When you look on the shelves at health food stores, natural food stores, or supermarkets, most likely you’ll see an array of various brands of red yeast rice. Some physicians are asking their patients to buy red yeast rice to control cholesterol. It’s important to choose a brand, if you use red yeast rice, that you are certain to be free from any citrinin, a toxin from fungus that is potentially harmful to the kidneys.
Are you buying brands known not to contain toxins? Have you ever wondered what’s in the red yeast rice and who controls what ingredients go in there? And if your doctors suggests red yeast rice, what brand do you buy and why? Does your health care professional keep up with the latest studies of what’s in which brand of red yeast rice?
According to the October 25, 2010 JAMA and Archives Journals article, “Active ingredient levels vary among red yeast rice supplements,” different formulations of red yeast rice, a supplement marketed as a way to improve cholesterol levels, appear widely inconsistent in the amounts of active ingredients they contain, according to a report in the October 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
In addition, one in three of 12 products studied had detectable levels of a potentially toxic compound. Read the study published in the Archives of Internal Medicine, 2010;170:1722-1727. “Chinese red yeast rice, also known as Hong Qu, is a medicinal agent and food colorant made by culturing a yeast, Monascus purpureus, on rice,” the authors write, according to the current press release, “Active ingredient levels vary among red yeast rice supplements,” as background information in the article.
The process produces compounds called monacolins, one of which (monacolin K) has been purified and marketed as lovastatin. The authors note that “Several studies have shown that specific formulations of red yeast rice reduce low-density lipoprotein cholesterol (LDL-C) significantly compared with placebo. This is likely related to the effects of monacolin K and the 13 other monacolins in the supplement, which also works to lower the production of cholesterol in the liver.”
Choose brands known not to contain toxins as verified by independent labs
In 2008, American consumers spent about $20 million on this supplement, often in response to recommendations from clinicians. However, to avoid being considered an unapproved drug by the U.S. Food and Drug Administration, manufacturers do not standardize or disclose the levels of monacolin K or other monacolins in their products, the authors note, according to the current news release.
Ram Y. Gordon, M.D., of Chestnut Hill Hospital, Philadelphia, and Abington Memorial Hospital, Abington, Penn., and colleagues evaluated monacolin levels in 12 commercial red yeast rice formulations and also tested for citrinin, a toxin from fungus that is potentially harmful to the kidneys.
Make sure your brand has been tested for and doesn’t contain any citrinin
Across the 12 products, levels of total monacolins ranged from 0.31 milligrams to 11.15 milligrams per capsule and levels of monacolin K or lovastatin ranged from 0.10 milligrams to 10.09 milligrams per capsule. Four of the formulations had elevated levels of citrinin.
“Red yeast rice has been used for centuries for its medicinal properties and is an increasingly popular alternative lipid-lowering therapy that may benefit patients with a history of coronary disease who cannot take statins, subjects who refuse statins or who prefer a ‘natural’ approach to pharmacotherapy, or patients with a history of statin-associated myalgias,” or muscle pains, the authors write according to the news release. “However, our study found dramatic variability of monacolin levels in commercial products and the presence of citrinin in one-third of formulations.”
Is the problem with the labeling of various brands? The news release notes, “Further oversight and standardization of the production and labeling of red yeast rice products may address some of the concerns raised in this study. Until these issues are addressed, physicians should be cautious in recommending red yeast rice to their patients for the treatment of hyperlipidemia [high cholesterol] and primary and secondary prevention of cardiovascular disease.”
It has been said by some physicians that “you need to make sure your red yeast product, if you take one, does not have the toxic fermentation by-product, citrinin in it.” You don’t want this mold toxin in any supplements. Citrinin is a mycotoxin that’s capable of damaging your kidneys and doing other genetic damage. So look for a product free of citrinin, such as Wakunaga’s Kyolic Formula 107 red yeast rice, which is free of citrinin. Also see the Jan. 19, 2010 Medical News Today article, “Higher Statin Doses Not Always Best At Preventing Coronary Artery Disease.”
Watch out for websites where you can’t find the information you want. If you have never heard of a vitamin company, find out why, as some sites don’t advertise. But most important is to see whether the site has resources listed where you can get more information about what ingredients are in the particular product.
Look for a list of references to medical journal articles and studies you can read. Also see the article on red yeast rice extract published by the Mayo Clinic. “Red yeast rice (Monascus purpureus) – MayoClinic.com.”
Here’s what the big debate is about when it comes to statins prescribed by doctors versus over-the-counter products such as red yeast rice. Chinese red yeast rice extract is a natural source of an active ingredient in many statin drugs called lovastatin. Doctors look at the differences in the formation of the molecules in red yeast rice compared to prescribed statins to find out which is safer for specific conditions and individuals.
On one hand, red yeast rice supplements appear to hold heart benefits, and on the other, some doctors urge caution in their use. But why are doctors considering prescribing statins to teenagers and even children? Some pediatricians recommend statins for children with high cholesterol.
As many as one in five American adolescents has LDL (bad) cholesterol levels that are too high and HDL (good) cholesterol levels that are too low — a fact that many doctors say means that it may be time to start regular cholesterol screening as part of back-to-school check-ups.
According to a new report from the U.S. Centers for Disease Control and Prevention, American teens — already identified as too often out-of-shape and overweight — are also at risk for cholesterol problems once thought to be seen only in the middle-aged.
The CDC publishes cholesterol findings from its nationwide survey
The CDC, which released the new cholesterol findings in its Jan. 22, 2010 issue of Morbidity and Mortality Weekly Report, reported high triglyceride levels are also a problem for adolescents. The numbers come from a nationwide survey conducted from 1999 through 2006 known as the National Health and Nutrition Examination Survey (NHANES). This survey found that 20.3 percent of 12- to 19-year-olds had higher-than-normal levels of LDL cholesterol or triglycerides, or low levels of HDL cholesterol.
The debate is about, should children and teenagers take statins?
And should adults take red yeast rice instead? If your doctor prescribes red yeast rice, what should you look for? First make sure the potentially toxic by-product, citrinin has been removed from the fermentation process. You only want to use the extract form of red yeast rice. What other supplements should you use along with red yeast rice?
Red yeast rice has been shown to normalize cholesterol as well or better than cholesterol-lowering drugs. Efficacy and safety have been proven in numerous clinical trials, and it has been used by millions of people in other countries for 2,000 years or more. (It’s a regular diet staple in Asia and is the source of the rich red color in Peking Duck.) Some doctors and/or nutritionists suggest using supplements in conjunction with red yeast rice products. See the website, Real Cholesterol Answers. Doctors are divided on the question of red yeast rice extract versus conventional, prescribed statins.
Heart experts are divided on whether the red rice yeast extract should be suggested as a treatment option to heart patients. A lot of people get muscle pain when they take statins and can’t tolerate prescription statins. But what are their symptoms or side effects when these types of patients switch to over-the-counter red rice yeast extract? Their liver enzymes still have to be tested to find out how the red yeast rice extract is affecting their liver, since the rice extract contains lovastatin, even if the molecule formation is a bit different from the commercial statin drugs.
Experts as well as consumers want to know how do you know the level of statin you’re getting from red yeast rice extract?
If some supplements are not standardized, how do you know what dose you’re getting? And if some supplements are standardized, how do you find out which products are and what levels of statins are in the various brands? Which brands are toxin-free, especially free from citricin?
The problem is that you don’t know which brands of statin are purified and which are standardized, which contain the toxin, citricin, and which are free of it. And how do you know what’s on the label of any brand of over-the-counter supplements contains what’s in the bottle?
That’s what the big debate is about when it comes to supplements. But patients who find statins cause them muscle pain may want products that work without the pain or other side effects. And if statins take out the COQ10 from your body, how do you know to replace the COQ10 unless it’s already in the supplement or somebody tells you to take it and why you have to?
Are you informed about COQ10 if you take statins?
When doctors prescribe a statin, how many tell their patients they also need to replace the COQ10 that the statin removes? Or how much to take? Unless you’re going to a cardiologist familiar with supplements and integrative medicine, how do you get the big picture of what works best for you?
Which red yeast rice products, according to the FDA have too many toxins? The U.S. Food and Drug Administration released a warning to consumers in August 2007 not to buy or eat three specific red yeast rice products promoted and sold on Web sites. The FDA found that since these products contained the same active ingredient as a prescription medicine, they are unauthorized to be sold over-the-counter or online. The FDA has reported on toxins in some red yeast products.
Consumers, nutritionists, and physicians all would like to know which product is most reliable. “Who tests the products as independent laboratories?” The debate also is between conventional medicine doctors and integrative medicine experts that suggest to patients or clients studies on red yeast rice found in health food stores or purchased online.
The question is whether the rice extract that says it’s free of citrinin is really free of the toxin? Only an independent lab test can tell you such an answer before you decide on buying a particular supplement.
According to a June 16th, 2009 Nutrition Business Journal article, “Red Yeast Rice Research Triggers (Mostly) Positive News for Supplements,” by Carlotta Mast, “A study published June 16 in the Annals of Internal Medicine showing the cholesterol-lowering benefits of red yeast rice triggered a cascade of news stories in the popular press—a welcome change from all of the negative headlines published over the last month about dietary supplements being unregulated, ineffective and, in some cases, dangerous.”
Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients: A Randomized Trial is the name of the study by researchers, David J. Becker, Ram Y. Gordon, Steven C. Halbert, Benjamin French, Patti B. Morris, and Daniel J. Rader. Red yeast rice is a dietary supplement that can decrease low-density lipoprotein (LDL) cholesterol levels and could be a treatment option for patients with statin-associated myopathy.
Investigators randomly assigned 62 patients with dyslipidemia and a history of intolerance to at least 1 statin to receive red yeast rice, 1800 mg twice daily, or placebo. After 12 and 24 weeks, LDL and total cholesterol levels improved more in the red yeast rice group than in the placebo group. Pain, creatinine phosphokinase, and liver enzyme levels did not differ between the groups.
In the study, researchers followed 62 patients who had tried taking prescription statins to lower their cholesterol but had to stop because the medications caused severe muscle pain, a common side effect of statins. All of the patients received nutrition and exercise counseling and half also received 1,800 mg of red yeast rice supplements every day.
After 12 weeks, those taking the supplements saw their LDL or “bad cholesterol” drop by a significant 27%. Those who did not take the red yeast rice supplements experienced a 6% drop in LDL.
According to the article, Red Yeast Rice Research Triggers (Mostly) Positive News for Supplements, Daniel Rader, MD, a lipid specialist at the University of Pennsylvania School of Medicine and an author of the study told ABC News. “I have to confess, I did not expect this degree of LDL lowering. And there were many fewer side effects than expected. I was pleasantly surprised with the degree of LDL lowering.”
The study, according to the abstract, concluded that red yeast rice and therapeutic lifestyle changedecrease LDL cholesterol level without increasing CPK or painlevels and may be a treatment option for dyslipidemic patientswho cannot tolerate statin therapy.
According to the article, Red Yeast Rice Research Triggers (Mostly) Positive News for Supplements, “The news was not all positive for the supplement industry, however. In nearly every story that was published about the red yeast rice study, reporters erroneously stated that supplements are not regulated.”
“Several stories also used the research to talk about the quality problems that have surfaced for red yeast rice and to issue warnings about supplement use.” Read what CNN reported at the site of the article, “Red Yeast Rice Research Triggers (Mostly) Positive News for Supplements.”
Also, according to NBJ research, “U.S. consumer sales of red yeast rice grew 6% to $20 million in 2008. More than half of sales—$11 million—were rung up in natural & specialty retailers.” But if you take red yeast rice, or any other statin or statin-like product, you need to also take COQ10 because statins wash out the COQ10 from your body. Some health foods stores may even offer free COQ10 if you’re buying red yeast rice from them. And some product manufacturers include COQ10 in the red yeast rice.
The majority of drugs are copied from nature and derived from fungal chemistry
Most people are surprised that the majority of drugs are copied from nature and derived from fungal chemistry, according to the book, The Cholesterol Hoax, page 46. The book explains that, “The natural statins of red yeast rice include 8-10 parts called monocolins in the pallet, just as they occur in nature. In contrast, the synthetic and very pricey statin prescription medications contain only one monocolin.”
What happens is that the prescription drug has the side effects, “in contrast to red yeast rice that has virtually no side effects.” Just be careful if you buy red yeast rice that your doctor knows about it so you can have a simple blood test to find out what it’s doing to your liver and kidneys. Red yeast rice contains lovastatin and eight other statin-type monocolins.
Remember that red yeast rice is cheaper than prescription statins. But you need to have your liver enzymes tested just the same. Find out from research studies whether the claims that red yeast rice “has actually improved liver function” are actually accurate. Check out studies on whether there’s a relationship between some statins and cataracts.
See, Statins linked with development of cataracts – TheHeart.org. Statin users are more than 50% likelier to develop age-related cataracts than nonusers, according to the results of a new study published August 13, 2012. Check out the article, Statin Use Tied to Possible Boost in Cataract Risk: MedlinePlus.
You’ll see it pulled from the market over and over and then put back. Some companies removed the statin from it and substituted other ingredients. But remember that not all red yeast products are safe. Some contain that toxic fermentation product called citrinin, which is a mold toxin that can cause kidney damage.
Wakunaga’s Kyolic Formula 107 Red Yeast Rice, according to The Cholesterol Hoax book, page 49, “is free of citrinin.” Check to see whether or not that brand product has removed the statin and substituted something else for that ingredient.
The company also makes aged liquid garlic extract, which many people (including our family) have been taking daily for years. Check out the product, if interested to see what’s in it these days. If you’re interested in the business, research, and economics of nutrition and supplements, view the pertinent news articles on the site for the Nutrition Business Journal.
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