Product Reviews
Cholesterol-Lowering Supplements Review (Sterols/Stanols and Policosanol)

Reviewed and edited by Tod Cooperman, M.D. Tod Cooperman, M.D.
Initial Posting: 4/20/19
Sterol, Stanol, and Policosanol Supplements for Cholesterol-lowering Reviewed by
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  • Do they work? Although many types of supplements are touted for lowering high cholesterol levels, those with the best evidence of efficacy are sterols/stanols, red yeast rice, and high-dose niacin. In this Review, we tested sterols/stanols. There is modest evidence of efficacy for other supplements such as policosanol (also tested in this Review), fish oil, garlic, guggulsterone, pantethine, soy protein, and Sytrinol (see Summary of Evidence table).
  • What did CL find? Tests by ConsumerLab revealed that one sterol product contained less of a specific sterol than claimed and a policosanol product did not contain the expected amount of a specific policosanol. Across products, the dose of sterols/stanols per serving ranged from 400 mg to 900 mg and 10 mg to 20 mg of policosanol. The cost to obtain 800 mg of sterols/stanols ranged from 16 cents to 74 cents and the cost for 20 mg of policosanol ranged from 11 cents to 59 cents. (See What CL Found)
  • Top Picks — Among products Approved in testing, ConsumerLab selected a Top Pick for sterols/stanols that provided an ample dose at relatively low cost and its effectiveness is backed by a positive clinical trial. The Top Pick for policosanol provided what may be the best form of policosanol and relatively low cost.
  • How much to take and when? Dosage for sterols is at least 400 mg with a meal or (1,000 mg for stanols), twice daily. For policosanol, it is 10 to 20 mg daily. See the ConsumerTips section for more about dosage and forms.
  • Cautions: Sterols/stanols may interfere with absorption of fat-soluble vitamins and, rarely, their use has been associated with elevations in liver enzymes. A range of side effects, including migraines and insomnia, have been reported with policosanol and it should be used with caution in people taking anti-platelet or anti-coagulant drugs. (For details, see Concerns and Cautions.)
What They Are:
According to the American Heart Association, 102.2 million Americans age 20 and older (almost 50 percent of American adults) have elevated blood cholesterol levels, a key risk factor for heart disease. Lifestyle changes such as improving diet, losing weight and increasing exercise are often effective. Various supplement ingredients may be helpful as well in lowering low-density lipoprotein (LDL or "bad cholesterol"), raising high-density lipoprotein (HDL or "good cholesterol"), and improving the LDL/HDL ratio. Some supplements may also reduce triglycerides.

Supplement ingredients that have been used to reduce cholesterol include sterols and sterol esters (also called phytosterols — or plant sterols, which are produced in the normal refinement of vegetable oils, or, alternatively, as a byproduct of papermaking from the oil of pinewood pulp), stanols and stanol esters (substances closely related to sterols that are derived from the same sources), red yeast rice (a yeast grown on rice), high doses of niacin (a B-vitamin), policosanol (a waxy substance from sugar cane, beeswax, wheat germ or rice bran wax), guggulsterone (a gum resin from a tree sap), garlic, fish oil, and soy protein. Soluble fiber in the diet as well as moderate intake of alcohol can also improve cholesterol levels.

What They Do:
The amount of evidence supporting the various cholesterol-lowering supplements varies. The best evidence is for sterols, stanols and their esters, red yeast rice and high dose-niacin (sold as a supplement as well as a prescription drug). Be aware, however, that there are safety concerns regarding the use of some of them. There is mixed evidence for whether soy can lower cholesterol. Below is a summary of information about several of the most popular ingredients used for cholesterol-lowering. See ConsumerTips™ for more information about the forms, suggested dosage, and safety considerations. In addition to the uses indicated above, these ingredients have other potential actions and uses (see the links below to the Natural Product Encyclopedia on this site).

It should be noted that while sterols and stanols can lower cholesterol, no study has shown a direct reduction in the risk of cardiovascular disease (see Concerns and Cautions below).

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