Statins for Our Kids?

The American Academy of Pediatrics is recommending wider cholesterol screening for children. Underpinning these recommendations is the understanding that elevated LDL (bad) cholesterol in kids can lead to an onset of cardiovascular disease earlier in adulthood. It recognizes that the plaque in an adult's arteries may have begun developing very early in life.

The recommendations call for cholesterol screening of children and adolescents, starting as early as the age of 2 and no later than the age of 10, if they come from families with a history of high cholesterol or heart attacks before 55 for men and 65for women.

Screening is also recommended for children when family history is unknown, or if they have other risk factors, like being at or above the 85th percentile for weight, or have diabetes. If the child’s cholesterol level is normal, retesting is suggested in three to five years.

The report also suggests that for a selected group of children, prescribing a statin medication might be appropriate. Drug treatment, according to these recommendations, should be considered for children 8 and older who have very elevated LDLs, or when family history or weight indicate multiple risk factors for developing heart disease.

Not surprisingly, these recommendations raised an outcry.

“When you have a kid whose cholesterol looks like an overweight 65-year-old, what do you do?” asks Dr. David Ludwig, director of the childhood obesity program at Children’s Hospital in Boston and quoted in The New York Times. In developing the recommendations, we "had to balance the risks of treating children with powerful drugs, about which there is limited long-term data, with the risks of not treating children with unprecedented cardiovascular disease risk factors.”

Dr Ludwig also is reflective about these recommendations. Quoted in the Times, he comments “my concern is what this is saying about society when we are so quick to prescribe drugs for these conditions before having systematically attacked the problem from the public health perspective”.

For many, the systematic solution focuses on addressing childhood obesity. No doubt, an extraordinarily important challenge in its own right. Yet, cholesterol management in children go beyond issues associated with obesity. Elevated cholesterol can be found in otherwise fit and thin adults and children alike.

Between weight loss and medication lies therapeutic nutrition as outlined by the National Cholesterol Education Program (NCEP) of the National Institutes of Health. Eating a balanced diet that replaces saturated fats and trans fats with monounsaturated fats (e.g. fats in olive oil, nut butters), adds high levels of soluble fiber from oats, beans, high-pectin fruits, and psyllium) and adds plant sterols can significantly improve cholesterol and blood lipid profiles. Other nutrients, including Omega-3s from fish oils, also have been found useful.

The NCEP asserts that therapeutic lifestyle changes with a particular emphasis on what we eat (not simply how much we eat) can deliver results comparable to many cholesterol-lowering medications. For links to the NCEP reports, clinical research and other educational materials advancing natural cholesterol management: Kardea Nutrition http://www.kardeanutrition.com/. For recipes: http://www.kardeagourmet.com/

Red Yeast Rice: Statin Alternative or Natural Statin

A study recently published in the Mayo Clinic Proceeding has confirmed the power of natural alternatives for cholesterol management. The study, authored by group of doctors and researchers associated with University of Pennsylvania, found that a combination of the Therapeutic Lifestyle Changes (TLC) recommended by the National Cholesterol Education Program (NCEP) of the National Institutes of Health coupled with red yeast rice and fish oil supplements led to a more substantial reduction in LDL (bad) cholesterol than did simvastatin, a statin medication sold by Merck Drug under the brand name Zocor.


The authors wrote “our study was designed to test a comprehensive and holistic approach to lipid lowering…. These results are intriguing and show a potential benefit of an alternative, or naturopathic, approach to a common medical condition, hyperlipidemia”

Statin Alternative or Natural Statin

The media reported the study as an “alternative to statins.” In reality, the choice is between a prescription, controlled statin and a natural source of statins. The active ingredient in red yeast rice supplements is a naturally occurring statin. It is chemically similar to the prescription lovastatin sold by Merck under the brand name of Mevacor. In short, red yeast rice does not represent a statin alternative, but rather a natural source of statins.

For those of us with a predisposition to natural products, this may seem like an intriguing option, but red yeast rice supplements face some important challenges. The authors of this study outlined the issues:
• In 2001, the US Food and Drug Administration determined that red yeast rice with a controlled level of the lovastatin was a drug, not a dietary supplement.
• As a result, the supplement manufacturer cannot control or test for the active compounds in red yeast rice supplement. While the chemical composition of the red yeast rice supplement used in the study was known and controlled, the composition of various products and the batch consistency between lots from the same source make recommending red yest rice supplements difficult.
• Taking red yeast rice without a physician’s supervision could also have unknown risks. The lovastatin component can cause the same side effects as any statin, and a potentially dangerous metabolite, citrinin, can form in poorly manufactured preparations.

Statin Alternative Do Exist

The American Heart Association, the American College of Cardiology, the American College of Preventive Medicine and many other health and medical organization participated in developing the NCEP recommendations. The recommendations emphasize that “many people will be able to lower their LDL enough” with lifestyle and nutritional changes alone. The NCEP reports that “if your LDL needs more lowering, you may have to take a cholesterol-lowering drug” in addition to the lifestyle changes . “However, by staying on the TLC Program, you’ll be keeping that drug at the lowest possible dose. “

The Kardea website provides an extensive amount of information about TLC. It also addresses some of the nutrients not specifically recommended by the NCEP, but widely reviewed by the medical community. The important point: before taking a statin----from a prescription or an herbal supplement---consider your alternatives.