[NPInfo] Natural cholesterol lowering

Tue Aug 19 17:49:09 PDT 2008

Red rice yeast is Monascus purpureus, is a fungus that has been used in
Chinese medicine for about 1000 years. It contains a number of "monacolins",
including Monacolin K and others. Monacolin A has activity against HMG CoA
after it is hydrolyzed to mevinic acid--registered with the FDA as
"lovastatin"--and was originally marketed as "Mevacor" in the U.S.

I located many warnings about potential side effects similar to the statins,
but in my (very quick) survey only one RCT (n=446) which tested a verified
RRY product against a "positive control" (standard of care) in China
(another herbal preparation). The Positive control lowered cholesterol by
8%, TGs by 12%. RRY performed well: HDL up by 19%, LDL down by 31%, TC by
22%. The only side effects were flatulence, heratburn and dizziness in some
participants. (Wang, et al. Curr Ther Res. 1997. 58;12: 964-978)

There was one case of rhabdomyolysis, while a kidney transplant pt. used RRY
while on cyclosporine. It is believed that, like the statins, the RRY may
have been poorly metabolized by the CYP450 system, also a metabolic
substrate for cyclosporine. The pt. recovered when the RRY was stopped.
(Ramesh Prasad, et al. Transplantation. 2002. 74;8:1200-1201. This was the
only potential myositis-related reference to RRY use I located.

Weil discusses the multifacted properties of herbs in Health & Healing (Rev.
Ed. 1988) and offers that compound natural products may contain principles
that balance out the negative aspects of other principles. It has been
hypothesized that this is why St. John's wort doesn't cause significant side
effects in most users, despite the fact that some of its components act as
MAO inhibitors, for example. The 10 known monacolins, as well as lignins,
and other substances in RRY may act the same way, as "buffers" or in ways
not yet known.

That herbal/natural products are loosely regulated in the U.S. does pose a
problem. Heber and colleages examined 9 commercially available compounds.
Only 1 contained the full complement of 10 monacolins, and 7/9 contained
measureable concentrations of citrinin (an undesired product of the
frementation process). Monacolins varied from 0.0% to 0.58% w/w. (J Alt.
Comp. Med. 2001. 7;2:133-139.) Cholestin3, the product used in the study by
Wang's team above, contains 0.4% w/w and is standardized, which prompted the
FDA in 1998 to declare Cholestin3 a drug and not a supplement. I recall that
litigation related to this found in favor of the manufacturer--the product
hadn't caused any known injuries or deaths. But I can't cite that, just
recall it from another short piece I read somewhere.

I have used RRY in a significant number of patients; casual observation
suggests that they do well without side effects and lipid lowering is about
what I'd expect with a statin. In truth, most of my patients are
drug-averse, and so while I am confortable with statins, I also see no
reason to be bugging them to "do it our way" as it were. I have become
increasingly uncomfortable with the quality of products in health food
stores, but am also averse to being in the supplement business, mainly for
ethical reasons. For the moment, I am warning patients about studies such as
the one by David Heber, and offering to get them professional-grade
supplements if they chose to spend the additional money (e.g., Integrative
Therapeutics, Douglas Labs, Thorne Research, Physiologics, etc.) Supplements
are assayed and the assays are available for review for various batches. 

Some spend the money, others don't. I haven't yet seen any correlation
between who buys their stuff at the local store versus who buys from a pro
outfit, but it's a small number of folks, since I practice 1 day a week now.
There are other references, including a trial that David Heber's team did,
at Sloan-Kettering's site (http://www.mskcc.org/mskcc/html/69352.cfm).

Hope that's helpful.

Eric

R. Eric Doerfler, CRNP, PhD(c), CCH
Instructor Of Nursing
RN-BS Program Coordinator
Penn State University, Capital Campus
777 W. Middletown Pike, Middletown PA 17057
717-948-6513 red1012 at psu.edu

Certified in Adult Primary Care & Classical Homeopathy
1521 Cedar Cliff Drive, Suite 203
Camp Hill PA 17011
717-761-6902
http://www.altmedresearch.us

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Margienp at aol.com
Sent: Tuesday, August 19, 2008 10:07 AM
To: npinfo at nurse.net
Subject: Re: [NPInfo] Natural cholesterol lowering

Yes but remember that red rice yeast can cause the same side effects as,
the statins. Muscle aches etc.

In a message dated 8/18/2008 1:56:57 P.M. Eastern Daylight Time,
mastrlock at hotmail.com writes:

Can  I get some natural remedies for lowering total cholesterol. I work in
psych  but have a pt that is into holistic medicine and wants info on this
topic.  Thanks in  advance.

Joe

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