Red yeast rice alert

2. July 2008 William Davis (9)
While there have been some positive reports in the media lately about the cholesterol-reducing effects of red yeast rice, Consumer Lab has issued a very concerning report.

Because Consumer Lab is a subscription website (incidentally, the $20 per year membership fee is money well spent for insightful tests on many supplements, though new reports only come out a handful of times per year), I won't discuss the results of their red yeast rice in its entirety.

However, Consumer Lab testing uncovered several disturbing findings:

--The lovastatin content varied by a factor of 100, from 0.1 mg per tablet/capsule in one brand up to 10.6 mg in another brand. By FDA regulations, lovastatin is a drug and NO red yeast rice preparation is supposed to contain ANY lovastatin. Nonetheless, despite the marketing of supplement manufacturers, it is probably the lovastatin that is largely responsible for the LDL-reducing effect. The monacolins or mevinolins in red yeast rice add little, if any, further LDL-reducing effect.

--Several preparations contain a potential kidney toxin called citrinin. The Walgreen's product, specifically, contained substantial quantities of this toxin.



Interestingly, the FDA has taken repeated action against red yeast rice manufacturers and distributors because they continue to contain lovastatin. In the FDA's most recent action in August, 2007, for instance, Swanson's product and Sunburst Biorganics' Cholestrix, were both sent letters to stop selling their product because it contained lovastatin.

The Consumer Lab findings would explain the enormous variation in LDL-reducing effect of various red yeast rice products. In my experience, some work and reduce LDL 40 mg/dl or so, some fail to reduce LDL at all, others generate a modest effect, e.g., 5-10 mg/dl LDL reduction.

In effect, red yeast rice IS a statin drug, albeit a highly variable and weak one. Although readers of The Heart Scan Blog know that I am a big fan of nutritional supplements and self-empowerment in health, I am a bigger fan of truth. I despise B--- S---- of the sort that emits from some nutritional supplement manufacturers and drug companies.

I am puzzled by much of the public's readiness to embrace a statin drug if it comes from a supplement company while avoiding it if it comes from a drug manufacturer. Personally, I do not like the drug industry, their questionable (at best) ethics, their aggressive marketing tactics, their sleazy sales people.

But, in this instance, if a statin effect is desired, I'd reach for generic lovastatin before I purchased red yeast rice. The Consumer Lab report tells us that red yeast rice IS essentially a statin drug, an inconsistent one that often contains a potential toxin.
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Comments (9) -

  • Jenny

    7/2/2008 1:09:00 PM |

    Thanks for blogging on this extremely important topic. The news coverage of this story was REALLY garbled.

    Here's a related question. Have you seen anything about the purity of the Vitamin D being sold in oil capsules. As enthusiastic as I am about it--I've had my levels measured and the supplementation has definitely raise them, I'm concerned about what contaminants might be in the pills since they all come from those Chinese factories full of adulterants.

    Any data on this?

  • sjbock

    7/2/2008 3:12:00 PM |

    One possible explanation as to why someone would purchase a supplement rather than a prescription drug is that the person has no health insurance and cannot afford or find a doctor who will write the prescription required for the drug.

  • mike V

    7/2/2008 7:44:00 PM |

    Of course, it is worth mentioning that lovastatin  originates naturally in RYR, and only became a drug courtesy of big pharma reinvention and patents?
    MikeV

  • Michael

    7/2/2008 8:27:00 PM |

    My cardiologist recommended I try Red Yeast Rice, as an alternative to Zocor, just to see if it can raise my HDL some and possibly push my LDL/Triglycerides down a little (they are already normal).

    Several weeks ago there was an article in regard to a major Chinese study on RYR - http://www.theheart.org/article/875035.do

    They used a specific type of RYR, Xuezhikang. The data from this study showed that RYR had better results than statins (In Western studies) in preventing a repeat heart attack. There was also a lower risk of mortality and cancer (which is rare to see in any statin study).

    And it is theorized that the non-statin components of RYR is why there is such a benefit. Most RYR studies have shown than the lovastatin dosage can be really small, yet have an equivalent or greater effect than a normal dosing of a statin. Lower dosage = less side effects, which is why many people prefer trying RYR over statins.

    As for the consumer labs report, are you allowed to post some of the brands that passed the test at least? Or several that didn't? I am currently trying RYR from Thorne, as they supposedly have good testing labs and also source their RYR from the US. But there is no actual way for me to know how good or bad their RYR is...

  • Mo

    7/4/2008 12:14:00 PM |

    If mainstream method cholesterol lowering is poisonous via supplemental or pharmacuetical methods, it shows that essentially this is slow poison. Not meant to be!

  • Dr. Brad

    7/7/2008 3:01:00 PM |

    As a physician and advocate for self-care and an integrative approach toward managing your health, I totally agree with your perspective.   Why take a nutritional supplement that contains similar family of compounds "HMG Co-A Reductase Inhibitors" when all that you get is additional risk due to quality assurance problems. A recent study published in the Mayo Clinic Proceedings actually showed that lifestyle change + RYR was as good as high dose Zocor in lowering LDL cholesterol, and ensured greater weight loss than Zocor.   Many people then assumed that RYR was the way to go because it’s ‘less toxic’—as I wrote in my blog, in my view, this is the wrong conclusion.  

    http://www.revolutionhealth.com/blogs/bradlyjacobsmdmph/lifestyle-and-herb-as-14623

  • Anonymous

    7/9/2008 9:54:00 AM |

    I just received my NMR lipoprofile results and I am not sure what to look for in the numbers.  Any help would be appreciated:

    LDL-P           584
    Small LDL-P     242
    Chol Total      121
    LDL-C           52 (FASTING)
    HDL-C           51
    Triglycerdes    91
    LDL particle size 21.8
    large HDL-P     10.8
    large VHDL-P     0.7

    I am a type 2 diabetic and not taking any medicine for it and lost 80 lbs over the years.

  • Anonymous

    4/11/2009 5:40:00 PM |

    I was surprised that no one has mentioned anything in this blog about the total phytochemistry of Red Yeast Rice, where the deep red purple color of the extract may ahve something to do with its bioactivity, and how it was used in TCM (traditional Chinese medicine) many years before Lovastatin was sold as drug for blood stasis (this means in TCM thickened blood that clots easily). Red Yeast Rice is known to contain a phytochemical array of flavonoids, phytosterols, and other monacolins besides the K. The flavonoids are the compounds that give RYR the reddish-purple pigment color. A wide array of flavonoids from many sources are known to modulate both cholesterol and lipid metabolism, while having blood thinning effects and being able to decrease smooth muscle cell growth of the arterial vessels (see grapefruit flavonoids and cholesterol lowering studies). Phytosterols are known to have cholesterol lowering effects. Other monacolins are in RRY and FDA even has allowed or not objected to the use of another type of monacolin (J) from Red Yeast Rice to be considered for use as a dietary supplement according to a letter submitted to the agency. It could be that the synergy of all of these components could be working to lower cholesterol. A side note is that the edible Oyster mushroom contains monacolin K and is considered a lipid lowering botanical with safe, food use.

  • buy jeans

    11/2/2010 9:18:06 PM |

    In effect, red yeast rice IS a statin drug, albeit a highly variable and weak one. Although readers of The Heart Scan Blog know that I am a big fan of nutritional supplements and self-empowerment in health, I am a bigger fan of truth. I despise B--- S---- of the sort that emits from some nutritional supplement manufacturers and drug companies

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The best fish oil

The best fish oil

29. January 2011 William Davis (30)
The best fish oils available are the liquid forms. Contrary to many people's expectations, the best liquid fish oils have no fishy odor or taste.

I use a lot of liquid fish oils because of the higher doses we use in the Track Your Plaque program, as well as our strategy of high-dose fish oil to reduce lipoprotein(a). Women, in particular, don't like taking the oodles of capsules required to achieve the higher doses we need. So the ladies really like the liquid forms.

The best liquid fish oils are non-fishy, highly-concentrated, and come in the better absorbed triglyceride form. Many capsules, including prescription Lovaza, are the less well-absorbed ethyl ester form. Several studies, such as this one, have now demonstrated that the naturally-occurring triglyceride form yields higher blood (RBC) levels of omega-3 fatty acids, likely due to more efficient digestion via pancreatic lipase.

While there are many good forms of fish oil and only a few bad, these are the best of the best:

Pharmax
The Pharmax Finest Pure Fish Oil with Essential Oil of Orange contains 1800 mg EPA + DHA per teaspoon. This is the preparation I've been taking.

Nordic Naturals
The Nordic Naturals lemon-flavored ProOmega Liquid contains 2752 mg EPA + DHA per teaspoon, the most concentrated of any fish oil I've seen.

(This list is not exclusive. These are just two brands I've used extensively with good results.)

These highly-concentrated, triglyceride forms are more expensive, due to their concentrated nature. 1 teaspoon Pharmax fish oil, for example, provides an equivalent quantity of omega-3 fatty acids as 6 standard fish oil capsules on a milligram for milligram basis, but more like 8 to 9 capsules when absorption efficiency is factored in. The triglyceride form is also more laborious to manufacture. On our Track Your Plaque Marketplace, our Pharmax 500 ml runs $58.95 list. (500 ml provides 100 teaspoons or 600-capsule equivalent.)

Note that, minus the protection of the capsule, liquid fish oils will oxidize if not refrigerated. So be sure to keep your liquid fish oil in the fridge.
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Comments (30) -

  • Christopher

    1/29/2011 4:17:37 PM |

    Dr. Davis, would like your thoughts on the Trader Joe's brand Omega-3 Fatty Acids:
    1200 mg Fish Oil
    400mg EPA
    200 DHA
    Thanks,
    Chris O

  • Anonymous

    1/29/2011 4:23:39 PM |

    I use Pharmax Finest Pure Fish Oil with Essential Oil of Orange from the TYP Marketplace.  I take 1 tablespoon per day to help reduce Lp(a).  Is it better to take this dose at one time or divide it through the day?

  • Kristjan Mar

    1/29/2011 4:53:10 PM |

    In Iceland where I come from we have a really high quality fish oil called Lysi.

    In my opinion liquid form is the only real way to take it, with caps you have to take a ridiculous amount to reach the same amount as in a tablespoon.

    Plus you have no way of knowing if the fish oil caps are spoiled except to chew them, often they're not even refridgerated in the supermarket.

  • Anonymous

    1/29/2011 5:02:21 PM |

    I remember from an earlier thread that spacing the dose out over the day works better than a big dose once daily. That makes sense, given that you are trying to alter some liver metabolism that goes on around the clock. I've been using the Life Extension capsules, six a day, for several years with pretty good results. It gets my TG from 400+ to about 170. I'm hoping the gram a day of regular niacin I've been taking for a few months helps further and gets my HDL out of the sewer (27). I'll know that in a few days...

  • Might-o'chondri-AL

    1/29/2011 6:43:34 PM |

    Nice tasting Liquid fish oil brand, 1 teaspoon=
    1,500 mg EPA
    + 750 mg DHA
    ----
    = 2,250 mg EPA + DHA
    +   380 mg other Omega 3
    -------
    = 2,630 mg. Omega 3/teaspoon
    (out of a total fish oil content of 4,400 mg./tsp.)

    Canada made "Natural Factors",
    "Dr. Michael Murray recommended pharmaceutical grade" says label; extracted
    from anchovy/sardine/mackerel;
    1 teaspoon stateside cost works out to less than US$1 a teaspoon; each teaspoon has 40 calories, 15 mg cholesterol, total fat 4.5 gr. (being 3.5 gr. polyunsaturated), natural vitamin E and natural orange flavor, no heavy metals/environmental toxins ... I've no financial interest in the product.

  • Anonymous

    1/29/2011 8:48:35 PM |

    What about Carlson's?



    http://www.amazon.com/Carlson-Finest-Liquid-Omega-3-Orange/dp/B001LF39S8/ref=wl_it_dp_o?ie=UTF8&coliid=I27QWKFK5P760T&colid=1J0P20X13IM7F

  • NatureDoctor

    1/29/2011 9:04:42 PM |

    What are your thoughts on Chris Masterjohn's research regarding very low requirements of polyunsaturated fats in the human diet?  High amounts of fish oil would certainly contravene this hypothesis.  I am referring to his position paper, How Essential Are The Essential Fatty Acids?

  • O Primitivo

    1/29/2011 9:18:37 PM |

    The best fish oils should be, as expected, in fish. Eat more fish!!!;))

  • David M Gordon

    1/29/2011 9:33:40 PM |

    "1 teaspoon Pharmax fish oil, for example, provides an equivalent quantity of omega-3 fatty acids as 6 standard fish oil capsules on a milligram for milligram basis, but more like 8 to 9 capsules when absorption efficiency is factored in."

    Color me confused, Dr D. At the moment, I ingest 6 (3, 2x/day) Sam's Club Omega 3 capsules (the ones you recommended in a long-ago post) to obtain the 6 Grams of total DHA and EPA/day. Does your comment I quote above mean that, with the liquid form, I can take less than the equivalent of 6G/day  because of its absorption efficiency? And how much, if yes?

    Really, I am sufficiently befuddled that I think even my question is not clear...

    Help!

  • Hannu K.

    1/29/2011 9:45:43 PM |

    Where can I check if the fish oil is trigyleride form?

  • reikime

    1/29/2011 11:20:55 PM |

    uh.. off topic.. when I clicked on my bookmark, to the Heart Scan Blog all of the website except these comments are in what looks like Russian!!  nothing else on my computer is corrupted...anyone else?.. and how do I fix this?  I am on an IMac.

    Thanks,
    Jeanne

  • reikime

    1/30/2011 12:36:45 AM |

    Fixed it!  funny that it was only this website.

    on topic- I am very intolerant to anchovies, will Krill oil help me?  can't take ANY fish oil with anchovy.

    Thanks

  • Might-o'chondri-AL

    1/30/2011 12:57:33 AM |

    Seeing some confusion here: the ideal active ingredients in fish oil are the EPA mg. & DHA mg. omega 3's. Lables indicate there are other omega 3 oils, plus other non-omega 3 oils in all products and together these are the mg of "fish oil" (product may specify yet another blending oil). Companies make their EPA mg. & DHA mg. concentrations different, incur production costs to make it higher doseage and our purchase price reflects that.

    If you have a theraputic goal for intake: it is not so much how much fish oil, but how much you need to take of any one specific product a day to meet your target for total EPA mg. & DHA mg. Omega 3 fatty acids. For a name brand product Doc recommended and gave his daily dose (whether capsule or liquid)he apparently did the math.

  • Anonymous

    1/30/2011 1:28:06 AM |

    Unfortunately I am illergic to fish oils and react badly to them. Not a good way for me to get my omegas so I need an alternative.

    Udo' Oil does do a 369 oil that has no fish oils. So far that is the only one I have been able to find I can handle.

  • Vlado

    1/30/2011 1:44:27 AM |

    best fish oil is no fish oil. Certainly if anyone knew how fish oils were made , they would not take them. It's interesting how dr. Davis says fish oil with no odor are best but those are simply sterilized and deodorized and for a reason so that the taste of smell would not be repulsed. Trust your own gut instead of anyone else I guess. Ray Peat has chronicled data and science behind the dangers and lipid peroxidation of fish oils. Brian Peskin makes a case that these derivative oils are a huge burden for the cells and should never be taken. Naturally such oils are protected by vitamin E and saturated fat but not in these fish oils. Most other literature documents effects of omega 3 on cancer metastasis, just google it.

  • Paul

    1/30/2011 6:16:26 AM |

    Now Foods Omega-3 Fish Oil 16.9 fl. oz.
    Serving Size: 1 tsp (5 ml)
    Servings Per Container: 100
    EPA: 740 mg
    DHA: 475 mg
    Other Omega-3 Fatty Acids: 185 mg
    Total Omega-3 Fatty Acids: 1,400 mg

    Cost: $19

    100% triglyceride form **

    ** Now Foods 16.9 fl. oz. is the brand I use and I can confirm this is the TG form after a polystyrene test.  (Take a styrofoam cup, place a small amount of fish oil at the bottom of the cup, wait ten minutes, and if it eats through the bottom it's the EE form.)  

    I can also attest that I do not suffer from "fish burps" that the EE form is known to cause.

  • Dr. William Davis

    1/30/2011 2:41:17 PM |

    Anonymous about Lp(a)--

    We have no formal data on dosing regimens, but I have been advising dividing dose in two, a.m. and p.m. This appears to be working well.

  • Dr. William Davis

    1/30/2011 2:43:35 PM |

    David--

    You may be confusing fish oil dose with dose of EPA+ DHA.

    Check your label to see EPA + DHA content. This is what you use to dose your fish oil.

  • SVinay

    1/30/2011 3:37:25 PM |

    Readers

    Is Carlsons fish oil the Triglyceride form one?

  • Anonymous

    1/30/2011 4:19:39 PM |

    SVinay:  Carlsons Super Omega-3 Fish Oil is the ethy ester form.

  • Marie-Anne

    1/30/2011 4:42:23 PM |

    I am currently taking Heart Health Omega-3 1000mg by Swiss Natural Sources.EPA 300 and DHA 200.  I take three capsules daily.  I have also purchased Jamieson's Omega-3 Select with the same EPA DHA content as the Swiss.  The Jamieson's is less fishy smelling and I will switch back to it when I finish the Swiss.  
    Canned boneless herring fillets are usually a part of my lunch.  Omega-3 2g.  I also found some canned cod liver.  I'll try it in an egg bake.

  • Anonymous

    1/30/2011 11:15:49 PM |

    For the poster who had a question about Carlson's... the liquid and low-dose caps are natural triglyceride. Their higher concentrate capsules are ethyl ester.

    I currently like Barlean's, as it's triglyceride and relatively inexpensive. Their higher concentrates are ethyl ester though, so go for the lower conc. ones if you want the trig form.

    I do disagree with Dr. Davis as far as preferring liquid however, due to oxidation issues. I'd recommend the caps instead, and simply chew them, if swallowing capsules bothers you. The caps do offer some extra oxidation protection.

  • Might-o'chondri-AL

    1/30/2011 11:31:16 PM |

    Hi Vlado,
    I think so-called
    "pharmaceutical" grade fish oil is distilled to seperate out concentrated gradients of "x"% DHA & "x" % EPA in a product. Yes, fish scraps that the oil is extracted from first gets heated, but so is cooked fish. Solvent residues concievably might be in some products; you can inform me of other compounds resistant to purifying out.

    1 teaspoon oil = 5 mL. = 200 pharmaceutical size droplets = 4.54 grams .... I, for example, weigh 79,379 grams (175 pounds/79.4 Kg.) and assume a daily teaspoon dose of 4.5 grams fish oil can be metabolized safely. If you've details on how the omega 3's are noxious when added into the diet please explain.

    Is my fish oil already peroxidized and/or are ingested omega 3 lipids peroxidized to my detriment at this level? My math shows that one teaspoon for me is 5.7 hundred-thousandths of my body weight; multiplying 0.000057 x 79379 grams that I weigh = 4.5 grams in teaspoon of oil.

  • Daniel A. Clinton, RN, BSN

    1/31/2011 5:57:57 AM |

    Is there any data guiding recommendations on the ratio of EPALaughingHA? I've never come across any primary data on the subject. To the best of my knowledge, the ideal intake and ratio of EPA and DHA remain unknown and a point of contention. I've noticed many fish oils have a 3:2 ratio of EPALaughingHA, but I don't know where that is coming from. I'd love to know your thoughts, Dr. Davis.

  • imwendym

    1/31/2011 4:17:13 PM |

    I love the brand from www.strongerfasterhealthier.com
    They make 5 flavors with zero fish oil taste. My kids ask for it, so it's a big win in our house. The concentration of EPA and DHA towered over even barleans.

  • Anonymous

    1/31/2011 9:32:48 PM |

    Carlson's Super DHA Gems and EPA Gems concentrate capsules are TG form.

  • Anonymous

    2/3/2011 12:07:55 AM |

    Dear Dr Davis

    I am looking for a Kosher liquid omega 3 fis oils
    I find nutri supreme research
    Calories   40

    Calories from Fat   40

    Total Fat   4.5g    7%**

    Cholesterol   18mg   6%**

    EPA   950 mg   *

    DHA   475 mg   *

    Other Omega 3   325 mg   *

    Total Omega 3 Fatty Acids   1750 mg

    is this ok? or there is something Kosher better?---------------------------------------------

  • Anonymous

    2/23/2011 12:46:07 PM |

    Check out Ascenta! All their fish oil is in triglyceride form.

    ascentahealth.com

  • Dawn

    5/6/2011 9:37:55 PM |

    What is your opinion of Krill Oil?

  • Sandra

    2/27/2012 1:16:03 PM |

    Dr. Williams, I am wondering what you think of only taking high doses of EPA? See the following article:
    http://igennus-hn.com/omega-3-epa-treatment-for-a-heart-condition-news-release/

    As I have M.E. (post viral fatigue syndrome) as well as astronomical total cholesterol (great tryglycerides), I''m interested in trying this protocol. Would love your input.

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