Many elderly patients, particularly in our Abbotts of Leigh clinic, ask if there are alternatives to statin drugs to lower high cholesterol.
What is cholesterol?
Cholesterol is made by the liver, but also found in fatty foods. There are two types of cholesterol: HDL or "good" cholesterol (high-density lipoproteins) and LDL or "bad" cholesterol (low-density lipoproteins (or LDL). If LDL cholesterol is high it gets deposited on the walls of your arteries, forming a plaque that clogs your blood vessels and stops your blood flowing properly. Eventually the plaque hardens your arteries, a condition called atherosclerosis. HDL cholesterol removes LDL cholesterol from the arteries and the body, via the liver.
It is important to keep LDL cholesterol levels low as high levels can make you more likely to have a heart attack or a stroke. So statin drugs have an important role to play. Unfortunately statin drugs are well known for their side effects and many people find that the side effects of the drugs outweigh their benefits.
Statin drug side effects
Common statin side effects include:
Headaches
Difficulty sleeping
Skin flushes
Muscle pain, aches, tenderness, or weakness (myalgia)
Drowsiness
Dizziness
Nausea or vomiting
Stomach cramps or pain
Bloating or gas
Diarrhoea
Constipation
Rashes
Some statins also carry warnings that memory loss, mental confusion, high blood sugar, and type 2 diabetes are possible side effects.
Although patient information leaflets say that statins are well tolerated by most people, we know that most people do not report side effects. In addition, the symptoms of muscle aches and pains are often put down to arthritis, or even sometimes dismissed as "at your age a few aches and pains are to be expected"! Equally, giddiness and dizziness are sometimes put down to "standing up too quickly".
If you do have a test which shows you have high LDL cholesterol levels, but your GP or Medical Herbalist does not believe you are in immediate danger, there are several things you can try before starting statin drugs.
Reduce your cholesterol intake
You can immediately improve your diet and cut down on foods that are high in cholesterol, saturated fat, and trans fats. Use olive oil instead of butter or blocks of margarine. Yoghurt instead of cream. Steam or grill instead of frying. Use low fat milk and cheeses. Try fish and tofu instead of red meat. Avoid fried and fatty foods like chips, bacon, burgers and commercial cakes and biscuits made of hydrogenated fats. Avoid crisps and nuts if you're snacking and replace them with dried fruit or pretzels. Eat more fruit and vegetables, especially raw.
In addition to this, it is worth taking a food supplement called red rice yeast. It comes in capsules and is taken daily.
If you have tested for high LDL levels, take red rice yeast capsules daily and ask to be retested every month for three months to see if your body can correct itself. Avoiding statin drugs and their well known side effects by improving your diet with this supplement will help to preserve your overall health for longer. If you are having other related problems or can't get to grips with your diet, book an appointment with a medical herbalist.
What is red rice yeast?
Red rice yeast (Monascus purpureus) is a food supplement made of a red coloured yeast grown on rice, that is used extensively in Chinese cooking to make such classics as Peking Duck and Char Siu. That is where they get their characteristic red colour from. Red rice yeast contains many natural compounds including a group of fourteen monacolins. One of them, monacolin K, is what the statin drug lovastatin is made from.
These monacolins work in similar way to statin drugs and lower cholesterol levels. However, perhaps as they are not so concentrated, or perhaps because other compounds provide a protective effect, red rice yeast does not seem to cause the same level of side effects as statin drugs ( Becker et al, 2009).
Red rice yeast does not cause the same side effects but is still efficacious in lowering harmful LDL cholesterol (Feuerstein & Bjerke, 2012). Where clinical trials have demonstrated side effects from red rice yeast, for example, similar levels of muscles weakness to pravastatin, the dose of red rice yeast has been surprisingly high
- 2400 mg x 2 times a day - a total of 4800 mg ( Halbert et al, 2010).
How much should I take?
An overview of multiple studies by Katan et al, 2003, showed that doses above 2000 mg total per day are unnecessary. They also showed that plant sterols and stanols work best when combined with an unsaturated fat diet.
Try taking 400 mg capsules 3 times a day (a total of 1200 mg), in combination with an improved diet, to help your LDL levels return to normal without experiencing side effects. If they are very high you could take 5 capsules a day (5 x 400 mg = 2000 mg) for the first week or two, but then lower the amount again, especially if you have been intolerant to statins previously.
If you are already on statins, you can decrease the statin dose while increasing the red rice yeast dose, but this should be done under the supervision of your medical herbalist or GP with access to frequent testing. It is best, if possible, to try red rice yeast first before commencing statin therapy.
Choosing the right red rice yeast
It is possible to buy red rice yeast on its own. This is the cheapest way but there are some things to take into consideration. Red rice yeast capsules made in the USA does not contain monacolin K. This is because the FDA regulations require it to be removed to avoid people who are taking it with statin drugs receiving too high a level. So it is 'weaker' than red rice yeast produced in the European Union where this is not required.
Red rice yeast is often sold in combination with the natural enzyme CoQ10 (ubiquinone) which is found in every cell of the body. Low levels of CoQ10 are particularly associated with heart failure, Parkinson's disease and gum disease. Statin drugs can reduce coenzyme Q10 levels by up to 40% (Ghirlanda et al, 1993). Some studies have also found, although results are mixed, that CoQ10 supplementation helps to reduce the muscle weakness commonly experienced as a side effect of statin therapy ( Caso et al, 2007).
CoQ10 also has other benefits as well as supporting heart health. It can increase energy. The heart, liver and kidneys which have the highest energy requirements also naturally have the highest CoQ10 levels in the body. It also boosts antioxidant levels. Antioxidants are found in berries, grape seeds and Vitamin E. They help to fight free radicals which are a primary trigger in cell ageing.
Although it is more expensive, it is a sensible precaution to buy a red rice yeast capsule with CoQ10 included, especially if you are taking high doses of red rice yeast or are still taking some statin drugs under the supervision of your medical
herbalist or healthcare practitioner.
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