Wednesday, January 21, 2015

Wisdom Wednesday: Red Yeast Rice

About once a month a patient will tell me their primary care physician recommended red yeast rice because their cholesterol is high. It was bad enough when I just had to counsel patients against the use of this dangerous supplement. Now I have to convince them that their doctor gave them bad advice.

Red yeast rice (RYR) is made from yeast (Monascuspurpureus) grown on rice. It is a dietary staple in some Asian countries. Processed red yeast rice supplements include red yeast rice extract (RYRE), which is any extract of red yeast rice, and Xuezhikang, an alcohol extract of red yeast rice.

RYR contains several compounds known as monacolins, which block the production of cholesterol. One of these, monacolin K, has the same structure as the drugs lovastatin and mevinolin. Studies suggest that RYR use may lead to a 10-33% reduction in low-density lipoprotein (LDL, or “bad”) cholesterol.

While that all sounds good, physicians should not be recommended this supplement, nor should anyone take it.

There are several problems with this supplement:

The first issue is dosage. There is no standardized amount of monacolins or lovastatin in these products. One tablet may contain as much as 20mg of lovastatin (twice the recommended starting dose to lower cholesterol) and the next tablet may contain little or none of the active compounds. If the supplement company standardizes the active compounds, like the manufacturer Pharmanex did with Cholestin, the FDA ruled that should be considered a drug not a dietary supplement. The U.S. District Court followed suit and ruled that Cholestin is an unapproved drug and it was removed from the U.S. market.

The second issue is potential toxicity and death from citrinic acid. Again, the levels of this toxic chemical vary from tablet to tablet and brand to brand.

The third is issue is side effects of all statin drugs – liver inflammation, muscle fatigue and pain, and cardiac myopathy (heart muscle damage). Red yeast rice has the same potential to create these side effects as the prescription drugs.

Finally, there is the issue of manipulating blood chemistries. There was a time, many years ago, when I would lower total cholesterol and LDL levels with supplements. Fish oil (omega 3 fatty acids), niacin, gugulipids and other supplements can readily lower these blood values. However, changing blood values does not necessarily improve health or reduce the risk of heart attack. Over 50% of people suffering their first heart attack have normal or even low cholesterol.

High cholesterol does indicate an imbalance in the body chemistry. The most common cause is a diet high in refined carbohydrates and trans-fats. The second most common cause is an underactive thyroid (hypothyroidism or Hashimoto’s Thyroiditis). Number three is a bacterial infection in the bowel that produces estrogen analogs as a waste product. These estrogen disruptors are reabsorbed into the blood stream and stimulate cholesterol production.

The least common cause of high cholesterol is a genetic issue that stimulates over production of cholesterol in the liver. The test for this issue is the L(p)a which is rarely performed. Although this is a genetic issue it does respond to gingko leaf extract or niacin.

The key is to treat the underlying cause of the cholesterol imbalance. Once corrected, the serum lipids will return to normal.

The Bottom Line:
If you feel you must lower your cholesterol by any means, then take the prescription drug, not red yeast rice. At least you will be monitored and you are taking a standardized dose. However, I really recommend you find out why your cholesterol is high and treat the underlying cause.

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