Herbal Safety: Herb or Pharmaceutical?

Red Yeast Rice

I still remember the conversation a few colleagues and I had with a nephrologist. He just had dialyzed a patient in acute renal failure (ARF) with a serum creatinine > 8 mg/dL (normal 0.6 – 1.2 mg/dL). Curious whether any of us could crack the case, he inquired: ‘What do you think caused this high serum creatinine in this young man?’

Creatinine is a by-product of muscle metabolism. Typically in a younger person, creatinine is held fairly constant in the body as the kidneys are constantly filtering and excreting it in urine. “Muscle trauma,” suggested one colleague. Satisfied with this suggestion, the nephrologist revealed that the patient had medicated himself with red yeast rice to lower his cholesterol. This caused severe rhabdomyolysis (breakdown of muscle tissue), a high release of creatinine, which shocked his kidneys.

Red yeast rice contains molecules known as monacolins. Amongst them is monacolin K which is identical to the molecule marketed as Mevacor® (Lovastatin). How much monacolin K or Lovastatin is in each batch is not clear. The compositions of red yeast rice products are not consistent and can vary, depending on culturing methods and yeast strains used.

In essence, the patient had unknowingly taken a prescription drug and experienced severe side effects of HMG CoA reductase inhibitors aka ‘Statins.’ He bypassed any monitoring such as testing for liver enzyme function, drug-drug or drug-food interactions (i.e. grapefruit juice) and bypassed any warnings to watch out for muscle aches or dark urine. Luckily the patient was not female & pregnant since statins are rated as ‘Pregnancy Category X’ which signifies potential to cause birth defects.

The FDA finally has set limits allowing only trace elements of monacolin K in red yeast rice supplements and sent out a warning letter to a company. But keep in mind, the FDA is not able to check every product on the market. Consumer reports still show higher amounts in supplements. https://www.consumerreports.org/dietary-supplements/red-yeast-rice-supplements-may-contain-dangerous-surprises/

I find nothing wrong with rubbing red yeast on your duck. But when you are taking a concentrated version of this powder, depending on the manufacturer, red yeast rice can be a potent prescription drug. If you like to improve your cholesterol/lipid profile, I would suggest to either commit to a ‘Statin’ drug prescribed and monitored by a physician, or get off on the right foot and choose a healthier, safer alternative, there are plenty of options.



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