Evidence from randomized trials on lipid-lowering by culinary herbs and spices

Cardiovascular diseases remain the leading cause of global mortality, with elevated cholesterol as a major modifiable lipid risk factor. This narrative review synthesized evidence from systematic reviews and meta-analyses of randomized controlled trials examining the effects of herbs, spices, and botanicals on total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) in adults with or at risk for dyslipidemia. Ten agents were identified with varying levels of evidence. Black cumin, garlic, fenugreek, amla, and cinnamon demonstrated robust TC reductions (10–33 mg/dl) and LDL-C reductions (10–35 mg/dl) across multiple independent meta-analyses. Ginger and dill showed more modest or inconsistent effects, while cardamom, saffron, and turmeric powder exhibited insufficient evidence. Proposed mechanisms include inhibition of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, reduced intestinal cholesterol absorption, enhanced bile acid excretion, and activation of peroxisome proliferator-activated receptors. High statistical heterogeneity was common across analyses. The evidence supports incorporating multiple lipid-lowering herbs and spices into plant-based dietary patterns, where they may provide cumulative cardiovascular benefits through complementary mechanisms and serve as functional dietary components for individuals seeking non-pharmacologic approaches to lipid management.