High Cholesterol

Why it works: Niacin reliably improves lipid numbers (↓LDL, ↓triglycerides, ↑HDL), but modern outcomes trials show no cardiovascular benefit when added to statins and more adverse effects. Most...

Instructions: Use prescription niacin and follow the label. Do not substitute other “niacin” products (immediate-release, sustained-release, or “no-flush”) interchangeably.. Product & timing. •...

Warnings: Absolute contraindications: Active liver disease (or unexplained transaminase elevations), active pe...

Studies: AIM-HIGH (NEJM 2011): In 3,414 statin-treated patients with...

Why it works: It’s a viscous soluble fiber. When mixed with fluid, psyllium forms a gel that binds bile acids and cholesterol in the gut, increasing fecal excretion. The liver then pulls more LD...

Instructions: Dose & schedule. • Target ~7 grams of soluble fiber from psyllium per day for lipid benefits. In practice, that’s commonly achieved with multiple servings of psyllium husk products...

Warnings: Choking/obstruction risk if taken with inadequate liquid or in people with swallowing difficulties (...

Studies: Systematic review & meta-analysis of RCTs (AJCN, 2018):...

Why it works: Plausible mechanisms (but not proven clinically to large effect):. • Garlic’s sulfur compounds (e.g., allicin, S-allyl-cysteine) may modestly reduce cholesterol synthesis, improve...

Instructions: If you’re considering a trial of garlic as an adjunct (not a substitute) to standard care, the most commonly studied regimens have been:. Standardized garlic powder tablets. • Dose...

Warnings: Bleeding risk / surgery: Garlic supplements can increase bleeding risk, especially with anticoagulan...

Studies: Supportive—but modest and mixed—evidence2018 meta-analysis (...

Why it works: Raises LDL-receptor (LDLR) activity so your liver clears more LDL from the blood. In liver cells, berberine stabilizes LDLR mRNA (via ERK/JNK signaling), increasing LDLR protein—a...

Instructions: Dose: Most RCTs used 500 mg twice daily (total 1,000 mg/day) for 12 weeks; some programs use 500 mg 2–3×/day (1,000–1,500 mg/day). MDPI. Timing: Take with (or just before) meals to...

Warnings: Drug interactions (clinically important):. • Calcineurin inhibitors (e.g., cyclosporine): An RCT in...

Studies: Modern meta-analysis of placebo-controlled RCTs (Drugs, 2023...

Why it works: Binds bile acids in the gut → increases cholesterol excretion. Soluble fibers like pectin form a viscous gel that binds bile acids and cholesterol, pulling them out in stool; the l...

Instructions: Form & timing. Use apple pectin powder or capsules with meals (the gel works where the food and bile are). Mix powder in water/food, or take capsules with a full glass of water. (G...

Warnings: Medication absorption:. • Like other fibers, pectin can bind medicines and reduce absorption. Separa...

Studies: Randomized, controlled, cross-over human trials (apple pecti...

Why it works: Same mechanism as a statin. Many RYR extracts naturally contain monacolin K, which is chemically identical to lovastatin, a prescription statin. It lowers LDL by inhibiting HMG-CoA...

Instructions: Common clinical trial dose: 600 mg twice daily of a standardized RYR extract (often the XZK preparation used in Chinese trials). At this dosing, daily monacolin K exposure in trial...

Warnings: Because monacolin K is a statin, RYR can cause statin-like side effects and interactions. Use only u...

Studies: Randomized outcome trial (XZK/RYR):CCSPS: ~4,870 post-MI pat...

Why it works: Multiple complementary mechanisms (distinct from statins):. • In liver cells, bergamot extract reduced total/free cholesterol and did not directly inhibit HMG-CoA reductase; instea...

Instructions: These are the dosing patterns used in clinical trials (not medical advice):. • Standardized flavonoid dose: Trials of Bergavit®/bergamot juice extract using ~150 mg/day of total fl...

Warnings: Potential drug interactions (CYP3A4/statins):. Bergamot and related citrus contain furanocoumarins (...

Studies: Randomized, double-blind, placebo-controlled (single-ingredi...

Why it works: Researchers think hawthorn could influence several atherosclerosis- and lipid-related pathways:. • Lipid-lowering actions (mostly preclinical): constituents (flavonoids like hypero...

Instructions: There’s no established, guideline-endorsed dosing for cholesterol. If used adjunctively (not as a substitute for statins or lifestyle changes), clinicians typically reference regim...

Warnings: Quality & adulteration (critical): several “tejocote root” (marketed as Mexican hawthorn, Crataegus...

Studies: Meta-analysis (2024, 14 RCTs of TCM formulas that include ha...

Why it works: Catechins (especially EGCG) in green tea modestly lower LDL-C and total cholesterol. A 31-trial meta-analysis of randomized controlled trials (3,321 adults) found green tea lowered...

Instructions: Option A — Brewed tea (safest place to start). • Aim: 2–4 cups/day of unsweetened green tea as part of a heart-healthy diet and exercise plan. This aligns with evidence that most t...

Warnings: General safety. • Brewed green tea is generally safe for adults; effects on lipids are small. (NCCIH...

Studies: Systematic review & meta-analysis (2020, 31 RCTs): Green...

Why it works: Proposed mechanism (bench science): Guggul’s plant sterols (E- and Z-guggulsterone) can antagonize the farnesoid X receptor (FXR) and activate the pregnane X receptor (PXR), which...

Instructions: Product & standardization. • Choose a product standardized to ~2.5% total guggulsterones (common in trials). JAMA Network. Dosing used in clinical studies. • The best-known RCT use...

Warnings: May worsen LDL in some people: As above, the JAMA RCT found LDL increased vs placebo. If you try gug...

Studies: Randomized, placebo-controlled RCT (Philadelphia, USA; JAMA...

Why it works: Modulates cholesterol/bile-acid pathways. In animals and cell models, curcumin influences nuclear receptors (FXR/LXR/Nrf2) that regulate bile-acid synthesis and cholesterol homeost...

Instructions: Formulations & dosing seen in trials. • Typical RCT regimens used curcumin 500–1,000 mg/day (often split) for 8–12 weeks; some studies add piperine 5–10 mg/day to boost absorption....

Warnings: Liver injury (rare but real): National regulators and case series report idiosyncratic hepatotoxicit...

Studies: Most comprehensive/modern syntheses2023 GRADE-assessed meta-...

Why it works: Soluble fiber → less cholesterol reabsorbed. Flaxseed is rich in viscous soluble fiber (mucilage). This binds bile acids and cholesterol in the gut, increases fecal loss, and nudge...

Instructions: Form: Prefer ground/milled flaxseed. Whole seeds often pass through undigested, so you miss the fiber and lignans. You can buy it pre-milled or grind whole seeds in a coffee grinde...

Warnings: Take with fluids & start gradually. Because of the high fiber content, start with 1 tablespoon/day a...

Studies: Health Canada assessment (2014, updated page 2017): Review a...

Why it works: Multiple lipid-lowering mechanisms have been proposed. In vitro and animal work suggests flavonoids in artichoke—especially luteolin—can inhibit HMG-CoA reductase (the enzyme stati...

Instructions: Forms & typical studied doses. • The EU herbal monograph lists common preparations and daily dose ranges, depending on extract strength (water or hydro-alcoholic):. • Dry extract o...

Warnings: Biliary disease cautions/contraindications. Because artichoke is choleretic, the EMA monograph lists...

Studies: Randomized, double-blind, placebo-controlled trial (Phytomed...

Why it works: It’s a viscous soluble fiber. In the small intestine, oat/barley β-glucan forms a gel that binds bile acids and cholesterol, increasing their fecal excretion; the liver then pulls...

Instructions: Target dose: 3 grams/day of oat/barley β-glucan, with meals, as part of an overall heart-healthy diet. Expect about a 5–10% LDL-C reduction at this dose when viscosity is adequate....

Warnings: Gluten/celiac considerations:. • Barley contains gluten → avoid barley β-glucan if you require a glu...

Studies: FDA health-claim regulation (21 CFR §101.81): recognizes die...

Why it works: Saponins bind cholesterol & bile acids in the gut, reducing intestinal absorption and increasing fecal sterol/bile-acid loss. Much of this work is in vitro and in animals, but it’s...

Instructions: Seed “food dose” used in the main human study: 40 g of alfalfa seeds three times daily (≈120 g/day) for 8 weeks. This regimen lowered total and LDL cholesterol in patients with typ...

Warnings: Autoimmune risk (seeds/sprouts): Alfalfa seeds and sprouts contain L-canavanine, which has been link...

Studies: Human clinical trial (uncontrolled, n=15)Mölgaard et al., At...