Natural Medicines Versus Statins

You may have read or heard very recently about a study out of the Cleveland Clinic that compared a low dose of a common statin drug rosuvastatin (brand name Crestor) in a head-to-head study against 6 different nutritional supplements and a placebo, and was found to be much better at lowering cholesterol and the (sometimes) harmful LDL cholesterol. The study, I’m sure, will be used to sledge-hammer patients into taking statin drugs of all sorts, giving a boost to the already-booming statin drug industry.   I recently read a critique of the study from ConsumerLab.com, a wonderful organization without an agenda beyond getting at the truth about natural and synthetic products. I wanted to share some of its points with you, as well as my own observations.

First, in an ideal world studies like this would be totally unbiased.   This study, however, was supported by the pharmaceutical company AstraZeneca, who makes Crestor.   Most of the researchers either worked for or consulted with AstraZeneca. In other words, this was an in-house study, which makes the issue of bias somewhat tricky. Also, there were NO researchers from the supplement industry included.

Second, the assumption is made that all supplements are the same.   This assumption works for rosuvastatin which contains identical amounts of active ingredients in every pill. But supplements differ a lot from one company to another. This is why we encourage patients not to grab the cheapest supplement off the store shelf, but to get it from trusted sources. Not only does quality and purity differ in supplements, but the actual content of active ingredients can vary from what the label says.

So, Nature’s Made fish oil was used, 2400 mg. This is not a very concentrated fish oil, and only high doses of concentrated fish oils are likely to lower lipids. And, cholesterol is not the best endpoint to study fish oil, which is more likely to lower triglycerides than cholesterol.

Red Yeast Rice was also studied, using a product from Arazo Nutrition. This product was analyzed by Consumer Lab and found not to have ANY statin compounds usually found in red yeast rice products known to lower cholesterol. Unfortunately there is not good regulation of the supplement industry, leaving patients at the mercy of inferior products, or contaminated ones for that matter.

Ceylon cinnamon is anecdotally said to lower cholesterol, but this is not supported by research, and I’m not sure why cinnamon was included in the Cleveland Clinic study, other than to demonstrate a negative effect.  

Garlic may have a mild triglyceride-lowering effect, but it is not known to lower LDL cholesterol. Likewise curcumin (tumeric) does not have a good track record in lowering cholesterol, although it is known to help prevent heart disease, perhaps by thinning the blood (as does garlic).

Plant sterols are interesting.   There is good research that they do in fact lower LDL cholesterol. But they do this by lowering the absorption of cholesterol, not the production as a statin does.   In this they are more akin to the drug Ezetimibe (Zetia). So in order for them to work they should be taken with meals (there is no indication in the study whether or not patients were given this instruction).

While it’s good that natural medicine is not being ignored totally,, it’s still concerning that the apparent goal of the study was to show the superiority of a drug.   All statins are not alike, and water-soluble statins like Crestor tend to be safer than oil-based statins like Lipitor. In my practice, I used low doses of rosuvastatin in situations where cholesterol was alarmingly high.   But before it becomes clear when and how to integrate natural therapies into a medical model, research will have to be done honestly and without bias.