Here's a truth that might surprise you: We all need cholesterol. It aids in the production of hormones and vitamin D and plays a crucial role in the production of bile acids needed to break down fats and digest food. The problem is, too many of us get too much of a good thing. To stay healthy, most doctors recommend keeping cholesterol numbers at or below 200 mg/DL. But a whopping 106.7 million Americans ages 20 and older exceed this optimal level. If you're one of them, chances are your doctor has prescribed—or offered to, anyway—a cholesterol-lowering medication in the statin family (brand names include Lipitor, Crestor, Lescol, Mevacor, Zocor and Pravachol). Hailed as the wonder drugs of the 21st century, statins slow down the production of cholesterol and increase the liver’s ability to remove LDL (or "bad") cholesterol. But statins also come with a slew of side effects, including muscle pain and soreness, digestive problems, skin rashes and even liver damage.
Is the benefit worth the risk? Before you fill your prescription, consider opting for a cholesterol-lowering supplement which, combined with exercise and a healthy diet, can help you keep cholesterol under control (without incurring the nasty side effects). "On top of a strong lifestyle foundation, supplements can often make the difference in pushing cholesterol into a satisfactory level," says Brent A. Bauer, M.D., FACP, director of the complementary and Integrative Medicine Program at the Mayo Clinic in Rochester, Minn. Here a short list of the best cholesterol-lowering supplements. Talk to your doctor about what's right for you and how to take them— especially if you're on any medications.
Niacin, a B vitamin, gathers extra "bad" LDL cholesterol in your blood and delivers it to your liver for disposal. "In some studies, very significant drops in total cholesterol have been achieved with niacin, " says Bauer.
How to use:
Take up to two grams a day of an extended-release formula, but talk to your doctor to determine the optimal dose for you. People with liver disease should avoid this one. Editor's pick: Nature's Bounty Flush-free Niacin ($11 for 50 500-milligram pills; drugstore.com)
2. Red yeast rice extract
This byproduct of fermented and cooked rice contains monacolin K, a natural substance known to inhibit the synthesis of cholesterol in the body. "Since multiple studies have shown efficacy, red yeast rice is a good first-choice supplement to discuss with your doctor," says Bauer. However, red yeast rice is not without controversy: A 2001 University of California, Los Angeles study found that the amount of active ingredient can vary wisely from product to product despite labeled dosage, and that certain brands contained trace amounts of the toxin citrinin. Buy yours from a reputable source.
How to use: Take 600 milligrams three times daily. People with hepatic or renal disease should check with their health care provider before using red yeast rice, says Julie Anne Chinnock, N.D., M P.H., a researcher and practicing naturopathic physician in Portland, Ore.
Editor's Pick Bluebonnet Nutrition CholesteRice Red Yeast Rice Complex ($47 for 90 capsules; luckyvitamin.com).
Packed with soluble fiber and commonly used to treat constipation, psyllium reduces cholesterol absorption in the intestines. Studies show that taking 5 to 10 grams of soluble fiber a day can lower LDL by 5 percent.
How to use: Take five grams of psyllium seed husk (about a teaspoon) twice a day in a full glass of water. Supplemental fiber may affect the absorption of other oral medications, so ingest them at least two hours apart.
Editor's Pick: NOW Foods Whole Psyllium Husk Powder ($15 for 12 ounces; iherb.com).
4. Soy protein isolate
Though researchers aren't quite sure why it works, studies have shown that soy intake can decrease LDL by 12 percent and triglycerides by 10 percent. If you don't like soy-rich foods like miso, soy flour, tempeh and soymilk, try hiding a daily dose of a low-sugar supplemental soy protein in a yummy fruit smoothie. Make sure to get a soy isolate, which has undergone a process to remove most of the fat and carbohydrates but leaves protein intact.
How to use: Recommended dosage is about 50 grams a day (a glass of soymilk has about 10 grams, ½ cup of tofu has 20 grams).
Editor's Pick: Bob's Red Mill Isolated Soy Protein Powder ($25 for 14 ounces; bobsredmill.com)
5. Omega-3 fish oil
While fish oil has been touted as a panacea for everything from depression to ulcers, researches found that it also regulates cholesterol. "Fish oils can decrease triglycerides and LDL and increase HDL, in part by reducing liver production and the release of VLDL (very-low-density lipoprotein), one of the three major types of lipoprotein," says Chinnock. Since contamination can be a concern, she recommends "getting it from a good source that test for heavy metals and pesticides."
How to use: For best results, take 2 to 4 grams of fish oil every day.
Editor's Pick: Carlson's Very Finest Fish Oil Lemon Flavor ( $25 for a 200-milliliter bottle; carlsonlabs.com).
6. Artichoke extract
Artichoke extract works by increasing bile production in the liver, which in turn increases cholesterol excretion—meaning that any excess is eliminated rather than absorbed. "Artichoke extract is an exciting complementary therapy for the prevention and treatment of arteriosclerosis and coronary heart disease," says Chinnock, who points to several studies showing positive effect on total cholesterol and LDL.
How to use: Take 500 milligrams three times daily.
Editor's Pick:Enzymatic Therapies Artichoke EXtract ($26 for 45 pills; vitaminshoppe.com)