In the United States, approximately 31 million adults have elevated cholesterol levels, a condition that doubles the risk of atherosclerotic cardiovascular disease compared to individuals with normal cholesterol levels. (8) Regulating blood cholesterol levels is essential to supporting cardiovascular health and preventing adverse outcomes, such as heart disease, myocardial infarction (heart attack) or strokes. Lifestyle modifications including physical activity, smoking cessation, a diet for cardiovascular health, weight management, and dietary supplements may improve cholesterol levels.
Learn about cholesterol and its functions, the risks of high cholesterol, and dietary supplements to support healthy cholesterol levels.
What is cholesterol?
Cholesterol is a waxy white substance found in cells throughout the body. It is produced in the body by the liver and absorbed from dietary sources (e.g., meat, dairy). As cholesterol does not dissolve in blood, it is packaged in molecules known as lipoproteins that act as cholesterol transport molecules (carriers). (6)
According to the Centers for Disease Control and Prevention, healthy adults should have their cholesterol levels checked every four to six years. Individuals with certain conditions (e.g., diabetes) or a family history of elevated cholesterol require more frequent testing. (1) Cholesterol transport molecules are measured in the blood using a lipid panel, which measures concentrations of high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, and total cholesterol. (6)
HDL molecules, commonly referred to as “good” cholesterol, are lipoprotein molecules that are responsible for transporting excess cholesterol from body tissues to the liver to be excreted. Low levels of HDL may increase the risk of atherosclerotic cardiovascular diseases (ASCVD). (6)
LDL molecules, commonly referred to as “bad” cholesterol, are also lipoproteins that act as cholesterol carriers. Over two-thirds of cholesterol in circulation is carried by LDL, where it is transported from the liver to body tissues to be used for its various functions. High levels of LDL in the blood increase the risk of atherosclerotic plaque formation and ASCVD. (6)
Triglycerides store fatty acids and are transported by very-low-density lipoprotein (VLDL) and chylomicrons. The cholesterol content of these triglyceride lipoproteins may be associated with the development of plaque in atherosclerosis. The breakdown of these lipoproteins may release particles that have blood clotting and pro-inflammatory effects. (7)
Total cholesterol is a measure of all cholesterol values combined.
The table below lists healthy blood cholesterol levels for various populations.
Functions of cholesterol
Cholesterol is required at optimal levels for various functions in the body. It acts as a structural component of cell membranes (2) and is used to produce bile acids, vitamin D, and steroid hormones (e.g., aldosterone, cortisol, estrogen, progesterone, testosterone). (2)(6) Cholesterol influences the fluidity of cells and plays a role in intracellular transportation (the movement of substances within the cell). (6)
What is high cholesterol?
Hypercholesterolemia, also known as high cholesterol, is characterized by elevated levels of cholesterol in the blood. In individuals with high cholesterol, the liver is unable to excrete excessive LDL, resulting in the development of atherosclerosis (the buildup of plaque deposits in blood vessels). Uncontrolled or chronic high cholesterol may be associated with complications, including:
- Carotid artery disease
- Coronary artery disease (e.g., angina, heart attack)
- Peripheral artery disease
- Stroke (9)
Causes and risk factors of high cholesterol
Factors that may result in increased cholesterol levels include:
- Certain health conditions (e.g., biliary obstruction, chronic kidney disease, hypertension, hypothyroidism, type 2 diabetes)
- Certain medications (e.g., cyclosporine, diuretics, glucocorticoids)
- Genetics, associated with familial hypercholesterolemia (FH)
- High dietary intake of saturated or trans fat
- Physical inactivity
- Smoking (8)
Hypercholesterolemia may be managed or prevented with lifestyle changes.
Dietary supplements to support healthy cholesterol levels
Treatment of high cholesterol commonly includes medications such as statins and bile acid sequestrants. (9) Unfortunately, these medications may have adverse effects including muscle pain, weakness, fatigue, and cognitive problems. (4) In addition to medications, there are several evidence-based dietary supplements that may help regulate cholesterol levels, including niacin, soluble fiber, plant sterols and stanols, artichoke leaf, and red yeast rice.
Niacin, also known as vitamin B3, is found in dietary supplements and foods such as meat (e.g., beef, poultry), fish (e.g., salmon, tuna), brown rice, and peanuts. (10) A systematic review of randomized controlled trials compared the cardiovascular effects of niacin when supplemented with statin medication to a control group receiving a placebo or other lipid-lowering therapies. The review found that the niacin with statin intervention was associated with a 21% increase in HDL cholesterol from baseline. The niacin with statin group also had a lower risk of cardiovascular mortality, coronary death, nonfatal myocardial infarction (heart attack), and stroke compared to the control group. However, the researchers concluded that niacin does not result in a significant risk reduction of cause-specific mortality, total mortality, or recurrent cardiovascular events. (3)
Dietary fibers are carbohydrates that are resistant to digestion in humans. Diets high in fiber have been associated with lower cholesterol levels and a decreased risk of cardiovascular disease. One type of fiber, soluble fiber, dissolves in water, forming a gel-like consistency, and is found in dietary sources such as flaxseed and psyllium. Examples of soluble fiber include β glucans, guar gum, and pectin. (11) Soluble fiber may help to improve cholesterol levels by stimulating the production of bile acids, reducing liver cholesterol content, increasing LDL cholesterol elimination, and slowing the absorption of dietary components in the small intestine, including cholesterol. (11)
Plant sterols and stanols
Plant compounds known as sterols and stanols have been shown to inhibit the absorption of cholesterol and lower LDL cholesterol levels by eight to 10%. Long-term studies have found that a dose of two grams per day of sterols/stanols are not associated with adverse effects and may be beneficial as a complementary treatment to statin medications in individuals with irregular lipid levels. (5)
The artichoke plant (Cynara scolymus L.) is consumed both as a food and as a herbal medicine. Cynarin, (14) chlorogenic acid, and luteolin have been identified as active components of the plant. (12) A review study suggests that a dose of two to three grams of artichoke leaf extract daily was associated with decreased LDL cholesterol, triglyceride, and total cholesterol levels. Interestingly, cooked artichoke hearts may also improve cholesterol levels as a result of its inulin (a soluble fiber) content. (12)
Red yeast rice
Red yeast rice (RYR), rice fermented by the mold species Monascus purpureus, contains a number of biologically active components, including isoflavones, monacolin K, monounsaturated fatty acids (MUFAs), and sterols. Monacolin K has been shown to inhibit a specific enzyme involved in regulating cholesterol production in the body. In clinical research, RYR supplementation has been found to have cholesterol-lowering effects, similar to the effects of statins. (11) It’s important to note that due to its similarity to statins, which act as HMG-CoA reductase inhibitors, RYR supplementation may be associated with certain adverse effects including depletion of the antioxidant coenzyme Q10 (CoQ10) and myopathy. (13) In these cases, supportive supplementation may be required.
The bottom line
Hypercholesterolemia, also referred to as high cholesterol, is a condition characterized by elevated cholesterol in the blood. Elevated cholesterol may increase the risk of atherosclerosis and heart disease, making achieving optimal blood lipid levels essential to prevention. Fortunately, measures to prevent elevated cholesterol include lifestyle modifications, including the use of certain dietary supplements. Speak with your integrative practitioner regarding your cholesterol levels and whether these supplements may benefit you.
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- Centers for Disease Control and Prevention. (2019, February 6). High cholesterol facts. Retrieved from https://www.cdc.gov/cholesterol/facts.htm
- Craig, M., & Malik, A. (2019). Biochemistry, cholesterol. In StatPearls . Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513326/
- Garg, A., Sharma, A., Krishnamoorthy, P., Garg, J., Virmani, D., Sharma, T., … Sikorskaya, E. (2017). Role of niacin in current clinical practice: A systematic review. The American Journal of Medicine, 130(2), 173–187.
- Golomb, B. A., & Evans, M. A. (2008). Statin adverse effects: A review of the literature and evidence for a mitochondrial mechanism. American Journal of Cardiovascular Drugs, 8(6), 373–418.
- Gylling, H., Plat, J., Turley, S., Ginsberg, H. N., Ellegård, L., Jessup, W., … Chapman, M. J. (2014). Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Atherosclerosis, 232(2), 346–360.
- Huff, T., & Jialal, I. (2019). Physiology, cholesterol. In StatPearls . Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470561/
- Karanchi, H., & Wyne, K. (2019). Hypertriglyceridemia. In StatPearls . Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459368/
- Karr, S. (2017). Epidemiology and management of hyperlipidemia. American Journal of Managed Care, 23(9 Suppl), S139-S148.
- National Heart Lung and Blood Institute. (n.d.). High blood cholesterol. Retrieved from https://www.nhlbi.nih.gov/health-topics/high-blood-cholesterol
- National Institutes of Health Office of Dietary Supplements. (2019). Niacin. Retrieved from https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/
- Santini, A., & Novellino, E. (2017). Nutraceuticals in hypercholesterolaemia: An overview. British Journal of Pharmacology, 174(11), 1450–1463.
- Santos, H. O., Bueno, A. A., & Mota, J. F. (2018). The effect of artichoke on lipid profile: A review of possible mechanisms of action. Pharmacological Research, 137, 170–178.
- Vercelli, L., Mongini, T., Olivero, N., Rodolico, C., Musumeci, O., & Palmucci, L. (2006). Chinese red rice depletes muscle coenzyme Q10 and maintains muscle damage after discontinuation of statin treatment. Journal of the American Geriatrics Society, 54(4), 718–720.
- Xia, N., Pautz, A., Wollscheid, U., Reifenberg, G., Förstermann, U., & Li, H. (2014). Artichoke, cynarin and cyanidin downregulate the expression of inducible nitric oxide synthase in human coronary smooth muscle cells. Molecules, 19(3), 3654–3668.