What are the benefits of starting with creatine over red rice yeast and fish oil?

Benefits of Creatine Over Red Rice Yeast and Fish Oil

For cardiovascular health and mortality reduction, moderate fish consumption (2+ servings/week) or fish oil supplements are superior to creatine or red yeast rice, with fish oil showing specific benefits for reducing fatal coronary heart disease events. 1

Comparing Cardiovascular Benefits

Fish Oil Benefits

• Fish oil consumption (from eating fish or supplements) has been associated with reduced risk of fatal coronary heart disease events, with moderate consumption (~2+ servings/week) showing the most benefit 1
• Fish oil supplementation improves several cardiovascular risk factors including blood pressure, heart rate, endothelial function, triglycerides, and adiponectin levels 1
• For patients with severe hypertriglyceridemia, prescription EPA (icosapent ethyl) at 4g/day can reduce triglycerides by ≥30% and has shown superior cardiovascular outcomes 2
• Fish oil has demonstrated anti-inflammatory effects by reducing inflammatory biomarkers and C-reactive protein 1
• In certain populations, particularly Black individuals, fish oil supplementation has shown a significant 77% reduction in myocardial infarction risk 1

Red Yeast Rice Benefits

• Red yeast rice containing monacolin K (3-10 mg/day) can reduce LDL cholesterol by 15-25% within 6-8 weeks 3
• Red yeast rice supplementation is associated with improvements in pulse wave velocity and endothelial function 3
• When combined with fish oil in a supplement, red yeast rice showed a 17.3% reduction in LDL-C, 12.1% reduction in total cholesterol, and 14.9% reduction in high-sensitivity C-reactive protein 4

Specific Populations and Considerations

Fish Oil in Specific Conditions

• For patients with IgA nephropathy and persistent proteinuria, fish oil (1g/day) is recommended despite 3-6 months of optimized supportive care 1
• For patients with diabetes and elevated triglycerides, fish oil supplementation may be beneficial, though results from trials have been mixed 1
• The cardiovascular benefits of fish oil appear most pronounced for fatal cardiac events rather than nonfatal events or stroke 1

Safety Considerations

• Fish oil supplements have an excellent safety profile with minimal risk of toxicity 5, 6
• Red yeast rice is generally well-tolerated, with mild myalgias occurring only in the most sensitive patients 3
• When supplemented in usual doses, fish oil is well-tolerated with only mild gastrointestinal effects reported 1

Dosing and Recommendations

Fish Oil

• For cardiovascular benefit, consumption of 2+ servings of fish per week or approximately 250 mg/day of long-chain omega-3 fatty acids is recommended 1
• For therapeutic effects in clinical conditions, higher doses (1-2 g/day of EPA+DHA) may be required 1
• The American Heart Association recommends four 3-ounce servings of oily fish weekly or 800-1000 mg/day of EPA+DHA for primary and secondary prevention of cardiovascular disease 6

Red Yeast Rice

• Effective dosing of red yeast rice typically contains 3-10 mg of monacolin K daily 3
• Combined supplements containing red yeast rice (2.8 mg monacolins) and fish oil (588 mg) have shown significant lipid-lowering effects 4

Common Pitfalls and Caveats

• Recent fish oil trials have shown mixed results, with older trials demonstrating more benefit than newer ones, possibly due to more aggressive background medical therapy in recent trials 1
• The dose-response effect for fish oil appears nonlinear, with moderate consumption providing most benefits and higher intakes not necessarily providing additional benefit 1
• Fish oil benefits may be reduced in populations with already high background fish intake 1
• Environmental contaminants in fish (dioxins, polychlorinated biphenyls) may partially reduce the cardiometabolic benefits of fish consumption 1
• Red yeast rice supplements can vary significantly in their monacolin K content, affecting their efficacy 3