Fish Oil, Red Yeast Rice Cut Cholesterol
Supplements, Lifestyle Change Work as Well as Cholesterol-Lowering Medications in Small Study
By
Kathleen Doheny
WebMD Health News
Reviewed By
Michael W. Smith, MD
July 23, 2008 — Supplements of fish oil and red yeast rice, coupled with
lifestyle changes in diet and exercise habits, can reduce cholesterol as much
as standard cholesterol-lowering medications known as statins, according to a
new study.
But the study's lead author, David J. Becker, MD, a cardiologist at Chestnut
Hill Hospital and the University of Pennsylvania Health System, emphasizes that
the alternative approach is not for everyone.
"Statins remain the primary and best treatment for people with high
cholesterol, especially if you have known coronary disease," Becker tells
WebMD. The study evaluated only people with high cholesterol who did not yet
have coronary disease.
"If you are someone dead set against taking a statin, this may be an
attractive option, assuming you are willing to make the lifestyle changes,"
Becker says.
"This is one of the first studies that has shown there is some promise
here," he says, referring to the alternative approach with supplements
instead of statins.
Finding alternatives to medication for lowering cholesterol is
important, he says, because studies show as many as 40% of people who get a
statin prescription are believed to take it for less than a year.
Supplements vs. Statins: Study Details
Becker and his colleagues studied 74 people with high cholesterol. Half took
the statin drug Zocor and the other half took red yeast rice
supplements. They were followed for 12 weeks.
Red yeast rice is the product of yeast grown on rice and includes several
compounds that hinder production of cholesterol in the body. Fish oil has been
shown to lower the blood fats known as triglycerides. The study was funded by
the state of Pennsylvania and is published in Mayo Clinic
Proceedings.
The medication group took 40 milligrams of Zocor daily and received
traditional counseling in the form of handouts on diet and exercise.
The supplement group took three fish oil capsules twice daily. In addition,
those with an LDL cholesterol higher than 160 mg/dL took 3.6 grams of red yeast
rice daily, divided into two doses. If the initial LDL level was 160 or less,
they took 2.4 grams of red yeast rice daily, divided into two doses.
The supplement group also attended weekly meetings and was taught about
lifestyle changes by a cardiologist and a dietitian. The group was urged to
follow a modified Mediterranean diet, limiting fat intake to less than 25% of
daily total calories, and to exercise for 30 to 45 minutes five to six times a
week.
Supplements vs. Statins: Results
"We followed them for a three-month period," Becker says. At the
study's end, the levels of bad cholesterol had declined nearly the same amount
in both groups. "The LDL declined 42% in the supplement group and 39% in
the Zocor group," Becker says.
The supplement group also lost an average of 10 pounds in 12 weeks, but
there was no significant weight loss in the medication group. Triglyceride
levels, while on average normal in both groups at the start, decreased by 29%
in the supplement group but just 9.3% in the medication group — a significant
difference, Becker says.
"This homeopathic, natural approach in a group of people who do not have
known coronary disease and who can make these kinds of exacting lifestyle
changes may be worth exploring in longer and better studies," Becker tells
WebMD.
Supplements vs. Statins: Second Opinion
The study results don't surprise Robert Eckel, MD, former president of the
American Heart Association and a professor of medicine at the University of
Colorado at Denver. The red yeast rice, he tells WebMD, works in much the same
way as a statin.
"Fish oils don't affect LDL cholesterol," he says, but only
triglycerides. And the participants' triglyceride levels, on average, were
normal, he says, and did not need reduction.
If you are trying to lower cholesterol, he says, the first step is to see a
doctor.
Supplements vs. Statins: Downsides & Caveats
Becker sees downsides to supplements over statins.
"The red yeast rice is an unregulated supplement," Becker says. He
cites a recent report in which researchers found significant differences in the
amount of red yeast rice in different brands of supplements.
In August 2007, the FDA warned against buying or eating specific red yeast
rice products (Red Yeast Rice/Policosonal Complex by Swanson Healthcare
Products, Inc., and Cholestrix) because they ''may contain an unauthorized drug
that could be harmful." FDA testing had detected lovastatin, the active
ingredient in Mevacor, a prescription drug for cholesterol lowering.
Red yeast rice sold in the U.S. typically comes in 600 milligram to 1,200
milligram doses, with recommendations of taking no more than 2,400 milligrams
(2.4 grams) a day, the lower dose used in the study. Doses higher than this
increase the risk of side effects similar to that of statin drugs, including
muscle pain or tenderness, and possibly liver damage. Red yeast rice and
statins work similarly in the body, so they should not be taken together, as
this increases the chance of side effects.
For anyone who wants to try the alternative approach, Becker recommends
talking with their doctor, having all recommended blood tests to make sure the
approach is working, and checking for potential side effects.
SOURCES: David J. Becker, MD, cardiologist, Chestnut Hill Hospital and University of
Pennsylvania Health System, Philadelphia. Becker, D. Mayo Clinic Proceedings, July 2008; vol 83: pp 58-764. Robert Eckel, MD, former president, American Heart Association; professor of medicine, University of Colorado at Denver. FDA: "Consumer Update, Aug. 9, 2007." American Heart Association: "Cholesterol Levels."
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