Managing High Cholesterol With Alternative Treatments
Nutritional supplements like niacin, psyllium, and plant sterols may help lower your cholesterol, but just because they're natural, they're not risk-free.
Medically reviewed by Pat F. Bass III, MD, MPH
High cholesterol treatment is different for everyone: Some people are able to bring cholesterol down with regular exercise and a healthy diet, while others need to be on medication despite these lifestyle changes.
If you need to manage your high cholesterol but don't want to take statins or other cholesterol-lowering drugs, there are some natural alternative treatments that have been shown to be effective. But when you consider these alternative treatments, you have to weigh the potential downsides associated with taking them — and consider your reasons for not wanting to take high cholesterol treatment like statins.
Alternative Cholesterol Treatments: What Works?
"There are certain approaches that are non-prescriptive that do seem to show lower [cardiac] events" and lower cholesterol levels, says Stanley L. Hazen, MD, PhD, director for the Center for the Cardiovascular Diagnostics and Prevention at the Cleveland Clinic. While he notes that garlic has not proven in studies to be significantly effective against high cholesterol, there is some medical evidence to support the use of other supplements, with caveats:
- Red yeast rice. This fermented rice "will help lower cholesterol levels and that has been shown in several studies," says Dr. Hazen. However, each brand "differs substantially from one to the other and lot to lot." Red yeast rice is also not monitored by the Food and Drug Administration (FDA). It's also important for people to understand, Hazen notes, that one of the components of red yeast rice is chemically identical to a statin, so the same benefits can be gained by taking a statin without the risks associated with taking an unregulated supplement.
- Niacin. This substance, which is actually a B vitamin, can be very effective in lowering high cholesterol levels, and was actually one of the first medications available to treat high cholesterol. But Hazen notes that side effects like flushing are common with niacin, and that it must be taken in very large amounts to be effective. "You're taking it like a drug when taking it in larger amounts," he says, so people interested in niacin should talk about it with their doctors first.
- Plant sterols. These plant substances actually help to block cholesterol absorption by the liver. While they can be effective, Hazen notes that you need a lot of them to be effective — 4 grams per day.
- Psyllium. This fiber, found in over-the-counter supplements like Metamucil, also helps to block the absorption of cholesterol. Two grams of psyllium daily — taken with a meal — can reduce cholesterol by as much as 5 to 10 percent, says Hazen.
- Flaxseed oil. While flaxseed oil supplements — in capsules or ground form — can help lower cholesterol by as much as 5 to 7 percent, Hazen says the seeds themselves should not be taken because "they will pass right through with no benefit." Flaxseed may also cause constipation if not taken with plenty of water.
- Soy. Soy has been found to improve overall heart health and lower cholesterol levels, and the FDA has approved marketing soy products as heart-healthy. Soybeans, tofu, soy milk, soy yogurt, and other soy products may all help to lower high cholesterol.
The biggest risk of taking these alternative treatments instead of proven therapies like statins is losing the major benefit that statins offer. Hazen says that statins can help save and prolong lives, and they're very safe drugs to use. Because they're so widely available, they're also often less expensive than over-the-counter supplements.
The other concern is the lack of regulation in how these supplements are manufactured. You may or may not be getting the substance that's named on the label, and you just don't know how much of the active ingredient the supplement contains. The safety of these supplements can't be guaranteed, so use caution when considering them.
Also, any time you take a medication without your doctor's supervision, you run the risk of interactions with other medications.
High Cholesterol Treatment: About Statins
Think about why you want to try alternative treatments for your high cholesterol. If you think "natural" offers better results and fewer side effects than a manufactured drug, that's often just not the case. Statins are safe, effective, and proven when it comes to treating high cholesterol and preventing heart disease. But that doesn't mean that statins alone are the answer. If you're considering supplements in addition to statins, diet, and exercise to help battle particularly high and difficult cholesterol levels, then talk to your doctor about what's beneficial and safe for you to try.
If you're already on statins and considering alternative treatments, never stop taking prescribed drugs on your own. Talk to your doctor about your concerns, and let him or her know you're interested in alternative treatments for high cholesterol management. The most important thing is getting your high cholesterol under control — which can save you from a debilitating heart attack or stroke and add years to your life.
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