Some of my readers and many of my friends have recommended a nutritional supplement called red yeast rice. I am deeply suspicious of nutritional supplements, alternative medicine, and anything else not tested in a double-blind clinical trial. That is, I am reluctant to subject myself to anything that is not evidence-based medicine. So I was interested to read that, in fact, red yeast rice is effective for lowering serum LDL.
Red yeast rice or Monascus purpureus is a yeast that grows on rice, and is a common part of an Asian diet. It is sold over-the-counter* under many names, the most suggestive being "Cholestin." Because it is a supplement, it falls under the umbrella of the Dietary Supplement Health and Education Act of 1994.
Before this misguided act was signed into law, the FDA regulated dietary supplements just as they did other food and drugs. The DSHEA turned oversight of dietary supplements over to the manufacturers, who now
...[do] not have to provide FDA with the evidence [they rely] on to substantiate safety or effectiveness before or after [they market their] products.
Also, manufacturers do not need to register themselves nor their dietary supplement products with FDA before producing or selling them. Currently, there are no FDA regulations that are specific to dietary supplements that establish a minimum standard of practice for manufacturing dietary supplements (US FDA/CFSAN "Dietary Supplements").
Red yeast rice is effective because it contains a powerful statin called Monacolin K, marketed by Merck as Mevacor.
Statins have significant side effects. The one that looms largest in my mind is liver toxicity. If I decided, in consultation with my physician, to begin drug therapy with Mevacor, she would carefully monitor my liver function with blood tests; she would carefully titrate my dosage so that I obtained the best results with the fewest side effects. I would, as far as these things go, be safe.
Or, on the advice of well-meaning friends and strangers, I could run out and buy red yeast rice* and take it like a vitamin with my Cheerios in the morning. I would not know the exact dose of Mevacor I was getting, I wouldn't know what other random proteins and dirt were in the preparation, and I wouldn't know what was happening to my liver until it was too late.
So here is a message to my friends: Natural is not better. Poison ivy is natural. Arsenic is natural. Toadstools are natural. Radon is natural. Dog shit is natural -- wanna eat a big spoonful? I'll pass, thanks.
*The FDA has worked hard over the past 10 years to get all red yeast rice/Mevacor supplements off the market. So if I go and get some to go with my Cheerios, it will probably be completely safe, and completely ineffective.
6 comments:
AP,
"But people have been using natural remedies for thousands of years!"
And people have been dying of preventable and curable illnesses at least as long.
Gah. Sometimes I wonder why we bother, but then I remember that good will someday prevail, as long as someone in one of the major studios is writing the screenplay.
Hey Angry Prof:
You and Panda Bear MD need to put your heads together on this.
http://pandabearmd.com/
Rock on.
I always want to ask the "natural" folks if they also sleep outdoors and groom each other for vermin.
if you do go on statins, an upside effect is that they lower the risk of dementia. Beneficial effect on small vessel walls.
Just go ahead and get the lovastatin (mevacor) prescribed by your doctor. You have the cholesterol count for it. The idea of going with a non-standardized,unregulated dietary supplement with no manufacturing practice (until later due to amendment of the Act) seems sub-optimal to going with the active ingredient in measured doses. Walmart is willing to sell it to you for $4 for a 30 day supply which I am willing to bet is cheaper than any dietary supplement.
Agree -- there's too much emphasis on 'natural', by people who don't know the facts. Heck, even the Dietary Supplement Information Bureau recommends physicians guidance on taking over the counter supplements.
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