This is a part of a series by advocate Susan Sloane about cholesterol. Read the first part of the series, Treating High Cholesterol: Statins and a Great Non-Prescription Option.

Susan B. Sloane, BS, RPh, CDE, has been a registered pharmacist for more than 20 years and a Certified Diabetes Educator for more than 15 years. Her two sons were diagnosed with diabetes, and since then, she has been dedicated to promoting wellness and optimal outcomes as a patient advocate, information expert, educator, and corporate partner.

We have heard for years that consuming plant-based foods is part of a heart-healthy diet. Part of this is because these foods are rich in phytosterols.


These compounds can be found in whole grains, vegetable oils, and may other fruits and vegetables. Several foods today are “fortified” with phytosterols, including certain types of margarine and salad dressings. The dosage needed to achieve a reduction in LDL, or "bad cholesterol," have been anywhere between 0.8 and two grams daily, and in some cases even more. Plant sterols work by competing with cholesterol for absorption in the gastrointestinal tract.

Although many studies have shown that plant sterols are effective in lowering cholesterol, there have been studies that have been less encouraging. What can't be denied is that plant-based foods are healthy in general.

The FDA has authorized a health claim that regular consumption of foods with plant sterols may reduce the risk of heart disease. In order to prevent vitamin deficiencies, a diet rich in fruits and vegetables is recommended in addition to any supplementation with plant sterols.

Since it would be difficult to get the appropriate dose of plant sterols to lower cholesterol simply by eating more foods containing them, many people take supplements containing plant sterols in a quantifiable amount. You may also see the term plant stanols on a label; this is a different form of a plant sterol (esterified) and tends to act on the body in the same way as a sterol.

Let's take a look at two common supplements you may have heard of and what you should know about them.

Red yeast rice

Red yeast rice is a product that many aficionados of natural products have embraced as the safe alternative to statins. Let me caution you that just because a product is available without a prescription does not mean you should freely take it without consulting your healthcare team.

Red yeast rice is a fungus that grows on, you guessed it, rice! Red yeast rice has been found to block cholesterol production in the liver. This is due to a substance in the red yeast rice called monacolin K, which is a form of lovastatin, one of the very first prescription drugs known as Mevacor.

The dietary supplement industry took hold of this claim and in 1997 launched Cholestin, which was taken off the shelf in 2001 by the FDA because it was too close to the actual prescription product and could be harmful if not monitored properly (liver function, etc.).

There are other red yeast products still available, and they may contain lovastatin in small amounts. As a dietary supplement these products are not regulated for quality, safety, and/or effectiveness.


Niacin is a B vitamin that has been used over the counter and in prescription forms for lowering cholesterol. Its main metabolic reaction besides having a lesser effect on lowering LDL is to raise HDL, which is the “protective” cholesterol in the body.

The amount of niacin needed to affect cholesterol is quite a bit more than the recommended daily allowance. This means that whether you take niacin in the over-the-counter or prescription form, you need to be monitored by a healthcare professional.

Side effects of niacin can include flushing, stomach upset, itching, high blood glucose, and liver damage. Obviously, for those with diabetes the effects of niacin on blood glucose must be carefully assessed, and the benefits of the drug must outweigh potential risks.

I cannot stress enough the importance of a heart healthy diet for keeping cholesterol levels low. Exercise is also important. As always, your best advice comes from your own healthcare professional.