Are Supplements To Lower Cholesterol Safe?

Are popular dietary supplements recommended to help with high cholesterol and triglycerides safe for everyone?

Mariela Santos Carballo, an internal medicine nurse practitioner at Franciscan Physician Network Hammond Clinic in Munster, reviews current research on how to lower cholesterol through diet changes and supplements.

What Does Research Say About How To Lower Cholesterol?

"Many healthcare professionals participate in scientific meetings to reach agreements on the best medication and non-medication options, like diets, supplements and physical activity, for the safe and effective control of dyslipidemia with the least number of adverse risks for patients," Carballo said.

Carballo cautions consumers to consider the sources of information and medical claims. Misinformation or misinterpretation of information can have severe negative impacts on your health. 

"Who has opened search pages on the internet or some social media and come across tips for food and supplements that help lower cholesterol or triglycerides?" she said. "But is this information coming from professionals with academic knowledge or from celebrities or companies that profit by promoting products without a scientific basis and are only committed to selling products?"

What Diet Changes Can Help Lower Cholesterol?

Lowering cholesterol with lifestyle changes often includes diet as a key component. Multiple international scientific societies agree that certain diets, including the Mediterranean diet and the DASH diet, improve blood levels of total cholesterol, LDL (low-density lipoprotein or the “bad” cholesterol) and triglycerides.

Mediterranean diet

When scientists look at the "Mediterranean diet," they've found that there isn't one strict, universally agreed-upon definition of what it is. One study might look at a diet with a lot of olive oil, another might focus on vegetables, and yet another on fish, with different amounts of each.

The Mediterranean diet is higher in fruits (fresh), vegetables (especially roots and greens), whole grains and fish rich in omega-3 fatty acids. It consists of low amounts of red meat and higher-fat dairy foods and recommends using olive oil, nuts, or margarines blended with rapeseed or flaxseed oils instead of butter.

Because the Mediterranean diet has been defined and practiced in studies differently with much variation, it's hard for scientists to confidently say, "Yes, following this exact version of the Mediterranean diet will lower your cholesterol, triglycerides and blood pressure."

"Because the Mediterranean diet analyzed in scientific studies showed low uniformity regarding the definition and amount of its components, it still showed low scientific evidence of its effectiveness in lowering cholesterol levels, triglycerides, and blood pressure," Carballo said.

From a rigorous scientific viewpoint, because no single "recipe" is consistently studied, the evidence for its specific effects on those health markers isn't as clear-cut as it could be. More consistent research is needed to pinpoint precisely which aspects of the Mediterranean diet, and in what amounts, are most effective for improving cholesterol and triglyceride levels.

DASH diet

Another diet that is widely accepted by scientific societies is the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension.

The DASH diet is high in vegetables, fruits, low-fat dairy products, whole grains, poultry, fish, and nuts and is low in sweets, sugar-sweetened beverages, and red meats. This eating plan is low in saturated fat, total fat, and cholesterol, and rich in potassium, magnesium, calcium, protein, and fiber.

"This diet has shown more robust evidence of its effectiveness for lowering cholesterol, triglycerides and reducing blood pressure levels," Carballo said. "The main difference between the Mediterranean diet and the DASH diet is that the latter has stricter definitions regarding fat content (saturated fat no more than 5% to 6% of total calorie count, no trans-fat), salt (no more than 2.3 g a day), and alcohol use, where the Mediterranean diet allows moderate use of wine, and the DASH diet discourages alcohol consumption."

Adjusting diet to health needs

The DASH and Mediterranean diets should be individualized according to the calorie expenditure of each person, and the presence of other diseases that require dietary restrictions such as diabetes, gout, lactose intolerance and celiac disease.

Carballo said the challenge comes in making and sticking to overall diet changes.

"It is not easy to change dietary patterns, so many people prefer to reduce the total amount of calories they consume, or choose some healthier options, or even opt for the isolated use of dietary supplements," she said, "and that is where the biggest mistakes can be made."

Coconut oil

"There is much publicity about the benefits of coconut oil in controlling dyslipidemia," Carballo said. "However, studies show that it causes a smaller increase in LDL cholesterol only when compared to butter, increasing LDL cholesterol when compared to other non-tropical vegetable oils such as safflower, sunflower, corn, soybean, olive and canola oil. There is also a difference regarding the type of coconut oil used, with hydrogenated being less recommended than its virgin version. In fact, the meta-analysis published in the AHA Journal in 2020 advises against using coconut oil in favor of other non-tropical vegetable oils."

Omega-3 fatty acids

Regarding omega-3 fatty acid supplements, medical societies have recommended a combination of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) as beneficial for lowering cholesterol, triglycerides, and cardiovascular risk.

"It seems that different formulations may have different actions," Carballo said. "According to research, DHA seems to increase HDL (good cholesterol) more than EPA, while EPA decreases LDL cholesterol more than DHA, and both promote an anti-inflammatory profile with cardiovascular protection. This review just considered trials that used 2 grams or more of near-pure EPA and DHA in a day since there is strong evidence that this dose is linked with positive impacts on relevant risk factors. There is also a recommendation by the latest American Association of Clinical Endocrinology for the use of EPA in its isolated form for lowering triglycerides."

Soluble fiber

Soluble fibers like Psyllium and Guar Gum are largely used and recommended as a supporting therapy for lowering cholesterol and triglycerides. Research studies suggest 15 grams of fiber each day for better lipid control.

Eating a diverse diet that includes vegetables and fruits can make reaching this recommended daily intake easy. If your diet is typically poor in fiber, supplementation may be beneficial.

"Fiber intake may lead to diarrhea, dehydration, or intestinal obstruction in people with acute inflammatory bowel conditions such as colitis flares or diverticulitis," Carballo said. "Using fiber supplements requires adequate hydration and being supervised by a healthcare provider in cases of patients with gastrointestinal diseases or food allergies".

Why Do High Cholesterol And Triglycerides Matter?

High levels of cholesterol and triglycerides (dyslipidemia) can be harmful to overall health and are significant risk factors for cardiovascular diseases that can lead to stroke, angina, heart attack, heart failure and peripheral artery disease.

Still, Carballo urges caution before trying new cholesterol-lowering supplement options.

"Look for medical attention when a concern about preventing or treating high cholesterol or triglycerides arises," Carballo said. "Since every person has different needs and may have different health conditions that require different supplements, diets or even medications for a short period or lifetime, your provider will be the best resource to guide you towards a healthier life."