Q. I recently heard that vitamins and herbs can control cholesterol. Can I take these instead of my medication?

A. First, no one should stop their prescription medication without the advice of their physician. Second, taking supplements in combination with a whole-person approach to cholesterol and cardiovascular disease with advice from a physician who can help you balance medication, herbs, and lifestyle factors may be the best way to go.

A recent study found that taking niacin, commonly known as vitamin B3, was better for preventing plaque formation in arteries than the prescription drug ezetimibe (Zetia). In July 2009, another study indicated that supplement called red yeast rice was effective in lowering LDL (bad cholesterol).

Before anyone considers stopping their prescription medication, here are some facts to consider:

• The niacin study used the supplement in combination with prescription statin drugs — not instead of them. Statins are a class of cholesterol-lowering drugs that includes drugs such as lovastatin (mevacor), atorvastatin (lipitor) and pravastatin (pravachol). It was also a relatively small study (180 people) and for a relatively short time. Just Niaspan (prescription-brand niacin) without medication was not evaluated in this study.

• The red yeast rice study simply compared it against placebo. It is no surprise that it worked in lowering cholesterol because the active ingredient in red yeast rice is a molecule identical to lovastatin, which is naturally produced by the yeast. You might ask why people wouldn't just take red yeast rice instead of a prescription drug. The answer is that the quality of the red yeast rice and the amount of active ingredient in it are poorly regulated. So while it is not a bad idea to get some cholesterol-lowering benefit from this natural source, you would be wise to check your cholesterol levels periodically to see if you are getting the effect you want. You also have to consider that both niacin and lovastatin can cause liver damage just as statin drugs can, even though they are natural products, so you need to be monitored anyway. Other studies have indicated that garlic, oat bran fiber and gugulipid (an ayurvedic herb) are also useful in controlling cholesterol.

These studies are encouraging in that they provide additional choices in controlling cholesterol and preventing heart disease. But neither they nor prescription drugs should be seen as the whole solution. Everyone should understand that most chronic disease — including heart disease and strokes — are caused by diet and lifestyle factors. Therefore, the most important and effective approach is to eliminate the cause by changing diet and lifestyle. Bear in mind that studies indicate that you can do even better than the America Heart Association dietary guidelines in controlling cholesterol and reversing heart disease.

After implementing a lifestyle approach, then herbs and supplements may be added and if these fail, prescription drugs should be used in combination with this whole-person approach. In this way, you have the best of all worlds and at least a fighting chance of being truly healthy and eventually eliminating your need for medications, herbs and specialized supplements.

Dr. Tamar Hoffmann is board-certified in internal medicine and also certified in ayurvedic medicine. She practices at the Complementary and Alternative Medicine Clinic at the John A. Burns School of Medicine. Reach her at 692-0908.