Table 2.

Other nutraceuticals with lipid-lowering properties [6,14].

Name	Mechanisms of Action	Main Lipid-Lowering Component(s)	Effects on Lipids	Safety and Tolerability
Artichoke leaf extract	Inhibition of liver cholesterol synthesis via action on HMG-CoAR; effects on sterol regulatory element binding protein and acyl-CoA acyl transferase (ACAT)	Luteolin	Up to 10% reduction in LDL-C; small reduction in TG	Transient minor GI effects
Bergamot	Inhibition of liver cholesterol synthesis via inhibition of HMG-CoAR and ACAT; may also increase fecal cholesterol excretion and reduce intestinal cholesterol absorption of bile acids	Brutieridin, melitidin, neoeriocitrin	Up to 15% reduction in LDL-C; small reduction in TG
Rice bran oil	Inhibition of liver cholesterol synthesis via inhibition of HMG-CoAR; reduction in intestinal cholesterol absorption	Gamma-oryzanol	0.18 mmol/L (7 mg/dL) reduction in LDL-C across 11 RCTs (p < 0.001)	No known side effects
Garlic	Inhibition of liver cholesterol synthesis via inhibition of HMG-CoAR, squalene mono-oxygenase, and acetyl-CoA synthetase; may also promote bile acid excretion	Allicin	Up to 5% reduction in LDL-C	Minimal, mostly GI side effects
Green tea extracts	Antioxidant effects; may also interfere with cholesterol absorption and inhibitcholesterol synthesis via inhibition of HMG-CoAR	Catechins, including epigallocatechin-3-gallate	Up to 5% reduction in LDL-C	Potential iron and folate deficiency with high doses; rare GI side effects, rash, transient elevation of BP
Vitamin B5 derivatives	Inhibition of fatty acid and cholesterol synthesis	Pantethine	Up to 11% reduction in LDL-C; smaller reductions in TG and total cholesterol	Well tolerated
Omega-3	Reduced VLDL and TG synthesis; increased fatty acid oxidation	Docosahexaenoic acid; eicosapentaenoic acid	25–30% reduction in TG levels; variable effects on LDL-C depending on components	Well tolerated, rare abdominal discomfort; fishy aftertaste
Coptis, Hydrastis, and Berberis spp.	Increased LDL-C excretion via increased expression of hepatic LDL receptors via inhibition of PCSK9	Berberine	~15% reduction in LDL-C; smallreduction in TG	Mild-to-moderate GI effects
Lupin	Unclear; multiple proposed mechanisms	Bioactive peptides; isoflavones	12% reduction in LDL-C; increase in HDL-C in some studies	Well tolerated; minor GI events
Soy	Unclear; multiple proposed mechanisms	Bioactive peptides; isoflavones	Up to 5% reduction in LDL-C; small reduction in TG and increase in HDL-C	Long-term use of high doses may disrupt fertility and thyroid function; may reduce absorption of calcium and other minerals
Turmeric	Unclear; multiple proposed mechanisms	Curcumin	Inconsistent effects reported; some studies report significant improvements in LDL-C, TG, and HDL-C	Well tolerated

BP = blood pressure; GI = gastrointestinal; HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; PCSK9 = proprotein convertase subtilistin/kexin type 9; RCTs = randomized controlled trials; TG = triglycerides; VLDL = very low-density lipoprotein.