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Health-minded people pursue heart disease prevention every way they can. But not every cholesterol lowering diet is compatible with cholesterol lowering drugs.

There's no doubt that taking a cholesterol lowering drug like a statin medication will lower your cholesterol. There's no doubt that lowering cholesterol naturally by pursuing a healthy lifestyle, particularly no smoking and a cholesterol lowering diet, will do even more than a statin for lowering your risk of future heart disease. [1,2] But not every method of lowering cholesterol naturally is compatible with all cholesterol lowering drugs. That's because the same enzymes your body uses to activate and eliminate cholesterol medications are also used to activate and eliminate naturally occurring chemicals in your food.

What are the specific foods and cholesterol lowering diets that just don't mix with standard cholesterol-lowering medications? Scientists are just beginning to understand how diet interactions with genetics and cholesterol medications, but here's a list of some of the important interactions your doctor probably doesn't have time to tell you about.

A list of cholesterol lowering drugs and cholesterol lowering diets that don't mix

  • Crestor, which is also known by the generic name rosuvastatin, is activated by the liver enzyme CYP2C9 [3]. Your body also uses this enzyme to process limonene, which is a chemical found in, as you might imagine, lemons, and also in most forms of mint, and the Japanese mint oil perilla [4], as well as blueberries. Many essential oils with a lemony scent contain a synthetic form of limonene. Eating a lot of these foods or using lemon-scented aromatherapy every day will interfere with your body's ability to activate Crestor. But that's not all. CYP2C9 is also counteracted by a chemical called apigenin [5]. There is apigenin in significant amounts in celery, celeriac, parsley, cilantro, and especially in chamomile tea. All of these products will also interfere with the action of Crestor for lowering cholesterol. The flavonols in red wine and purple grape juice and the flavones in broccoli, carrots, celery, dandelion greensgreen peppers, navel oranges, olive oil, parsley, peppermint, perilla leaf and perilla oil, rosemary, and thyme likewise can interfere with the drug. [5] If you eat a healthy plant food diet, you may not get the full effects of Crestor. However, that also means you won't get as many of its side effects.
  • Lipitor, which is also known by the generic name atorvastatin, is activated by the liver enzyme CYP3A4 [6]. Grapefruit juice contains a chemical that is also activated by CYP3A4, so drinking grapefruit juice or eating grapefruit lowers the effectiveness of the drug.
  • Mevacor, which is also known by the generic name lovastatin, and which is bioidentical with the chemical in red yeast rice, is likewise activated by CYP3A4 [7]. Avoid Earl Grey tea, grapefruit, and grapefruit juice with Mevacor and red yeart rice.
  • Pravachol, which is also known by the generic name pravastatin, is not affected by changes in the CYP3A4 [8]. You can drink grapefruit juice without reducing the effect on this drug. However, orange juice makes Pravachol more available in your bloodstream [9]. It increases the effectiveness and increases the side effects of the drug.
  • Zocor, which is also known by the generic name simvastatin, is activated by the liver enzyme CYP3A4. This means that if you drink graprefruit juice, you reduce the effects of Zocor. However, the ability to lower cholesterol is also reduced in Zocor by consuming capsaicin, the chemical that makes hot peppers hot [10]. The effectiveness of Zocor is also reduced by the plant chemical quercetin [11], or at least that is what scientists conclude from studies in pigs. If you eat the five to nine servings of fruits and vegetables often recommended by the DASH diet, especially capers, carob, dill, Hungarian wax peppers, red onion, radicchio, buckwheat, kale, cranberries, black plums, black-eyed peas (cowpeas), and blueberries, you reduce the effectiveness of the drug.

Do you really need to be keeping track of whether you drank a cup of Earl Grey tea or there was too much oregano in your marinara sauce to use cholesterol lowering drugs effectively? The simple answer is no. You don't have to become a fanatic about regulating the food you eat whether you are using cholesterol lowering drugs or cholesterol lowering diet. But if the drugs aren't working the way your doctor expected them to, then one of more of these food and diet interactions may be a significant problem.

Different people make different amounts of the CYP enzymes that activate and eliminate medications and chemicals in foods [12]. Some people are also much more prone to side effects of statin treatment by virtue of their genetics [13], and doctors are only beginning to test for the relevant genetics and only for a few eligible patients. The technology simply hasn't been around long enough for it to catch on, and to be reliably paid for by health insurance. In the meantime, if your dietary program for lowering cholesterol naturally is otherwise healthy but interferes with the action of your statin drug, don't change a successful diet. Change the drug. There will be a statin that you can take in a low dose that your body can use.

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