The six supplements most commonly promoted for lowering cholesterol are red yeast rice, fish oil, plant sterols, garlic, cinnamon, and turmeric. These were the six tested head-to-head against a low-dose statin in the landmark SPORT trial published in the Journal of the American College of Cardiology. The results were sobering: none of the six significantly lowered LDL cholesterol compared to placebo, while even a small dose of a statin reduced it substantially. That doesn’t mean every supplement on this list is worthless, but the picture is more complicated than most supplement marketing suggests.
How the Six Supplements Were Tested
The SPORT trial randomized 199 adults with elevated LDL cholesterol and increased cardiovascular risk to receive either 5 mg of rosuvastatin (a low-dose statin), a placebo, or one of the six supplements. The statin won by a landslide. None of the supplements produced a statistically meaningful drop in LDL compared to the placebo group. A Journal of Lipid Research review examining the same six supplements reached a similar conclusion: the data to support clinically significant LDL lowering are lacking, and available evidence suggests these supplements are ineffective at reducing the type of cholesterol most linked to heart disease.
That said, some of these supplements do have real effects on specific parts of your lipid profile, and a couple have more nuance than a single trial can capture. Here’s what the evidence actually shows for each one.
Red Yeast Rice
Red yeast rice is the most pharmacologically interesting supplement on this list because its active compound, monacolin K, is chemically identical to the prescription statin lovastatin. Earlier studies suggested it could lower LDL by 21 to 30 percent, with as little as 6 mg of monacolin K per day producing a roughly 25 percent reduction. That’s a meaningful effect, comparable to a low-dose statin.
The catch is that since 1998, the FDA has classified red yeast rice products containing significant amounts of monacolin K as unapproved drugs rather than dietary supplements. The agency has requested that several products be pulled from the market, citing risks of severe muscle problems that can lead to kidney damage. Many products remain available despite this, but their monacolin K content varies wildly from brand to brand. Some contain enough to work like a statin (with statin side effects), while others contain almost none. You’re essentially taking an unregulated, inconsistently dosed version of a prescription drug.
Fish Oil (Omega-3 Fatty Acids)
Fish oil is widely taken for heart health, but its primary effect is on triglycerides, not LDL cholesterol. At prescription-strength doses of 4 grams per day, omega-3 fatty acids reduce triglycerides by roughly 27 percent in people not taking other lipid-lowering medications, and by about 21 percent in people already on a statin. For very high triglyceride levels (above 500 mg/dL), reductions of 30 percent or more are common.
The LDL story is more complicated. Products containing both EPA and DHA can actually raise LDL cholesterol by 15 to 36 percent in people with very high triglycerides. EPA-only formulations don’t appear to have this effect. For people with moderately elevated triglycerides, neither type raises LDL when used alone or with a statin. DHA tends to raise HDL (the “good” cholesterol) more than EPA does, though the clinical significance of that difference isn’t clear. If your main concern is LDL, fish oil is not the right tool.
Plant Sterols and Stanols
Plant sterols are the supplement on this list with the most consistent, well-documented effect on LDL. These naturally occurring compounds, found in small amounts in vegetables, nuts, and grains, work by blocking cholesterol absorption in the gut. At a dose of 2 grams per day, plant sterols lower LDL cholesterol by 8 to 10 percent. The National Cholesterol Education Program recommends this 2-gram daily target as part of a heart-healthy diet.
You can get plant sterols from fortified foods like certain margarines, orange juices, and yogurt drinks, or from standalone supplements. The Cleveland Clinic recommends eating foods with at least 0.65 grams per serving twice daily with meals, totaling at least 1.3 grams. The effect is modest compared to a statin but is real and reproducible. Plant sterols work best as an add-on to other cholesterol-lowering strategies rather than a standalone treatment.
Garlic
Garlic has been one of the most popular natural remedies for cholesterol for decades. Early meta-analyses suggested it could lower total cholesterol by 5 to 6 percent. But a rigorous Stanford University study put that claim to rest, finding no meaningful cholesterol-lowering effect from garlic in any form, whether raw, powdered, or aged extract. The study was specifically designed to address the weaknesses of earlier, smaller trials. Garlic has other potential health benefits, but reliably lowering LDL is not one of them.
Turmeric and Cinnamon
Turmeric and cinnamon round out the six most commonly promoted cholesterol supplements, but neither has convincing evidence behind it. Both performed no better than placebo in the SPORT trial, and the broader research base is thin. The Journal of Lipid Research review found no support for clinically significant LDL lowering from either one. While both spices contain bioactive compounds with anti-inflammatory properties studied in other contexts, there’s no reliable reason to take them for cholesterol management.
Two Supplements With Stronger Evidence
Interestingly, two supplements that weren’t part of the SPORT trial’s “famous six” have more robust evidence for LDL reduction than most of those that were.
Psyllium (Soluble Fiber)
Psyllium husk, a soluble fiber supplement, lowers LDL by about 6.7 percent and total cholesterol by 4.7 percent when taken at a dose of roughly 10 grams per day (5.1 grams twice daily). These results come from a 26-week randomized trial in men and women with elevated cholesterol who were already following a cholesterol-lowering diet. Soluble fiber works by binding to bile acids in the gut, forcing your liver to pull cholesterol from the bloodstream to make more. The effect is modest but well-established, and psyllium carries virtually no risk of serious side effects.
Berberine
Berberine, a compound found in several plants including goldenseal and barberry, works through a mechanism similar to statins. It increases the number of LDL receptors on liver cells, helping your liver clear more LDL from the blood. It also reduces the production of a protein called PCSK9, which normally breaks down those receptors. A large meta-analysis of clinical trials found berberine reduced total cholesterol by about 21 mg/dL, LDL by about 10 mg/dL, and triglycerides by about 24 mg/dL, while slightly increasing HDL. These effects are real but smaller than what a statin delivers.
How Supplements Compare to Statins
The most important takeaway from the research is one of scale. A low-dose statin typically reduces LDL by 30 to 50 percent. The best-performing supplements, plant sterols and psyllium, reduce it by roughly 7 to 10 percent. Berberine falls somewhere in between but closer to the supplement end. Red yeast rice can match statin performance, but only because it literally contains a statin, and commercially available products are unreliable in their dosing.
This doesn’t mean supplements are pointless. For someone with borderline-high cholesterol who wants to avoid medication, combining plant sterols with soluble fiber and dietary changes can produce a meaningful cumulative reduction. But for people with significantly elevated LDL or established heart disease risk, supplements alone are unlikely to close the gap. The SPORT trial made this point clearly: when matched against even a minimal statin dose, none of the six popular supplements came close.
Safety Considerations
Cholesterol supplements can interact with prescription medications, particularly statins and blood thinners. Red yeast rice carries the same risk of muscle damage as prescription statins because it contains the same active compound. Fish oil at high doses can increase bleeding risk. Berberine can affect how your liver processes other drugs, potentially changing their effectiveness. The NHS notes that supplements are not tested the same way as prescription medicines, and there isn’t enough safety data to confirm that most herbal remedies are safe to combine with statins like atorvastatin. If you’re taking any cardiovascular medication, your doctor or pharmacist needs to know about every supplement you’re using.