Wednesday, June 17, 2009
Jon's Health Tips - Red Yeast Rice
I wrote a while ago about my secret desire to take a statin so I could eat lot more Egg McMuffins. One of my correspondents replied with a warning about muscle pain from statins, which I was not aware was as much of a problem as it appears to be.(Taking CoEnzyme Q-10 may relieve these pains) But an alternative has just appeared - and I am seriously thinking of trying it - although Egg McMuffins won't become a regular thing even so.
Red Yeast Rice Helps Reduce Cholesterol
Red yeast rice -- it's been a staple of some Asian countries for more than 1,000 years. As food coloring, it gives Peking Duck its signature red glow. And as herbal medicine, it lowers cholesterol levels.
"It works much the way a statin would work, by reducing the amount of cholesterol that the liver makes, but in a much gentler level," said Dr. Christopher Cannon a cardiologist at Boston's Brigham and Women's Hospital.
This latest study published in the Annals of Internal Medicine followed 62 patients who had tried taking prescription statins, such as Lipitor or Zocor, but complained it left them with severe muscle pains.
In the study, all of the patients received counseling on nutrition and exercise. Additionally, half of the participants also took 1,800 mg of red yeast rice supplements every day. After 12 weeks, those taking the supplements saw LDL, the "bad cholesterol," drop by a remarkable 27 percent. Those who did not take the red yeast rice supplements saw their LDL drop by only 6 percent.
Only two patents on the supplements reported those persistent muscle pains.
"I was pleasantly surprised with the degree of LDL lowering," said Dr. Daniel Rader a lipid specialist at the University of Pennsylvania School of Medicine and an author of the study. "I have to confess, I did not expect this degree of LDL lowering. And there were many fewer side effects than expected."
Research published last year in the American Journal of Cardiology showed that heart attack patients in China who took a red yeast rice supplement daily were 45 percent less likely to have another attack within five years.
The problem with this approach, however, is that unlike statin drugs, red yeast rice is not regulated. So whether it's purchased as dried grains, ground powder or a pill from a health food store, it's difficult to be certain exactly how much of the active ingredient you're consuming or whether it's been contaminated in any way.
About red yeast rice
Red yeast rice comes from yeast (Monascus purpureus) that is grown on rice. This bright reddish purple fermented rice, which acquires its colour from being cultivated with the mold Monascus purpureus, is served as a dietary staple in some Asian countries.
There has been some question about red yeast rice supplements:
In 2007 the FDA warned physicians and consumers to steer clear of several cholesterol-lowering supplements that contain what the FDA terms "unauthorized" lovastatin.
FDA testing revealed that several brands of nonprescription "red yeast rice extract" supplements, marketed as Red Yeast Rice, Red Yeast Rice/Policosonal Complex, and Cholestrix, contained lovastatin, a regulated prescription drug. In a MedWatch safety alert, the FDA tells consumers to "avoid using" the products because they "may contain an unauthorized drug that could be harmful to their health." Not mentioned in the FDA alert is the fact that lovastatin, marketed as Mevacor, first isolated from a fungus, also occurs naturally in certain forms of red yeast rice that are made when rice is cultivated with the mold Monascus purpureus.
In the products that the FDA targeted, lovastatin is not named in the list of product ingredients. The products are manufactured by Nature's Value Inc, Kabco Inc, and Sunburst Biorganics, respectively, and sold over the internet by the manufacturers, or in the case of Red Yeast Rice, by Swanson Healthcare Products.
The FDA's Medwatch alert notes that lovastatin can cause severe muscle problems leading to kidney impairment. "The risk is greater in patients who take higher doses of lovastatin or who take lovastatin and other medicines that increase the risk of muscle adverse reactions such as nefazodone (an antidepressant), certain antibiotics, drugs used to treat fungal infections and HIV infections, and other cholesterol-lowering agents," an FDA press release states. "Consumers who use any red yeast rice products should consult their healthcare provider if they experience any problems that may be due to these products."
Here' another study:
Chinese Red Yeast Rice May Prevent Heart Attack
(published by the US Gov't)
People who have had a heart attack may be able to reduce the risk of another attack by 45 percent by taking a purified extract of Chinese red yeast rice, a new study suggests.
What's more, the need for bypass surgery or angioplasty was reduced by one third, and death from cancer was reduced by two-thirds among those taking the extract, called Xuezhikang (XZK).
"A purified form of Chinese red yeast rice significantly reduced the risk of having another heart attack," said lead researcher Dr. David M. Capuzzi, director of the Cardiovascular Disease Prevention Program at the Myrna Brind Center of Integrative Medicine at Thomas Jefferson University in Philadelphia.
Although the results of the study are encouraging, people shouldn't run out and start taking Chinese red yeast rice to prevent heart attacks, Capuzzi said. He noted that the Chinese red yeast rice in health-food stores isn't pure. "This particular preparation [used in the study] was made by a biotech company. So the purity of the components was assured," he said.
In the study, almost 5,000 people in China who'd had a heart attack were randomly selected to receive capsules containing XZK or a placebo. The XZK capsules contained a combination of lovastatin, lovastatin hydroxyl acid, ergosterol, and other components, the report said.
During five years of follow-up, the researchers found that 10.4 percent of those receiving a placebo had a second heart attack, compared with 5.7 percent of those receiving XZK.
Also, those treated with XZK were 30 percent less likely to die from a cardiovascular problem and 33 percent less likely to die from any cause. And the need heart surgery or angioplasty was reduced by one third, the researchers reported.
The findings are published in the June 15 issue of the American Journal of Cardiology.
Capuzzi said a drug that includes Chinese red yeast rice may soon be used much the same way as cholesterol-lowering drugs to prevent heart attacks.
One heart expert thinks this study shows that Chinese red yeast rice may be another way to lower cholesterol, thereby preventing heart attack.
"Numerous clinical trials have established that statin medications in conjunction with lifestyle modification reduce the risk of recurrent cardiovascular events and prolong life in patients with prior myocardial infarction [heart attack] and elevated, average, or below average cholesterol levels," said Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles.
This new study may extend these prior findings to the statin medication lovastatin, which is derived from Chinese red yeast, Fonarow said.
"However, it is very important to note, as the authors do in the paper, that the various components of the specific XZK preparation used in this trial have not been adequately studied for its consistency, stability, and individual pharmacologic properties. As such, further study is required," Fonarow said.
Another expert thinks that red yeast rice might confer an extra measure of protection against heart attack.
The extract of red yeast rice contains lovastatin, a drug that has been proven to improve cholesterol profiles and decrease risk of heart attack, said Dr. Byron Lee, an associate professor of cardiology at the University of California, San Francisco.
"However, the improvement in the patients on the extract is far beyond what you would expect with lovastatin alone, so maybe there is some other natural component in the extract that is conferring the extra benefit," Lee said. "That would be quite exciting."
Chinese red yeast rice is rice that has been fermented by red yeast. This rice has been used in China for many centuries as a food preservative, food coloring, spice, and in rice wine. Red yeast rice remains a staple in China, Japan and in Asian communities in the United States.
Red yeast rice also has been used as a medicine for more than 1,000 years. It has been used to improve blood circulation and treat indigestion and diarrhea, the study authors said.
More U.S. Gov't Info:
Red yeast rice is the product of yeast ( Monascus purpureus ) grown on rice, and is served as a dietary staple in some Asian countries. It contains several compounds collectively known as monacolins, substances known to inhibit cholesterol synthesis. One of these, "monacolin K," is a potent inhibitor of HMG-CoA reductase, and is also known as mevinolin or lovastatin (Mevacor®, a drug produced by Merck & Co., Inc).
Red yeast rice extract has been sold as a natural cholesterol-lowering agent in over the counter supplements, such as CholestinTM (Pharmanex, Inc). However, there has been legal and industrial dispute as to whether red yeast rice is a drug or a dietary supplement, involving the manufacturer, the U.S. Food and Drug Administration (FDA), and the pharmaceutical industry (particularly producers of HMG-CoA reductase inhibitor prescription drugs or "statins").
The use of red yeast rice in China was first documented in the Tang Dynasty in 800 A.D. A detailed description of its manufacture is found in the ancient Chinese pharmacopoeia, Ben Cao Gang Mu-Dan Shi Bu Yi, published during the Ming Dynasty (1368-1644). In this text, red yeast rice is proposed to be a mild aid for gastric problems (indigestion, diarrhea), blood circulation, and spleen and stomach health. Red yeast rice in a dried, powdered form is called Zhi Tai. When extracted with alcohol it is called Xue Zhi Kang.
Uses based on scientific evidence:
Since the 1970s, human studies have reported that red yeast lowers blood levels of total cholesterol, low-density lipoprotein/LDL ("bad cholesterol"), and triglyceride levels. Other products containing red yeast rice extract can still be purchased, mostly over the Internet. However, these products may not be standardized and effects are not predictable. For lowering cholesterol, there is better evidence for using prescription drugs such as lovastatin. Grade A
Coronary heart disease
Preliminary evidence shows that taking Monascus purpureus by mouth may result in cardiovascular benefits and improve blood flow. Additional study is needed before a firm recommendation can be made. Grade C
Early human evidence suggests the potential for benefits in diabetics. Additional study is needed before a firm recommendation can be made. Grade C
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Acetaminophen toxicity, anthrax, anti-inflammatory, antimicrobial, antioxidant, blood circulation problems, bruised muscles, bruises, cancer, colic in children, cuts, diarrhea, digestion, dysentery (bloody diarrhea), exercise performance enhancement, food additive (coloring), food preservative, hangover, high blood pressure, HIV (associated hyperlipidemia), immunosuppression, indigestion, liver disorders, metabolic disorders, obesity, ovarian cancer, postpartum problems, spleen problems, stomach problems, weight loss, wounds.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
1,200 milligrams of concentrated red yeast powder capsules have been taken two times per day by mouth with food.
The average consumption of naturally occurring red yeast rice in Asia has been reported as 14-55 grams per day.
Children (younger than 18 years)
There is not enough scientific evidence to recommend red yeast for children.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
There is one report of anaphylaxis (a severe allergic reaction) in a butcher who touched meat containing red yeast.
Side Effects and Warnings
There is limited evidence on the side effects of red yeast. Mild headache and abdominal discomfort can occur. Side effects may be similar to those for the prescription drug lovastatin (Mevacor®). Heartburn, gas, bloating, muscle pain or damage, dizziness, asthma, and kidney problems are possible. People with liver disease should not use red yeast products.
In theory, red yeast may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. A metabolite of Monascus called mycotoxin citrinin may be harmful.
Pregnancy and Breastfeeding
Prescription drugs with similar chemicals as red yeast cannot be used during pregnancy. Therefore, it is recommended that pregnant or breastfeeding women not take red yeast.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
There are not many studies of the interactions of red yeast rice extract with drugs. However, because red yeast rice extract contains the same chemicals as the prescription drug lovastatin, the interactions may be the same. Fibrate drugs or other cholesterol-lowering medications may cause additive effects or side effects when taken with red yeast. Alcohol and other drugs that may be toxic to the liver should be avoided with red yeast rice extract. Taking cyclosporine, ranitidine (Zantac®), and certain antibiotics with red yeast rice extract may increase the risk of muscle breakdown or kidney damage.
Certain drugs may interfere with the way the body processes red yeast using the liver's "cytochrome P450" enzyme system. Inhibitors of cytochrome P450 may increase the chance of muscle and kidney damage if taken with red yeast.
In theory, red yeast may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
Red yeast may produce gamma-aminobutyric acid (GABA) and therefore can have additive effects when taken with drugs that affect GABA such as neurontin (Gabapentin®).
Red yeast may also interact with digoxin, niacin, thyroid medications, and blood pressure-lowering medications. Caution is advised.
Red yeast may alter blood sugar levels; patients with diabetes or taking insulin or blood sugar-lowering medications by mouth should consult with a qualified healthcare professional, including a pharmacist. Dosing adjustments may be necessary.
Interactions with Herbs and Dietary Supplements
Red yeast may interact with products that cause liver damage or are broken down in the liver. Grapefruit juice may increase blood levels of red yeast. Milk thistle, St. John's wort, niacin, and vitamin A may interact with red yeast rice extract. Coenzyme Q10 levels may be lowered by red yeast rice extract. Cholesterol-lowering herbs and supplements such as guggul or fish oils may have increased effects when taken with red rice yeast. Although not well studied, red yeast may also interact with astaxanthin and zinc. Caution is advised.
Certain herbs and supplements may interfere with the way the body processes red yeast using the liver's "cytochrome P450" enzyme system. Inhibitors of cytochrome P450 may increase the chance of muscle and kidney damage if taken with red yeast.
In theory, red yeast may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba , and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Red yeast may also interact with digitalis (foxglove), or herbs and supplements that affect the thyroid or blood pressure. It may also have anti-inflammatory effects and should be used cautiously with other herbs or supplements that may have anti-inflammatory effects.
Red yeast may alter blood sugar levels in the blood, and patients with diabetes or taking herbs and supplement to control blood sugar should use with caution.