ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MICHELE NORRIS, host:

And I'm Michele Norris.

Cholesterol drugs are some of the hottest pharmaceutical products on the market. But in this study, it takes a look at what happens when people try what some consider a more natural approach - a dietary supplement called red rice yeast. The study is published today in the Mayo Clinic Proceedings.

As NPR's Allison Aubrey reports, the results come with one major caveat.

ALLISON AUBREY: Barry Baron is a 59-year-old engineer who lives in the suburbs of Philadelphia. These days, he's trying to eat right, walk the cul-de-sac with his wife in the evenings, and to keep his cholesterol in check, he's taking capsules of red rice yeast. This whole wellness program began as a fluke a few years ago when he learned from his doctor that his blood pressure and cholesterol were way too high. At first, he was dismissive.

Mr. BARRY BARON (Engineer): Well, I sort of put it in the back of my mind and said, no, it's really not that big of a deal.

AUBREY: But then he met a cardiologist named David Becker who runs a program called Change of Heart. Becker was looking for patients like Baron who were at risk of having heart attacks or strokes to participate in the 12-week experiment.

Dr. DAVID BECKER (Cardiologist): The key point is to get people to make lifestyle changes.

AUDREY: Becker also wanted to compare what happens to cholesterol levels when you add a standard cholesterol-lowering drug, such as the statin Zocor, versus the dietary supplement, red rice yeast. Becker said he'd been hearing anecdotes for years that red rice yeast works. In fact, the original statin drugs were derived from a similar yeast.

To test this, he put about 35 patients on Zocor and 35 others on red rice yeast.

Dr. BECKER: And after 12 weeks, the results were virtually indistinguishable.

AUDREY: Meaning patients in both groups significantly reduced their cholesterol levels, especially the bad type of cholesterol called low-density lipoproteins.

Dr. BECKER: The LDL went down in both groups about 40 percent.

AUDREY: And Becker said he can't say for certain how much the diet and exercise were responsible for the improvements, but he has noticed that red rice yeast doesn't seem to produce the muscle cramping that is sometimes the side effect of statin drugs.

Dr. BECKER: If you were very anxious to avoid cholesterol medications or if you had side effects from those medications, then this might be an alternative.

AUDREY: Becker says he would never take certain patients off statin drugs, this includes people who have advanced heart disease - meaning they've already had a heart attack, angioplasty, or stunts. For them, statin medications can be life-saving. But for people who's just like 59-year-old Barry Baron who had only high cholesterol but no other signs of illness, the combination of lifestyle changes and supplements seems to be working well.

Mr. BARON: I just had a stress test done and went with flying colors, actually improved my health.

AUDREY: Baron says he knows he's got to have the discipline to keep up the exercise and diet, that's in his control. But here's the caution with red rice yeast: The capsules used during a study were tested and certified for their potency and purity. But cardiologist David Becker says, that's not necessarily the case for all bottles of red rice yeast that you'll find on drugstore shelves.

Dr. BECKER: You just don't know what you're getting, and you can get a batch one time which is perfect and lowers your cholesterol, and then you can get another batch in the same company that might not be as good because nothing's regulated.

AUDREY: A new analysis out today from the supplement testing company, ConsumerLab.com, confirms this point. ConsumerLab's Todd Cooperman says he tested 10 brands of red rice yeast and found shocking differences in concentrations of the main active ingredient called lovastatin.

Dr. TODD COOPERMAN (President, ConsumerLab.com): We found a 100-fold difference. One product had over 10 milligrams of lovastatin per pill; another one had less than 0.1 milligrams of lovastain.

AUDREY: Another finding is that four of the 10 grams were contaminated with a substance called citrinin which is known to be toxic to the kidneys. All of this information puts consumers in a tough spot. The results of red rice yeast are promising, but as with all unregulated supplements, problems with quality control and contamination undermine confidence.

Allison Aubrey, NPR News, Washington.

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