One of the most significant discoveries in preventive medicine is that elevated levels of cholesterol in the blood accelerate atherosclerosis , a condition commonly known as hardening of the arteries. Along with high blood pressure , inactivity, smoking , and diabetes , high cholesterol has proven to be one of the most important promoters of heart disease , strokes , and peripheral vascular disease (blockage of circulation to the extremities, usually the legs).
Cholesterol does not directly clog arteries like grease clogs pipes. The current theory is that elevated levels of cholesterol irritate the walls of blood vessels and cause them to undergo harmful changes. Because most cholesterol is manufactured by the body itself, dietary sources of cholesterol (such as eggs) are not usually the most important problem. The relative proportion of unsaturated fats (from plants) and saturated fats (mainly from animal products) in the diet is more significant.
When the consequences of elevated cholesterol were first being researched, total cholesterol was the only measurement considered. Today, the overall lipid profile is taken into account. LDL (“bad”) cholesterol, HDL (“good”) cholesterol, and triglycerides are the most common measurements related to cholesterol. Lipoprotein A and oxidized LDL cholesterol are drawing increasing attention as well.
This change in emphasis has thrown some long-standing recommendations into confusion. For example, reducing total fat intake generally decreases total cholesterol. On this basis, medical authorities long ago adopted a policy of recommending low-fat diets. However, when you take into account other lipid measurements, it is now clear that reducing fat intake is not the clear blessing it first appeared to be. Low-fat diets improve total and LDL cholesterol levels, but worsen HDL and triglyceride levels. Conversely, low-carb, high-fat diets tend to raise levels of LDL and total cholesterol, but reduce triglycerides and raise HDL. Some researchers use these effects as “proof” that the low-fat diet is healthier, 270 but, in fact, the current state of knowledge does not tell us whether the changes in lipids produced by low-fat diets are better or worse than the changes produced by low-carb diets. It is possible that a diet low in carbs and high in mono-unsaturated fats (eg, olive oil) offers the best of both worlds, but this has not been conclusively proven. 271-276 What is clear is that losing weight is extremely important. If you are overweight and lose weight, your cholesterol profile is almost certain to improve. 188
Increasing exercise and losing weight may produce adequate improvements in the lipid profile. If such lifestyle changes are not effective, however, there are many highly effective drugs to choose from. Medications in the statin family are most effective, and they have been shown to prevent heart attacks and reduce mortality. Other useful conventional options include ezetimibe (Zetia), fibrate drugs , and various forms of the vitamin niacin (discussed below).
There are several herbs and supplements that appear to help lower cholesterol levels. For some (such as stanols/sterols, vitamin B 3 , fiber, and soy), the evidence is sufficiently strong to have produced mainstream acceptance.
Note: If your primary problem is elevated triglycerides, see the High Triglycerides article.
Stanols are substances that occur naturally in various plants. Their cholesterol-lowering effects were first observed in animals in the 1950s. Since then, a substantial amount of research suggests that plant stanols (usually modified into stanol esters) can help to lower cholesterol in individuals with normal or mildly to moderately elevated cholesterol levels. Stanols are available in margarine spreads, salad dressings, and dietary supplement tablets. Related substances called plant sterols appear to have equivalent effects, 173,189 and in this subsection we will refer to sterols and stanols and their esters somewhat interchangeably.
Plant stanol esters reduce serum cholesterol levels by inhibiting cholesterol absorption. 10 Because they are structurally similar to cholesterol, stanols (and sterols) can displace cholesterol from the "packages" that deliver cholesterol for absorption from the intestines to the bloodstream. 1 The displaced cholesterol is then excreted from the body. This not only interferes with the absorption of cholesterol from food, it has the additional (and probably more important) effect of removing cholesterol from substances made in the liver that are recycled through the digestive tract.
Numerous double-blind, placebo-controlled studies, ranging in length from 30 days to 12 months, have found stanol esters and their chemical relatives effective for improving cholesterol profile levels. 2-15,167-169,174,175,263,280 The combined results suggest that these substances can reduce total cholesterol and LDL ("bad") cholesterol by about 10%-15%. 16,278,279 However, stanols/sterols do not appear to have any significant effect on HDL ("good") cholesterol or triglycerides.
Fish oil has also been shown to have a favorable effect on fats in the blood, in particular triglycerides. A study investigating the possible benefit of combining sterols with fish oil found that together they significantly lowered total cholesterol, LDL-cholesterol and triglycerides, and raised HDL-cholesterol in subjects with undesirable cholesterol profiles. 286
Individuals taking statin drugs may benefit from using stanols/sterols as well. 20,21,170,241,278 According to one study, if you are on statins and start taking sterol ester margarine as well, your cholesterol will improve to the same extent as if you doubled the statin dose. 170 Stanols or sterols also appear to enhance the effects of cholesterol-lowering diets. 17,174
Stanols or sterols also appear to be safe and effective in helping to improve cholesterol profile in people with type 2 (adult-onset) diabetes. 18,19,175
For more information, including dosage and safety issues, see the full Stanols article.
The common vitamin niacin, also called vitamin B 3 , is an accepted medical treatment for elevated cholesterol with solid science behind it. Several well-designed, double-blind, placebo-controlled studies have found that niacin reduced LDL cholesterol by approximately 10% and triglycerides by 25%, and raised HDL cholesterol by 20%-30%. 22-27 Niacin also lowers levels of lipoprotein A—another risk factor for atherosclerosis—by about 35%. Furthermore, long-term use of niacin has been shown to significantly reduce death rates from cardiovascular disease. 28
Niacin appears to be a safe and effective treatment for high cholesterol in people with diabetes as well, and (contrary to previous reports) does not seem to raise blood sugar levels. 29 Unfortunately, niacin, if taken in sufficient quantities to lower cholesterol, can cause an annoying flushing reaction and occasionally liver inflammation. 30 Close medical supervision is essential when using niacin to lower cholesterol.
Combining high-dose niacin with statin drugs (the most effective medications for high cholesterol) further improves lipid profile by raising HDL (“good”) cholesterol. 149-151 Unfortunately, there are real concerns that this combination therapy could cause a potentially fatal condition called rhabdomyolysis.
A growing body of evidence, however, suggests that the risk is relatively slight in individuals with healthy kidneys. Furthermore, even much lower doses of niacin than the usual dose given to improve cholesterol levels (100 mg versus 1,000 mg or more) may provide a similar benefit. 152 At this dose, the risk of rhabdomyolysis should be decreased.
Nonetheless, it is not safe to try this combination except under close physician supervision. Rhabdomyolysis can be fatal.
For more information, including dosage and safety issues, see the full Vitamin B 3 article.
Water-soluble fiber supplements (such as psyllium, hydroxymethylcellulose and its relatives, and beta glucan from oats) are thought to lower cholesterol, 253,263,291 and the FDA has permitted products containing this form of fiber to carry a "heart-healthy" label. 31 It must be kept in mind, however, that the bulk of the supporting evidence for this theory comes from studies of oats conducted by manufacturers of oat products. 255 A typical dose of oat bran is 5 to 10 g with each meal and at bedtime; psyllium is taken at 10 g with each meal.
Soy protein appears capable of modestly lowering total cholesterol, LDL ("bad") cholesterol, and triglycerides by approximately 5%-15%. 32,238,287 The FDA has allowed foods containing soy protein to make the "heart-healthy" claim on the label. One study suggests that substituting as little as 20 g daily of soy protein for animal protein can significantly improve cholesterol levels. 33 Higher doses appear to cause increased benefit. 238
Although it was once thought that isoflavones are the active ingredients in soy responsible for improving cholesterol profile, evidence suggests otherwise. 34-41,153,158-161,190-194,256,277,288,290 Other substances, such as certain soy proteins, may be more important. However, it has been additionally suggested that soy protein must be kept in its original state to be effective. Ordinary soy protein extracts are somewhat damaged (“denatured”). In a double-blind study of 120 people, a special “preserved” soy protein extract proved more effective for improving cholesterol profile than standard denatured soy protein extracts. 260
For more information, including dosage and safety issues, see the full Soy article.
Although primarily used to stimulate gallbladder function, artichoke leaf may be helpful for high cholesterol as well.
In a double-blind, placebo-controlled study of 143 individuals with elevated cholesterol, artichoke leaf extract significantly improved cholesterol readings. 81 Total cholesterol fell by 18.5% as compared to 8.6% in the placebo group; LDL cholesterol fell by 23% versus 6%; and the LDL to HDL ratio decreased by 20% versus 7%. In a subsequent study of 75 otherwise healthy people with high cholesterol, artichoke leaf extract significantly reduced total cholesterol compared to placebo, but it did not affect LDL, HDL, or triglycerides levels. 283
Red yeast rice is a traditional Chinese medicinal substance. It is made by fermenting a type of yeast called Monascus purpureus over rice. It contains cholesterol-lowering chemicals in the statin family , including one identical to the drug lovastatin. Like statin drugs, red yeast rice appears to be effective for improving various aspects of the lipid profile, including total cholesterol, LDL cholesterol, and the LDL/HDL ratio. 205-206,259 Presumably it also presents the same safety risks as statins, compounded by the uncertainty regarding how much active drug any particular batch of red yeast rice contains.
In a 2011 review of 22 trials, researchers concluded that an alcohol extract of red yeast rice (called xuezhikang) was no more or less effective than statins in lowering levels of cholesterol and triglycerides in people with high cholesterol and/or high triglycerides. 292 They also found that the supplement may be more effective than inositol nicotinate (another cholesterol-lowering medication) in reducing cholesterol levels.
For more information, including complete dosage and safety issues, see the full Red Yeast Rice article.
Numerous studies enrolling a total of many thousands of individuals purported to show that the substance policosanol , made from sugarcane, can markedly improve cholesterol profile. However, the single Cuban research group behind these studies has a financial connection to the product. It was not until 2006 that independent research groups began to report their results on the use of policosanol for hyperlipidemia. Currently, 9 such independent studies have been reported, enrolling more than 500 people, and in not one of these studies has policosanol proved to be more effective than placebo. See the full Policosanol article for detailed information.
In a 12-month study of 223 postmenopausal women, calcium supplements (calcium citrate at a dose of 1 g daily) significantly improved the ratio of HDL ("good") cholesterol to LDL ("bad") cholesterol. 155 This appears to have been primarily due to a meaningful rise in HDL levels.
Krill are tiny shrimp-like crustaceans that flourish in the Antarctic Ocean and provide food for numerous aquatic animals. Krill oil , similar but not identical to fish oil , may improve cholesterol profile. 204 Fish oil may enhance the effectiveness of drugs in the statin family. 252,264 EPA, another constituent of fish oil, may help prevent severe heart complications in people with high cholesterol already taking statins. 254
One double-blind study found evidence that cinnamon , taken at a dose of 1-6 grams daily, improved triglyceride, LDL cholesterol, and total cholesterol, without worsening HDL cholesterol in people with type 2 diabetes. 198
A review of 10 randomized trials consisting of 542 patients found that cinnamon may help decrease total cholesterol, LDL cholesterol, and triglyceride levels in patients with type 2 diabetes. Doses of cinnamon ranging from 0.12 g to 6 g showed significant decreases compared to placebo or no treatment. There were also beneficial increases in HDL cholesterol as well. Unfortunately, there were several flaws in the trials, including the amount of the preferred dose and length of treatment. 295 At present, it would be premature to consider cinnamon an evidence-based treatment for high cholesterol, but it has definitely shown some promise.
Inconsistent evidence hints that flaxseed might reduce LDL cholesterol and, overall, slow down atherosclerosis . 95,96,98-100,157,208,284Flaxseed oil may be helpful as well, although evidence is again inconsistent. 209,242 It may be the generic fiber and not the other specific ingredients in flaxseed that benefit cholesterol levels. 97,184 Studies of purified lignans (found in flaxseed) have yielded mixed results. 210,269
A growing body of evidence suggests that increased consumption of nuts such as almonds, walnuts, pecans, and macadamia nuts may improve lipid profile and reduce heart disease risk, presumably because of their high monounsaturated fat content. 101-109,163,211-212,281
Olive oil is known to improve cholesterol profile. Up until recently, it has been thought that the monounsaturated fats in olive oil are its primary active ingredients. However, some evidence hints that polyphenols in olive oil (particularly, virgin olive oil) may play a positive role as well. 239
Some but not all studies suggest that "friendly" bacteria ( probiotics ) might be able to improve cholesterol profile. 123-128,213, 250 So-called " prebiotics ," substances that enhance the growth of friendly bacteria, have shown inconsistent benefit in studies as well. 214-221 One study found that any improvement, if it does occur, is short-lived. 262
Both black tea200 and green teas enriched with either theaflavin 201 or catechins 261 have shown promise for lowering cholesterol. 201,293 There is some suggestion that without such enhancement, both green tea 222 and black tea 266 may be ineffective.
Dark chocolate contains substances related to those in black and green tea, and it too has shown some promise for improving cholesterol profile. 243-244, 251,262
Other preliminary double-blind trials suggest potential benefit with the Iranian herb Achillea wilhelmsii , 93 the Peruvian herb caigua ( Cyclanterha pedata ), carob fiber , 94,223 the Chinese caterpillar/fungus cordyceps , 224Ipomoea batatus (sweet potato), 162 and a drink containing broccoli and cabbage. 199
Chitosan , a type of insoluble fiber derived from crustacean shells, has been proposed for reducing cholesterol levels. But, current evidence suggests that if it does offer any benefits, they are minimal at best. 84-92,147,148,187,197,225-226,285
A comprehensive review combining the results of 14 studies found that glucomannan , a dietary fiber derived from the tubers of Amorphophallus konjac , significantly reduced total and LDL cholesterol levels. 289
Weaker, and in some cases inconsistent, evidence suggests potential benefit with alfalfa ; 132-146 berberine (found in goldenseal , honey , Oregon grape , and barberry ); 227,282beta-hydroxy-beta-methylbutyrate (HMB) ; 164blue-green algae ; 129-131,233conjugated linoleic acid (CLA) ; 165L-carnitine ; 185,230-232Ayurvedic herb Eclipta alba (also know as Bhringraja or Keshraja); 257 grape polyphenols; 228-229mesoglycan ; 110-112 and nopal cactus . 268
Studies on whether the mineral chromium can improve cholesterol levels have returned mixed results. 113-121 However, this mineral may offer benefit for people taking drugs in the beta-blocker family. These medications, used for high blood pressure and other conditions, sometimes reduce HDL cholesterol levels. Chromium supplements may offset this side effect. 122
Rice bran oil, like other vegetables oils, appears to favorably change lipid profile as well as reduce heart disease risk in other ways. 166, 234 Weaker evidence suggests that gamma oryzanol , a substance found in rice bran oil, can also improve lipid profiles.
Substances related to vitamin E called tocotrienols are sometimes promoted as improving cholesterol levels. However, while benefit has been reported in test-tube studies, animal studies, and nonblinded human trials, properly designed studies have failed to find it effective. 177, 246-249
A number of studies published in the 1980s and 1990s reported that various garlic preparations, including raw garlic, stabilized garlic powder, and aged garlic, can lower cholesterol. 68,69 However, several more recent and generally better-designed studies have found that if any benefits exist, they are so small as to be of little help in real life. 70-76,202,235,245
Similarly, guggul , the sticky gum resin from the mukul myrrh tree, has been widely marketed as a cholesterol-reducing herb. However, while preliminary studies found evidence of benefit, 77-80 they all suffered from significant design flaws; a well-designed study did not find guggul effective. 186
A small randomized trial involving 67 people with high cholesterol found evidence to support the use of sage leaf extract (500 mg every 8 hours) for modestly lowering total and LDL cholesterol levels. 294 In another randomized trial of 86 people with high cholesterol and diabetes , sage leaf extract improved cholesterol (HDL and LDL) and trigycerides when compared to placebo. 296
In addition, various herbs and supplements may interact adversely with drugs used to treat high cholesterol. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.
2. Gylling H, Miettinen TA. Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholesterolaemic NIDDM patients before and during sitostanol ester-margarine treatment. Diabetologia. 1994;37:773-780.
4. Vanhanen HT, Blomqvist S, Ehnholm C, et al. Serum cholesterol, cholesterol precursors, and plant sterols in hypercholesterolemic subjects with different apoE phenotypes during dietary sitostanol ester treatment. J Lipid Res. 1993;34:1535-1544.
5. Blair SN, Capuzzi DM, Gottlieb SO, et al. Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy. Am J Cardiol. 2000;86:46-52.
6. Nguyen TT, Dale LV, von Bergmann K, et al. Cholesterol-lowering effect of stanol ester in a US population of mildly hypercholesterolemic men and women: a randomized controlled trial. Mayo Clin Proc. 1999;74:1198-2206.
8. Hallikainen MA, Sarkkinen ES, Uusitupa MI. Effects of low-fat stanol ester enriched margarines on concentrations of serum carotenoids in subjects with elevated serum cholesterol concentrations. Eur J Clin Nutr. 1999;53:966-969.
10. Tammi A, Ronnemaa T, Gylling H, et al. Plant stanol ester margarine lowers serum total and low-density lipoprotein cholesterol concentrations of healthy children: the STRIP project. Special Turku Coronary Risk Factors Intervention Project. J Pediatr. 2000;136:503-510.
11. Hallikainen MA, Uusitupa MI. Effects of 2 low-fat stanol ester-containing margarines on serum cholesterol concentrations as part of a low-fat diet in hypercholesterolemic subjects. Am J Clin Nutr. 1999;69:403-410.
12. Gylling H, Radhakrishnan R, Miettinen TA. Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine: women and dietary sitostanol. Circulation. 1997;96:4226-4231.
13. Jones PJ, Ntanios FY, Raeini-Sarjaz M, et al. Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men. Am J Clin Nutr. 1999;69:1144-1150.
14. Vanhanen HT, Kajander J, Lehtovirta H, et al. Serum levels, absorption efficiency, faecal elimination and synthesis of cholesterol during increasing doses of dietary sitostanol esters in hypercholesterolaemic subjects. Clin Sci. 1994;87:61-67.
17. Maki KC, Davidson MH, Umporowicz DM, et al. Lipid responses to plant-sterol-enriched reduced-fat spreads incorporated into a National Cholesterol Education Program Step I diet. Am J Clin Nutr. 2001;74:33-43.
18. Gylling H, Miettinen TA. Effects of inhibiting cholesterol absorption and synthesis on cholesterol and lipoprotein metabolism in hypercholesterolemic non-insulin-dependent diabetic men. J Lipid Res. 1996;37:1776-1785.
19. Gylling H, Miettinen TA. Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholesterolaemic NIDDM patients before and during sitostanol ester-margarine treatment. Diabetologia. 1994;37:773-780.
20. Gylling H, Miettinen TA. Effects of inhibiting cholesterol absorption and synthesis on cholesterol and lipoprotein metabolism in hypercholesterolemic non-insulin-dependent diabetic men. J Lipid Res. 1996;37:1776-1785.
21. Blair SN, Capuzzi DM, Gottlieb SO, et al. Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy. Am J Cardiol. 2000;86:46-52.
25. Lal SM, Hewett JE, Petroski GF, et al. Effects of nicotinic acid and lovastatin in renal transplant patients: a prospective, randomized, open-label crossover trial. Am J Kidney Dis. 1995;25:616-622.
26. Elam MB, Hunninghake DB, Davis KB, et al. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients With diabetes and peripheral arterial disease. The ADMIT Study: a randomized trial. JAMA. 2000;284:1263-1270.
27. Morgan JM, Capuzzi DM, Guyton JR, et al. Treatment effect of Niaspan, a controlled-release niacin, in patients with hypercholesterolemia: a placebo-controlled trial. J Cardiovasc Pharmacol Ther. 1996;1:195-202.
29. Elam MB, Hunninghake DB, Davis KB, et al. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease. The ADMIT Study: a randomized trial. JAMA. 2000;284:1263-1270.
33. Teixeira SR, Potter SM, Weigel R, et al. Effects of feeding 4 levels of soy protein for 3 and 6 wk on blood lipids and apolipoproteins in moderately hypercholesterolemic men. Am J Clin Nutr. 2000;71:1077-1084.
34. Crouse JR III, Morgan T, Terry JG, et al. A randomized trial comparing the effect of casein with that of soy protein containing varying amounts of isoflavones on plasma concentrations of lipids and lipoproteins. Arch Intern Med. 1999;159:2070-2076.
36. Anthony MS, Clarkson TB, Hughes CL Jr, et al. Soybean isoflavones improve cardiovascular risk factors without affecting the reproductive system of peripubertal rhesus monkeys. J Nutr. 1996;126:43-50.
37. Greaves KA, Parks JS, Williams JK, et al. Intact dietary soy protein, but not adding an isoflavone-rich soy extract to casein, improves plasma lipids in ovariectomized cynomolgus monkeys. J Nutr. 1999;129:1585-1592.
41. Howes JB, Sullivan D, Lai N, et al. The effects of dietary supplementation with isoflavones from red clover on the lipoprotein profiles of post menopausal women with mild to moderate hypercholesterolaemia. Atherosclerosis. 2000;152:143-147.
56. Pons P, Rodriguez M, Robaina C, et al. Effects of successive dose increases of policosanol on the lipid profile of patients with type II hypercholesterolaemia and tolerability to treatment. Int J Clin Pharm Res. 1994;14:27-33.
59. Castano G, Mas R, Arruzazabala ML, et al. Effects of policosanol and pravastatin on lipid profile, platelet aggregation and endothelemia in older hypercholesterolemic patients. Int J Clin Pharmacol Res. 1999;19:105-116.
60. Crespo N, Illnait J, Mas R, et al. Comparative study of the efficacy and tolerability of policosanol and lovastatin in patients with hypercholesterolemia and noninsulin dependent diabetes mellitus. Int J Clin Pharmacol Res. 1999;19:117-127.
64. Fernandez JC, Mas R, Castano G, et al. Comparison of the efficacy, safety and tolerability of policosanol versus fluvastatin in elderly hypercholesterolaemic women. Clin Drug Invest. 2001;21:103-113.
65. Castano G, Mas R, Fernandez JC, et al. Efficacy and tolerability of policosanol compared with lovastatin in patients with type II hypercholesterolemia and concomitant coronary risk factors. Curr Ther Res. 2000;61:137-146.
71. Superko HR, Krauss RM. Garlic powder, effect on plasma lipids, postprandial lipemia, low-density lipoprotein particle size, high-density lipoprotein subclass distribution and lipoprotein (a). J Am Coll Cardiol. 2000;35:321-326.
79. Singh RB, Niaz MA, Ghosh S. Hypolipidemic and antioxidant effects of Commiphora mukul as an adjunct to dietary therapy in patients with hypercholesterolemia. Cardiovasc Drugs Ther. 1994;8:659-664.
86. Ormrod D, Holmes CC, Miller TE. Dietary chitosan inhibits hypercholesterolaemia and atherogenesis in the apolipoprotein E-deficient mouse model of atherosclerosis. Atherosclerosis. 1998;138:329-334.
88. Deuchi K, Kanauchi O, Imasato Y, et al. Effect of the viscosity or deacetylation degree of chitosan on fecal fat excreted from rats fed on a high-fat diet. Biosci Biotechnol Biochem. 1995;59:781-785.
89. Deuchi K, Kanauchi O, Shizukuishi M, et al. Continuous and massive intake of chitosan affects mineral and fat-soluble vitamin status in rats fed on a high-fat diet. Biosci Biotechnol Biochem. 1995;59:1211-1216.
92. Ho SC, Tai ES, Eng PH, et al. In the absence of dietary surveillance, chitosan does not reduce plasma lipids or obesity in hypercholesterolaemic obese Asian subjects. Singapore Med J. 2001;42:6-10.
97. Singer P, Jaeger W, Berger I, et al. Effects of dietary oleic, linoleic, and alpha-linolenic acids on blood pressure, serum lipids, lipoproteins and the formation of eicosanoid precursors in patients with mild essential hypertension. J Hum Hypertens. 1990;4:227-233.
99. Jenkins DJ, Kendall CW, Vidgen E, et al. Health aspects of partially defatted flaxseed, including effects on serum lipids, oxidative measures, and ex vivo androgen and progestin activity: a controlled crossover trial. Am J Clin Nutr. 1999;69:395-402.
103. Abbey M, Noakes M, Belling GB, et al. Partial replacement of saturated fatty acids with almonds or walnuts lowers total plasma cholesterol and low-density-lipoprotein cholesterol. Am J Clin Nutr. 1994;59:995-999.
107. Zambon D, Sabate J, Munoz S, et al. Substituting walnuts for monounsaturated fat improves the serum lipid profile of hypercholesterolemic men and women. A randomized crossover trial. Ann Intern Med. 2000;132:538-546.
110. Vecchio F, Zanchin G, Maggioni F, et al. Mesoglycan in treatment of patients with cerebral ischemia: effects on hemorheologic and hematochemical parameters. Acta Neurol (Napoli). 1993;15:449-456.
112. Postiglione A, De Simone B, Rubba P, et al. Effect of oral mesoglycan on plasma lipoprotein concentration and on lipoprotein lipase activity in primary hyperlipidemia. Pharmacol Res Commun. 1984;16:1-8.
118. Roeback JR Jr, Hla KM, Chambless LE, et al. Effects of chromium supplementation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers. A randomized, controlled trial. Ann Intern Med. 1991;115:917-924.
120. Offenbacher EG, Rinko CJ, Pi-Sunyer FX. The effects of inorganic chromium and brewer's yeast on glucose tolerance, plasma lipids, and plasma chromium in elderly subjects. Am J Clin Nutr. 1985;42:454-461.
121. Preuss HG, Wallerstedt D, Talpur N, et al. Effects of niacin-bound chromium and grape seed proanthocyanidin extract on the lipid profile of hypercholesterolemic subjects: a pilot study. J Med. 2000;31:227-246.
122. Roeback JR, Hla KM, Chambless LE, et al. Effects of chromium supplementation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers. A randomized, controlled trial. Ann Intern Med. 1991;115:917-924.
126. Richelsen B, Kristensen K, Pedersen SB. Long-term (6 months) effect of a new fermented milk product on the level of plasma lipoproteins—a placebo-controlled and double blind study. Eur J Clin Nutr. 1996;50:811-815.
128. Agerholm-Larsen L, Bell ML, Grunwald GK, et al. The effect of a probiotic milk product on plasma cholesterol: a meta-analysis of short-term intervention studies. Eur J Clin Nutr. 2000;54:856-860.
130. Gonzalez de Rivera C, Miranda-Zamora R, Diaz-Zagoya JC, et al . Preventive effect of Spirulina maxima on the fatty liver induced by a fructose-rich diet in the rat, a preliminary report. Life Sci. 1993;53:57-61.
144. Molgaard J, von Schenck H, Olsson AG. Alfalfa seeds lower low density lipoprotein cholesterol and apolipoprotein B concentrations in patients with type II hyperlipoproteinemia. Atherosclerosis. 1987;65:173-179.
153. Dewell A, Hollenbeck CB, Bruce B. The effects of soy-derived phytoestrogens on serum lipids and lipoproteins in moderately hypercholesterolemic postmenopausal women. J Clin Endocrinol Metab. 2002;87:118-121.
158. Messina M, Gardner C, Barnes S. Gaining insight into the health effects of soy but a long way still to go: commentary on the fourth International Symposium on the Role of Soy in Preventing and Treating Chronic Disease. J Nutr. 2002;132:547S-551S.
159. Sanders TA, Dean TS, Grainger D, et al. Moderate intakes of intact soy protein rich in isoflavones compared with ethanol-extracted soy protein increase HDL but do not influence transforming growth factor beta(1) concentrations and hemostatic risk factors for coronary heart disease in healthy subjects. Am J Clin Nutr. 2002;76:373-377.
160. Nestel PJ, Yamashita T, Sasahara T, et al. Soy isoflavones improve systemic arterial compliance but not plasma lipids in menopausal and perimenopausal women. Arterioscler Thromb Vasc Biol. 1997;17:3392-3398.
161. Jenkins DJ, Kendall CW, Jackson CJ, et al. Effects of high- and low-isoflavone soyfoods on blood lipids, oxidized LDL, homocysteine, and blood pressure in hyperlipidemic men and women. Am J Clin Nutr. 2002;76:365-372.
162. Ludvik BH, Mahdjoobian K, Waldhaeusl W, et al. The effect of Ipomoea batatus (Caiapo) on glucose metabolism and serum cholesterol in patients with type 2 diabetes: a randomized study. Diabetes Care. 2002;25:239-240.
163. Jenkins DJ, Kendall CW, Marchie A, et al. Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation. 2002;106:1327-1332.
165. Noone EJ, Noone EJ, Roche HM, et al. The effect of dietary supplementation using isomeric blends of conjugated linoleic acid on lipid metabolism in healthy human subjects. Br J Nutr. 2002;88:243-251.
167. Ostlund RE Jr, Racette SB, Okeke A, et al. Phytosterols that are naturally present in commercial corn oil significantly reduce cholesterol absorption in humans. Am J Clin Nutr. 2002;75:1000-1004.
169. Amundsen AL, Ose L, Nenseter MS, et al. Plant sterol ester-enriched spread lowers plasma total and LDL cholesterol in children with familial hypercholesterolemia. Am J Clin Nutr. 2002;76:338-344.
173. Vanstone CA, Raeini-Sarjaz M, Parsons WE, et al. Unesterified plant sterols and stanols lower LDL-cholesterol concentrations equivalently in hypercholesterolemic persons. Am J Clin Nutr. 2002;76:1272-1278
175. Lee YM, Haastert B, Scherbaum W, et al. A phytosterol-enriched spread improves the lipid profile of subjects with type 2 diabetes mellitus A randomized controlled trial under free-living conditions. Eur J Nutr. 2003;42:111-117.
176. Castano G, Fernandez L, Mas R, et al. Comparison of the efficacy, safety and tolerability of original policosanol versus other mixtures of higher aliphatic primary alcohols in patients with type II hypercholesterolemia. Int J Clin Pharmacol Res. 2002;22:55-66.
177. Mustad VA, Smith CA, Ruey PP, et al. Supplementation with 3 compositionally different tocotrienol supplements does not improve cardiovascular disease risk factors in men and women with hypercholesterolemia. Am J Clin Nutr. 2002;76:1237-1243.
178. Oosthuizen W, Vorster HH, Vermaak, WJ, et al. Lecithin has no effect on serum lipoprotein, plasma fibrinogen and macro molecular protein complex levels in hyperlipidaemic men in a double-blind controlled study. Eur J Clin Nutr. 1998;52:419-424.
181. Childs MT, et al. The contrasting effects of a dietary soya lecithin product and corn oil on lipoprotein lipids in normolipidemic and familial hypercholesterolemic subjects. Atherosclerosis. 198;38:217-228.
188. Michael L, Dansinger, MD. One year effectiveness of the Atkins, Ornish, Weight Watchers, and Zone diets in decreasing body weight and heart disease risk. Paper presented at: American Heart Association 2003 Scientific Sessions; November 12, 2003.
190. Nikander E, Tiitinen A, Laitinen K, et al. Effects of isolated isoflavonoids on lipids, lipoproteins, insulin sensitivity, and ghrelin in postmenopausal women. J Clin Endocrinol Metab. 2004;89:3567-3572.
191. Atkinson C, Oosthuizen W, Scollen S, et al. Modest protective effects of isoflavones from a red clover-derived dietary supplement on cardiovascular disease risk factors in perimenopausal women, and evidence of an interaction with ApoE genotype in 49-65 year-old women. J Nutr. 2004;134:1759-1764.
192. Kreijkamp-Kaspers S, Kok L, Grobbee DE, et al. Effect of soy protein containing isoflavones on cognitive function, bone mineral density, and plasma lipids in postmenopausal women. JAMA. 2004;292:65-74.
193. Dalais FS, Ebeling PR, Kotsopoulos D, et al. The effects of soy protein containing isoflavones on lipids and indices of bone resorption in postmenopausal women. Clin Endocrinol (Oxf). 2003;58:704-709.
197. Metso S, Ylitalo R, Nikkila M, et al. The effect of long-term microcrystalline chitosan therapy on plasma lipids and glucose concentrations in subjects with increased plasma total cholesterol: a randomised placebo-controlled double-blind crossover trial in healthy men and women. Eur J Clin Pharmacol. 2003 Nov 7. [Epub ahead of print]
199. Takai M, Suido H, Tanaka T, et al. [LDL-cholesterol-lowering effect of a mixed green vegetable and fruit beverage containing broccoli and cabbage in hypercholesterolemic subjects]. Rinsho Byori. 2003;51:1073-1083.
204. Murkovic M, Abuja PM, Bergmann AR, et al. Effects of elderberry juice on fasting and postprandial serum lipids and low-density lipoprotein oxidation in healthy volunteers: a randomized, double-blind, placebo-controlled study. Eur J Clin Nutr. 2004;58:244-249.
208. Stuglin C, Prasad K. Effect of flaxseed consumption on blood pressure, serum lipids, hemopoietic system and liver and kidney enzymes in healthy humans. J Cardiovasc Pharmacol Ther. 2005;10:23-27.
210. Hallund J, Ravn-Haren G, Bugel S, et al. A lignan complex isolated from flaxseed does not affect plasma lipid concentrations or antioxidant capacity in healthy postmenopausal women. J Nutr. 2005;136:112-116.
212. Tapsell LC, Gillen LJ, Patch CS, et al. Including Walnuts in a Low-Fat/Modified-Fat Diet Improves HDL Cholesterol-to-Total Cholesterol Ratios in Patients With Type 2 Diabetes. Diabetes Care. 2004;27:2777-2783.
215. van Dokkum W, Wezendonk B, Srikumar TS, van den Heuvel EG. Effect of nondigestible oligosaccharides on large-bowel functions, blood lipid concentrations and glucose absorption in young healthy male subjects. Eur J Clin Nutr. 1999;53:1-7.
218. Schaafsma G, Meuling WJ, van Dokkum W, Bouley C. Effects of a milk product, fermented by Lactobacillus acidophilus and with fructo-oligosaccharides added, on blood lipids in male volunteers. Eur J Clin Nutr. 1998;52:436-40.
219. Jackson KG, Taylor GRJ, Clohessy AM, Wlliams CM. The effect of the daily intake of inulin on fasting lipid, insulin and glucose concentrations in middle-aged men and women. Br J Nutr. 1999;82:23-30.
226. Lehtimaki T, Metso S, Ylitalo R, et al. Microcrystalline chitosan is ineffective to decrease plasma lipids in both apolipoprotein E epsilon4 Carriers and non-carriers: a long-term placebo-controlled trial in hypercholesterolaemic volunteers. Basic Clin Pharmacol Toxicol. 2005;97:98-103.
228. Zern TL, Wood RJ, Greene C, et al. Grape polyphenols exert a cardioprotective effect in pre- and postmenopausal women by lowering plasma lipids and reducing oxidative stress. J Nutr. 2005;135:1911-1917.
229. Hansen AS, Marckmann P, Dragsted LO, et al. Effect of red wine and red grape extract on blood lipids, haemostatic factors, and other risk factors for cardiovascular disease. Eur J Clin Nutr. 2005 Jan 26. [Epub ahead of print]
231. Pistone G, Marino A, Leotta C, et al. Levocarnitine administration in elderly subjects with rapid muscle fatigue: effect on body composition, lipid profile and fatigue. Drugs Aging. 2003;20:761-767.
232. Rahbar AR, Shakerhosseini R, Saadat N, et al. Effect of L-carnitine on plasma glycemic and lipidemic profile in patients with type II diabetes mellitus. Eur J Clin Nutr. 2005 Mar 2. [Epub ahead of print]
233. Shaish A, Harari A, Hananshvili L, et al. 9-cis beta-carotene-rich powder of the alga Dunaliella bardawil increases plasma HDL-cholesterol in fibrate-treated patients. Atherosclerosis. 2006 Jan 12. [Epub ahead of print]
236. Duthie SJ, Jenkinson AM, Crozier A, et al. The effects of cranberry juice consumption on antioxidant status and biomarkers relating to heart disease and cancer in healthy human volunteers. Eur J Nutr. 2005 Jul 20. [Epub ahead of print]
237. Koh-Banerjee PK, Ferreira MP, Greenwood M, et al. Effects of calcium pyruvate supplementation during training on body composition, exercise capacity, and metabolic responses to exercise. Nutrition. 2005;21:312-319.
241. Castro Cabezas M, de Vries JH, Van Oostrom AJ, et al. Effects of a stanol-enriched diet on plasma cholesterol and triglycerides in patients treated with statins. J Am Diet Assoc. 2006;106:1564-1569.
243. Polagruto JA, Wang-Polagruto JF, Braun MM, et al. Cocoa flavanol-enriched snack bars containing phytosterols effectively lower total and low-density lipoprotein cholesterol levels. J Am Diet Assoc. 2006;106:1804-1813.
245. Gardner CD, Lawson LD, Block E, et al. Effect of raw garlic vs commercial garlic supplements on plasma lipid concentrations in adults with moderate hypercholesterolemia: a randomized clinical trial. Arch Intern Med. 2007;167:346-353.
246. Ajuluchukwu JN, Okubadejo NU, Mabayoje M, et al. Comparative study of the effect of tocotrienols and -tocopherol on fasting serum lipid profiles in patients with mild hypercholesterolaemia: a preliminary report. Niger Postgrad Med J. 2007;14:30-33.
247. Kerckhoffs DA, Brouns F, Hornstra G, Mensink RP. Effects on the human serum lipoprotein profile of beta-glucan, soy protein and isoflavones, plant sterols and stanols, garlic and tocotrienols. J Nutr. 2002;132:2494-2505.
248. Mensink RP, van Houwelingen AC, Kromhout D, et al. A vitamin E concentrate rich in tocotrienols had no effect on serum lipids, lipoproteins, or platelet function in men with mildly elevated serum lipid concentrations. Am J Clin Nutr. 1999;69:213-219.
251. Baba S, Osakabe N, KatoY, et al. Continuous intake of polyphenolic compounds containing cocoa powder reduces LDL oxidative susceptibility and has beneficial effects on plasma HDL-cholesterol concentrations in humans. Am J Clin Nutr. 2007;85:709-717.
253. Queenan KM, Stewart ML, Smith KN, et al. Concentrated oat beta-glucan, a fermentable fiber, lowers serum cholesterol in hypercholesterolemic adults in a randomized controlled trial. Nutr J. 2007 Mar 26. [Epub ahead of print].
254. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007;369:1090-1098.
256. Ho SC, Chen YM, Ho SS, et al. Soy isoflavone supplementation and fasting serum glucose and lipid profile among postmenopausal Chinese women: A double-blind, randomized, placebo-controlled trial. Menopause. 2007 Mar 19. [Epub ahead of print]
258. Reiner Z, Tedeschi-Reiner E, Romic Z. Effects of rice policosanol on serum lipoproteins, homocysteine, fibrinogen, and C-reactive protein in hypercholesterolaemic patients. Clin Drug Investig. 2005;25:701-707.
260. Hoie LH, Guldstrand M, Sjoholm A, et al. Cholesterol-lowering effects of a new isolated soy protein with high levels of nondenaturated protein in hypercholesterolemic patients. Adv Ther. 2007;24:439-447.
264. Davidson MH, Stein EA, Bays HE, et al. Efficacy and tolerability of adding prescription omega-3 fatty acids 4 g/d to simvastatin 40 mg/d in hypertriglyceridemic patients: an 8-week, randomized, double-blind, placebo-controlled study. Clin Ther. 2007;29:1354-1367.
265. Reppas C, Swidan SZ, Tobey SW, et al. Hydroxypropylmethylcellulose significantly lowers blood cholesterol in mildly hypercholesterolemic human subjects. Eur J Clin Nutr. 2007 Sep 19. [Epub ahead of print]
270. Tay J, Brinkworth GD, Noakes M, et al. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am Coll Cardiol. 2008;51:59-67.
271. Howard BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295:655-666.
272. Berglund L, Lefevre M, Ginsberg HN, et al. Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states. Am J Clin Nutr. 2007;86:1611-1620.
273. Pelkman CL, Fishell VK, Maddox DH, et al. Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women. Am J Clin Nutr. 2004;79:204-212.
279. Vissers MN, Trip MD, Pritchard PH, et al. Efficacy and safety of disodium ascorbyl phytostanol phosphates in men with moderate dyslipidemia. Eur J Clin Pharmacol. 2008 Mar 5. [Epub ahead of print]
280. Allen RR, Carson L, Kwik-Uribe C, et al. Daily consumption of a dark chocolate containing flavanols and added sterol esters affects cardiovascular risk factors in a normotensive population with elevated cholesterol. J Nutr. 2008;138:725-731.
283. Bundy R, Walker AF, Middleton RW, et al. Artichoke leaf extract ( Cynara scolymus ) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: A randomized, double blind placebo controlled trial. Phytomedicine. 2008 Apr 16.
286. Micallef MA, Garg ML. The lipid-lowering effects of phytosterols and (n-3) polyunsaturated fatty acids are synergistic and complementary in hyperlipidemic men and women. J Nutr. 2008;138:1086-1090.
287. Harland JI, Haffner TA. Systematic review, meta-analysis and regression of randomised controlled trials reporting an association between an intake of circa 25g soya protein per day and blood cholesterol. Atherosclerosis. 2008 Apr 15.
289. Sood N, Baker WL, Coleman CI. Effect of glucomannan on plasma lipid and glucose concentrations, body weight, and blood pressure: systematic review and meta-analysis. Am J Clin Nutr. 2008;88:1167-1175.
291. Wei ZH, Wang H, Chen XY, et al. Time- and dose-dependent effect of psyllium on serum lipids in mild-to-moderate hypercholesterolemia: a meta-analysis of controlled clinical trials. Eur J Clin Nutr. 2008 Nov 5.
294. Kianbakht S, Abasi B, Perham M, Hashem Dabaghian F. Antihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomized double-blind placebo-controlled clinical trial. Phytother Res. 2011;25(12):1849-1853.
296. Kianbakht S, Dabaghian FH. Improved glycemic control and lipid profile in hyperlipidemic type 2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomized placebo. Controlled clinical trial. Complement Ther Med. 2013;21(5):441-446.
Last reviewed September 2014 by EBSCO CAM Review Board
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2012 EBSCO Publishing All rights reserved.
What can we help you find?close ×