Efficacy and Safety of Black Pepper Supplementation in Adults with Borderline Hypercholesterolemia: A Randomized, Placebo-Controlled Trial

Black pepper (Piper nigrum) has long been used in traditional medicine for digestive and metabolic health, and piperine, its primary bioactive compound, has demonstrated lipid-lowering effects in preclinical studies; however, clinical evidence remains limited. This randomized, double-blind, placebo-controlled trial evaluated the efficacy and safety of black pepper capsules on lipid profiles in adults with borderline hypercholesterolemia. Forty-seven participants aged 20–34 years with LDL-C 130–189 mg/dL or 35–60 years with LDL-C 100–130 mg/dL were randomized to receive black pepper capsules (250 mg twice daily, providing approximately 7.16 mg/day of piperine) or a placebo for 12 weeks. Primary outcomes included changes in total cholesterol, LDL-C, HDL-C, triglyceride, non-HDL-C, and VLDL-C, measured at baseline, week 8 and week 12. Safety was assessed via liver and renal function tests at baseline and week 8, with adverse events monitored throughout the study. Black pepper supplementation was safe and well tolerated, with no serious adverse events or clinically significant changes in liver or renal function; minor gastrointestinal side effects were self-limiting. No statistically or clinically significant differences were observed between the black pepper and placebo groups in lipid profile changes over 12 weeks (p > 0.05), and age subgroup analyses showed no meaningful LDL-C reductions. In conclusion, black pepper capsules at a dose of 500 mg/day were safe but did not significantly improve lipid profiles in adults with borderline hypercholesterolemia.