Fish Oil, Red Yeast Rice Cut Cholesterol

Supplements, Lifestyle Change Work as Well as Cholesterol-Lowering Medications

Supplements of fish oil and red yeast rice, coupled with lifestyle changes in diet and exercise habits, can reduce cholesterol as much as statins, according to a new study. But the study's lead author, David J. Becker, MD, a cardiologist at 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 said. The study evaluated only people with high cholesterol who did not yet have coronary disease. The study was funded by the state of Pennsylvania and is published in Mayo Clinic Proceedings.

"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.

Becker and his colleagues studied 74 people with high cholesterol. Half took Zocor and the other half took fish oil and red yeast rice supplements. They were followed for 12 weeks. 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.

At end of a three-month period, the LDL levels 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.

The study results don't surprise Robert Eckel, MD, former president of the American Heart Association and a professor at the University of Colorado. He says the red yeast rice works in much the same way as a statin. "Fish oils don't affect LDL cholesterol - only triglycerides". And the participants' triglyceride levels, on average, were normal, he says, and did not need reduction.

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.

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. (adapted from WebMD)