Managing High Cholesterol: Do You Need Medication or Natural Alternatives?

High cholesterol?

Hello, I would like to ask about my health situation.
Two years ago, during my first health check, I found out that my total cholesterol was 350 mg/dL, low-density lipoprotein (LDL) cholesterol was 241 mg/dL, and high-density lipoprotein (HDL) cholesterol was 60 mg/dL.
The doctor prescribed medication for me, and after three months, my LDL cholesterol dropped to 90 mg/dL.
However, after stopping the medication, my LDL cholesterol rose again to 178 mg/dL within three months.
I then stopped taking the medication and started taking red yeast rice from my family, and after three months, my LDL cholesterol was at 140 mg/dL.
Since then, my LDL cholesterol has remained around 140 mg/dL, my HDL cholesterol has stayed around 60 mg/dL, and my total cholesterol is about 230 mg/dL, which I have not been able to lower further.
I would like to ask: 1.
Do I need to continue medication treatment? 2.
I understand that cholesterol levels can rise again after stopping medication; will my cholesterol levels also rise again after stopping the red yeast rice, similar to the medication?

Chen Xiaodi, 30~39 year old female. Ask Date: 2020/06/14

Dr. Hou Angting reply Family Medicine

1.
Since the treatment goals for cholesterol are related to the individual's health condition and diseases, it is recommended to discuss this with the prescribing physician.
However, exercise and dietary control remain essential steps.
2.
Because red yeast rice from the maternal family is not a medication, its efficacy is unclear.

Reply Date: 2020/06/14

More Info

Managing high cholesterol is a critical aspect of cardiovascular health, and your situation presents a common dilemma faced by many individuals. Based on the information you've provided, let's address your questions and provide some insights into managing high cholesterol effectively.

1. Do You Need Medication?
Given your history of high cholesterol, particularly with a total cholesterol level of 350 mg/dL and LDL (low-density lipoprotein) cholesterol reaching 241 mg/dL, it is understandable that your healthcare provider initially prescribed medication. After three months of treatment, your LDL cholesterol dropped significantly to 90 mg/dL, which is commendable. However, the subsequent rise to 178 mg/dL after discontinuing medication indicates that your cholesterol levels can rebound without ongoing treatment.
The decision to resume medication should be based on several factors, including your current LDL levels, overall cardiovascular risk, and any other health conditions you may have. The American Heart Association recommends that individuals with a history of high cholesterol, especially those with elevated LDL levels, consider statin therapy or other lipid-lowering medications if lifestyle changes alone are insufficient to maintain target cholesterol levels. Given your LDL levels are still elevated, it may be prudent to discuss the possibility of resuming medication with your healthcare provider.

2. Will Red Yeast Rice (娘家大紅麴) Have a Similar Effect?
Red yeast rice is a natural supplement that contains monacolin K, which is chemically identical to the active ingredient in the prescription statin lovastatin. While it can help lower cholesterol levels, its efficacy can vary significantly among individuals. Your experience of lowering LDL cholesterol to 140 mg/dL after taking red yeast rice suggests it can be beneficial, but it is essential to recognize that the effects may not be as robust or consistent as those achieved with prescription medications.

Just like with statins, if you stop taking red yeast rice, there is a possibility that your cholesterol levels could rise again. This rebound effect is common with many cholesterol-lowering interventions, whether they are pharmaceutical or natural. Therefore, if you find that red yeast rice helps maintain your cholesterol levels, it may be a viable long-term option, but regular monitoring is crucial.

Additional Considerations:
- Lifestyle Modifications: Regardless of whether you choose medication or natural alternatives, lifestyle changes play a vital role in managing cholesterol levels. A heart-healthy diet rich in fruits, vegetables, whole grains, and healthy fats (like those found in olive oil and avocados) can significantly impact cholesterol levels. Regular physical activity, maintaining a healthy weight, and avoiding tobacco smoke are also critical components of cholesterol management.

- Regular Monitoring: Since your cholesterol levels have shown variability, regular follow-up with your healthcare provider is essential. This will allow for timely adjustments to your treatment plan, whether that involves resuming medication, continuing with red yeast rice, or making further lifestyle changes.

- Consultation with Healthcare Providers: It is advisable to have an open discussion with your healthcare provider about your cholesterol management strategy. They can help assess your overall cardiovascular risk, consider any potential side effects of medications or supplements, and tailor a plan that suits your individual needs.

In conclusion, while natural alternatives like red yeast rice can be beneficial, they may not replace the need for medication in all cases, especially if cholesterol levels remain elevated. Regular monitoring and a comprehensive approach that includes lifestyle changes are essential for effective cholesterol management.

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