Dietary supplements: clinical cholesterol-lowering efficacy and potential mechanisms of action

Abstract

This review aims to analyse the efficacy of dietary supplements in reducing plasma cholesterol levels. Focusing on evidence from meta-analyses of randomised controlled clinical trials, with an emphasis on potential mechanisms of action as supported by human, animal, and cell studies. Certain dietary supplements including phytosterols, berberine, viscous soluble dietary fibres, garlic supplements, soy protein, specific probiotic strains, and certain polyphenol extracts could significantly reduce plasma total and low-density lipoprotein (LDL) cholesterol levels by 3–25% in hypercholesterolemic patients depending on the type of supplement. They tended to be more effective in reducing plasma LDL cholesterol level in hypercholesterolemic individuals than in normocholesterolemic individuals. These supplements worked by various mechanisms, such as enhancing the excretion of bile acids, inhibiting the absorption of cholesterol in the intestines, increasing the expression of hepatic LDL receptors, suppressing the activity of enzymes involved in cholesterol synthesis, and activating the adenosine monophosphate-activated protein kinase signalling pathway.

Keywords:

• Dietary supplement
• Cholesterol
• Cholesterol-lowering
• Hypocholesterolemic activity
• Clinical trial

Ethics statement

This review does not include any research involving humans or animals.

CRediT authorship contribution statement

Qian Ge: Writing-review & editing, Writing-original draft, Visualisation, Data curation, Conceptualisation. Yue Yan: Writing-review&editing, Writing-originaldraft, Validation, Resources, Conceptualisation. Yang Luo: Visualisation, Resources, Investigation, Formal analysis. Tai Teng: Visualisation, Resources, Investigation, Formal analysis. Caixia Cao: Visualisation, Resources, Investigation, Formal analysis. Danqing Zhao: Validation, Formal analysis. Jing Zhang: Validation, Formal analysis. Caihong Li: Validation, Formal analysis. Wang Chen: Data curation, Formal analysis. Binkun Yang: Data curation, Formal analysis. Zicheng Yi: Data curation, Investigation. Tengwen Chang: Data curation, Investigation. Xiang Chen: Writing – review & editing, Writing-original draft, Supervision.

Disclosure statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Funding

This work was supported by the Key Research and Development Program of Ningxia [No. 2023BCF01025], Natural Science Foundation of Ningxia [No. 2023AAC03418], the National Natural Science Foundation of China [NSFC, No. 32260628] and the Yinchuan University-Enterprise Joint Innovation Institute [No. 2022XQZD011].