Only a few supplements have good evidence for lowering LDL, and the best of them are really concentrated foods. Psyllium (soluble fibre) and plant sterols both lower LDL in trials. Red yeast rice works because it contains a statin-like compound, which brings the risks of a statin without the quality control. Fish oil lowers triglycerides, not LDL.
The short version
Evidence for LDL: psyllium and plant sterols. Use with caution: red yeast rice and berberine. For triglycerides: prescription-strength omega-3, not over-the-counter fish oil. Always tell your doctor and pharmacist about any supplement, especially if you take a statin or other medicines.
At a glance
| Supplement | Effect on lipids | Evidence | Main cautions |
|---|---|---|---|
| Psyllium husk | Lowers LDL | Good. The FDA allows a heart-health claim for 7 g a day of psyllium soluble fibre. | Take with plenty of water; bloating. Ask a pharmacist about timing with medicines. |
| Plant sterols and stanols | Lower LDL by about 6 to 12% at 0.6 to 3.3 g a day | Good for LDL. No trials show they prevent heart attacks. NICE does not advise them for prevention. | Labels advise against use in pregnancy or for young children unless advised by a doctor. |
| Red yeast rice | Lowers LDL | Contains monacolin K, which is the same as lovastatin. Content varies between brands. | Statin-type side effects; don't combine with a statin; possible contamination (citrinin). Regulators in the EU tightened limits in 2022. |
| Berberine | Lowers LDL in small, short trials | Limited. Trials are small and mixed in quality; no heart-outcome data. | Interacts with some medicines; not for pregnancy. Ask a pharmacist. |
| Fish oil (omega-3) | Lowers triglycerides; may raise LDL slightly | Prescription doses (about 4 g a day) lower very high triglycerides by 30% or more. | Higher doses are linked to a higher risk of atrial fibrillation. Over-the-counter capsules rarely contain enough. |
| Niacin | Lowers LDL, raises HDL | Trials showed no added benefit on top of statins. | Flushing and other side effects; no longer recommended for most people. |
| Garlic, cinnamon, apple cider vinegar | Little or inconsistent effect | Weak. | Generally safe in food amounts; not a substitute for treatment. |
Psyllium: the best-supported supplement
Psyllium husk is a soluble fibre. A meta-analysis of 67 trials found about 0.06 mmol/L (2 mg/dL) of LDL lowering for each extra gram of soluble fibre a day, and the US FDA permits a health claim that 7 g a day of psyllium soluble fibre, as part of a diet low in saturated fat, may reduce the risk of heart disease. Food sources do the same job: oats, barley, beans and lentils. See soluble fibre and cholesterol.
Start with a small dose and increase it gradually with plenty of water. Taking it with other medicines may reduce their absorption, so ask your pharmacist how to space them.
Plant sterols and stanols
A meta-analysis of 124 studies found plant sterols and stanols lower LDL by about 6 to 12% across 0.6 to 3.3 g a day, with the effect levelling off at around 3 g. They are added to some spreads, yoghurt drinks and supplements. They do not have a trial showing they prevent heart attacks, and NICE does not advise them for preventing heart disease, so mention them to your GP. See cholesterol from 6 to 5 for how they fit with other changes.
Red yeast rice and berberine: where to be careful
Red yeast rice contains monacolin K, which is chemically the same as the statin lovastatin. That is why it lowers LDL, and why it can cause the same muscle and liver problems. The amount varies between products, and some have been found to contain citrinin, a kidney-toxic contaminant. Don't take it with a statin, and avoid it if you are pregnant or have liver disease. If you need a statin-strength effect, a prescribed and monitored statin is safer.
Berberine is a plant compound. Small trials show reductions in LDL and blood sugar, but long-term safety and heart-outcome data are lacking and it interacts with several medicines. Talk to a pharmacist before using it.
Fish oil is for triglycerides
The American Heart Association says prescription omega-3 at about 4 g a day lowers triglycerides by 30% or more in people with very high levels, but EPA plus DHA can raise LDL in that group. For most people, eating fish twice a week is the better route. See what to eat for high triglycerides and our salmon food check.
Questions to ask before you buy
- Does it contain a drug-like ingredient (such as monacolin K)?
- Does it interact with my medicines? (Ask a pharmacist, especially if you take a statin, blood thinner or blood pressure tablet.)
- Is there a food that does the same job? (Oats, beans and nuts usually do.)
- Can I show it works? Re-test your lipids after about 3 months.
See also what to eat on statins.
This is general information, not medical advice. If you take cholesterol medication or have a heart condition, check changes to your diet with your doctor, dietitian or pharmacist.
Sources
- Brown L, et al. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. 1999;69:30–42.
- FDA 21 CFR 101.81: Health claims: soluble fiber from certain foods and risk of coronary heart disease.
- Ras RT, et al. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of studies in healthy subjects. Br J Nutr. 2014;112:214–219.
- Skulas-Ray AC, et al. Omega-3 fatty acids for the management of hypertriglyceridemia: a science advisory from the American Heart Association. Circulation. 2019;140:e673–e691.
- NICE NG238: Cardiovascular disease: risk assessment and reduction, including lipid modification.
- Blumenthal RS, Morris PB, et al. 2026 ACC/AHA Guideline on the Management of Dyslipidemia. J Am Coll Cardiol. 2026;87(19).
Frequently asked questions
What supplement lowers cholesterol the most?
Psyllium and plant sterols have the best evidence. Plant sterols lower LDL by about 6 to 12% at 0.6 to 3.3 g a day, and psyllium by about 2 mg/dL (0.06 mmol/L) per gram of soluble fibre. Red yeast rice also lowers LDL because it contains a statin-like compound, but it carries risks.
Is red yeast rice safe?
It can cause the same side effects as a statin (muscle pain, liver problems) and the amount of active ingredient varies between products. Some products have been contaminated with citrinin. Don't take it with a statin, and talk to your doctor first.
Does fish oil lower cholesterol?
Fish oil lowers triglycerides, particularly at prescription doses, but it does not lower LDL and may raise it slightly in people with very high triglycerides. Eating fish twice a week is a good way to get omega-3.
Does berberine lower LDL?
Small, short trials suggest it lowers LDL, but the evidence is limited, it interacts with medicines and there are no heart-outcome data. Talk to a pharmacist before using it.
Can I take supplements with a statin?
Some are fine and some are not. Red yeast rice duplicates a statin, and others may interact. Always check with your pharmacist or doctor before adding a supplement.
See what actually moves your numbers
Log your food and your lab results in Heart Tracker to check whether a change, including a supplement, is moving your LDL, HDL and triglycerides.
- Barcode scanner
- LDL & HDL trends
- Voice meal logging
