#1

Ezetimibe is known to reduce absorption of Omega 3 fatty acids. That made me wonder whether I should keep taking it. But I had a new thought about all this and would welcome inputs.

My HDL has always been very high. For years I have been eating salmon every week and taking large-ish doses of EPA/DHA. But I assumed the sky-high HDL (it was 125) was mostly genetic.

After months on Repatha + Ezetimibe, all lipids were way down. And HDL was down to 114 – still sky high, but down.

So now I am thinking – not to worry about Ezetimibe blocking the EPA/DHA – may-be that (together with the salmon) is what is partly what’s driving the HDL. Perhaps I should even reduce the amount of EPA/DHA that I am taking. And restart a bit of the stanols.

This group has been so helpful to me in my efforts to hone my protocol.
Thank you

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#2

Ezetimibe is generally known to raise HDL though?

#3

Currently waiting for my Omega 3 Quant test results. Lab received the sample, results should be available within a week. I’ve been on ezetimibe for well over a decade, current n-3 intake is low dose daily krill oil, also 1/4 cup walnuts and 1 tablespoon ground flax in morning smoothie and occasional salmon for dinner.

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#4

That will be an extremely interesting test result. I have recently paused Ezetimibe because of concerns over Omega 3 absorption.

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#5

I try to keep at least an 18 hour gap after taking Ezetimibe and consuming anything with ALA/EPA/DHA and vitamin K.
It’s the best way I can think of doing it if taking Ezetimibe daily.

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#6

Do you have any mimimum time between omega 3 intake and ezetimibe? I have used to wait 3 hours, eating fat fish around 7 pm and ezetimibe around 10 pm. If chat gpt is to be trusted (no time for anything more) “Fatty fish can take a few hours to be fully digested and for its nutrients, including omega-3 fatty acids, to be absorbed. A safe window to wait might be 2-3 hours post-meal, but this can vary based on the amount of fish consumed and individual digestion rates”.

With one meal a day I eat a huge portion of fat fish. Stimulated by this thread I will increase the safety margin by putting my ezetimibe next to my floss for intake just prior to bed time.

Plus will have an omega 3 test to check.

This forum is great.

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#7

I don’t think that measures alpha-linolenic acid, which probably has benefits outside of weak conversion to EPA and DHA, and ALA is what ezetimibe might block. I don’t think anyone has suggested it blocks EPA and DHA.

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#8

There is indeed a study floating around on one of these threads strongly suggesting it blocks EPA/DHA absorption.

(Edit: no there isn’t)

#9

Link? A fast search doesn’t find it…

#10

Oops you’re right – I was thinking about the ALA study. I actually found another pilot study that specifically found ezetimibe does not block absorption of EPA:

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#11

It may, however, inhibit vitamin E absorption:

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#12

Thanks! I’d been looking for a study. That matches up with what users here, @约瑟夫_拉维尔 , have been reporting.

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#13

I wonder if this would work for ALA as well? Seems like it should.

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#14

I take ezetimibe in AM. I take fish oil in AM and PM, and I eat fish most nights. So I mostly used the 4 hours gap or more. My omega index was 12%

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#15

I have become increasingly concerned about how much ezetimibe might be reducing the assimilation of important nutrients and supplements. The drug has done a good job of dropping my Apo(b) into the normal range but I wonder about its long term effects. Its effects on the assimilation of some omega-3s and some tocopherols and tocotrienols have been studied slightly, presumably because of widespread interest and use but what about a half dozen or more supplements the assimilation of which might also be reduced or blocked by the drug. Is anyone aware of more comprehensive human clinical research speaking to this topic?

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#16

I posted a study on this forum about it some months ago that indicated Eze could block absorption of omega 3s. But then I had my omega 3 index measured at 10.3% so I’m not worried any longer.

Get tested. Omegaquant.

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#17

I have read all or most refereed articles reporting clinical research or metanalysis, including the one you posted. The scant research is suggestive of the belief that ezetimibe will not substantially block and adsorption of at least some forms of omega-3 under some conditions but it does not exhaust even the omega-3 questions or close all doubts as to its validity. Beyond that, it says little and we know little. Specifically, we know almost nothing about a large number of related dietary substances that may be blocked (partially or wholly) by this drug. To name a few: pro-resolving mediators, omega-7, astaxanthin, lutein.

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Statin monotherapy vs combination with ezetimibe
#18

Well…get tested for omega 3 to get a clear answer on that one. If your omega 3 is good, what does it matter what happens in other people?

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#19

I’m just not being clear. I listed a few of the supplements I take, all of which are important to me in varying degrees. Whatever the individual differences, one strand of inquiry in our group is to track down side effects. These comments are in that vein. We know very little in terms of controlled comparisons about possible longer term effects.

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#20

Question #1: is there a best time to take ezetemibe, from the point of view of effectiveness of its primary purpose - blood lipids?

The answer seems to be - at least as prescribing goes - there is no time of night or day when it is “best” or “most effective” to take for blood lipids.

If so, then we are free to take it whenever we wish.

Question #2: does a substantial break in time from the last consumption of fats or supplements (such as above mentioned astaxanthin) remove the danger of ezetemibe interfering with nutrient absorbtion?

If yes (re: question #2), then if you consume dinner - or your last meal and/or supplements 4 hours or more from the time you go to sleep, then why not take your ezetemibe just before you go to sleep? Example: dinner/supplements 6 pm, take ezetemibe 10 pm, sleep. That gives you many hours before and after taking of ezetemibe of isolating it from any nutrient digestion.

Personally, my plan is to start taking bempedoic acid + ezetemibe fairly soon, and in view of the information above, I think it would be best for me to take it just before sleep (I go to bed midnight), so 4-6 hours after my last meal.

The issue of timing of medication, exercise, meals, supplements and so on becomes ever more complicated with polypharmacy, but I think we have to resign ourselves to not being able to time everything perfectly if you take, say, 8 prescription medications and 20 otc supplements, you are inevitably going to have irresolvable conflicts. The hope is that such conflicts will result in “suboptimal” and not “abolishing”.

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