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
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.