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Lower cholesterol safely: nutritional interventions for healthy lipids.


At Life Extension[R], we have long maintained that one's decision to take a particular drug should be based on individual blood test findings.

For blood lipids, we recommend members seek to achieve the following optimal ranges:
Total cholesterol  160-180 mg/dL

LDL                50-99 mg/dL

HDL                50-60 mg/dL (and higher)

Triglycerides      Under 80 mg/dL

Statin drugs lower LDL and total cholesterol, but have only a modest effect on boosting artery-cleansing HDL. Statin drugs do not lower triglycerides.

Physicians often rely solely on high-dose statin drug therapy to achieve desired blood lipid readings. One problem with this approach is that side effects elevate markedly as the dose of the statin drug is increased.

While you should take all necessary steps to protect heart health--which may include cholesterol-lowering medications--high-dose statins are often unnecessary. They should not be considered the only approach, given their considerable risks at high doses. The side effects of sustained statin use are well documented--muscle wasting, cognitive impairment, blurred vision, and nerve damage, among others.

The encouraging news is that safe, low-cost, broad-spectrum interventions exist right now, especially for individuals with elevated cholesterol, LDL, and triglyceride levels (and low HDL) who do not have other risk factors for vascular disease.


In this article, we explore a novel set of natural lipid-lowering compounds shown to support healthy cholesterol levels. Monacolin-K, a compound found in standardized red yeast rice extract, is a naturally occurring statin. It may surprise you to learn that in clinical studies, red yeast rice along with healthy lifestyle practices lowers cholesterol as effectively as the prescription drug simvastatin. (1)

A substantial body of supportive research further indicates that monacolin-K also reduces triglycerides and boosts HDL, thus offering a safer and broader spectrum alternative to taking synthetic prescription statins. (2), (3), (4), (5), (6), (7), (8)

You will also discover the clinically demonstrated heart-protective benefits of other natural compounds that can bring your blood lipids into healthy balance, lower C-reactive protein (CRP) in the blood, quell chronic system-wide inflammation, and support healthy endothelial function.

Together they provide a potent, complementary alternative to prescription statin drugs.


The simple answer is: many of them have been misled by Big Pharma. It's no exaggeration to say that statins have become the new aspirin in mainstream medicine's war on cardiovascular disease. They're considered wonder drugs by many in the medical community. As one leading cardiologist observed, "You can't go to a cardiology conference and ask who's on statins without everyone's hand going up." (9)

This almost casual attitude toward statin drug use largely stems from industry influence. Not content with letting doctors decide whether or not to prescribe statins on the merits of questionably favorable research data, some drug companies have apparently taken to bribing physcians to push statins on their patients. A 2009 investigative report disclosed that Pfizer and AstraZeneca, pharmaceutical giants that make the two best-selling statins--Lipitor[R] and Crestor[R], respectively--offered Canadian doctors $100 for every new patient they put on the cholesterol-lowering drugs. (10) This outrageous marketing ploy is nothing new. In 2003, when AstraZeneca was poised to launch Crestor[R], which was already known to have twice the adverse side effects of other statins, another unethical deceit was discovered. Dr. Bryan Brewer, a highly influential cholesterol researcher, raved about the drug, telling attendants at a seminar at an American Health Association convention that the drug was safe and effective. His comments were conveniently published in a "special supplement" of the American Journal of Cardiology, timed perfectly with the release of Crestor[R] to the US market. (11)


An investigation later revealed that Dr. Brewer had financial ties to AstraZeneca as a paid speaker. It also revealed that AstraZeneca directly financed Dr. Brewer's American Health Association seminar and Circulation's special supplement. Dr. Brewer's monetary ties to the drug maker were not disclosed in his article.


Red yeast rice (RYR), a staple of Chinese medicine and a traditional Asian seasoning, is made by fermenting polished rice with various strains of the yeast monacus purpureus. It contains a naturally occurring statin called monacolin-K.

Monacolin-K effectively lowers cholesterol by acting as an HMG-CoA reductase inhibitor--the same mode of action as synthetic statin drugs. Bioactive compounds found in RYR complement monacolin-K's lipid-lowering effects, including unsaturated fats. (12) These act both as cholesterol-lowering and anti-inflammatory agents. (13)

Mainstream medicine has been slow to embrace red yeast rice (RYR) as an alternative treatment therapy because the FDA does not regulate the supplement--and because many doctors remain unaware of its lipid-lowering ability and safety profile. This constitutes a great disservice to the millions of Americans now taking synthetic statin drugs. There is a wealth of compelling evidence indicating RYR's power to lower low-density lipoprotein (LDL) and triglyceride levels and raise high-density lipoprotein (HDL)--without unwanted and sometimes dangerous side effects.


In one of the largest studies of its kind, a meta-analysis of 93 randomized controlled trials involving almost 10,000 Chinese patients found that RYR could significantly lower levels of total cholesterol, LDL, and triglycerides, and raise levels of HDL compared with placebo. (14)

In a study specifically designed to determine if RYR could lower lipid levels without causing myalgias (muscle pain), researchers conducted a randomized, double-blind, placebo-controlled trial in patients with high cholesterol. (15) Study participants were randomly assigned to take either 1,800 mg of red yeast rice or placebo twice daily for 24 weeks. All participants were also enrolled in a 12-week therapeutic lifestyle change program during the study.

LDL levels decreased more in the RYR treatment group (average decrease of 35 mg/dL) than in participants receiving the placebo (average placebo decrease was 15 mg/dL). The RYR treatment achieved these results without increasing muscle pain or CPK (creatine phosphokinase)--an enzyme in the blood that indicates muscle damage.

RYR has been shown in some studies to perform as well or better than some widely used synthetic statins. In one randomized, open-label clinical trial, investigators looked at 74 individuals with high cholesterol, dividing them between a simvastatin treatment group (40 mg/day) and an alternative treatment (AT) group. (1)

The alternative treatment included lifestyle changes and ingestion of RYR and fish oil supplements for 12 weeks; the statin group received their medication and traditional counseling. Both groups achieved a statistically significant reduction in LDL levels (AT group -42.4% and the simvastatin group -39.6%). But the AT group also achieved significant reductions in triglycerides (-29% in the AT group vs. -9.3% in the statin group) and weight loss (-5.5% vs. -0.4% of body weight in the statin group). The data showed that lifestyle changes (i.e., diet, exercise, relaxation techniques) combined with ingestion of RYR and fish oil reduced LDL in proportions similar to standard therapy with simvastatin. Investigators concluded that, "This multifactorial, alternative approach to lipid lowering has promise for a subset of patients unwilling or unable to take statins."


Individuals already suffering from coronary heart disease (CHD) may also benefit from RYR as it has been shown to blunt the increase in triglycerides following a meal in patients with clinically documented coronary heart disease (CHD). (16) After a high-fat meal, RYR significantly reduced fasting serum lipids while increasing fasting HDL. Post-meal triglyceride levels fell by 43% after 6 hours in the treatment group--but not in the control group.


Pantethine is the active form of vitamin B5 (or pantothenic acid), the molecule used to make coenzyme A (CoA). CoA is involved in the transport, synthesis, and oxidation of fatty acids to and from the cells, and into the mitochondria. As a member of the B-complex family of vitamins, pantothenic acid is essential to numerous bodily functions, including synthesis of neurotransmitters, hormones, and hemoglobin. Studies have shown that pantethine can reduce serum triglycerides and cholesterol levels while increasing HDL levels. This is true across a broad range of at-risk populations.

Cardiovascular diseases are the main cause of death in women, especially post-menopause. In a 16-week study of 24 menopausal women with high cholesterol (total cholesterol greater than or equal to 240 mg/dL), pantethine yielded significant reductions of total cholesterol, LDL, and LDL/HDL ratio. (17)

Another study of pantethine in 7 children and 65 adults with high cholesterol and/or high triglycerides showed a significant reduction in total cholesterol, LDL, and triglycerides--as well as a substantial increase in HDL. (18)

In another illustrative clinical trial, researchers examined the effect of oral treatment with pantethine on 20 patients with elevated cholesterol and triglycerides. (19) They found significant decreases of total cholesterol, LDL, and triglycerides, with increased levels of HDL.


* Cholesterol-lowering statin drugs are one of the most widely prescribed classes of drugs.

* While protecting heart health is an important lifelong habit, the long-term effects of high-dose statin drugs carry considerable risks and should not be taken without thoughtful consideration.

* Safe, low-cost interventions are available now for those seeking to safeguard heart health.

* Red yeast rice contains monacolin-K, which works by the same mechanism as statin drugs to lower cholesterol.

* Red yeast rice has been shown to lower LDL, total cholesterol, and triglycerides while raising HDL. Red yeast rice has even benefitted individuals who could not tolerate the side effects of statin drugs.

* Since red yeast rice works similarly to statin drugs, practitioners recommend consuming extra CoQ10 while using it.

* Other therapies that support healthy cholesterol levels include beta-sitosterol, pantethine, policosanol, and niacin.


Using prescription statins is not without serious health risks and no one knows the long-term effects of living on them for life, which is how they must be taken. People who use them and then quit a year later face elevated risk levels of stroke and heart attack. (34), (35) Many people who take statins have to stop because of muscle pain, the most commonly reported side effect. (36), (37) A serious and potentially fatal type of rhabdomyolysis (muscle breakdown) has also been reported in statin users. (38), (39), (40), (41)

Numerous published studies have documented other hazards of taking statin drugs that afflict an untold number of users, including muscle damage, (42) cognitive impairment, (43) vision problems, (44) peripheral neuropathy, (45), (46), (47) and tendonopathy. (48)

Published surveys reveal that doctors tend to deny or to minimize statin risks to their patients. These denials occur even when patients present with symptoms that are well-documented adverse reactions to statin drugs, such as muscle pain and detrimental changes in memory, concentration, and mood. (49)


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(2.) Li JJ, Lu ZL, Kou WR, et al. Beneficial Impact of Xuezhikang on Cardiovascular Events and Mortality in Elderly Hypertensive Patients With Previous Myocardial Infarction From the China Coronary Secondary Prevention Study (CCSPS). J Clin Pharmacol. 2009;49:947-56.

(3.) Lu Z, Kou W, Du B, et al. Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol. 2008;101:1689-93.

(4.) Zhao SP, Lu ZL, Du BM, et al. Xuezhikang, an extract of cholestin, reduces cardiovascular events in type 2 diabetes patients with coronary heart disease: subgroup analysis of patients with type 2 diabetes from China coronary secondary prevention study (CCSPS). J Cardiovasc Pharmacol. 2007;49:81-4.

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(13.) Man RY, Lynn Eg, Cheung F, Tsang PS. Cholestin inhibits cholesterol synthesis and secretion in hepatic cells (HepG2). Mol Cell Biochem. 2002 Apr;233(1-2):153-8.

(14.) Liu J, Zhang J, Shi Y, et al. Chinese red yeast rice (Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials. Chin Med. 2006;1:4.

(15.) Becker DJ, Gordon RY, et al. Red yeast rice for dyslipidemia in statin-intolerant patients. Annals Int Med. 2009 Jun;150 (16):830-9.

(16.) Zhao SP, Liu L, Cheng YC, Li YL. Effect of xuezhikang, a cholestin extract, on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease. Atherosclerosis. 2003;168:375-80.

(17.) Binaghi P, Cellina G, Lo Cicero G, Bruschi F, Porcaro E, Penotti M. Evaluation of the cholesterol-lowering effectiveness of pantethine in women in perimenopausal age. Minerva Med. 1990;81:475-9.

(18.) Bertolini S, Donati C, Elicio N, et al. Lipoprotein changes induced by pantethine in hyperlipoproteinemic patients: adults and children. Int J Clin Pharmacol Ther Toxicol. 1986;24:630-7.

(19.) Gensini GF, Prisco D, Rogasi PG, Matucci M, Neri Serneri GG. Changes in fatty acid composition of the single platelet phospholipids induced by pantethine treatment. Int J Clin Pharmacol Res. 1985;5:309-18.

(34.) Blanco M, Nombela F, Castellanos M, et al. Statin treatment withdrawal in ischemic stroke: a controlled randomized study. Neurology. 2007;69:904-910.

(35.) Heeschen C, Hamm CW, Laufs U, et al. Withdrawal of statins increases event rates in patients with acute coronary syndromes. Circulation. 2002;105:1446-52.

(36.) Brown WV. Safety of statins. Curr Opin Lipidol. 2008;19:558-62.

(37.) Ahn SC. Neuromuscular complications of statins. Phys Med Rehabil Clin N Am. 2008;19:47-59, vi.

(38.) Oldemeyer JB, Lund RJ, Koch M, Meares AJ, Dunlay R. Rhabdomyolysis and acute renal failure after changing statin-fibrate combinations. Cardiology. 2000;94:127-8.

(39.) Omar MA, Wilson JP. FDA adverse event reports on statin-associated rhabdomyolysis. Ann Pharmacother. 2002;36:288-95.

(40.) Schech S, Graham D, Staffa J, et al. Risk factors for statin-associated rhabdomyolysis. Pharmacoepidemiol Drug Saf. 2007;16:352-8.

(41.) Staffa JA, Chang J, Green L. Cerivastatin and reports of fatal rhabdomyolysis. N Engl J Med. 2002;346:539-40.

(42.) Hanai J, Cao P, Tanksale P, et al. The muscle-specific ubiquitin ligase atrogin-1/MAFbx mediates statin-induced muscle toxicity. J Clin Invest. 2007 Dec;117(12):3940-51.

(43.) King DS, Wilburn AJ, Wofford MR, Harrell TK, Lindley BJ, Jones DW. Cognitive impairment associated with atorvastatin and simvastatin. Pharmacotherapy. 2003;23:1663-7.

(44.) Fraunfelder FW, Richards AB. Diplopia, blepharoptosis, and ophthalmoplegia and 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitor use. Ophthalmology. 2008;115:2282-5.

(45.) Gaist D, Garcia Rodriguez LA, Huerta C, Hallas J, Sindrup SH. Are users of lipid-lowering drugs at increased risk of peripheral neuropathy? Eur J Clin Pharmacol. 2001;56:931-3.

(46.) de Langen JJ, van Puijenbroek EP. HMG-CoA-reductase inhibitors and neuropathy: reports to the Netherlands Pharmacovigilance Centre. Neth J Med. 2006;64:334-8.

(47.) Chong PH, Boskovich A, Stevkovic N, Bartt RE. Statin-associated peripheral neuropathy: review of the literature. Pharmacotherapy. 2004;24:1194-203.

(48.) Chazerain P, Hayem G, Hamza S, Best C, Ziza JM. Four cases of tendinopathy in patients on statin therapy. Joint Bone Spine. 2001;68:430-3.

(49.) Golomb BA, McGraw JJ, Evans MA, Dimsdale JE. Physician response to patient reports of adverse drug effects: implications for patient-targeted adverse effect surveillance. Drug Saf. 2007;30:669-75.

By Robert Haas, MS
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Title Annotation:REPORT
Author:Haas, Robert
Publication:Life Extension
Article Type:Report
Date:Mar 1, 2010
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