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August 27, 2013

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I didn’t know that lovastatin is equivalent to red yeast rice. According to uptodate, red yeast rice contains an estimated 2.4 mg lovastatin per 600 mg rice. This is important to warn patients not to supplement red yeast rice along with lovastatin.

Although this information is presented as a beneficial finding, there is a downside to inhibiting HMG-CoA reductase. For example selenocysteine requires a specific tRNA to be decoded. Isopentylation of this tRNA requires an intermediate of the mevalonate pathway: isopentenyl pyrophosphate, which is why one of the side effects of statin medications, neuromuscular syndrome, is identical to that which is seen with selenium deficiency. Inhibiting the mevalonate pathway also results in decreased formation of the antioxidant CoQ10; dolichol (which is involved in the synthesis of glyoproteins which are involved in neuropeptide formation affecting emotions); and tau proteins which help glial cells maintain their structure. It would be interesting to see if the cholesterol lowering properties of red yeast are also associated with these adverse effects.

I am always asked at work how can I lower my cholesterol without medication. Maybe in the near future more recommendations will be made especially in the new guidelines. Diet changes are highly needed for those that need aid in lowering cholesterol.

I think the important point to note here is that red yeast rice contains lovastatin. It is very important to caution patients not to take both red yeast rice and statin medications concurrently. Additionally, many medications can interact with red yeast rice as a result of it’s containing this statin and therefore healthcare professionals should guide patients on this information, and likewise, patients should make their physicians and pharmacists aware if they are taking the product.

I am curious as to how much Red Yeast Rice (RYR) the patients in this study had to take in order to see an effect. If it was an obscene amount, I would feel comfortable telling patients about RYR as an alternative to currents, but would not recommend they take it due to concerns about edibility, texture, cost comparativeness to statins, etc. If the amount of RYR needed is small or even "reasonable," this study may go a long ways in providing alternatives to statins for patients who cannot tolerate them, wish to stay off prescription drugs, cannot afford prescription drugs, etc. Too bad that information isn't available in the abstract!

Looking at the details of the study, it seems like red yeast rice may be a promising treatment option for patients who cant take statins. Muscle breakdown is a rare albeit serious side effect of statin use and something for clinicians to be weary of. Its encouraging to see that the study showed statistical significance and no elevation in CPK (a marker of muscle breakdown)!

I see some comments saying that the article is not very contributory, since we already have a several statins already available on the approved-drug market. This blog also discusses the safety of taking red yeast rice. I believe the safety component is just as, if not the most important reason for researching herbals. Some of the best poisons are 100% nature made. Information on adverse effects and interactions is a valuable contribution to the science community even if information on efficacy is lacking.

This study shows that red yeast rice extract could have the potential to be an option for lowering cholesterol in patients who cannot tolerate prescription drugs. According to data from the CURVES trial, lovastatin can give an LDL reduction of 21 - 36%, depending on the dose given. From the results of this study, red yeast rice can give a comparable LDL reduction to the starting dose of lovastatin by giving a 22% LDL reduction. It would be interesting to see future trials geared toward comparing the efficacies of red yeast rice extract and lovastatin.

My friend's mother has high cholesterol and her doctor recommended her to instead of taking the supplement, simply switching from white rice to red yeast rice as rice was a part of her everyday meals. She complained that it was difficult to swallow the red yeast rice because of its texture. I wonder how much of the actual rice one has to consume to receive the benefit of cholesterol lowering.

I understand that red yeast rice is a natural supplement, but many medications are made from natural products. As it has been shown to be the same ingredient found in lovastatin, I don’t see a clinical use for this product. Why use a supplement that is not regulated as strictly when there is a prescription medication that has the same ingredient with a lot more testing. The only place where I would consider using red yeast rice is if the patient refused to take medication and only wanted to use CAM. In that case I think this would be an effective option.

Red yeast rice seems to be a good option if you want a low-potency statin that is available without a prescription. I would still want to be sure the product I was purchasing was the most standardized and purest version possible.

This is an interesting topic I read in a PharmacistLetter once. Most people view medicine with the opinion that CAM and western medicine are polar opposites. In truth, though, there is really no fundamental difference between these two branches of health care. Remedies of plant origin have active ingredients just like pharmaceutical drugs. Efficacy is just biochemistry on the cell level. Red yeast rice is a prime example of this blurring of the boarder between CAM and western medicine.

It seems frustrating that red yeast rice is not readily available since it provides a potential benefit. But is should be noted that even though the red yeast rice contains components similar to that of lovastatin. It does not provide the same pharmaceutical grade or standardization. if purchasing this naturopathic product off the internet, one can not know the exact components involved.

While statins are the gold standard to lowering cholesterol, some patients may be on the borderline between the need to begin statin therapy and trying alternative methods before the need to involve statins. Along with aerobic exercise and a healthy diet, incorporating red yeast rice may keep someone from having to add a statin to their daily medication regimen.

Based on this study, 22% sounds like a pretty decent reduction of LDL as well as a 15% reduction in total cholesterol. My mother refuses to take her cholesterol medication because of side effects and since this study shows few to no side effects with red yeast rice, I would definitely mention this to her. Definitely interested in seeing more information on this topic.

There are a number of alternative treatments for lowering cholesterol. Apart from Red Yeast Rice, garlic, guggulipid, policosanol, fenugreek seeds and leaves, artichoke leaf extract, yarrow, holy basil etc. Other spice like ginger, turmeric and rosemary have also shown to lower cholesterol. But as the research shows, these herbs are not standardized hence it better to use Lovastatin or other prescription cholesterol lower medications after diet and exercise fail.

@gs, it is not so much a comparison, as an origin story. Statins were developed from red yeast rice. One of them, lovastatin, is chemically indistinguishable from a component of red yeast rice, monacolin K. See: http://en.wikipedia.org/wiki/Red_yeast_rice#Red_yeast_rice_and_drugs

Like, MT, I would also like to see red yeast rice compared to statins. Also, it seems as though the only means of getting red yeast rice is through the internet? Half the patients that would require this type of medications probably are not experts at the internet and it would be hard for them to actually purchase it. I find it interesting that the study conducted had physicians and their spouses. I guess it would make some sense since they practically eat the same food anyway.

I don't know if I would recommend red yeast rice to a patient for reducing cholesterol just yet. Since the authors state that it does just contain lovastatin, wouldn't it just be another way to tell patients to take a statin without taking the actual drug? Why beat around the bush, and not just offer the gold standard statin?

I think that for patients that may not need the lipid lowering levels of a true statin, this is a good alternative. However I feel that in order for me to fully recommend this product to patients the FDA would have to do a lot more regulating. This article and many others state that there is no current regulations on natural products. I would like to see what the long term side effect profile was for this supplement before I would recommend it for daily use.

Although the study shows that red yeast rice has cholesterol-lowering effects, I would be hesitant to conclude that it would an effective alternative therapy to statins. In my opinion, I think more studies need to be done to determine the efficacy of red yeast rice. I would, however, recommend red yeast rice as a diet modification or addition for individuals on top of their medication regimen. Lifestyle changes can potentially help lower cholesterol and prevent cholesterol from worsening.

I would find this study more interesting if it proposed an alternative mechanism by which red yeast rice lowers cholesterol. Otherwise, I think it feels like they're trying to reinvent the wheel. Red yeast rice lowers cholesterol because it contains lovastatin. Patients may not experience adverse side effects to the degree they would on other statin therapy likely due to the fact the amounts in red yeast rice may be below average doses. It would be interesting if side effects and standardization in addition to cholesterol were tracked in a study with a red yeast rice supplement. That way it could be seen if it has any quantitative benefits over lovastatin.

I think this article helps prove the fact how medications come from natural products and naturopathic remedies may be a cheaper or sometimes more convenient alternative to prescription drugs. The article stated that components of red yeast rice have the same components that make up the prescription drug lovastatin (Mevacor®)

In my opinion, statins are one of the top ten discoveries of modern medical science. They decrease LDLs , inflammation, stabilize atherosclerotic plaques and actually decrease their size. In general they fight cardiovascular disease on so many levels. I don’t believe red yeast rice should be even compared with statins.

I'd be curious to see how RYR would compare to an agent such as simvastatin. It's great that this study showed there is a benefit versus placebo but I think the study should now be expanded to look the RYR/statin comparison. There are plenty of people who would much rather use something natural instead of a drug. The more information we have, the better we can counsel and guide our patients.

After reading the study, I’m still a little skeptical about recommending red yeast rice for cholesterol lowering effects. The study compared red yeast rice against placebo and it showed favoring results for the cholesterol lowering effects of red yeast rice but aren’t statins the gold standard for cholesterol? I would like to see studies comparing the red yeast rice against a statin before recommending this natural product.

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