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Supplements for High Cholesterol: What Lowers LDL, by How Much, and What to Avoid

For high cholesterol, no supplement matches a statin. In a 28-day trial, a low-dose statin cut LDL by about 35% more than placebo, while fish oil, garlic, turmeric, cinnamon, plant sterols and red yeast rice did no better than placebo. Across many longer trials, psyllium fiber, oat beta-glucan and plant sterols lower LDL a little (grade A). Red yeast rice contains the statin lovastatin, so never take it with a statin.

Published Updated How we grade evidenceEditorial policy

People often ask whether a supplement can stand in for a statin. Here is what the trials show for psyllium, plant sterols, oats, berberine, red yeast rice, fish oil, black seed, bergamot, garlic and CoQ10, how much each lowers LDL (the cholesterol that builds up in arteries), and which ones carry real risks.

The short version

  • Statins lower LDL far more than any supplement, and lowering LDL with them lowers heart attack and stroke risk. Grade A (Laffin 2023; CTT 2015).
  • Psyllium, oat beta-glucan and plant sterols lower LDL a little. Grade A (Jovanovski 2018; Ho 2016; Ras 2014).
  • Red yeast rice works because it contains a statin, with a statin's risks, and some tablets in Japan were tied to serious kidney injury. Grade B (Li 2022; Shinzawa 2025).
  • Fish oil lowers triglycerides, not LDL, and raises the risk of an irregular heartbeat. Grade A (Wang 2023; Gencer 2021).
  • Garlic lowered LDL a little in the larger pooled analyses, but they disagree, and it did no better than placebo in a 28-day trial. Grade C (Khoo 2009; Ried 2013; Behrouz 2026).

Can a supplement replace a statin?

No, and no supplement should be swapped for a prescribed medicine. In the SPORT trial, adults with raised LDL and higher heart risk took a low-dose statin, a placebo, or one of six popular supplements for 28 days. Of 190 who finished, the statin group's LDL fell about 35% more than placebo; fish oil, cinnamon, garlic, turmeric, plant sterols and red yeast rice did not lower LDL significantly more than placebo (Laffin 2023). The trial was funded by a drug company, per its disclosure statement, and 28 days is short for fiber or sterols. Across 27 statin trials (174,149 people), each 1 mmol/L (about 39 mg/dL) drop in LDL cut major heart attacks and strokes by about a fifth in men and a sixth in women, and lowered deaths from any cause (CTT 2015). Grade A. Whether you need a statin is a decision for you and your prescriber; this guide gives no medicine doses.

What supplements actually lower LDL?

Grade A for three fibers and sterols, each for a modest drop:

  • Psyllium. In 28 trials (1,924 people), about 10 g a day lowered LDL by 0.33 mmol/L (about 13 mg/dL) (Jovanovski 2018). See our psyllium page.
  • Oat beta-glucan. In 58 trials (3,974 people), about 3.5 g a day, mostly in foods, lowered LDL by 0.19 mmol/L (about 7 mg/dL) (Ho 2016). See our fiber page.
  • Plant sterols and stanols. Across 124 studies, 0.6 to 3.3 g a day lowered LDL by 6% to 12%, with more from higher amounts (Ras 2014).

Each gives a modest drop on its own. Our high cholesterol page leads with black seed oil and bergamot; we grade those lower because their trials are smaller and less consistent (below).

Is red yeast rice a natural statin?

It is a statin. Grade B that it lowers LDL. NCCIH says red yeast rice can contain monacolin K, which is chemically identical to the prescription statin lovastatin; some products contain almost none and others contain large amounts (NCCIH). In 15 trials (1,012 people), red yeast rice lowered LDL about as much as statins it was compared with (Li 2022).

The risks are a statin's risks plus a supplement's. NCCIH says products with significant monacolin K can cause the same side effects as statins, including muscle, kidney and liver damage, and the same drug interactions; some contain citrinin, a kidney toxin, and in a 2021 analysis only 1 of 37 products had citrinin below the European Union limit (NCCIH). In 2023 to 2024, Japanese kidney doctors reported 192 patients whose kidneys were damaged after taking certain red yeast rice tablets sold in Japan; most had low kidney function, and 87% still did at last follow-up (Shinzawa 2025). Pooled trials found no more muscle problems than control (Fogacci 2019), but trials don't catch rare harms or bad batches. Never take red yeast rice with a statin, and tell your prescriber if you take it.

Does berberine lower cholesterol?

Grade B for berberine on its own, for modest drops. In 8 placebo-controlled trials of berberine alone in adults, most with high blood fats or high blood sugar, LDL fell about 0.5 mmol/L (about 19 mg/dL); triglycerides fell about 0.37 mmol/L (about 32 mg/dL) in 9 trials, results varied widely between trials, and HDL did not change (Liu 2025). A larger 2024 review is not used because its references include many combination products, trials from a research group whose work we exclude and a retracted trial. It is not a statin substitute. If you take metformin, see can I take berberine with metformin? and ask your prescriber or pharmacist. See our berberine page.

Does fish oil lower cholesterol?

It lowers triglycerides, not LDL. Grade A. Across 90 trials (72,598 people), triglycerides fell further as the omega-3 dose rose, most clearly above 2 g a day in people with high blood fats, while LDL followed a J-shaped curve rather than a steady fall (Wang 2023). In large trials, fish oil made atrial fibrillation (an irregular heartbeat) about a quarter more likely overall, and about half more likely above 1 g a day (Gencer 2021). If you take a blood thinner, see can I take fish oil with Eliquis?. See our fish oil page.

What about black seed, bergamot and garlic?

  • Black seed (Nigella sativa): grade B, with caveats. In 34 studies (2,278 people), it lowered LDL, total cholesterol and triglycerides and raised HDL against control (Rounagh 2024). The pooled effects were unusually large, which usually points to small, uneven trials. See our black seed page.
  • Bergamot: grade C. A network analysis of 131 trials ranked bergamot first for LDL lowering, but its authors noted the bergamot evidence came from a relatively small group of studies (Osadnik 2022).
  • Garlic: grade C, small effect; the pooled analyses disagree. A 2026 review of 108 trials (7,137 adults) found LDL about 5.9 mg/dL lower with garlic than without it (Behrouz 2026). A 2013 review of 39 trials found LDL about 9 mg/dL lower in people with total cholesterol above 200 mg/dL who took it for more than 2 months (Ried 2013). An earlier review of 13 trials (1,056 people) found no change (Khoo 2009), and garlic did no better than placebo in the 28-day SPORT trial. That is about the size of the oat drop, far less than a statin's.

Does CoQ10 help statin muscle aches?

Grade C: the reviews disagree. One analysis of 12 trials (575 people) found CoQ10 eased statin-related muscle pain, weakness and cramps (Qu 2018); another, limited to 7 trials (321 people) in people with statin muscle pain, found no benefit and no change in how many stayed on their statin (Kennedy 2020); a 2025 analysis of 7 trials (389 people, 100 to 600 mg a day) found a small drop in pain (Kovacic 2025). Muscle pain on a statin is worth raising with your prescriber, who can check for rare muscle damage or change the plan. See our CoQ10 page.

What we'd skip

  • Niacin pills for cholesterol. Niacin raised HDL and lowered LDL, but in two large trials (3,414 and 25,673 people on statins) it did not lower heart attacks or strokes; the larger one found more serious problems with diabetes control, new diabetes, infections and bleeding (AIM-HIGH 2011; HPS2-THRIVE 2014). Upper limit for adults: 35 mg a day of niacin from supplements, because more causes flushing and, at high doses, liver damage; take more only with blood tests or your clinician's advice (NIH ODS; check your stack).
  • Red yeast rice on top of a statin, or instead of one without your prescriber (above).
  • Policosanol. It did not change blood fats in the network analysis (Osadnik 2022).
  • Garlic, cinnamon and turmeric pills for a big LDL drop. No better than placebo in SPORT (Laffin 2023); for turmeric with a blood thinner, see can I take turmeric with Eliquis?.

Safety and interactions

  • Red yeast rice has statin side effects and interactions, and contamination risks (NCCIH). Stop it and get checked promptly for unexplained muscle aches or weakness, urine the color of cola, or yellowing of the skin or eyes.
  • Fish oil: irregular heartbeat risk rises with dose (Gencer 2021).
  • Fiber supplements such as psyllium can lower how much of some medicines you absorb, levothyroxine among them (Wiesner 2021); ask your pharmacist how far apart to take them.
  • Several supplements at once: check your stack against the upper limits.
  • Don't stop or change a prescribed cholesterol medicine on your own; ask the prescriber or pharmacist. Pregnancy or breastfeeding: ask a clinician.

When to see a doctor

  • You have never had a cholesterol test, or your LDL is high: ask whether your overall heart risk calls for treatment.
  • Muscle pain, weakness or dark urine on a statin or red yeast rice.
  • Chest pain, heaviness or discomfort, or pain in one or both arms, the back, neck or jaw: call 911, even if you are not sure it is a heart attack (NHLBI).

FAQ

What is the best supplement for high cholesterol? Psyllium fiber, oat beta-glucan and plant sterols have the best evidence (grade A), but each lowers LDL only a little. No supplement matched a low-dose statin in a head-to-head trial.

Is red yeast rice safe? It contains monacolin K, which is the statin lovastatin, so it carries statin side effects and interactions, and some products contain a kidney toxin. Never take it with a statin.

Can berberine replace a statin? No. On its own, berberine lowered LDL only modestly in placebo-controlled trials (grade B), and no supplement should replace a prescribed medicine without your prescriber.

Does fish oil lower cholesterol? It lowers triglycerides (grade A), not LDL, and it raises the risk of an irregular heartbeat, more so above 1 g a day.

Can I take CoQ10 with statins? The trials gave CoQ10 to people already on statins, and reviews disagree on whether it eases statin muscle aches (grade C). Tell your prescriber about muscle pain.

Sources

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