Lipid is another word for fat, and cholesterol is one of many lipids in our bodies. We need lipids to build healthy cells, but high levels of lipids in the bloodstream can build up in the walls of our arteries. Over the years or even decades, these deposits grow and can reduce blood flow. Even worse, these deposits can suddenly burst, causing a blood clot to form that can cause a heart attack or stroke.
According to the CDC, ninety-five million US adults age twenty or older have elevated blood cholesterol levels (> 200 mg/dL). Nearly twenty-nine million adult Americans have very high total cholesterol levels (> 240 mg/dL). The danger is that those with raised cholesterol levels have about twice the risk of developing cardiovascular disease, including heart attacks and strokes, as people with normal levels. Furthermore, slightly less than half of the adults who could benefit from cholesterol medicine are taking it.1
However, the story is far more complicated than just high cholesterol. Dyslipidemia is the term for when a person has an abnormal amount of lipids in their bloodstream. It includes high levels of the dangerous low-density lipoprotein (LDL), also called bad or lethal cholesterol, or high levels of potentially harmful triglycerides (TG) called hypertriglyceridemia. Also, it can include abnormally low levels of high-density lipoprotein (HDL), also called good or healthy cholesterol. I teach my patients that the H in HDL stands for “healthy cholesterol,” while the L in LDL stands for “lethal cholesterol.” In general, the higher the HDL and the lower the LDL and TG, the better.
A blood test (measuring total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides) is the easiest and most economical way to detect abnormalities in your blood lipids. Natural Medicines™ advises, “Heart-healthy lifestyle choices such as healthy diet and regular exercise are recommended to all patients with dyslipidemia. Those with a high enough risk may also qualify for drug therapy involving a statin.” But drug therapy should typically be used only if lifestyle changes do not work.
The American Heart Association (AHA) says, “In all individuals, emphasize a heart-healthy lifestyle across the life course. A healthy lifestyle reduces atherosclerotic cardiovascular disease (ASCVD) risk at all ages. In younger individuals, healthy lifestyle can reduce development of risk factors and is the foundation of ASCVD risk reduction. In young adults 20 to 39 years of age, an assessment of lifetime risk facilitates the clinician-patient risk discussion and emphasizes intensive lifestyle efforts.” AHA adds, “In all age groups, lifestyle therapy is the primary intervention. When lifestyle interventions alone are not enough to lower LDL, statins generally provide the most effective lipid-lowering treatment.”2
Diets—Which Ones Are Best?
Several nutritional approaches benefit both dyslipidemia and hypertension, resulting in significant reductions in the risk of cardiovascular disease, including heart attacks, heart failure, and stroke. Which method is the best? Each year, the editors of US News and World Reports convene “a panel of food and health experts to rank 40 diets on a variety of measures.”3 In their 2020 ratings for the best “Heart-Healthy Diets,” the Ornish diet was first, followed by the Mediterranean and DASH diets.4
ORNISH DIET. Most of my patients have not heard of the Ornish diet. US News says, “The Ornish Diet was created in 1977 by Dr. Dean Ornish—a clinical professor of medicine at the University of California, San Francisco . . . to help people ‘feel better, live longer, lose weight and gain health.’ The plan is low in fat, refined carbohydrates, and animal protein, which Ornish says makes it ideal. But it’s not just a diet: his strategy also emphasizes exercise, stress management, and relationships.” US News says the pros are that it’s “solid nutritionally” and “your heart will love you.” The cons are that “staying the course could be tough if you’re aiming to reverse heart disease” and it’s “not exactly cheap.”5
MEDITERRANEAN DIET. Number two in heart-healthy diets is the Mediterranean diet. US News says, “It’s generally accepted that the folks in countries bordering the Mediterranean Sea live longer and suffer less than most Americans from cancer and cardiovascular ailments. The not-so-surprising secret is an active lifestyle, weight control, and a diet low in red meat, sugar and saturated fat and high in produce, nuts and other healthful foods. The Mediterranean Diet may offer a host of health benefits, including weight loss, heart and brain health, cancer prevention, and diabetes prevention and control. By following the Mediterranean Diet, you could also keep that weight off while avoiding chronic disease.”6 The pros are that it is “nutritionally sound” and “diverse [in] foods and flavors,” while the cons are that it is “lots of grunt work” and “moderately pricey.”7
US News adds, “There isn’t ‘a’ Mediterranean diet. Greeks eat differently from Italians, who eat differently from the French and Spanish. But they share many of the same principles.”8 Working with the Harvard School of Public Health, Oldways, a nonprofit food think tank in Boston, developed a consumer-friendly Mediterranean diet pyramid that offers guidelines on how to fill your plate—and maybe wine glass—the Mediterranean way.9
DASH DIET. The third-place heart-healthy diet is the DASH diet. US News reports it “is promoted by the National Heart, Lung, and Blood Institute” and “emphasizes the foods you’ve always been told to eat (fruits, veggies, whole grains, lean protein, and low-fat dairy), which are high in blood pressure-deflating nutrients like potassium, calcium, protein and fiber. DASH also discourages foods that are high in saturated fat, such as fatty meats, full-fat dairy foods, and tropical oils, as well as sugar-sweetened beverages and sweets. Following DASH also means capping sodium at 2,300 milligrams a day, which followers will eventually lower to about 1,500 milligrams.” The DASH diet is balanced and can be followed long term, which is a key reason nutrition experts rank it as US News’ tied for second-best “Overall Diet,” with an overall score of 4.1 out of 5, just behind the Mediterranean diet. The pros are that it is “nutritionally sound” and “heart healthy,” while the cons are that it is “lots of grunt work” and “somewhat pricey.”10
PLANT-BASED DIETS. In the “Best Plant-Based Diet” category, the experts chose, in this order, the Mediterranean diet, the Flexitarian diet, and the Nordic diet. In “The Easiest Diet to Follow,” the Mediterranean diet was once again tops followed by a second-place tie between the Flexitarian diet and the DASH diet. The “Best Weight-Loss Diet” was Weight Watchers, followed by the Vegan diet.11
BEST DIETS OVERALL. In the “Best Diets Overall,” “The Best Diets for Healthy Eating,” and “The Best Diets for Diabetes,” the Mediterranean diet came in first place, followed by a second-place tie between the DASH diet and the Flexitarian diet. Taken together, it seems to me these three are the best to consider—with the Mediterranean diet nosing slightly ahead of the others.
Natural Medicines rates the Mediterranean diet as “Likely Safe” and “Possibly Effective” for cardiovascular disease (CVD), cognitive function, dementia, and diabetes; “Possibly Ineffective” for hypertension; and “Insufficient Evidence” for cancer. As for the DASH diet, Natural Medicines rates it “Likely Safe” and “Likely Effective” for hypertension; “Possibly Effective” for CVD, hyperlipidemia, and weight loss; and “Insufficient Evidence” for diabetes or overall mortality.
FLEXITARIAN DIET. About the Flexitarian diet, US News says, “Flexitarian is a marriage of two words: flexible and vegetarian. The term was coined more than a decade ago . . . in [a] 2009 book [sic, it was published in 200812] . . . [that] says you don’t have to eliminate meat completely to reap the health benefits associated with vegetarianism—you can be a vegetarian most of the time, but still chow down on a burger or steak when the urge hits. By eating more plants and less meat, it’s suggested that adherents to the diet will not only lose weight but can improve their overall health, lowering their rate of heart disease, diabetes and cancer, and live longer as a result.”13
The pros are that the Flexitarian diet is “flexible” with “lots of (tasty) recipes,” and the cons are the “emphasis on home cooking” and it “might be tough if you don’t like fruits and veggies”14—although I would consider cooking at home to be a great thing. Natural Medicines rates the “semi-vegetarian” Flexitarian diet as well as other vegetarian diets as “Likely Safe” and “Possibly Effective” for diabetes, hypertension, and obesity and “Insufficient Evidence” for cancer, CVD, hypercholesterolemia, and overall mortality.
Overall, US News rates the Mediterranean diet 4.2 out of 5, while giving the DASH and Flexitarian diets a 4.1 out of 5 rating. The Mediterranean rates #1 in the categories “Best Diets Overall,” “Best Plant-Based Diets,” “Best Diabetes Diets,” and “Easiest Diets to Follow,” while falling to #2 in “Best Heart-Healthy Diets” (after Ornish and ahead of DASH).15
Therefore, the Mediterranean diet is my number-one recommendation—and is also recommended or very highly rated by the AHA,16 the American Society for Nutrition,17 the Cleveland Clinic,18 Consumer Reports,19 the European Food Information Council,20 Johns Hopkins,21 the Harvard School of Public Health,22 Mayo Clinic,23 Today’s Dietitian (the trade publication for registered dietitians and other nutrition professionals),24 Tufts University,25 the Women’s Heart Foundation,26 the WHO,27 the USDA,28 and many other universities as well as national and international medical and health groups.
Exercise versus “Sitting Disease”
The editors of Reader’s Digest tell us, “What is arguably the most common health problem in America today [is] sitting disease.”29 In fact, a 2020 study from the CDC concluded more than “one in seven adults across all US states and territories are physically inactive.” They define physical inactivity “as doing no leisure-time physical activities in the past month—such as running, walking for exercise, or gardening.” Across the US, “southern states had the highest rate of inactivity (28 percent), followed by the Northeast (26 percent), Midwest (25 percent), and the West (21 percent).”30
Researchers from the University of Cambridge reported sitting too much is twice as likely to lead to premature death as being obese!31 Cleveland Clinic investigators reported a clear connection between exercise and longer, healthier life. Cleveland Clinic cardiologist and study author Wael A. Jaber, MD, told CNN, “Being unfit . . . had a worse prognosis, as far as death, than being hypertensive, being diabetic, or being a current smoker.” He added, “We’ve never seen something as pronounced as this.” He concluded that lack of exercise “should be treated as a disease that has a prescription, which is called exercise.”32 Regular exercise increases longevity, reduces fatigue and disability, reduces the risk of heart disease, and improves mental health.
Statins
When diet and exercise fail to control dyslipidemia, by far the most effective, safe, and economical treatment for abnormal lipids is a class of prescription drugs called statins or HMG-CoA reductase inhibitors. They block the production of cholesterol. The experts at Natural Medicines conclude, “Statins can lower LDL cholesterol by up to 55 percent. Plus, they can boost HDL cholesterol levels by 5 to 15 percent. Patients who take a statin have a significantly reduced risk of adverse cardiovascular outcomes such as heart attack and stroke.” The AHA adds, “Research shows statins may lower heart attack risk by at least 25 percent and may also help patients with heart disease avoid cardiac procedures such as coronary stents.”33
Unlike natural medicines, statins are pharmaceutical-grade products. Furthermore, they can be far, far less expensive than over-the-counter products, and almost all insurance plans cover them. But, even so, pharmacy coupons or cash prices may be even lower. For example, the lowest GoodRx.com (my favorite website for comparative drug prices) cost for several commonly prescribed and very effective statins where I live is below $20 for a three-month supply, and in the case of atorvastatin (generic Lipitor®), for less than $7 for a three-month supply—less than 7 cents a day!
Are there potential side effects? Absolutely! Remember what I told you earlier? “If a medication (even a natural medication) does not have side effects, then it will have no effects!” However, as the AHA advises, “The benefits of the cholesterol-lowering medicines called statins far outweigh any risk of side effects, according to a new analysis of decades of scientific research. In fact, side effects of statins are rare.”34 Nevertheless, whether to take a statin is a surprisingly complicated question and beyond the scope of this book. CNN has an excellent article on the topic.35
Natural Medicines instructs health professionals, “For patients who want to incorporate a natural approach into their treatment, there are several viable options including plant sterols/stanols.” ConsumerLab.com says, “Plant-based sterols and stanols . . . are produced in the refinement of vegetable oils. . . . The FDA permits sterol-containing products to claim that they help reduce the risk of heart disease when used with a diet low in saturated fat and cholesterol. For a manufacturer to make this claim, their product must provide a total of 800 mg of free sterols (1.3 grams of sterol esters) divided into at least two servings per day and taken with meals.”
ConsumerLab adds, “It should be noted that while sterols and stanols can lower cholesterol, no study has shown a direct reduction in the risk of cardiovascular disease.” Natural Medicines agrees, concluding, “Keep in mind that these products have only been shown to reduce cholesterol, a risk factor for heart disease. They have not been shown to reduce the risk of cardiovascular outcomes, such as heart attack.”
Nevertheless, as Natural Medicines points out, “Plant sterols and stanols are now considered mainstream. Plant sterols are in Promise® Activ Spread, Smart Balance® Buttery Spread, Minute Maid® Premium Heart Wise orange juice, and many other products. Stanols are in Benecol® spreads and others.”
For those choosing to take a sterol/stanol supplement, among ConsumerLab’s “Approved” products is their “Top Pick”: Nature Made® CholestOff® Plus. ConsumerLab says, “It provides the right ingredients at the best price and even has a clinical study to support its efficacy. Each two-softgel dose claims to provide 900 mg of a combination of sterols and stanols.” ConsumerLab adds, “Our tests showed that it did (actually, it contained 96.5 percent of this, but this is within an acceptable range) and the vast majority of this was from sterols. . . . CholestOff® Plus is also in the ester form, which may be more effective than the free form, and it is in softgel form, which may be more effective than a tablet.”
In addition, “CholestOff® Plus was, by far, the least expensive source of sterols/stanols, at just sixteen cents per 900 mg. The cost to obtain the same amount of sterols/stanols from other products ranged from forty-seven to seventy-four cents.”
However, Natural Medicines warns that sterols, which are absorbed, could theoretically worsen cardiovascular outcomes. They advise, “Until more is known, some experts recommend only using plant stanol products (e.g., Benecol®, others), which are not absorbed, and avoid plant sterol products.” The NMBER® ratings for Benecol® Smart Chews and Benecol® Softgels (McNeil Consumer Healthcare) are 9 out of 10; however, the Benecol® spreads (Buttery, Light, Olive, and Soft Cheese) are only rated 5 out of 10.
My recommendation is that if you’re comfortable trying a sterol, CholestOff® Plus is the way to go. If not, then the Benecol® Smart Chews or Softgels may be for you.
High Fiber Foods for Dyslipidemia
Natural Medicines also recommends high-fiber foods, such as blond psyllium and whole grains. They explain, “Fibrous foods can also help lower cholesterol. The FDA permits health claims for some whole grain foods. Foods that contain at least fifty-one percent whole grains (whole wheat, whole oats, dried corn, barley) may claim to reduce the risk of heart disease. It’s the fiber in whole grains that seems to reduce heart disease. The FDA also allows health claims for blond psyllium and oat bran due to their soluble fiber content.”
“Blond psyllium is among the most studied sources of fiber,” writes Natural Medicines. “Like other fibers, blond psyllium can decrease cholesterol by absorbing dietary fats in the GI tract, preventing systemic absorption, and increasing cholesterol elimination in fecal bile acids. Patients who consume 10 to 12 grams of blond psyllium per day can decrease total cholesterol by 3 to 14 percent, LDL cholesterol by 5 to 11 percent. . . . Blond psyllium seems to be most effective at lowering cholesterol when taken with food at mealtime. But blond psyllium doesn’t seem to work when taken in doses of 6 grams daily or less.”
For those not wanting to increase fiber in their diet, Natural Medicines lists over two hundred products in powder or capsules containing blond psyllium that are NMBER rated 9 out of 10. The powders come as “tasteless” or flavored and can often be mixed into food, juice, water, coffee, or tea. Labdoor is also planning to review fiber products.
Another source of fiber that has been shown to lower cholesterol are whole grains, particularly oats. Natural Medicines advises, “Clinical research shows that consuming 56 to 150 grams of whole oat products, such as oatmeal and oat bran . . . can significantly lower total cholesterol and LDL cholesterol . . . by about 4 to 14 mg/dL.” They add, “Whole oat products might be more effective in lowering LDL cholesterol and total cholesterol,” and tell us doctors to “explain to patients that the extent of cholesterol lowering that occurs while taking fiber is highly variable. It all depends on how much is consumed and the other contents of the diet. A person who consumes a high amount of fiber along with a low-fat diet will likely have the greatest reduction in cholesterol.” I would say “A person who consumes a high amount of fiber along with a healthy-fat diet combined with regular exercise will have even greater reductions in bad cholesterol, weight, BMI, and blood sugar while increasing their good cholesterol.”
ConsumerLab says, “Although oats don’t naturally contain gluten, oat cereals may become cross-contaminated with gluten from wheat products during processing, a potential concern for some people.” ConsumerLab tested products against the FDA standard for “gluten-free,” as well as its own, more stringent “ultra-gluten-free” standard. If you like an oat cereal in the morning like I do, here are ConsumerLab’s “Top Picks” based on product quality and cost per serving (forty grams of dry cereal):
The Academy of Nutrition and Dietetics (AND) says, “Dietary fiber contributes to health and wellness in a number of ways:
AND cautions, “Many Americans fall far short of the recommended daily amount in their diets. Women should aim for 25 grams of fiber per day, while men should target 38 grams, or 14 grams for every 1,000 calories.” They add, “Fiber is found in plant foods. Eating the skin or peel of fruits and vegetables provides a greater dose of fiber, which is found naturally in these sources. Fiber also is found in beans and lentils, whole grains, nuts and seeds. Typically, the more refined or processed a food is, the lower its fiber content. For example, one medium apple with the peel contains 4.4 grams of fiber, while ½ cup of applesauce contains 1.4 grams, and 4 ounces of apple juice contains no fiber.”37
When it comes to fiber-rich breakfast cereals, Consumer Reports says they “have made progress on the road to tastiness.” In tests they performed fourteen years ago, their lab reported that most high-fiber cereals “tasted more like straw than grain.” But in subsequent tests of twenty-six cereals, most with at least 6 grams of fiber, “more than two-thirds tasted very good or better.”38 You just want to find a brand that’s high in protein, whole grains, and fiber, with zero added sugar and zero sodium. Add fruit, a few nuts, and milk or yogurt, and you cover four bases at once: fruit, protein, a complex carbohydrate, and dairy.
EPA and DHA (Fish Oil) for Hypertriglyceridemia
Natural Medicines’ experts advise physicians, “Fish oil is appropriate for patients with hypertriglyceridemia. Save krill oil for patients who can’t tolerate fish oil. Don’t recommend fish oil for hypercholesterolemic patients with normal triglyceride levels, as fish oil may increase LDL cholesterol levels.”
Eicosapentaenoic acid (EPA, which is a long-chain polyunsaturated fatty acid [PUFA] derived from marine mammals and oily fish) is available as a natural medicine. However, it’s also available by prescription. Vascepa® has been approved, along with diet modification, to reduce TG levels in adults with severe (≥ 500 mg/dL) high triglycerides (called hypertriglyceridemia). In December 2019 this approval was extended to include it in addition to statins to reduce the risk of cardiovascular events among adults with elevated TGs (≥ 150 mg/dL) who also have either established cardiovascular disease or diabetes and two or more additional risk factors for cardiovascular disease.
ConsumerLab writes, “Vascepa®, which has been shown to reduce the risk of cardiovascular disease in people with elevated levels of triglycerides, provides 960 mg of EPA per capsule, and two of these capsules are taken twice daily with meals. The cash price for each capsule is about $2.50, or $10 per day (pricing can vary, or an annual cost of approximately $3,000). InMay 2020, the FDA approved a generic competitor to Vascepa®, but in late 2020, its launch had not been announced, apparently due to ongoing patent dispute.”
As discussed in ConsumerLab’s Review of Fish Oil Supplements, “highly concentrated fish oil supplements can provide about the same amount of EPA with little DHA, like Vascepa®, but for as little as 30 percent the cost of Vascepa®.” ConsumerLab also says, “Fish oil in softgels is generally the least expensive way to get good-quality EPA and DHA.” Under its “Best Picks,” ConsumerLab recommends:
GNC® Triple Strength EPA [which] can provide about the same amount of EPA (along with a bit more DHA) as Vascepa® at less than one-third the cost. Both appear to be ethyl esters. One difference between them, however, is that the GNC product is enteric coated, delaying its release of oils until after it passes through the stomach. While this may reduce “fishy burps,” it’s not clear how this may affect absorption. It’s possible that earlier release of the oils in the gut could allow their earlier mixing and better stimulate the bile production needed for absorption of the oils in the small intestine. If that is of concern, one could potentially bite open the GNC softgel, negating the effect of the enteric coating.
Another option suggested by ConsumerLab to get the recommended amount of EPA (about 3,840 mg per day in divided doses) at an even lower cost is to purchase a fish oil product that is not as highly concentrated. However, these products “will likely include significant amounts of other omega-3 fatty acids . . . making the dose larger, i.e. more softgels, capsules, or liquid.”
ConsumerLab also warns, “While EPA/DHA combinations, as found in the prescription fish oil Lovaza® and many supplements, can lower triglycerides, they have not, to date, been shown to lower the risk of cardiovascular disease like Vascepa®.” They add, “A generic version of Lovaza is also available at lower cost. It is sold by Teva Pharmaceuticals as one-gram capsules of ‘omega-3-acid ethyl esters’ and was approved by the FDA as providing approximately the same amounts of EPA and DHA in the same chemical form as Lovaza.”
As for its “Top Pick,” ConsumerLab writes, “If cost is more of an issue than the size and number of pills you take, our ‘Top Pick’ is Kirkland Signature™ [Costco®] Fish Oil 1000 mg, which provides 250 mg of EPA plus DHA as moderately concentrated fish oil in the ‘triglyceride’ form per softgel. The cost is just 3 cents per softgel, making it the most economical product at 1 cent per 100 mg of EPA and DHA. In addition, although not stated on the label, its omega-3s appear to be in the triglyceride form so that you’re likely to get the best absorption.”
ConsumerLab adds, “If you want twice the dose of omega-3s (600 mg) from the same sized pill as Kirkland [Signature™], you can spend 20 cents a pill for Life Extension® Omega Foundations Super Omega-3 EPA/DHA With Sesame Lignans & Olive Extract. If you want even more omega-3s without taking a second pill, we suggest Solgar® Triple Strength Omega 3 950 mg at 29 cents per softgel. These two products are our ‘Top Picks’ for high concentration fish oil.”
As I was writing this book, ConsumerLab announced a new finding:
If you want even more omega-3s without taking a second pill—and at even lower cost per 100 mg of EPA and DHA—we [now] suggest Spring Valley™ [Walmart] Maximum Care Omega-3 2000 mg. Each softgel costs only 12 cents and provides a whopping 955 mg of EPA and DHA. These two products [from Life Extension and Spring Valley] are our “Top Picks” for high concentration fish oil. (Note: We added the Spring Valley™ Maximum Care product to this Review in January 2020 after a ConsumerLab reader spotted it on the market as a great deal and suggested that we test it. It replaces Solgar Triple Strength Omega 3 950 mg as a “Top Pick” because it provides similar amounts of omega-3s but at less than half the cost).
If you want an extremely concentrated fish oil to compete with the prescription version, another of ConsumerLab’s “Top Picks” is Minami Garden of Life® Platinum Omega-3 Fish Oil. ConsumerLab writes, “Each softgel provides 984 mg of EPA and DHA. However, each capsule is 70 cents [currently 75 cents]—much more expensive than others. This product provides a similar concentration and amount of omega-3s per capsule as more expensive prescription fish oils such as Lovaza® . . . (and) it may actually be better absorbed than Lovaza®.”
However, an even better priced option is “Viva® Naturals, which provided 940 mg of EPA and DHA per softgel for only 17 cents [currently 19 cents]—less than one-third the cost of Minami.” The current Viva® Naturals fish oil is an “Ultra Strength Omega-3 Fish Oil” with 1880 mg of EPA and DHA (1400 mg of EPA and 480 mg of DHA), which I found online for as little as 22 cents per softgel.
The ConsumerLab review also includes information on omega-3 fatty acids from other sources, such as algal oil, calamari oil, green-lipped mussel oil, and krill oil. ConsumerLab does warn, “Note, however, that prescription drugs are held to higher standards than fish oil dietary supplements, including the clinical demonstration of safety and efficacy and more rigorous manufacturing standards and oversight. This should be considered when comparing products.”
Other Natural Medicines for Hyperlipidemia
Red yeast rice is manufactured from rice on which a particular yeast has grown and produces cholesterol-lowering compounds that are a reddish color. It is a popular supplement in America, and Natural Medicines considers it “Possibly Effective” and “Likely Effective” for hyperlipidemia. They point out, “Clinical research shows that taking certain red yeast rice products (Cholestin®, Pharmanex; Xuezhikang®, Beijing Peking University; and others) 1–5 grams daily can significantly lower total cholesterol by 11 to 23 percent and low-density lipoprotein (LDL) cholesterol by 22 to 34 percent.”
Also, “Most studies show that red yeast rice products can significantly decrease triglycerides and increase high-density lipoprotein (HDL) cholesterol in patients with hyperlipidemia. It may take up to 12 weeks to see the effects of red yeast rice on lipid parameters.” But here’s the catch: “These products provide up to 10–20 mg daily of monacolin K, which is identical to the ‘statin’ drug, lovastatin.”
ConsumerLab warns, “In the late 1990s . . . the FDA determined that Cholestin®, by containing lovastatin, was an unapproved drug and ordered it removed from sale. A reformulated version of Cholestin®, containing no red yeast rice, is currently sold in the US. However, other red yeast rice dietary supplements continue to be sold in the US.”
What about the other red yeast rice supplements? ConsumerLab advises, “The amount of lovastatins in the tested supplements ranged 1,500 percent. . . . When used according to their suggested serving sizes, only two of nine products provided amounts known to lower cholesterol in clinical trials. One of these two was half the price of the other, making it our ‘Top Pick.’” ConsumerLab also found that lovastatin levels had fallen by 37 to 81 percent since 2014 in products it previously tested. This could result in decreasing efficacy.”
Therefore, ConsumerLab warns, “Based on the varying amounts of lovastatins in products and decreases in these amounts over time, it may be preferable to use a prescription statin drug to ensure a more consistent dose (prescription lovastatin is also available at a lower cost than lovastatin from red yeast rice). However, red yeast rice may be effective for some people who don’t respond to statin drugs and certain side effects may be diminished.” A large study in Taiwan found that people who used red yeast rice (typical dose 600 mg containing 5.7 mg of monacolin K, taken twice daily) had a 54 percent lower risk of developing diabetes compared to people who used prescription lovastatin over five years.39
If you decide to take red yeast rice instead of a prescription statin, ConsumerLab’s “Top Pick” is HPF Cholestene™. A serving of two capsules twice daily provides 12.9 mg of lovastatins—a dose likely to help lower elevated cholesterol levels. ConsumerLab says, “Comparing the cost to obtain 10 mg of lovastatins from each product, HPF Cholestene™ appears to provide the best value—just 49 cents per 10 mg, which is less than half the cost of getting the same amount of lovastatins from the next least expensive product, Nature’s Sunshine®, at $1.03. The highest cost to get 10 mg of lovastatins is $7.60 from Nature’s Way®.”
However, in my area I can purchase prescription atorvastatin for as little as 7 cents for 10 mg and lovastatin for as little as 10 cents for 10 mg. This is 80 percent less than the lowest priced “Approved” or “USP®-Verified” red yeast rice products. And I’m guaranteed purity and consistency of product.
Natural Medicines concludes, “Don’t recommend red yeast rice products due to product consistency issues and related safety concerns.” I agree with that recommendation.
As for other popular natural medicines for hyperlipidemia, Natural Medicines tells doctors, “Due to questions about the effectiveness of garlic and policosanol, don’t recommend them.” Another wise caution is to “always remind patients about the importance of using treatments proven to reduce adverse cardiovascular outcomes (e.g., statins or pure EPA). Just because a drug or supplement reduces LDL cholesterol levels, this does not always equate to improved cardiovascular morbidity or mortality.”
The following chart indicates the amazing number of natural medicines that have been evaluated for dyslipidemia. As you can see, the vast majority would either not be recommended or are not worth your money. But there are some safe and effective winners to consider. More detailed information is available from ConsumerLab.com and Natural Medicines.
Natural Medicines for Dyslipidemia, including
Hypercholesterolemia and Hypertriglyceridemia
Most of the recommendations in the chart are based on the “Safety and Effectiveness Ratings” contained in Natural Medicines™ and explained in chapter 4 of this book. They assume the use of high-quality, uncontaminated products and the use of typical doses. Keep in mind that some products are never appropriate for some patients due to concomitant disease states, potential drug interactions, or other clinical factors. Details are available at Natural Medicines™.