Wednesday, June 22, 2011

Statins and Red Yeast Rice Dangers

Are you taking a statin? I have had patients claim to have a variety of side effects of statin drugs.  Statins are  those drugs that lower cholesterol and  very rarely cause serious side effects.

These drugs have been proven to reduce heart attacks, strokes and death from heart disease. The FDA approved the first statin in the United States in 1987.

There are now 7 statins on the market in the United States: lovastatin, pravastatin, simvastatin, fluvastatin, pitavastatin (Livalo) atorvastatin (Lipitor) and rosuvastatin (Crestor). The first 3 listed are lower in cost because they are available as a generic instead of the higher cost brand name. These first 3 are also found in nature; you might say they are naturally occurring or “natural”. Lovastatin, for example, is found in certain yeasts or fungi. The other statins are synthesized; they are not naturally occurring.

Some people get achiness in their muscles with statins. This is not joint achiness and it does not happen on one side of the body. Those symptoms would be from something else.

Most of the time the muscle achiness from statins is nothing serious. The cause of the achiness is not clear. And often if people get that symptom with one statin they will get it with the other statins.

 It’s too bad if they can’t tolerate statins. These drugs are very safe overall and quite effective in saving lives especially in persons at high risk for heart disease, like persons with diabetes. In the United Kingdom, you can get simvastatin without a prescription. That’s how safe statins are.

But safety is a relative thing. There is an increased, but still low, risk of serious muscle damage when certain drugs are taken by people on high doses of statins, especially 80 milligrams of simvastatin or lovastatin. In fact, the FDA recently advised caution on using the 80 milligram dose of simvastatin. Doctors need to know about interactions between drugs so that risk to the patient is as low as possible.

Sometimes people take red yeast rice because they’ve heard it can safely and “naturally” lower their cholesterol. Red yeast rice, is a so-called dietary supplement, so the FDA does not strictly regulate it. Some red yeast rice preparations may actually work to lower cholesterol.

Why is that? Well, it turns out that red yeast rice contains a chemical called monacolin K. Monacolin K is chemically identical to lovastatin.

Remember some yeasts make lovastatin and the yeast used in making red yeast rice makes monacolin K, otherwise known as lovastatin. But these red yeast rice supplements are not standardized; that means that the amount of monacolin, if any, in the red yeast rice preparation you buy may vary considerably each time you buy it and may vary when you change the brand you buy.

Also keep in mind that there have been reports of muscle symptoms, rarely serious, from red yeast rice just like you might expect for people taking lovastatin.

In the past, I told my patients who did okay with red yeast rice and got their cholesterol to goal, that they should also do fine with the prescription pill lovastatin.
And, after all, lovastatin by prescription is usually cheaper.

And they’ll know what they’re getting in each pill of prescription lovastatin. You can never be sure with the red yeast rice pills.

But now, speaking of not knowing, there is another reason to stay away from red yeast rice. A recent study showed that one third of the red yeast rice products on the market contain an increased amount of citrinin, a chemical substance which has been shown to cause mutations and kidney damage.

So now, I advise my patients, if you want to significantly and most safely lower your cholesterol, stick with statins by prescription. And get regular monitoring by your medical doctor.


  1. Thanks for the information. Could you comment on some of the herbs and supplements that are advertised to control blood sugar?

  2. Erun: Yes coming soon are posts on cinnamon and chromium. But for now, know that there are no herbs or supplements that have been shown to provide improvement in glucose for those with Type 1 Diabetes.