Dyslipidemia

Overview: The Role of Chronic Inflammation in Dyslipidemia

Chronic inflammation is a condition characterized by the prolonged activation of the immune system, resulting in the release of pro-inflammatory molecules. This persistent inflammatory response can have a significant impact on various physiological processes, including lipid metabolism. Here’s how chronic inflammation affects lipid levels:

Impact on Lipid Profile:
- Chronic inflammation can alter the lipid profile by increasing levels of triglycerides and low-density lipoprotein (LDL) cholesterol, while decreasing levels of high-density lipoprotein (HDL) cholesterol.
- Elevated levels of triglycerides and LDL cholesterol are associated with an increased risk of atherosclerosis and cardiovascular disease, while reduced HDL cholesterol levels are linked to impaired reverse cholesterol transport and increased inflammation.
Inflammatory Cytokines and Lipid Metabolism:
- Inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), can disrupt lipid metabolism by influencing the production and clearance of lipoproteins in the liver.
- These cytokines can promote the synthesis of triglycerides and suppress the activity of enzymes involved in the breakdown of lipids, contributing to dyslipidemia.
Insulin Resistance and Lipid Dysregulation:
- Chronic inflammation is closely linked to insulin resistance, a condition in which cells become less responsive to the effects of insulin.
- Insulin resistance can lead to dysregulation of lipid metabolism, resulting in increased production of triglycerides and LDL cholesterol, as well as reduced clearance of these lipids from the bloodstream.
Oxidative Stress and Lipid Peroxidation:
- Inflammatory processes can induce oxidative stress, leading to the production of reactive oxygen species that can damage lipids, including LDL cholesterol particles.
- Lipid peroxidation, a result of oxidative stress, can render LDL cholesterol more atherogenic, contributing to the development of arterial plaques and cardiovascular complications.
Systemic Inflammation and Lipid Imbalance:
- Systemic inflammation, characterized by elevated levels of circulating inflammatory markers, can disrupt lipid homeostasis and promote an atherogenic lipid profile.
- The interplay between chronic inflammation and lipid imbalance creates a pro-atherogenic environment, increasing the risk of cardiovascular events and metabolic disorders.

1. Astaxanthin

Astaxanthin is a carotenoid pigment with antioxidant and anti-inflammatory properties. It is found in algae which when eaten by flamingos, salmon, and shrimp, gives them the pink color.

A 2022 meta-analysis of 14 epidemiological studies found that astaxanthin can significantly reduce the concentrations of total cholesterol, low-density lipoprotein cholesterol (LDL-C), tryglicerides, as well as of glucose and systolic blood pressure, and at the same time increasing the c concentration of high-density lipoprotein cholesterol (HDL-C; increasing it is positive).

Another meta-analysis and systematic review from 2020 2examine 20 animal and five human studies. Twenty animal studies evaluated the effect of ASTX on lipid profile, of which 17 studies reported significant beneficial impact on one or more lipids. Five clinical trials evaluated the effect of ASTX on lipid profile; from these, three reported significant beneficial effect on at least one lipid.

Safety: a review article published in the journal Food and Chemical Toxicology 2 concluded that astaxanthin is safe for human consumption at doses up to 40 mg/day.

2. Bergamot

Bergamot, a citrus fruit, has shown efficacy in improving lipid profiles in patients with dyslipidemia in several clinical trials. A 2022 meta-analysis of 15 randomized controlled trials with over 1300 patients found that bergamot significantly reduced LDL-cholesterol by 38.3mg/dL, triglycerides by 35.7mg/dL and increased HDL-cholesterol by 4.2mg/dL compared to placebo or no treatment.

A 2019 systematic review of 12 articles showed a significant decrease in total cholesterol, triglycerides and LDLc. The decrease in total cholesterol varied from 12.3% to 31.3%, from 7.6% to 40.8% in LDL-C, and from 11.5% to 39.5% in triglycerides. Eight trials reported HDLc increase after intervention with bergamot. Overall, a dose-dependent and possible synergistic effect when administering with statins can be deducted from these trials.

Safety: The 2019 study also found that bergamot is safe for human consumption at doses up to 1500 mg/day. Additionally, a 2021 systematic review concluded that bergamot is well-tolerated with no serious adverse effects reported across the evaluated studies.

3. Blueberries

Multiple randomized controlled trials have demonstrated significant improvements in lipid profiles including reduction of LDL-cholesterol and increase in HDL-cholesterol after blueberry consumption in dyslipidemic adults. A 2020 systematic review and meta-analysis of 10 RCTs with over 550 patients found blueberry supplementation significantly lowered LDL-C and increased HDL-C.

Additionally, a 2022 meta-analysis of 12 trials reported that blueberry intake substantially reduced total-cholesterol by and LDL-c versus control. These lipid-lowering effects appeared more pronounced at higher doses of blueberries.

Overall, current evidence from high-quality systematic reviews supports the use of blueberries to improve dysregulated lipid levels by modestly yet significantly reducing LDL and total cholesterol while raising HDL cholesterol in patients with dyslipidemia.

Safety: blueberries are considered non-toxic without any major side effects. Minor gastrointestinal upsets like nausea or diarrhea have been occasionally reported.

4. Cayenne pepper

Cayenne pepper is a spice that contains capsaicin (CAP), a compound that has antioxidant and anti-inflammatory properties.

A 2022 meta-analysis and systematic review analyzed nine randomized controlled trials with 461 patients. They found that supplementation with CAP significantly decreased total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) among patients with metabolic syndrome. The results revealed that CAP decreased TG levels in women but not in men.

Another meta-analysis from 2022 analyzed eight trials that with 393 participants. Supplementation with capsinoids and fermented red pepper paste resulted in a significant reduction in TC, although other measures were in the right direction but not significant enough.

Another meta-analysis from 2023 examined total of four eligible RCTs and found that CAP supplementation could significantly reduce total cholesterol (TC) but did not significantly affect other measures.

Safety: a 2021 systematic review examining possible side effects found cayenne pepper is likely safe for most healthy adults in culinary doses [2]. But higher doses or extracts may increase risk of gastrointestinal side effects like stomach irritation, cramping or diarrhea in sensitive individuals. The tolerance also varies based on the individual spiciness perception.

5. Cinnamon

Cinnamon is a polyphenol-rich spice that has beneficial effects on markers of cardio metabolic health such as lipid profile, oxidative stress, and inflammation.

An umbrella meta-analysis of eleven meta-analyses from 2023 showed that cinnamon consumption can significantly improve total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C) but not tryglicerides.

In a 2022 meta-analysis a total of 35 clinical trials were included for final analysis. Pooling of results showed a significant reducing effect of cinnamon on total cholesterol, triglyceride, low density lipoprotein-cholesterol, serum glucose, serum insulin, and waist circumstance. These lowering effects on TG, TC, LDL-C, and serum glucose levels were robust in studies that used cinnamon supplementation dose ≤1.5 g. Also, our findings of the present meta-analysis showed that cinnamon supplementation could have favorable effects on high density lipoprotein-cholesterol as well as systolic and diastolic blood pressure among patients with metabolic diseases.

Safety: Another umbrella review of meta-analyses and systematic reviews published in the same journal concluded that cinnamon is safe for human consumption and has no significant toxic or side effects regardless of dose and duration3.

6. Curcumin

Curcumin is also the main ingredient of turmeric, a common ingredient in Indian and Middle Eastern cuisines, and of Curcuma Longa, another spice and medicinal herb.

A 2022 meta-analysis and systematic review found nine eligible randomly controlled trials with 604 subjects. The results showed a significant reduction in triglycerides, total cholesterol, low density lipoprotein cholesterol, an increases high density lipoprotein cholesterol (HDL-c), and decreases in fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) compared with controls.

Another meta-analysis from 2019 found that evidence from 12 RCTs for TG, 14 RCTs for TC, 13 RCTs for LDL cholesterol, and 16 RCTs for HDL cholesterol showed that turmeric and curcuminoids could lower blood TG, TC, and LDL cholesterol, and increase HDL cholesterol.

The mechanisms of action may involve modulating lipid metabolism, reducing oxidative stress and inflammation, and enhancing endothelial function.

Safety: Curcuma longa and curcumin are generally considered safe and well-tolerated, with no serious adverse effects reported in most clinical trials. However, some cases of liver injury have been associated with high doses or prolonged use of Curcuma longa and curcumin supplements, especially in combination with piperine, a compound that enhances their absorption and bioavailability. The risk of liver injury may be higher for people with pre-existing liver conditions, or who take medications that affect liver function. Therefore, it is advisable to consult a doctor before taking Curcuma longa and curcumin supplements, and to monitor liver enzymes regularly.

7. Fenugreek

Fenugreek is an herb that has been used for various health conditions, including diabetes, menstrual cramps, and high cholesterol. Some studies have suggested that fenugreek may help lower cholesterol and triglyceride levels in people with dyslipidemia, especially when combined with other herbs or dietary interventions. Fenugreek may also have anti-inflammatory, antioxidant, and hypoglycemic effects that could benefit people with dyslipidemia.

A meta-analysis of 12 RCTs (14 arms) with 560 participants found a significant decrease in plasma concentrations of total cholesterol, triglycerides, and low-density lipoprotein cholesterol (LDL-C), as well as an increase in plasma high density lipoprotein cholesterol (HDL-C).

A 2020 meta-analysis included 12 articles. We found that fenugreek seed vs. placebo can reduce total cholesterol, LDL-C, fasting blood glucose and HbA1c.

In another 2020 meta-analysis 15 RCTs involving 281 cases consumed fenugreek, 255 control cases in controlled group (11 articles), and 136 cases in uncontrolled group (4 articles) were analyzed in our study. Pooled data indicated a significant impact of fenugreek supplementation on lowering TC, LDL, TG, and increasing the high‐density lipoprotein (HDL).

Safety: When taken by mouth: Fenugreek is commonly consumed in foods. It is possibly safe when the powdered seed is taken for up to 3 years. Side effects may include diarrhea, stomach upset, bloating, and gas. It may also cause allergic reactions in some people. It may cause allergic reactions, gastrointestinal symptoms, liver toxicity, or hypoglycemia in some people. Fenugreek should not be used by children, pregnant or breastfeeding women, or people with bleeding disorders or hormone-sensitive cancers.

8. Flaxseeds/Linseeds

Flaxseeds are rich in fiber, omega-3 fatty acids, and lignans. These nutrients may help lower cholesterol, triglycerides, blood pressure, and inflammation in people with dyslipidemia and related diseases.

Thirty-one RCTs involving 1,698 participants were included in meta-analysis from 2021, published BY BMP, revealed that flaxseed consumption had an overall beneficial effect on serum TC, LDL-C, TG, apo B and IL-6 in patients with dyslipidemia related diseases, but not on apo A, HDL-C, hs-CRP, CRP and anthropometric indices.

An updated systematic review and dose-response meta-analysis of sixty-two randomized controlled trials from 2020 published in ScienceDirect showed that flaxseed supplementation significantly reduced total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C).

Safety: When taken in recommended amounts, flaxseed and flaxseed oil are generally safe to use. However, when taken in large amounts and with too little water, flaxseed can cause bloating, gas, and diarrhea. Avoid use of flaxseed and flaxseed oil during pregnancy.

9. Folic Acid

Folic acid is a type of B vitamin that is normally found in foods such as dried beans, peas, lentils, oranges, whole-wheat products, liver, asparagus, beets, broccoli, brussels sprouts, and spinach. Folic acid helps your body produce and maintain new cells, and also helps prevent changes to DNA that may lead to cancer.

As a medication, folic acid is used to treat folic acid deficiency and certain types of anemia (lack of red blood cells) caused by folic acid deficiency.

A 2021 systematic review and meta-analysis of 34 randomized clinical studies with 21,787 found that folic acid significantly reduced triglycerides and total cholesterol.

Folic Acid: Uses, Benefits & Side Effects – Drugs.com

Beneficial effects of folic acid supplementation on lipid markers in adults: A GRADE-assessed systematic review and dose-response meta-analysis of data from 21,787 participants in 34 randomized controlled trials

10. Garlic

Garlic may lower cholesterol and triglycerides. Several meta-analyses have shown that garlic supplements can reduce total cholesterol and triglycerides in people with dyslipidemia, especially when taken for longer than 2 months. Garlic may have other cardiovascular benefits. Garlic may also improve endothelial function, blood pressure, inflammation, and oxidative stress in people with dyslipidemia and related diseases.

A systematic review and meta-analysis from 2018, published by Pcde found this:

“In the present study, the total sample under review was 1273 individuals, with a mean of 39 samples per study. Overall, garlic was more influential than placebo in reducing the levels of lipid parameters including triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), and fasting blood sugar (FBS) and HbA1C. In the meta-analysis, the concentration of serum TC, LDL, TG, and HDL in the group receiving garlic compared with the placebo showed a significant decrease of 16.87 mg/dl (95% CI, −21.01, −12.73) (P = 0.001), 9.65 mg/dl (95% CI, −15.07, −4.23) (P = 0.001), 12.44 mg/dl (95% CI, −18.19, −6.69) (P = 0.001), and increased for 3.19 mg/dl (95% CI, 1.85, 4.53) (P = 0.001), respectively. Also, the concentration of serum FBS and HbA1C serum showed a significant decreased for 10.90 mg/dl (95% CI, −16.40, −5.40) (P = 0.001) and 0.60 mg/dl (95% CI, −0.98, −0.22) (P = 0.001), respectively.”

Safety: Garlic powder is generally considered safe to eat. It is made from dehydrated and ground garlic cloves, and is a popular seasoning used in many different types of cuisine. It is a good source of vitamins and minerals, including vitamin C, manganese, and selenium. However, some people may be allergic to garlic and should avoid consuming it. Additionally, consuming large amounts of garlic powder may lead to stomach discomfort or other side effects. As with any food, it is always best to consult with a healthcare professional before making any dietary changes.

11. Ginger

A meta-analysis of 26 trials found that ginger supplementation significantly reduced these lipid parameters in people with dyslipidemia.

A meta-analysis from 2018 analyzed 12 trials (586 participants) were included in the meta-analysis. Pooled analysis suggested that ginger supplementation reduced triacylglycerol (TAG) and low-density lipoprotein cholesterol (LDL-C). As inter-study heterogeneity was high, studies were classified by ginger dosage. Stratified analysis showed a significant reduction in TC and TAG in studies which used ≤2 g/day of ginger. However, a similar significant effect was not observed in trials with >2 g/day of ginger.

Similarly, a 2023 meta-analysis found that ginger reduced total cholesterol and triglycerides significantly.

Safety: Ginger root is considered safe by the U.S. Food and Drug Administration (FDA), and the daily approved intake is up to 4 grams.

12. Irvingia Gabonensis

Irvingia gabonensis, also known as African mango, is a tree native to West Africa that produces edible fruits and seeds. The seeds are used for medicinal purposes, especially for weight loss, high cholesterol, and diabetes.

Irvingia gabonensis seeds contain high amounts of soluble fiber, which can bind to bile acids and cholesterol in the gut and increase their excretion, thus lowering blood cholesterol levels. Irvingia gabonensis seeds may also modulate the activity of adiponectin, leptin, and PPAR-gamma, which are involved in lipid metabolism and inflammation. This may reduce fat accumulation and improve insulin sensitivity, leading to lower triglyceride and LDL-cholesterol levels and higher HDL-cholesterol levels.

A meta-analysis of 5 RCTs showed that compared with the control group, the Irvingia gabonensis seed extract supplementation group exhibited a significant total cholesterol reduction of 24% and an LDL-cholesterol reduction of 27%.

A randomized double-blind placebo controlled investigation from 2009 with 102 healthy, overweight and/or obese volunteers. The results showed significant improvements in body weight, body fat, and waist circumference as well as plasma total cholesterol, LDL cholesterol, blood glucose, C-reactive protein, adiponectin and leptin levels.

Safety: Irvingia gabonensis seeds appear to be safe and well-tolerated, with no serious adverse effects reported in clinical trials. The most common side effects are mild gastrointestinal symptoms, such as flatulence, headache, and sleep problems [1,2].

13. L-Carnitine

L-Carnitine is a compound that plays a role in fatty acid oxidation and energy metabolism. It has been proposed as a potential treatment for dyslipidemia, a condition characterized by abnormal levels of lipids in the blood, which is a risk factor for cardiovascular diseases.

According to the latest meta-analysis and systematic reviews, L-Carnitine supplementation can improve lipid profile and reduce cardiovascular risk in patients with dyslipidemia, especially those with diabetes, obesity, or nonalcoholic fatty liver disease. The effects of L-Carnitine on lipid parameters include decreasing total cholesterol, triglycerides, low-density lipoprotein cholesterol, and atherogenic indices, and increasing high-density lipoprotein cholesterol. The mechanisms of L-Carnitine in modulating lipid metabolism may involve enhancing fatty acid oxidation, reducing lipogenesis, regulating gene expression, and improving insulin sensitivity.

The results of recent meta-analysis showed significant effects of L-carnitine on FBG, insulin, HOMA-IR, Triglycerides, total cholesterol, LDLc, and Alanine transaminase.

A Systematic Review and Meta-Analysis of Randomized Controlled Trials (2019) include 67 studies indicated that L-carnitine administration led to a significant decrease in triglycerides, total cholesterol, LDL-cholesterol and a significant increase in HDL-cholesterol levels.

Safety: Carnitine does not have an established tolerable upper intake level. However, doses of approximately 3 g/day of carnitine supplements can cause nausea, vomiting, abdominal cramps, diarrhea, and a fishy body odor. It might also cause muscle weakness in people with uremia and seizures in those with seizure disorders.

Note: the dose in our solutions is 500mg (0.5g)

14. Nigella Sativa

Nigela Sativa (NS) reduces plasma levels of total cholesterol, LDL-C and triglycerides, antioxidant and anti-inflammatory effects. NS and its active component, thymoquinone, can scavenge free radicals, modulate inflammatory cytokines, and inhibit lipid peroxidation.

A 2016 meta-analysis and systematic review found a total of applicable 17 randomized clinical trials. The results showed significant effects of L-carnitine on FBG, insulin, triglycerides, total cholesterol, low density lipoprotein cholesterol and Alanine transaminase.

A systematic review from 2015 shows that NS reduces plasma levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides, but the effect on high-density lipoprotein cholesterol (HDL-C) was not significant.

A Study from 2012, which included 94 subjects that took 2 gr/day NS capsules, found a significant decline in TC, TG, and LDL-c, and a significant elevation in HDL-c/LDL-c, compared with their baseline data and to group 1 patients.

15. Pantethine

Pantethine is a chemical that occurs naturally in the body. It’s related to vitamin B5 (pantothenic acid). In Japan and China, pantethine is available as a prescription drug for hyperlipidemia. Don’t confuse pantethine with pantothenic acid, as these are not the same.

In a review of nutraceuticals role in treating dyslipidemia more than 28 clinical trials have shown consistent and significant improvement in serum lipids. TC is decreased by 15%, LDL by 20%, Apo B by 27.6%, and TG by 36.5% over 4 to 9 months. HDL and Apo A1 are increased by 8%. The effects on lipids are slow, with peak effects at 4 months, but may take up to 6 to 9 months. In addition, pantethine reduces lipid peroxidation of LDL, lipid deposition, intimal thickening, and fatty streak formation in the aorta and coronary arteries. Pantethine inhibits cholesterol synthesis and accelerates fatty acid metabolism in the mitochondria by inhibiting hepatic acetyl‐CoA carboxylase; increases CoA in the cytoplasm, which stimulates the oxidation of acetate at the expense of fatty acid and cholesterol synthesis; and increases Krebs cycle activity. In addition, cholesterol esterase activity increases and HMG‐CoA reductase activity decreases. There is 50% inhibition of fatty acid synthesis and 80% inhibition of cholesterol synthesis. 5

In a 2005 review and meta-analysis of pantethine’s effects on hyperlipoproteinemia twenty-eight studies (n=646) were included. Seven were randomized controlled trials but only data from the pantethine treatment arms were used in the review. The remaining studies were single-group comparisons with baseline.
The mean percentage decrease in total cholesterol from baseline was 8.7% after 1 month, 11.6% after 2 months, 12.6% after 3 months and 15.1% after 4 months.
The mean percentage decrease in LDL-C from baseline was 10.4% after 1 month, 15.2% after 2 months, 17.7% after 3 months and 20.1% after 4 months.
The mean percentage decrease in serum triacylglycerols was 14.2% after 1 month, 15.8% after 2 months, 23.7% after 3 months and 32.9% after 4 months.
The mean percentage increase in HDL-C from baseline was 6.1% after 1 month, 7.8% after 2 months, 10.7% after 3 months and 8.4% after 4 months.

16. Plant Sterols (Phytosterols)

Plant sterols are naturally occurring sterols of plant origin that include B‐sitosterol (the most abundant), campesterol and stigmasterol (4‐desmethyl sterols of the cholestane series), and the stanols, which are saturated. Plant sterols are much better absorbed than plant stanols. The daily intake of plant sterols in the United States is about 150 mg to 400 mg per day mostly from soybean oil, various nuts, and tall pine tree oil.

The plant sterols are also anti‐inflammatory and decrease the levels of pro‐inflammatory cytokines such as hs‐CRP, interleukin (IL) 6, IL‐1b, tumor necrosis factor α, phospholipase 2, and fibrinogen, but these effects vary among the various phytosterols. Other potential mechanisms include modulation of signaling pathways, activation of cellular stress responses, growth arrest, reduction of Apo B 48 secretion from intestinal and hepatic cells, reduction of cholesterol synthesis with suppression of HMG‐CoA reductase and CYP7A1, interference with sterol regulatory element‐binding proteins (SREBPs), and promotion of reverse cholesterol transport via ABCA1 and ABCG1. The biological activity of phytosterols is both cell‐type and sterol specific.

According to a review of over 40 clinical trials on the effects of Phytosterols on Dyslipidemia:
The incorporation of 2 g of phytosterols daily into margarine, mayonnaise, orange juice, olive oil, low-fat milk, yogurt, and tablets is associated with significant reductions in low-density-lipoprotein (LDL) cholesterol from baseline over 1–12 months in adults with normal or high cholesterol, in children, and in patients with type 2 diabetes mellitus. Phytosterol dosages of 1.6–3 g daily have been shown to reduce LDL cholesterol by 4.1–15% versus placebo within the first month of therapy. Several placebo-controlled trials found that the addition of phytosterols to statin therapy was associated with reductions of 7–20% in LDL cholesterol for up to 1.5 years. Overall, phytosterols are useful for reducing LDL cholesterol in patients who cannot reach their treatment goal by diet alone or who are taking maximum tolerated doses of statins. These products offer an alternative to statins in patients who cannot take statins or whose statin dosage is restricted because of potential drug interactions or concomitant diseases

According to a review of nutraceuticals’ role in treating dyslipidemia, plant sterols have a dose‐dependent reduction in serum lipids. TC decreases by 8%, LDL decreases by 10% (range 6–15%) with no change in TGs or HDL on doses of 2g to 3g per day in divided doses with meals.

A recent meta‐analysis of 84 trials showed that an average intake of 2.15g per day reduced LDL by 8.8% with no improvement with higher doses.

Safety: according to the review of clinical trials, commonly reported adverse effects are primarily gastrointestinal in nature.

17. Silymarin

Silymarin, a compound extracted from Silybum marianum, is an herbal supplement that has been proposed as a potential treatment for dyslipidemia, a condition characterized by abnormal levels of lipids in the blood, which is a risk factor for cardiovascular diseases.

Meta-analysis of Sixteen studies involving 1358 patients from 2020 showed that compared with control, silymarin significantly reduced levels of fasting blood glucose, hemoglobin A1c, total cholesterol, triglyceride, low-density lipoprotein-cholesterol, C-reactive protein, and increased high-density lipoprotein-cholesterol.

Another meta-analysis of Ten clinical trials from 2019 indicated that silymarin supplementation in combination with other treatments (not silymarin alone) reduced total cholesterol, and low-density lipoprotein. Also, silymarin increased high-density lipoprotein concentration. Blood concentration of triglyceride was significantly after silymarin supplementation in comparison with controls. meta-analysis revealed that silymarin supplementation in combination with other treatments had a favorable effect on blood lipids.

Safety: Silymarin is generally safe and well-tolerated, with no severe adverse effects or toxicity reported in the doses used in the studies. However, some mild gastrointestinal symptoms, such as nausea and diarrhea, may occur in some individuals.

18. Strawberries

Strawberry extract is rich in antioxidants, such as anthocyanins, flavonoids, and vitamin C, that may protect against oxidative stress and inflammation associated with dyslipidemia.

A meta-analysis included eleven RCT from 2020 shows that strawberries significantly reduced CRP levels, total cholesterol, and LDL-cholesterol.

Another comprehensive systematic review and meta-analysis of randomized controlled trials (2019), 14 clinical trials were included for final analysis. The pooled effect size showed that strawberry supplementation decreased circulating oxidized LDL, malondialdehyde, C-reactive protein, total cholesterol, and diastolic blood pressure.

Systematic Review and Meta-Analysis of 44 Randomized Controlled Trials and 15 Prospective Cohort Studies from 2021. Pooled analysis of RCTs showed that purified anthocyanin supplementation could significantly reduce total cholesterol, blood LDL cholesterol and triglyceride while increase HDL cholesterol concentrations. Purified anthocyanins also markedly decreased circulating tumor necrosis factor alpha and C-reactive protein.

Safety: Strawberry extract is well tolerated and safe, with no serious adverse effects reported in clinical trials. However, some mild gastrointestinal symptoms, such as nausea, vomiting, and abdominal discomfort, may occur in some individuals.

Effects of strawberry intervention on cardiovascular risk factors: a meta-analysis of randomised controlled trials

Effects of strawberry supplementation on cardiovascular risk factors: a comprehensive systematic review and meta-analysis of randomized controlled trials

Anthocyanins, Anthocyanin-Rich Berries, and Cardiovascular Risks: Systematic Review and Meta-Analysis of 44 Randomized Controlled Trials and 15 Prospective Cohort Studies