[mrsD]

This subject is very important.
Because information on this subject is very conflicting, readers here should read this information I've collected carefully and discuss with your doctor the best way to approach your
cholesterol or elevated lipid problems before doing things yourself.
Some of the sites I will be posting may have high doses of some supplements.
I don't recommend really high anything, so if you choose to do~~ for example very high dose
Vit C or anything else...~~you should be monitored by a doctor.

The main drugs we have today for cholesterol issues have large tradeoffs.(serious side effects).
So benefit vs risk is an important issue to consider if your doctor wants you to use statins.
Also, be aware than many doctors do NOT understand statin side effects clearly. This is because
they may only listen to drug salespeople and not research for themselves, or take their patients' complaints seriously. If your doctor does not listen to YOU, consider getting another doctor.

This subject comes up on the various boards here often, and it is difficult to keep all the information more easily accessible.

I've just purchased Dr. Jay Cohen MD's book on statins. It is a very interesting read.

I am starting this thread today, so people can come on here and give their experiences with alternative cholesterol issues.

And as time is showing the actual role of cholesterol is not as big as was once thought. Oxidation of LDL and inflammatory markers such as homocysteine and C-reactive protein, seem more instrumental in causing damage to the cardiovascular system.

So I will be building this thread slowly. Please contribute your experiences as well.

The medical tide now is turning, concerning statins and cholesterol.
This first post will be a link fest... for patients who want to see the most
recent opinions on this subject:
Dr. Jay Cohen, MD
http://www.medicationsense.com/index.html
http://www.medicationsense.com/statin_drugs_book.html

Dr. Graveline MD has a good website too:
http://www.spacedoc.net/

And of course, The Cholesterol Myth:
http://www.ravnskov.nu/cholesterol.htm

Many people choose to use alternative supplements for cholesterol lowering.
I'll be adding information about them in the future. This subject is HUGE, and Big DOLLARS
are involved for the drug companies. So in a sense there is a political motivation to
make as much money as possible.

The direction of research is now moving away from statins. There are only two left on patent,
and these will be expired soon. So we already see new commercials on TV and an increase
in media coverage. But the truth is that no new statins are in the pipeline at this time.
And the research is showing that endothelial inflammation of the blood vessels is the real culprit
in cardiovascular disease. So some of the interventions for this problem are moving toward
reducing this inflammation. That is where supplements come in. Some exciting new papers are
appearing on curcumin and resveratrol (from red wine) as being very helpful.

Statins have alarming side effects, with new ones showing up as time passes. Pulmonary fibrosis is recently linked to them. But also they have shown to be causes of peripheral neuropathy, loss of cognition and memory, serious elevations in liver function, and cancer in lab animals. One common effect of statins is their negative effects on the mitochondria of your cells. Statins seem to damage them, and hence the cell can no longer function normally to provide energy.


So readers here, will have to return to this thread, and see what is being posted. All are welcome to ask questions and provide their experiences with this health problem. This is a huge subject, so there will be alot of homework for readers to do here. There is just no way to make this topic quick and easy!

Here are some posts that already have had discussions here on statins/cholesterol:

http://neurotalk.psychcentral.com/thread33964.html

http://neurotalk.psychcentral.com/thread38209.html

http://neurotalk.psychcentral.com/sh...hlight=Lipitor

http://neurotalk.psychcentral.com/thread59339.html

Our Parkinson's forum often has interesting information on statins, as they relate to
Parkinson's disease. Here is a link to the search there on the word "statin":
http://neurotalk.psychcentral.com/se...g_searchinfo=1

And a similar search on Peripheral Neuropathy. We get many visitors who have had negative side
effects/nerve damage from statins:
http://neurotalk.psychcentral.com/se...g_searchinfo=1

[pabb]

mrs d tried to start new thread, site wouldnt let me....so...any known relationship between statins and cardiomyopathy? dont know if it is hypertrophic or dialated....my sister was just dx and also has LBBB, and only a 30% EJ fraction....asked doc about activity restrictions, and was told no, which surprises me......no known heart attack, no hptn and seemed to tolerate the statin.....our mother had a "threatened/aborted heart attack and did have hypertension....didnt tolerate statins until i started her on Co Q10,
i am concerned .....any info you could provide would be appreciated.... tia

[mrsD]

Your question illustrates the confusion out there about statins.

On the one hand...studies show anti-inflammatory effects of statins that are independent of their cholesterol lowering actions. It is this anti-inflammatory effect that is supposed to be the "heart" of their success in studies.

Many many studies are on PubMed about this subject. But I don't know how accurate they are. I recall a similar blitz of positive studies with hormone replacement therapy that were all erroneous, as well as antidepressants use in children that were positive and then withdrawn. (drug companies forced to reveal the negative studies).

So it is really hard to know who to believe these days.

If you Google this subject you will find doctors who claim that there is an "epidemic" of heart failure now and they believe it is from statin use-- like this example:

According to Dr. Langsjoen, "In my practice of 17 years in Tyler, Texas, I have seen a frightening increase in heart failure secondary to statin usage: statin cardiomyopathy. Over the past five years, statins have become more potent, have been prescribed in higher dosages, and have been used with reckless abandon in the elderly and in patients with normal cholesterol levels. We are in the midst of a congestive heart failure epidemic in the U.S., with a dramatic increase over the past decade. Are we causing this epidemic through our zealous use of statins? In large part, I think the answer is yes. We are now in a position to witness the unfolding of the greatest medical tragedy of all time. Never before in history has the medical establishment knowingly created a life-threatening nutrient deficiency in millions of otherwise healthy people."

from http://www.townsendletter.com/FebMar2006/coq100206.htm

We do know that statins DAMAGE mitochondria. And since the heart is the most active muscle in the body, it is only logical that damage here would be signficant and deadly.

Toxicol Appl Pharmacol. 2007 Jun 21; : 17658574 PubMed

Mitochondrial impairment by PPAR agonists and statins identified via immunocaptured OXPHOS complex activities and respiration.

MitoSciences, Inc., 1850 Millrace Drive, Eugene, OR 97403, USA
Sashi Nadanaciva , James A Dykens , Autumn Bernal , Roderick A Capaldi , Yvonne Will

Mitochondrial impairment is increasingly implicated in the etiology of toxicity caused by some thiazolidinediones, fibrates, and statins. We examined the effects of members of these drug classes on respiration of isolated rat liver mitochondria using a phosphorescent oxygen sensitive probe and on the activity of individual oxidative phosphorylation (OXPHOS) complexes using a recently developed immunocapture technique. Of the six thiazolidinediones examined, ciglitazone, troglitazone, and darglitazone potently disrupted mitochondrial respiration. In accord with these data, ciglitazone and troglitazone were also potent inhibitors of Complexes II+III, IV, and V, while darglitazone predominantly inhibited Complex IV. Of the six statins evaluated, lovastatin, simvastatin, and cerivastatin impaired mitochondrial respiration the most, with simvastatin and lovastatin impairing multiple OXPHOS Complexes. Within the class of fibrates, gemfibrozil more potently impaired respiration than fenofibrate, clofibrate, or ciprofibrate. Gemfibrozil only modestly inhibited Complex I, fenofibrate inhibited Complexes I, II+III, and V, and clofibrate inhibited Complex V. Our findings with the two complementary methods indicate that (1) some members of each class impair mitochondrial respiration, whereas others have little or no effect, and (2) the rank order of mitochondrial impairment accords with clinical adverse events observed with these drugs. Since the statins are frequently co-prescribed with the fibrates or thiazolidinediones, various combinations of these three drug classes were also analyzed for their mitochondrial effects. In several cases, the combination additively uncoupled or inhibited respiration, suggesting that some combinations are more likely to yield clinically relevant drug-induced mitochondrial side effects than others.

Using CoQ-10 may be protective, but we don't know what doses to use compared to the doses of statin. For example I have never seen a recommendation for say 100mg of CoQ-10 for 10mg Lipitor, etc. It is rather hit and miss.

In Dr. Jay Cohen's book, he has many many reports from older patients who saw lowered cholesterol without damage in doses quite low. 2.5mg of Lipitor, 10mg Pravachol, 5 mg of Zocor. He believes that statins may help without harming people if used in much lower doses. That the high doses we are suggested to use are not accurate or necessary.

Personally I think it is possible. I have seen patients coming to me in their 40's with CHF...and before statins, that was pretty rare.

When the patents run out on statins soon, that is when the NEGATIVE studies will appear. That is the way other drugs' problems are eventually revealed and the truth then comes out.

[pabb]

thanks.....my mom had the muscle issue with the statins...so it would seem reasonable that my sister might as well,,just not all the muscles ...

[pabb]

sent you an email...inre: townsend letter article from 2006

[mrsD]

By far this is the best known, and most used alternative supplement for cholesterol issues.

Historically red yeast rice has been used for centuries in China for cardiovascular problems.

When the first statin appeared in US...Mevacor by Merck, there was a huge push to remove competitive products like red yeast rice so that Mevacor would have a clear path medically.
This was similar to what happened with l-tryptophan.
The company who made a very high quality product Cholestin, was forced by the courts to change its product and remove red yeast rice. This is the new product:
http://www.pharmanex.com/corp/produc...holestin.shtml

However, interest in red yeast rice did not wane. And today it is back (like l-tryptophan as well).

I've been reading about red yeast rice for years. No one single reference gives all the details about it.
So far I see 3 major things one should be aware of in choosing to try red yeast rice:

1) Where does this red yeast rice come from? Most comes from China but there are companies here in US who make it too. Given the problems lately with China and adulteration, choosing a US produced form may be safer. Two that I know use US product are the NOW company, and Doctor's Best.
They openly state this. I am not going to research all of the suppliers out there, so if you decide to use red yeast rice, I'd strongly suggest you contact the company you intend to use yourself.

2) Not all suppliers have a standarized amount of red yeast rice in them. They all vary.
Consumerlab tested some, and found:
http://www.consumerlab.com/reviews/R...ed_Yeast_Rice/

http://uk.reuters.com/article/health...97022820080709

http://www.liebertonline.com/doi/abs...ournalCode=acm

[mrsD]

By far this is the best known, and most used alternative supplement for cholesterol issues.

Historically red yeast rice has been used for centuries in China for cardiovascular problems.

When the first statin appeared in US...Mevacor by Merck, there was a huge push to remove competitive products like red yeast rice so that Mevacor would have a clear path medically.
This was similar to what happened with l-tryptophan.
The company who made a very high quality product Cholestin, was forced by the courts to change its product and remove red yeast rice. This is the new product:
http://www.pharmanex.com/corp/produc...holestin.shtml

However, interest in red yeast rice did not wane. And today it is back (like l-tryptophan as well).

I've been reading about red yeast rice for years. No one single reference gives all the details about it.
So far I see 3 major things one should be aware of in choosing to try red yeast rice:

1) Where does this red yeast rice come from? Most comes from China but there are companies here in US who make it too. Given the problems lately with China and adulteration, choosing a US produced form may be safer. Two that I know use US product are the NOW company, and Doctor's Best.
They openly state this. I am not going to research all of the suppliers out there, so if you decide to use red yeast rice, I'd strongly suggest you contact the company you intend to use yourself.

2) Not all suppliers have a standarized amount of red yeast rice in them. They all vary.
Consumerlab tested some, and found:
http://www.consumerlab.com/reviews/R...ed_Yeast_Rice/

http://uk.reuters.com/article/health...97022820080709

http://www.liebertonline.com/doi/abs...ournalCode=acm

3) There is a contaminant called citrinin that can be present in some red yeast rice extracts.
Quality manufacturers state clearly that their product does not contain this contaminant: NOW and Doctor's Best are examples.

J Altern Complement Med. 2001 Apr;7(2):133-9.Click here to read Links
An analysis of nine proprietary Chinese red yeast rice dietary supplements: implications of variability in chemical profile and contents.
Heber D, Lembertas A, Lu QY, Bowerman S, Go VL.

UCLA Center for Human Nutrition, UCLA School of Medicine, Los Angeles, California 90095-1742, USA. dheber@mednet.ucla.edu

OBJECTIVES: Some strains of Chinese red yeast rice, when prepared by solid fermentation, produce compounds called monacolins that inhibit cholesterol production. When used as a dietary supplement to achieve and maintain healthy cholesterol levels, Chinese red yeast rice has significant potential to reduce health care costs and contribute to public health by reducing heart disease risk in individuals with moderate elevations of circulating cholesterol levels. Whereas one proprietary strain of Chinese red yeast rice has been demonstrated to lower cholesterol levels significantly in clinical trials, other strains being sold as Chinese red yeast rice dietary supplements have not undergone similar evaluation. In order to determine whether the results of a clinical trial conducted with one strain of Chinese red yeast rice could be generalized to other preparations of Chinese red yeast rice, nine different commercially available dietary supplements were purchased tested for chemical constituents. DESIGN: Monacolins were measured by high performance liquid chromatography (HPLC) that separates the various monacolins in Chinese red yeast rice. Citrinin concentration, a toxic fermentation byproduct, was measured by radioimmunoassay. RESULTS: Total monacolin content varied from 0% to 0.58% w/w and only 1 of 9 preparations had the full complement of 10 monacolin compounds. Citrinin was found at measurable concentrations in 7 of the 9 preparations. CONCLUSIONS: The findings from clinical trials demonstrating significant and clinically relevant cholesterol reduction using a defined Chinese red yeast rice preparation containing 10 different monacolins cannot be generalized to preparations that do not contain the same levels and profile of monacolins. Standardized manufacturing practices should be established for Chinese red yeast rice sold as a dietary supplement in order ensure equivalence of content of active ingredients in preparations being sold to the public and to limit the production of unwanted byproducts of fermentation such as citrinin. In common with other botanical dietary supplements, the full potential of this product will not be realized until standards for production and labeling of Chinese red yeast rice are further developed.
PMID: 11327519

How to use red yeast rice:
Here are two links with good information about this herb:
http://www.umm.edu/altmed/articles/red-yeast-000323.htm

This one goes into a huge drug interaction paragraph which seems rather common to
many that are available on the net..some may not really be applicable to red yeast rice but they are included for safety reasons:

http://www.intelihealth.com/IH/ihtIH...l?d=dmtContent

I have seen one paper of one case of interaction with the antibiotic Biaxin. So the standard warnings for use with Zithromax, erythromycin, antifungals, Biaxin etc (the same warnings for the old Seldane) apply.

I don't think patients should take red yeast rice should do so without a doctor's supervision.
You need to monitor liver functions (it is rare to have this effect on the liver but it should be monitored anyway).

Dr. Jay Cohen suggests in his book, that mild to moderately elevated patients may see good lowering of cholesterol. Also he suggests that C-reactive protein may lower as well.
Here is a recent paper from 2008 with results:

Chin Med J (Engl). 2008 Aug 20;121(16):1588-94.Click here to read Links
Statin alternatives or just placebo: an objective review of omega-3, red yeast rice and garlic in cardiovascular therapeutics.
Ong HT, Cheah JS.

HT Ong Heart Clinic, Penang, Malaysia. htyl@stremyx.com

OBJECTIVE: The aim of this review is to objectively access the trial evidence on the role of omega-3, red yeast rice and garlic in preventing clinical cardiovascular events. Given the large number of clinical trials favoring statin use in cardiovascular disease, it is important to see if evidence is available for these supplements and whether they could replace statin therapy. DATA SOURCE: A PubMed search was conducted using the keywords 'trial, omega-3, red yeast rice, xuezhikang, garlic, cholesterol, cardiovascular, outcomes'; the resulting trials were reviewed together with the references quoted in the papers obtained. STUDY SELECTION: The studies selected are prospective, randomized, placebo-controlled studies with predefined clinical cardiovascular end-points recruiting at least 2000 patients, with a follow-up over 2 years. RESULTS: Modest dose omega-3 fatty acid has been shown in GISSI-P (11 324 patients, follow-up 3.5 years) to produce a reduction in sudden death of 45%, and in cardiac death of 35%, acting probably via an anti-arrhythmic effect. In JELIS (18 645 patients, follow-up 4.6 years), high dose omega-3 given to Japanese patients on a high fish diet and already on statin treatment produced further benefit with a 19% reduction of nonfatal cardiovascular outcomes; fatal cardiac events are not affected. CCSPS (4870 patients, follow-up 4 years), a secondary prevention trial using xuezhikang, a commercial red yeast rice preparation, produced a 46% reduction in nonfatal myocardial infarction and coronary death. There has been no trial to show that garlic reduces clinical cardiovascular outcomes. A rigorous trial with constant assessment of chemicals in the study material in 192 patients found that over a 6-month follow-up, raw garlic and 2 commercial preparations do not significantly affect lipid levels. CONCLUSIONS: Omega-3 in modest doses reduces cardiac deaths, and in high doses reduces nonfatal cardiovascular events. Red yeast rice reduces adverse cardiac events to a similar degree as the statins. It is unlikely that garlic is useful in preventing cardiovascular disease.

PMID: 18982874

This is an older study:
http://www.ajcn.org/cgi/content/abstract/69/2/231

And this:
http://www.creators.com/lifestylefea...ol-levels.html

Dosing... To start, I'd go carefully. Start at 600mg twice a day. Do this for 3 months and get retested.
If this works, you don't need to go higher. Many of the medical sites I found suggest 1200mg twice a day. If you use a quality product, going higher is probably not necessary. If you get NO improvements you may have to start a statin at very low doses and titrate up further with that if you choose.

There are not many reports of side effects. I found one at PubMed:

Transplantation. 2002 Oct 27;74(8):1200-1.Click here to read Links
Rhabdomyolysis due to red yeast rice (Monascus purpureus) in a renal transplant recipient.
Prasad GV, Wong T, Meliton G, Bhaloo S.

Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, 61 Queen Street East, 9th Floor, Toronto, Ontario M5C 2T2 Canada. prasadr@smh.toronto.on.ca

Rhabdomyolysis is a known complication of hepatic 3-methylglutaryl coenzyme A reductase (HMG-CoA) inhibitor (statin) therapy for posttransplant hyperlipidemia, and thus monitoring for this effect is indicated. We report a case of an herbal preparation-induced rhabdomyolysis in a stable renal-transplant recipient, attributed to the presence of red yeast rice (Monascus purpureus) within the mixture. The condition resolved when consumption of the product ceased. Rice fermented with red yeast contains several types of mevinic acids, including monacolin K, which is identical to lovastatin. We postulate that the interaction of cyclosporine and these compounds through the cytochrome P450 system resulted in the adverse effect seen in this patient. Transplant recipients must be cautioned against using herbal preparations to lower their lipid levels to prevent such complications from occurring.
PMID: 12438974

Compared to statins this is a very low incidence. And this patient was a renal transplant patient getting immune suppressing drugs which act on the liver enzymes and perhaps enhanced the activity of the ingredients in the red yeast rice.

[mrsD]

I got my latest lipid scores today.

Using 1200mg Red Yeast Rice daily-- Doctor's Best brand:

My total cholesterol went down 25pts
my LDLs went down 17 pts
my HDLs went up 18pts
triglycerides went down almost 100 pts!

I am going to increase red yeast rice to 2400mg daily (as per Dr. Cohen's book). (2 in the morning and 2 at bedtime).

We are retesting in 3mos!

I also use the non-flush niacin 1000mg a day.

I am pleased.

[pabb]

i was under the impression that the same chemicals were involved, with the red rice yeast and statins?????

[mrsD]

Originally Posted by pabb

i was under the impression that the same chemicals were involved, with the red rice yeast and statins?????

The herb red yeast rice contains several (up to 10) compounds that lower cholesterol. It is thought that because they are present in a "group" they exert the cholesterol lowering in a more gentle fashion.

There is great variability with red yeast rice products. Some are better than others. I address that above.
And there have been reports of Chinese produced red yeast rice being contaminated intentionally with lovastatin to make those sources seem stronger. So I am using only American made red yeast rice.

In Dr. Cohen's book (which I just loaned my doctor so I don't have it here now), his quoted medical source says that with 500 patients who use this herb, no side effects were reported.

Just for the record, I am starting d-chiro inositol now. I just ordered it. It is really expensive, but the studies show vast improvements in metabolic syndrome with it. I've been watching it for years. I used metformin for a while, but after 6months it made me very ill... acidosis. I was very disappointed when that happened.