut bacteria and cholesterol metabolism.
This patented supplement ingredient, which is derived from citrus and palm fruit, boasts potent heart-health properties. Research shows that in as little as one month, 300 mg daily of Sytrinol can lower total cholesterol by up to 30 percent, harmful LDL cholesterol by 27 percent, and triglycerides by 34 percent.
Supporting Supplements and Foods
Some additional supplements support healthy cholesterol levels as one of many benefits, such as lower levels of chronic inflammation, better heart health, and overall well-being. These include fish oil, non-GMO soy protein, Aged Garlic Extract, vitamin D, and probiotics. Helpful foods include cocoa, nuts, olive oil, cinnamon, flaxseed, fish, and natto.
Natural Cholesterol Busters
Bluebonnet Nutrition Niacin contains 100 mg of niacin as nicotinic acid per capsule.
Jarrow Formulas Pantethine features Pantesin, a proprietary version of the nutrient.
NOW Foods Sytrinol blends citrus and palm fruit extract with policosanol and other nutrients.
Reserveage Nutrition Bergamot Cholesterol Support uses patented bergamot from Italy.
Wakunaga Kyolic Red Yeast Rice is a super trio of red yeast rice, Aged Garlic Extract, and CoQ10.