Revisiting Cholesterol‐Lowering Nutraceuticals and Functional Foods: Mechanistic Insights Into Cholesterol Homeostasis and Gut Microbiota

ABSTRACT The gut microbiota acts as a crucial intermediary between diets and human health. The accumulating evidence suggests that gut microbiota may play a significant role in cholesterol metabolism. This review elucidates four primary mechanisms by which gut microbiota may influence plasma cholesterol via: (1) modulating the ratio of free bile acids to conjugated bile acids and facilitating the elimination of total bile acids, (2) producing the short‐chain fatty acids (SCFAs) and attenuating the cholesterol synthesis, (3) reducing the production of Lipopolysaccharide (LPS) and inhibiting the cholesterol synthesis, and (4) transforming cholesterol to coprostanol and decreasing the cholesterol absorption. In addition, this review will investigate the roles of various nutraceuticals and functional foods in maintaining cholesterol homeostasis, primarily via their interactions with the gut microbiota. These nutraceuticals and functional foods include dietary fibers, phytosterols, γ ‐oryzanols, plant phenolic compounds, plant and fish oils, plant proteins, whole grains, soy foods, spicy foods, Monascus ‐fermented products, prebiotics, selenium‐enriched foods, policosanol, and berberine. The insights presented herein will lay a robust scientific groundwork for addressing hypercholesterolemia and cardiovascular diseases by modulating the gut microbiota, offering promising avenues for therapeutic intervention.