Supplements and Statins

Red yeast rice is effectively a second statin. Its monacolin K is the same molecule as lovastatin. Taking it with a prescribed statin doubles up on the drug and raises the risk of muscle, liver and kidney damage. Don't combine without your doctor.

Piperine may raise statin levels. Simvastatin, lovastatin and atorvastatin are cleared by CYP3A4, which piperine inhibits — higher levels mean more risk of muscle side effects. Rosuvastatin and pravastatin depend less on CYP3A4.

St. John's wort weakens some statins. It lowers blood levels of simvastatin and similar statins.

High-dose niacin with a statin: more side effects, no fewer heart attacks. In large trials of people on statins, adding 1–3 g/day of nicotinic acid didn't reduce cardiovascular events and raised the risk of diabetes, bleeding and other side effects. Cardiology guidelines don't recommend it as an add-on.

Statins lower CoQ10 levels. Statins block the pathway that makes CoQ10. Supplementing is reasonable, but trials on statin-related muscle pain are mixed.

High-dose TMG can nudge cholesterol up. In a meta-analysis of randomized trials, 4 g/day or more of betaine for at least 6 weeks raised total cholesterol slightly (about 13 mg/dL). If you're treating high cholesterol, stay below that dose or recheck your lipids.

Pterostilbene may raise LDL cholesterol. In a randomized trial, pterostilbene alone raised LDL by about 17 mg/dL; the rise was smaller in people already on cholesterol medication. Recheck your lipids after starting.