We know it’s a drag to think about, but high cholesterol ups your risk of heart disease and can’t be ignored. “If lifestyle modification alone hasn’t controlled your cholesterol, or you can’t tolerate cholesterol-lowering drugs, supplements may be an option for you,” says preventive cardiologist Stephen Devries, MD, associate professor of medicine at Northwestern University and executive director of the Gaples Institute for Integrative Medicine. Here, three of the most potent supplements to consider discussing with your doctor. Caveat: Remember to never start any supplement without first consulting your doctor.

Red Yeast Rice

Used in Chinese medicine for centuries to lower cholesterol and improve circulation, r.y.r. contains multiple cholesterol-lowering substances, including the statin Monacolin K, better known as lovastatin.

What it does: Reduces LDL (bad) cholesterol by 20 to 30 percent. R.y.r. is often tolerated when prescription statins cannot be used due to side effects.

Possible Side Effects: Liver irritation, muscle pain. R.y.r. should not be taken with prescription statins.

Caveat: Have your doctor monitor you, and request periodic liver blood tests; liver-related side effects are not visible.

Niacin

Also known as vitamin B3, niacin has been used since the 1950’s to improve cholesterol. It’s available over-the-counter or via prescription.

What it does: Considered the most effective drug for raising HDL (good) cholesterol (by up to 35 percent) while also mildly lowering LDL (bad) cholesterol and decreasing triglycerides.

Possible side effects: Flushing (think: hot flashes), lasting 30 to 60 minutes. It’s annoying, but harmless, usually subsiding after a week or two. Liver and muscle irritation can also occur and require doctor monitoring.

Caveat: Containing a bound form of niacin that’s difficult for the body to use, “no-flush” versions are minimally effective. Avoid niacinamide and nicotinamide, which sound like niacin but have no lipid-lowering properties.

Fish Oil

Highly elevated triglycerides can cause inflammation of the pancreas and should be treated. Fish-oil supplements (with active ingredients EPA and DHA) are among the best treatments.

What it does: Lowers triglyceride levels (but does not lower bad cholesterol).

Possible side effects: Burping, gas, digestive problems, bloating.

Caveat: Fish oil can have a blood-thinning effect and is often stopped before surgical or dental procedures. Check with your doctor or dentist.

If you’re curious about these supplements, discuss dosing and monitoring with your doctor. If you’d like to find an integrative physician who combines conventional medicine with alternative and complementary approaches (acupuncture, herbal medicines, massage, stress reduction), try this nifty search tool.

Chime in! What supplements for cholesterol have You asked your doctor about?