In developed countries, cardiovascular disease (heart disease) remains the leading cause of death. The Heart and Stroke Foundation reports that every 7 minutes a Canadian loses his/her life to a heart attack or stroke.

Hypercholesterolemia, specifically elevated LDL (low-density lipoprotein), has been identified as a major risk factor for heart disease and stroke. To reduce the risk, current Canadian dyslipidemia (cholesterol) guidelines recommend:

Dietary Interventions:

  • reducing the intake of saturated fat

  • reducing the intake of refined sugars

  • increasing the intake of fruits, vegetables and fibre

Maintain a Healthy Weight

Integrate Regular Physical Exercise

  • At least 30 to 60 minutes of moderate to vigorous physical activity on most, but preferably all, days of the week

Smoking Cessation

Physiological Stress Management

What concerns me, as a pharmacist, is that 9 in 10 Canadians (90%) have at least one risk factor for heart disease or stroke (smoking, alcohol, physical inactivity, obesity, high blood pressure, high blood cholesterol, diabetes). As a community pharmacist, I identify many patients who cannot tolerate first-line cholesterol-lowering drugs (such as statins and fibrates). Motivated patients are looking for other or complementary options to help lower their cholesterol and reduce the risk of developing heart disease. Let’s take a brief look at some of the popular supplements that might help to lower cholesterol.


There is controversy concerning garlic’s ability to lower cholesterol. High dosages (up to 7.2g of aged garlic or 300 mg three times per day of 1.3% allicin) are required to obtain significant cholesterol reduction (up to approx. 20%). However, this may be impractical due to garlic’s significant odour and the potential for serious drug interactions with medications.


One of the most under-utilized treatments for hyperlipidemia (high cholesterol) is good old fibre. Several studies have found that in groups of patients who increased their fibre to 12g psyllium three times per day, total cholesterol decreased up to 20% and LDL (bad cholesterol) reduced by 30%, HDL (good cholesterol) increased by 21%, - but only when fibre intake was combined with other healthy eating habits. Keep in mind that such a quantity of fibre may cause stomach problems such as bloating, gas and diarrhea.

Plant Sterols

You have probably seen the new food products (margarine-type spreads, yogurts, etc.) fortified with plant sterols for “heart health.” Cholesterol is the major sterol of most animals, including humans, while phytosterols are the major sterols of plants. Plant sterols are chemically similar to cholesterol, but are poorly absorbed. Plant sterols then compete for cholesterol-binding sites and therefore, reduce the absorption of cholesterol from the intestines. Health Canada has approved a claim of “reducing the risk of heart disease” for products that contain a total serving of 1 gram of plant sterols and sets up a daily intake limit of up to 3g per day for adults. The following is a brief list of plant sterols in vegetables, fruits and berries that would assist in reaching the daily goal:



Amount of phytosterols mgm per kg (fresh weight)

Approximate daily intake for cholesterol lowering benefit



11 kg



17 kg



9 kg



7.5 kg



1.4 kg



5.5 kg



13 kg



27 kg

Sweet corn (frozen)


7 kg

The following is a list of common natural health products and functional (fortified) foods with plant sterols available in Canada:


Brand Name

Type of Product

Amount of phytosterols per serving

Astro BioBest with Sterols



Drinkable Yogurt


Becel Proactiv



Centrum Cardio


1g/2 tablets

Danone Danacol

Drinkable Yogurt


MinuteMaid Heartwise

Orange Juice


According to Health Canada, the average of 2 grams per day of plant sterols is effective in decreasing LDL cholesterol. Orally, plant sterols are usually well tolerated; in some patients they can cause nausea, indigestion, gas, diarrhea and/or constipation.

Dietary Changes

A few dietary changes can also be made to help lower cholesterol. Perhaps the most newsworthy, other than dietary fibre previously discussed, is increased consumption of walnuts. A diet including 30-108g of walnuts per day can lower LDL and total cholesterol.

This is by no means an exhaustive list of all supplements used to help lower cholesterol. Niacin, artichoke extract, red yeast extract and soy products also have some evidence supporting their lipid lowering claims. Another fact to remember is that fish oils are not recommended for lowering cholesterol; however, they can lower triglycerides in doses of 1- 5 gm per day.

As a pharmacist I am available to assist my patients with cholesterol-lowering therapy, either with add-on options or products to help alleviate side effects. I cannot stress the importance of adhering to the appropriate prescribed therapy by your physician.

Norm Corriveau, B.Sc.Phm.


Vitamins and the Cholesterol-lowering Benefits of Phytosterols, rxBriefCase, Nov. 2011

SelfCare and Wellness, DrugStore Canada, Oct/Nov. 2011

Canadian HealthcareNetwork, Practice Issues: Management of Dyslipdemia, Oct. 2011

Life Beyond Statins: Strategies and benefits of lipid goal attainment, Sept. 2011