Integrative Approaches to Healthy Lipid (Cholesterol) Levels

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For years, we have known that lipid levels affect blood vessel health. Lipids are a class of chemicals that includes fats, waxes, oils, and steroids. Cholesterol is one type of lipid. Triglycerides are another. Using guidelines from groups like the American Heart Association, clinicians help people improve their lipid levels so they will be less likely to have damaged blood vessels (vascular disease) and plaque buildup (atherosclerosis) in the heart and other parts of the body. There are different ways to keep lipids at the healthiest levels possible to protect the heart, brain, kidneys, eyes – everywhere in the body, really. Healthy lifestyle choices matter, and complementary approaches, such as taking dietary supplements, can be helpful as well.

Why Does Cholesterol Matter?

Keeping lipids under control is one way to reduce the risk of heart attacks, strokes, or other blood vessel-related problems. There are others too, and all these risk factors are important to keep in mind, including:

1. Keep blood sugars healthy. Prevent insulin resistance and diabetes.
2. Avoid tobacco and other sources of nicotine.
3. Keep blood pressure numbers in a good range. For more information, go to Integrative Approaches to Hypertension.
4. Engage in regular physical activity.¹
5. Aim for a healthy weight.

Figure 1 has more information on what protects and harms arteries.

What Is Measured in a Cholesterol Panel and Why?

Different types of lipids measured in lab tests. The first one listed is total cholesterol. We need cholesterol to live. It is part of all our cells, and it is used to make important compounds like estrogen, testosterone, vitamin D, and bile.

Triglycerides are also important. They are a different type of lipid from cholesterol. Triglycerides can increase risk of vascular disease too, and if levels get very high, they can harm the pancreas and other organs. Triglycerides are mainly stored in fat cells and can be made by the liver. Triglycerides come from fatty foods we eat, and the body makes them if we eat more calories than we need. If someone eats too much fat or too many calories in general, or if someone has genes that put them at higher risk, their body may have high triglycerides.

Figure 1 Factors that help and harm a person's blood vessels

Because lipids do not mix well in water, the body has special ways to carry them in the blood. Cholesterol and triglycerides are carried in tiny, round particles called lipoproteins. Lipoproteins have a core of triglycerides and cholesterol that is surrounded by apolipoproteins, which dissolve in water. Apolipoprotein B (ApoB) is one example. If ApoB is high, it means a person has more risk for blood vessel disease.

There are 5 different types of lipoprotein particles, named based on how dense (heavy) they are. There are three that you will hear about the most:

1. High-density lipoprotein (HDL) is often called “good cholesterol.” It moves fats back to your liver so your body can get rid of them. Up to a point, higher levels of HDL lower a person’s risk of heart attacks. Some studies show that high HDL’s (especially above 100 mg/dL) may increase risk, but other studies do not agree.^2,3
2. Low-density lipoprotein (LDL) is also called “bad cholesterol.” Higher levels are linked to higher risk of strokes, heart attacks, and other blood vessel problems. Heart attacks occur when plaques form in the heart’s arteries and break open, blocking flow of blood to the heart muscle. LDL is a main source of the plaque. Plaque also contains white blood cells, damaged artery cells, calcium, and clotted blood. The higher a person’s LDL, the higher their risk of making plaque. If people have vascular disease, the goal is to keep their LDL low.
3. You may also see very low-density lipoprotein, VLDL. VLDL is also a “bad” form of cholesterol.

For people wanting to learn more about how lipids affect blood vessel health, there are good illustrations at Atherosclerosis by the American Heart Association. Most of the dietary supplements that are used to manage lipids stop plaque formation somewhere along the process.

What Should Someone’s Cholesterol Numbers Be?

Clinicians rely heavily on lab values to guide treatment of cholesterol numbers. Recommendations change over the years, based mostly on research findings. In the United States, these depend on someone’s 10-year risk of having a heart attack or stroke. A person can go to ASCVD Risk Estimator Plus and enter their blood pressure numbers, cholesterol lab values, and other information to find their risk level. Risk matters, because if risk is low, medications are not as helpful. The United States Preventative Services Task Force suggest statin drugs be prescribed for people who have 1 or more risk factors and more than a 10% risk of having a heart attack or stroke over 10 years, if they are between ages 40-75.⁴ The American College of Cardiology recommends consideration of a statin if the 10 year risk is >5% if certain risk factors are present.⁵

Once you know your risk, you can see where your numbers should be. Most of the most recent guidelines focus on LDL.⁵

• Studies show that lower LDL is better, even as levels go below 50 mg/dL. The American Heart Association recommends that LDL to at least be under 100 mg/dL (with total cholesterol under 150 mg/dL).
• For people who have had a heart attack or stroke or other major risk factors, dropping the number by half, or at least under 70 mg/dL is the goal.

A large 2016 review found that for every 18-point drop in LDL values, risk of heart events dropped to around 77% of what it would have been.⁶

HDL is also important. For every 1 mg/dL rise in HDL, there is a 3-4% reduction in cardiovascular mortality.

How Can an Integrative Approach Be Used?

If cholesterol numbers are abnormal, there are things people can do to improve them. Lifestyle measures, like healthy eating and physical activity, are important. Working at the level of body chemistry, with medications and/or dietary supplements can help too. An integrative, whole health approach can include medications, and it recognizes that they may sometimes have adverse effects, that people have different preferences and opinions, and that other approaches can help as well. For some, integrative approaches can help a person avoid having to take medications or at least make it possible for them to take lower doses. How aggressive treatment needs to be depends on how high a person’s risk is. Treatment is much more intense, for example, if someone has already had a heart attack.

What is a Good Starting Place?

It can feel overwhelming trying to decide where to start to lower cholesterol. Consider these tips:

1. Take a gentle approach. It is not about self-blame.
2. Change one thing at a time. It may be easier to add or cut back on one food group and slowly build up to an overall approach to eating like the Mediterranean diet, or the Portfolio Diet (covered in the next section).
3. Once someone is using a particular approach to eating, it can help to follow it for a few months and then see how lab numbers are doing.
4. If numbers are very abnormal, a person’s care team may encourage them to start right away with medications. They can still make other changes too, but if they are taking cholesterol medicine they should talk to a clinician before they take dietary supplements too.
5. Regardless of what medications or supplements a person is using, healthy lifestyle should always be part of the mix.

How Does Nutrition Affect Cholesterol?

Focusing on nutrition is one of the most powerful ways to improve cholesterol numbers in most people. While drugs usually target one specific chemical in the body, nutrition affects the body in all sorts of ways. Healthy eating has many other health benefits as well; for example, it reduces inflammation, lowers cancer risk, decreases arthritis pain, and helps preserve brain function.

Medical guidelines used to focus mainly on how much cholesterol people eat, but large studies have shown there is more to it.⁷ The US Food and Drug Administration recommends keeping cholesterol intake under 300 mg per day. Go to Cholesterol Content of Foods for a list of cholesterol levels in various foods. Beyond that, though, there are many other eating suggestions that can also help, related to factors like fiber intake, the types of fat a person eats, and certain food groups that are especially good choices.

Heart-Healthy Diet Plans

Many different diets can be helpful at keeping cholesterol at healthy levels.⁸ The key is for a person to figure out which eating pattern is best for them, based on their budget, personal tastes, and cultural background. Three great examples of diets to consider include:

1. The Mediterranean (Medi) Diet and other Traditional Diets. This is a great first choice. A 2024 study found that a person’s chances of dying from coronary artery disease or having major heart cardiac events were about half of what they were compared to people in a control group if they ate the Medi Diet.⁹ While we still have more to learn,¹⁰ this is a good option to consider.¹¹ To learn more, go to the American Heart Association’s What is the Mediterranean Diet?. To see an example of a Medi Diet food pyramid, go to Mediterranean Diet Food Pyramid: What is it and How to Follow it.The Mediterranean diet is one example of a traditional way of eating. Most traditional ways of eating are not as well-studied as the Mediterranean diet. However, because they are plant-centered and based on whole foods, they will likely support healthy lipids. The important thing to remember about these ways of eating is that they avoid processed foods and are low in sweetened foods and drinks and red and processed meat.
   

   Mediterranean and other Traditional Diets: A Quick Look

   • • Get most of your daily calories and protein from plant-based foods (fruits, vegetables, whole grains, legumes, and nuts).
     • Keep fat intake moderate, with a lot of it coming from unsaturated fats like olive oil, canola oil, and the oils found in nuts.
     • For meat eaters, focus on poultry, lean meat, and seafood as the main sources of animal protein. Limit red meat.
     • Examples of traditional ways of eating from Africa, Asia, Latin America, and also Vegetarian, and Vegan diets can be found by on the OLDWAYS Cultural Food Traditions website at Explore heritage diets.
       
       
2. The Dietary Approaches to Stop Hypertension (DASH) Diet. In a study by the American Heart Association of 10 different diets, the DASH diet was ranked as one of the best.¹² To learn more about this diet, go to DASH Eating Plan.
   

   DASH Diet: A Quick Look

   • • Eat a lot of fruits, vegetables and whole grains.
     • Include fat free or low-fat dairy, vegetable oils, nuts, beans, fish, and poultry.
     • Limit sugar-sweetened foods and drinks.
     • Limit saturated fats (discussed later).
       
       
3. The Portfolio Diet. This diet also leads to good changes in cholesterol and overall heart risk.¹³ For more information, go to What Is the Portfolio Diet, and Does It Lower Cholesterol?
   

   Portfolio Diet: A Quick Look

   The following amounts of different foods are based on a 2,000 calorie/day diet (these are discussed more in the next section):

   • • 20 grams (less than 1 ounce) of fiber. This is discussed more later.
     • 50 grams of soy protein from foods such as tofu, meat alternatives and soy milk.
     • 2 grams (.064 ounces) of plant sterols.
     • Eating more legumes (peas, beans, lentils, and peanuts).
     • 30 grams of almonds – about 23 almonds (one ounce). Walnuts, cashews, Brazil nuts and macadamia nuts are also good choices

Other diets that can be helpful include:¹²

• • Vegetarian, including lactovegetarian (includes dairy) and ovo-vegetarian (includes eggs)
  • Vegan (no animal products at all)
  • Pescetarian (fish is the only form of meat eaten)

Very low-fat diets and low carb diets were rated as not being as helpful for heart health. Keto diets and Paleo Diets have lower ratings than those mentioned above.¹⁴

What About Specific Foods and Their Effects?

A 2021 review focused on specific foods that raised or lowered LDL.¹⁵ Here are some important tips:

1. Pay attention to the types of fat you eat. What types of fats a person eats changes their lipid levels and their heart disease risk.¹⁶ This is different from simply avoiding cholesterol in the diet.
   
   • Choose unsaturated fats. Unsaturated fats are liquid at room temperature and can be divided into two general categories, polyunsaturated and monounsaturated.
     
     • Polyunsaturated fats. Oils high in polyunsaturated fat include corn, soybean, safflower, and sunflower. Foods high in polyunsaturated fats include fatty or oily fish such as anchovies, salmon, sardines, bluefin tuna, mackerel, and black cod, Also some nuts and seeds including walnuts, flaxseeds, and sunflower seeds.
       
       
       • Omega-3 fats, which the body cannot make on its own, are a type of polyunsaturated fats. The AHA recommends 3 grams daily on average (for example, through eating 2 servings of fish each week). Omega-3’s are also found in flax oil, walnuts, and a variety of other foods. The National Institutes of Health suggest getting 1.1-1.6 grams daily. Higher doses may be taken to lower triglycerides for people who have very high numbers (>500 mg/dl), but there has been a link to heart arrhythmias with supplementation (atrial fibrillation) and it is not clear that risk of heart attacks is lowered with these supplements.¹⁷ Stroke risk may also increase.¹⁸ It is probably best to get omega-3’s in the diet if possible. To learn more about omega-3 content in foods, go to Omega-3 Fatty Acids.

   A large 2023 review of 90 trials found that 1 gram daily of fish oil lowered triglycerides by 19 mg/dL and increased HDL by 1.4 mg/dL. LDL went up by just a few points.¹⁹ With a 2 gram/day dose, triglycerides dropped by 43 mg/dL, and other numbers changed just a bit. At 3 grams/day, triglycerides decreased by 69 mg/dL.

   • • Monounsaturated fatty acids (MUFAs). Olive oil is best known for being high in monounsaturated fatty acids. Other oils include canola, peanut, sesame, and high-oleic sunflower. Food sources include avocados, peanut butter, and various seeds and nuts (sesame seeds, almonds, hazelnuts).²⁰ MUFAs lower LDL and may even raise HDL. 20-40 grams daily of MUFA’s (10-20% of daily caloric intake) is suggested.
   • • • A large 2023 review found that a diet focused on avocados lowers total cholesterol and LDL, but it doesn’t affect triglycerides or fasting blood sugars.²¹ Some studies indicate a positive effect of 1 avocado per day.²¹ Other studies show a benefit of with just 1-2 per week.²² A medium avocado contains 15 grams of MUFAs. It also contains between 220 and 250 calories so it’s important to take that into account if you are watching your total number of calories per day.
         
         
       • Canola oil improves many cholesterol measures. It drops LDL by about 8.9 mg/dL when used as a main source of fat in the diet. 1 tablespoon of canola oil contains around 8.8 grams of MUFAs.
         
         
       • Olive oil has polyphenols that help with cholesterol levels, and recent studies suggest it mostly raises HDL versus lowering LDL.²³ 1 tablespoon of olive oil contains around 9.6 grams of MUFAs.
         
         
   • Avoid saturated fats. Saturated fats are solid at room temperature. Sources include butter and other dairy products as well as poultry (especially with the skin) and red meats.
     
     
   • Avoid trans- fats. Trans- fats lower the good cholesterol (HDL), raise the bad cholesterol (LDL), and increase heart disease. These fats are mostly made in labs and used to create foods that stay solid at room temperature and last a long time. They are sometimes called “partially hydrogenated oils.” Trans-fats are now banned in the US and many other countries, but they can still be created when oils (like the ones in deep fat friers) are cooked at high heat.
     
     
2. Choose foods with phytosterols (plant sterols and stanols). These natural compounds come from plants, and their chemical structure is a lot like cholesterol. They keep the gut from absorbing as much cholesterol in the diet. Eating 2 grams of phytosterols a day will drop LDL by 10%. Research shows that it is more helpful to add them in when a person is taking a statin drug (like rosuvastatin or simvastatin) than just to double the dose of the statin.²⁴
   

   Foods that have sterols and stanols include vegetables, fruits, legumes (beans, lentils, chickpeas), nuts, seeds, vegetable oil, and whole grains. They are added to some foods now, including margarines, cheeses, bread, milk, cottage cheese, yogurt, salad dressings, snack bars, orange juice, and even meats.²⁵ To see a list of phytosterol levels in different foods have, go to Plant Sterol and Stanol Contents in Different Foods. Many different supplements containing plant sterols and stanols are also available.

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   A good dose of plant sterols/stanols in supplement form is 2-3 grams daily. Be careful not to eat too many calories by trying to get enough of them from foods where they have been added, like spreads or juices.

3. Eat enough fiber. Fibers are carbohydrates that are not digested by the gut. Foods high in soluble fiber (fiber that dissolves in water, as compared to insoluble fiber) cause fats to pass on through the gut versus being absorbed into the bloodstream. Soluble fiber reduces LDL levels by an average of about 9 mg/dL. One large review where people took an average of 10.2 mg of psyllium daily found a reduction in LDL of 12.7 mg/dL.²⁶ Remember, insoluble fiber is different. It is fiber that does not dissolve as well in water and helps more with constipation.
   

   Guidelines encourage people over age 2 to get 14 grams of fiber for every 1000 calories they eat each day. Many experts say that at least ¼ of total fiber should be soluble. To see how much fiber is in different foods, go to Food Sources of Dietary Fiber. Fiber also helps to reduce risk of type 2 diabetes, stroke, colorectal cancer, and diverticular disease. It slows down how the gut takes up carbohydrates, and people who take it before meals can promote weight loss, because it absorbs water and makes them feel fuller. Most people only eat about 15 grams of fiber a day, so supplementing is a good choice.

   Some examples of water-soluble fiber include:

   • • Pectin. This form of fiber is found in fruits, vegetables and seeds. Carrots, apples and the white substance on the inner rinds of citrus fruits are excellent sources of pectin. A Scottish study found that eating two carrots a day decreased cholesterol by about 10%.²⁷ Eating apples reduces total cholesterol and LDL to a small degree.²⁸
   • • Cereal brans can lower total cholesterol, LDL, and blood glucose.
       • Oat bran has some of the most powerful effects.²⁹ A British study showed a 5% reduction in cholesterol with daily ingestion of oat bran cereal.³⁰
         
         
       • Barley contains water-soluble fibers like beta-glucan, which can also be found in wheat, fungi (mushrooms), and yeast. Barley has been shown to lower LDL cholesterol by about 10 points.³¹ Sources include 3 grams of barley oil extract and 30 grams of barley bran flour.³²
         
         
       • Rice bran was found in a review of 11 studies to lower LDL by an average of 15 mg/dL and triglycerides also by 15 mg/dL.³³

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   Fiber can make it harder to digest or absorb some drugs, as well as some vitamins and minerals like calcium, iron, zinc, and vitamin B₁₂. Take fiber supplements at least an hour apart from taking anything else.

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4. Eat other foods that can help. Some of these have already been mentioned:

• Legumes (foods from pods, like peas, lentils, beans). A 2024 study found that those who have higher overall legume intakes reduced their LDL by an average of 6.2 mg/dL.³⁴
  
  
• Nuts. Nuts are an excellent source of omega-3 polyunsaturated fat, fiber, plant sterols and flavonoids. Nuts are also high in calories, so the dose should remain less than ¼ cup or about a handful a day (1 oz) unless weight gain is needed.³⁵ “Eat a handful, not a can full!” Increasing nut consumption works best at lowering cholesterol if they are consumed in place of saturated fat in the diet. A recent study found that adding nuts to the diet can lower LDL by 3.5-10 mg/dL and triglycerides by 4-15 mg/dL.³⁶ Be careful to avoid nuts with added oils or excess salt.
  
  
• Soy protein. Soy protein lowers LDL better than dairy protein.³⁷ Soy slows down the digestion of cholesterol and changes how LDL cholesterol is processed by the body. Research shows that soy proteins lowered LDL by about 11%, versus 6% with milk protein.³⁷ Aim for 25-50 grams of soy protein daily. 10 grams of soy can be obtained from 1 to 2 cups of soy milk, 4 ounces of tofu, 1 ounce of soy flour, or 1/2 cup of textured soy protein. Eating soy foods is better than taking a supplement, unless it is made of whole soy protein. Many soy supplements only include isoflavones (such as genistein and daidzein) but do not include the fiber or the plant sterols, so they do not work as well for cholesterol. A 2021 review found that soy consumption was linked to a decrease in LDL of 8 mg/dL in people with type 2 diabetes.³⁸
  
  
• Turmeric (the spice, popular in Indian food, that makes food orange). A 2023 review concluded that eating turmeric (and its main active ingredient, curcumin) can lower total cholesterol, triglycerides (6.7 mg/dL drop), and reduce LDL by an average of 5 mg/dL and raise HDL and average of 1.8 mg/dL.³⁹ A person can cook with it (a teaspoon is 200 mg) or take a supplement. The supplement can be taken at doses of 500-1000 mg three times a day. It is also a powerful anti-inflammatory and can help with arthritis pain and other problems. More is absorbed into the body if it is taken with black pepper. Side effects are rare; sometimes people can get GI issues, like nausea, vomiting, reflux, or constipation.
  
  
• Foods with polyphenols. These include grapes, cocoa, blueberries, cranberries, black currants, peanuts, green and black tea, onions, legumes, and parsley. Any blue, purple or dark colored grape or berry will be rich in them. While they do not change cholesterol numbers much, they seem to keep white blood cells from taking up cholesterol, which is one of the steps of plaque formation in the blood vessels.⁴⁰ Add these foods as part of an overall healthy diet.
  
  
• Grapes and grape products contain phenolic compounds like resveratrol that do not have a significant influence on cholesterol but appear to be protective against heart disease, especially for people who eat a lot of saturated fats.
  
  

How Much Does Physical Activity Help?

The short answer is that physical activity helps a lot, not just with lipids but with many other risk factors. Aerobic exercise uses continuous movement to increase heart rate (like jogging or cycling). Resistance training is strength training or weight training. Both types of activity help. Here are some important recent study findings:

• A large 2024 review found that physical exercise markedly reduces many risk factors for blocked arteries, and this included lipid values.⁴³ Most types of exercise helped, including high intensity interval training and qi gong. Low to moderate intensity exercise had favorable effects.
  
  
• A 2025 analysis of 19 studies found that aerobic exercise improved lipids in overweight and obese people. People did better the more regularly they exercised, the harder they exercised, and based on how long they had been regularly staying active. The more they moved toward their ideal weight, the better they did.⁴⁴
  
  
• Another review focused on men with obesity. Total cholesterol decreased by 10-15% for those who did combined resistance and cardiovascular exercise.⁴⁵
  
  
• A 2025 review focused on older adults found that in addition to lowering blood pressure, aerobic and resistance exercise combined helped lower LDL and triglycerides.⁴⁶ HDL level improved with aerobic and combined training, but not tai chi.
  
  
• A review of 57 studies found tai chi reduces triglyceride levels.⁴⁷

At least 150 minutes a week is typically encouraged,⁴⁸ with exercise happening most days of the week, but it best to tailor an activity plan to each individual’s needs and abilities. A large 2022 found that exercise training lowers total cholesterol by 5%, LDL 2 % and triglycerides by 15%; it raises HDL by 6%.⁴⁹ Of course, this will vary from person to person and the amount/type of activities they do. It’s important to remember that the benefit of exercise on cardiovascular health extends beyond improvements in cholesterol.

What About Mind-Body Approaches?

Mind-body approaches, including managing anger and stress, seem to reduce overall vascular disease risk; more research is needed to assess the overall benefits of meditation.⁵⁰ A 2024 study concluded, based on findings from 16 studies, that doing regular static meditation (meditation without movement) reduced total cholesterol by 14 mg/dL on average and triglycerides by 33 mg/dL.⁵¹

How Does Sleep Help?

Short and long sleep times each night are tied to more heart risk in general.⁵² It is not clear how much sleep times affect cholesterol numbers, but aiming for good sleep is important just the same.⁵³ Treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) can help to improve many risk factors for heart disease, including triglyceride levels.⁵⁴ Sleep apnea is linked to abnormal triglycerides and total cholesterol, but not as much to LDL levels.⁵⁵

NOTE: If cholesterol remains elevated despite incorporating these lifestyle measures, the cause may be related to an increased production of cholesterol from the liver, and the patient would benefit from a prescription medication (statin) to reduce risk.

What About Complementary Health Approaches Like Acupuncture?

When it comes to complementary approaches to manage lipids, supplements have the most research supporting their use. A few studies of acupuncture showed it might help too, when combined with medications. A 2025 review of 18 different studies of people with known heart disease found that acupuncture combined with standard treatments helped lower LDL, A1c (a diabetes measure), and inflammation more than standard therapies alone.⁵⁶ A 2024 review of 16 Chinese studies found that if acupuncture was added to statin therapy, numbers improved even more. Decreases of total cholesterol averaged 35 mg/dL, LDL 23.5 mg/dL, and triglycerides 63 mg/dL.⁵⁷ Bias in the studies was rated as high, so more information is needed before we can make any reliable conclusions on acupuncture for this indication.

Which Dietary Supplements Should I Consider?

Several dietary supplements show promise for lowering cholesterol. It is usually best, if possible, to focus on nutrition and physical activity first. If risk is high, it may be best to explore whether medications should be part of the plan. Most supplements need to be taken for several weeks to have full effect. Start them at a dose that is at the low end of what is recommended and increase as needed and as tolerated. The following have favorable effects on lipid values, though red yeast should be used with caution. Niacin and fish oil supplements are not currently recommended.

• Alpha-lipoic acid (ALA) ALA is an antioxidant produced naturally in the body and available in the diet in broccoli, potatoes, spinach, yams, carrots, beets, red meats and other foods. A 2021 review found that taking it for 16 weeks lowers total cholesterol by 11 mg/dL, LDL by 11 mg/dL, and triglycerides by 31 mg/dL.⁵⁸ It has less of an effect on HDL. Dose is 300-1,200 mg daily, and it tends to be safe to take at these doses.
  
  
• Artichoke Extract Artichoke extract has compounds that seem to block an enzyme called HMG-CoA reductase, similar to how statin medications lower cholesterol. It increases bile production as well. It is best to eat artichokes, but if not possible, the dose of artichoke extract is 600-900 mg three times/day or 900 mg three times daily.⁵⁹ Taking leaf extract or concentrated juice capsules led to drop in cholesterol by 18 mg/dL, LDL by 15 mg/dL, and triglycerides by 9 mg/dL, with little effect on HDL.⁶⁰
  
  
• Berberine Berberine is a bitter yellow compound found in a number of plants, particularly in the roots. In a 2023 review, it was found to reduce total cholesterol by an average of 18.5 mg/dL, triglycerides by up to 30 mg/dL, and LDL by 18 mg/dL.⁶¹ It also lowered apoB levels. Berberine rarely causes nausea, bloating, and other digestive problems. Dosing is 0.4-1.5 grams daily.
  
  
• Bergamot (Citrus bergamia) Bergamot is a citrus fruit from Europe. Its polyphenols (which can also be derived from other fruits and vegetables) were found, in a study of one specific product, to lower LDL by 20% and triglycerides by 17%, with an 8% increase in HDL in people unable to tolerate statin drugs.⁶² In another study, bergamot plus 10 mg of the statin drug rosuvastatin led to similar improvements in labs as taking 20mg of rosuvastatin alone.⁶³ Bergamot extract seems to be safe when used at doses of 500-1,000 mg daily.
  
  
• Black seed (Nigella sativa) Black seed, also known as black cumin or black caraway (not the same as the spices cumin or caraway) is used as a flavoring agent. A 2017 review focused on people with type 2 diabetes found that black seed lowered total cholesterol by 23 mg/dL and LDL by 22 mg/dL.⁶⁴ A 2024 review of 34 studies concluded that total cholesterol and LDL were lowered and that HDL increased with its use.⁶⁵ The dose is typically 1-2.5 grams of black seed oil daily, or 1-2 grams daily for the powder.
  
  
• Ecklonia cava (brown algae) Ecklonia is eaten as a food in Japan and Korea. Like many foods that improve lipid numbers, it is high in polyphenols. After taking it for about 3 months, it reduces LDL by an average of 11%.⁶⁶ Dosing is 144-600 mg daily.
  
  
• Garlic (Allium sativum) A large review of 26 studies reported in 2016 found that garlic lowered LDL by 10% if taken for 2 months or more.⁶⁷ A 2023 review found it can not only lower LDL but also reduce total cholesterol and triglycerides and increase HDL.⁶⁸ Large studies have found garlic supplementation lowers total cholesterol by 15-25 mg/dL and LDL by 6-17 mg/dL. It increases high-density lipoprotein (HDL) cholesterol by about 1.5 mg/dL.⁶⁹ The benefits of garlic were greater for individuals who used it long-term and who had higher baseline total cholesterol levels. Garlic powder and aged garlic extract were more effective in reducing serum total cholesterol levels, and garlic oil was more effective in lowering serum triglyceride levels.

Suggested daily doses of garlic are 1 clove or 2-5 grams of fresh raw garlic (so garlic in the diet also helps), 0.4-1.2 grams of dried powder, and 300-1,000 mg of garlic extract, or 2,400 mg daily of aged garlic extract.⁷⁰

• Green Tea (Camellia sinensis) Compounds Drinking green tea or taking an extract lowered total cholesterol by 5-24 mg/dL and LDL by 2-25 mg/dL, depending on the dosing.⁷¹ A cup of green tea contains about 187 mg of EGCG. A review of 17 trials found that taking epigallocatechin gallate (ECGC), found in green tea, for 4-14 weeks reduced LDL by 9 mg/dL.⁷² Doses ranged from 100-850 mg a day.
  
  
• Indian gooseberry (Phyllanthus emblica) Indian gooseberry (sometimes known as amla) is eaten as a food and has been used in Asian healing traditions for a long time. A 2023 review found it reduces total cholesterol by 39 mg/dL, LDL by 15-34 mg/dL, and triglycerides by 22-52 mg.⁷³ Effects on HDL are not clear. Dosing of the extract is 500-1000 mg daily.
  
  
• L-carnitine L-carnitine is made from amino acids found in the body. It is different from acetyl-L-carnitine and propionyl-L- carnitine, which are used as supplements as well. It rarely has any side effects. It seems to reduce total cholesterol by 8 mg/dL, LDL by 11, and triglyceride levels by 9.5 mg/dL. It increases HDL levels by 1.6 mg/dL on average.⁷⁴ It tends to be quite safe. Dosing is usually 1-4 grams daily.
  
  
• Niacin (vitamin B3) – no longer recommended as a supplement Niacin (Vitamin B3) has been used for a long time to improve all the different cholesterol numbers. However, recent research suggests it should be avoided.⁷⁵ Studies show that lipid numbers improve, but numbers of heart attacks and strokes do not go down. Niacin is broken down into compounds like 4PY and 2PY, which increase inflammation in the body and raise the level of VCAM-1, a substance which actually make arteries more likely to get blocked. It is best simply to get niacin in the diet. It is added to fortified foods, and 14-18 mg a day is a good total amount to aim for. Higher doses can cause flushing, fatigue, high blood sugars, heartburn, and vision problems.
  
  
• Red Yeast Rice (RYR)⁷⁶ – use with caution RYR is made by fermenting white rice with the mold Monascus purpureus. The process turns the rice red and produces compounds like monacolin K (also called mevinolin). It is the same molecule as the statin drug, lovastatin. Like statin medications, it decreases the liver’s production of cholesterol by inhibiting an enzyme called HMG CoA reductase. RYR also has other compounds that can affect cholesterol. Large reviews have found RYR reduces LDL by about 21-29 mg/dL and triglycerides by 20-27 mg/dL.^77,78 HDL is increased by about 3 mg/dL.

Most labels do not say how much monacolin K/lovastatin are in a product, because if they do, a product will be classed as a drug instead of a supplement. This makes it hard to decide what RYR supplements to take. ConsumerLab.com found that many products have low levels of the beneficial compounds and levels of harmful ones.⁷⁹ Side effects of RYR can be the same as for statins, including liver and kidney damage and muscle pain, as well as digestive problems.

A byproduct of RYR production, citrinin, which can be found in some supplements, causes kidney damage. In March 2024 it was reported that 5 people died and over 100 more went to the hospital because of Japanese products (including Beni Koji Choleste-Help) that contained citrinin.⁸⁰ Given that statins are less costly than they used to be, many experts suggest it may be best to take a statin drug (like simvastatin or atorvastatin) instead of using RYR,⁷⁹ if possible.

Examples of safe products. Products that have been found to be free of citrinin while having high concentrations of active ingredients as tested by a private lab (consumerlab.com) include:

• • Cholestene Red Yeast Rice, 600 mg capsules
  • Chole-sterin Red Yeast Rice, 600 mg capsules
  • NSI Red Yeast Rice, 600 mg capsules
  • Doctors Best Red Yeast Rice, 1200 mg capsules.

The dose of RYR is typically 600 mg taken 2-4 times daily.

NOTE: At this point, given safety concerns and unknown levels of active compounds, red yeast rice should be used with caution and other options may be worth considering first.

Overall Tips for Lowering Lipids

In Conclusion

Congratulations on taking steps to improve your lipids, and your overall health. Keep at it. Explore the different approaches described in this handout, one at a time, and it will likely help you keep your lipids where you want them to be. And that will increase your ability to be at your healthiest.

The information in this handout is general. Please work with your health care team to use the information in the best way possible to promote your health and happiness.

What we know about integrative health care has come to us thanks to the efforts, experiences, and collective wisdom of people from many cultures and backgrounds. We wish to acknowledge all the healers, researchers, patients, and peoples who have informed the content of this tool.

Author(s)

This handout was adapted for the Osher Center for Integrative Health at the University of Wisconsin-Madison, by J Adam Rindfleisch, MD, from the original created by David Rakel, MD and revised by Steve Humpal MS4, and Charlene Luchterhand, MSSW.

Revised: March, 2025

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