Drugs vs. Dietary Supplements: Head-to-Head Science

Working Together with Statin Drugs
Some people who are sensitive to statin medications taken for high cholesterol may develop statin-related muscle pain (myalgia). Instead of prescribing these patients statins, physicians may instead prescribe an alternative, second-line therapy-the drug ezetimibe. Still, in many cases, the use of ezetimibe alone may not be enough to achieve targeted LDL cholesterol reductions. In these cases, these patients may benefit from a combined treatment of ezetimibe and alternative therapies.

In a recent study, Arrigo Cicero and colleagues retrospectively analyzed the charts of patients visiting the lipid clinic at the University of Bologna in Italy. These patients were moved to ezetimibe therapy due to statin-related myalgia(1) and were also prescribed additional therapeutics to further reduce LDL levels.

Ezetimibe treatment alone was associated with an average 17% LDL reduction. Several alternative treatments resulted in further LDL reductions, however, including: 1) a 19% reduction with a combination of red yeast rice (3 mg monacolin K) and berberine (500 mg), 2) a 17% reduction using berberine alone (500 mg twice daily), and 3) a 10% reduction with a combination of phytosterols (900 mg) and psyllium (3.5 g) taken twice daily. The alternatives were well tolerated and effective, indicating their potential benefits as adjunctive treatments for individuals intolerant to statin drugs.

A number of individuals sensitive to statin medications for cholesterol develop statin-related muscle pain, or myalgia. Such subjects are often prescribed the drug ezetimibe as a standard, second-line therapy alternative to statins. In many cases, however, the use of ezetimibe alone may not achieve targeted levels of LDL cholesterol. These patients may benefit from a combined treatment with ezetimibe and alternative therapies that may facilitate greater LDL reductions.



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Curcumin vs. Ibuprofen for Arthritis Pain
Nonsteroidal anti-inflammatory drugs (NSAIDs) are ubiquitously used to relieve pain in osteoarthritis patients. But NSAIDS may come with their own adverse effects. Side effects can include ulcers, gastrointestinal bleeding, and perforation of the stomach or intestines. And because NSAIDs are often used long-term, medical researchers are intent on identifying effective alternatives with a more favorable safety profile.

A double-blind randomized controlled trial led by Vilai Kuptniratsaikul of Mahidol University in Bangkok, Thailand, compared the effectiveness of a botanical curcumin extract and ibuprofen (a commonly used NSAID) for pain relief and joint function in patients with knee osteoarthritis.(2)

For four weeks, a total of 367 individuals received a daily dose of either 1,200 mg ibuprofen or 1,500 mg of Curcuma domestica extract comprising 75%–85% curcuminoids (curcumin’s active constituent). Both groups saw significant improvements in total WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores as well as scores for joint function and pain compared to baseline levels. The magnitude of effect for both treatments was similar, indicating that curcumin was as effective as ibuprofen for pain-related symptoms of knee osteoarthritis.



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Glucosamine and Chondroitin vs. Celecoxib for Osteoarthritis
Celecoxib is a drug that inhibits the COX-2 (cyclooxygenase 2) enzyme and reduces pain and inflammation in osteoarthritis. However, the use of this drug is associated with significant adverse effects, including up to a 37% increase in major vascular events as well as the gastrointestinal events associated with all NSAIDs.(3) Glucosamine and chondroitin may be effective natural alternatives and showed significant benefits for osteoarthritis in earlier trials. The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) found that this combination was effective in reducing discomfort in the subgroup of osteoarthritis patients suffering from moderate to severe pain.(4)

A decade later, March Hochberg and colleagues of the University of Maryland (College Park, MD) published results of a trial comparing glucosamine hydrochloride and chondroitin sulfate (1,500 mg per day and 1,200 mg per day, respectively) with celecoxib (200 mg per day) in patients with knee osteoarthritis experiencing severe pain.(5) This six-month trial including 606 patients.

Glucosamine/chondroitin supplementation led to a decrease in WOMAC pain scores of 50.1% compared to a 50.2% decrease with celecoxib. Both groups showed a reduction of greater than 50% in measures of joint swelling. Scores for joint stiffness and functional improvement were also similar between the groups. These results indicate that glucosamine/chondroitin are as effective as celecoxib for painful knee osteoarthritis.



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Garlic vs. Atenolol for High Blood Pressure
The number of people with high blood pressure continues to grow worldwide. Nearly 70 million Americans suffer from the condition(6), and only half have their condition under sufficient control. Cleary, there is need for effective interventions.

Herbs such as garlic may possess significant benefits for blood pressure. In a recent trial led by Rizwan Ashraf at King Khalid University (Abha, Saudi Arabia), researchers compared the effects of garlic supplementation to effects of the drug atenolol (a beta-blocker) and placebo in individuals with high blood pressure.(7)

In the 24-week study, 210 individuals with hypertension were divided into seven groups. Five groups consumed garlic in doses ranging from 300 mg daily to 1,500 mg daily. One group used atenolol (100 mg daily). One group consumed placebo. Blood pressure readings were taken at baseline, at week 12, and at week 24.

In the garlic groups, there was a significant dose-dependent reduction in systolic and diastolic blood pressure. The results of the higher-dose garlic groups were comparable to those achieved by the drug atenolol. In the group consuming 1,500 mg of the garlic preparation daily, the average systolic blood pressure reduction was 7.6 mm Hg, while with atenolol, the average decrease was 9.2 mm Hg. This study indicates that garlic preparations are effective for reducing blood pressure and that the results may be on par with first-line drug therapies.

Irfan Qureshi is executive director, research and regulatory affairs, for Healthy Directions.References
1. Cicero AFG et al., “Additional therapy for cholesterol lowering in ezetimibe-treated, statin-intolerant patients in clinical practice: results from an internal audit of a university lipid clinic,” Current Medical Research and Opinion. Published online June 8, 2016.

2. Kuptniratsaikul V et al., “Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study,” Clinical Interventions in Aging. Published online March 20, 2014.

3. Coxib and traditional NSAID Trialists’ (CNT) Collaboration et al., “Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials,” Lancet, vol. 382, no. 9894 (August 31, 2013): 769-779

4. Clegg DO et al., “Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis,” New England Journal of Medicine, vol. 354, no. 8 (February 23, 20016): 795–808

5. Hochberg MC et al., “Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib,” Annals of the Rheumatic Diseases, vol. 75, no. 1 (January 2016): 37–44

6. High Blood Pressure Facts. www.cdc.gov/bloodpressure/facts.htm. Accessed July 24, 2016.

7. Ashraf R et al., “Effects of Allium sativum (garlic) on systolic and diastolic blood pressure in patients with essential hypertension,” Pakistan Journal of Pharmaceutical Sciences, vol. 26, no. 5 (September 2013): 859–863



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