If you want to lower your cholesterol, changing your diet and exercise habits is a good place to start. However, a healthy diet and regular exercise aren’t always enough to reduce your cholesterol to a healthy range.

Some people choose to treat their high cholesterol with supplements and herbs instead of more traditional medications. Opinions are mixed on their effectiveness. While some evidence suggests these treatments are effective, scientific research is minimal. Here’s what we know about the benefits and risks.

Plant sterols are a group of substances called phytochemicals. These chemicals occur naturally within plants and some foods. They’re not essential nutrients but are thought to affect health. Phytochemicals can be found in a variety of foods, including:

  • nuts
  • seeds
  • legumes
  • fruits
  • vegetables
  • cereals

Some processed foods, such as margarine and orange juice, are fortified with plant sterols.

These substances are believed to reduce cholesterol in your blood by blocking the absorption of “bad” low-density lipoprotein (LDL) cholesterol. A study in The American Journal of Cardiology showed that getting 2 to 2.5 grams of sterols a day could lower LDL levels by 10 to 14 percent in some people. You can add this amount of plant sterols to your daily diet by drinking two 8-ounce servings of plant sterol-fortified orange juice per day.

Omega-3 fatty acids, commonly found in fish oil, may slow the buildup of plaque in the arteries. Plaque is formed in your arteries when cholesterol combines with fat, calcium, and other substances in your blood. If plaque is allowed to build up and harden in your arteries, your arteries will become narrow. This can put you at greater risk of having a heart attack or stroke.

When taken at high doses, fish oil can also lower elevated triglycerides. While it remains unclear how, high triglyceride levels may cause your artery walls to thicken or your arteries to harden. This puts you at a higher risk of having a heart attack or stroke. Pancreatitis can also be caused by high triglycerides.

However, large doses of fish oil can increase the risk of bleeding for some people. You should not take large doses if you take any blood-thinning medications. Talk with your doctor before taking fish oil supplements, especially if you’re taking any other medications. Your doctor can help you determine the right dosage for you.

Red yeast rice is made by fermenting rice with red yeast (Monascus purpureus). It has been used in China for centuries as both a medicine and cooking ingredient. It can be bought in drugs stores in capsule form.

In medicine, red yeast rice is primarily used to lower cholesterol. The beneficial components of red yeast rice are monacolins. These chemicals interfere with cholesterol formation. One of these monacolins, monacolin K, has the same structure as the cholesterol medication lovastatin. Your doctor may prescribe you lovastatin or other statin drugs to lower LDL cholesterol levels.

Because red yeast rice naturally contains the same components of some prescription medications, there has been debate about whether it should be classified as a drug and banned from over-the-counter sales. The Food and Drug Administration (FDA) now requires that any red yeast rice products containing more than trace amounts of monacolin K cannot be legally sold as dietary supplements. Despite this FDA regulation, some red yeast rice products currently on the market in the United States may contain more than trace amounts of monacolin K. The labels on red yeast rice products usually do not state the amount of monacolin K present. Consumers thus have no way of knowing whether a particular product is safe, effective, or legal.

Niacin is a B vitamin that is also known as nicotinic acid. Your body uses niacin to turn food into energy. Your body also uses niacin to keep your nervous system, digestive system, skin, hair, and eyes healthy. Most people consume enough niacin in their daily diets, but it’s also included in many multivitamins.

Niacin has also been found to help raise your levels of “good” high-density lipoprotein (HDL) cholesterol. Niacin may increase HDL by more than 30 percent. HDL is considered good because it helps remove cholesterol from your arteries. Consistently removing cholesterol from your arteries helps keep them from becoming blocked. Keeping your arteries clear greatly reduces your risk of having a heart attack or stroke.

Several good natural sources of niacin include tuna, chicken, cereals, legumes, and seeds. For niacin to benefit your cholesterol levels, you must take it in higher doses that can be prescribed by your doctor. You can also buy niacin as an over-the-counter supplement. Because over-the-counter supplements are not regulated like prescription medications, the ingredients and effects can vary widely. It is important to consider that taking niacin in high doses increases your risk for harmful side effects. Possible side effects include:

  • bleeding
  • diabetes
  • infection
  • liver damage
  • stroke

Because of potential side effects, you should discuss with your doctor whether niacin supplements are the best treatment for you.

If you’re looking to try alternative treatments to lower your cholesterol, there are a few steps you can take now:

  • Discuss with your doctor which treatments may work best for you.
  • Research how these alternative treatments may interact with any medications you’re taking.
  • Be aware that supplements may have unknown side effects because they’re not regulated in the same way that drugs are.