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Although it is by no means the only major risk factor, elevated serum cholesterol is clearly associated with a high risk of heart disease. Most medical doctors suggest cholesterol levels should stay under 200 mg/dl (5.2 mmol/liter). Cholesterol levels lower than 200 are not without risk, however, as many people with levels below 200 have heart attacks.

As levels fall below 200, heart disease risk continues to decline. Many nutritionally oriented doctors consider cholesterol levels of no more than 180 to be optimal.  Medical laboratories now subdivide total cholesterol measurement into several components including LDL cholesterol (which is directly linked to heart disease) and HDL cholesterol (the so-called “good” cholesterol). The relative amount of HDL to LDL is more important than total cholesterol. For example, it is possible for someone with very high HDL to be at relatively low risk for heart disease even with total cholesterol above 200. Evaluation of changes in cholesterol requires consultation with a healthcare professional and includes measurements of blood levels of total cholesterol as well as HDL and LDL cholesterol. Click here for Cholesterol Home Testing

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Safety Issues
Coenzyme Q10
Garlic
Guggulipid
Niacin
 

If your cholesterol is a little higher than it should be, you're probably trying to adjust it by following a diet low in saturated fat and cholesterol. Unfortunately for many of us, this approach just doesn't do the trick. Natural treatments, however, may help reduce moderately elevated cholesterol levels. Of these, inositol hexaniacinate (no-flush niacin) and pantethine are vitamins accumulating notable track records, as is the herbal supplement guggulipid. Red yeast rice is a newcomer, and results of studies in both China and the United States indicate that it's a supplement worth considering.

Red yeast rice may more effectively reduce moderately elevated cholesterol levels (200-240 mg/dl) than cholesterol-reducing diets. Its cholesterol reducing actions are thought to be due to mevinolin, a chemical identical to lovastatin. Lovastatin and other statins are chemicals used in conventional medicine to reduce cholesterol. In 1999, lovastatin was also shown to reduce death rates from cardiovascular disease.

bullet 
Red Yeast Rice: Familiar Food, New Heart-Helper
A rise in cholesterol levels among the Chinese led their researchers to seek less expensive cholesterol-reducing drugs than the statin drugs used here. Their approach was simple: Test the cholesterol- reducing effects of the traditional Chinese remedy, red yeast rice.  Made by fermenting rice with red yeast (Monascus purpureus Went), red yeast rice is not new to China or to neighboring Japan, where it has long been used as a food coloring agent and preservative and to make red rice sake and liqueur. The red edging on boneless Chinese spare ribs is due to red yeast rice. Asians have also used the food product to treat indigestion, diarrhea, and to improve blood circulation. In 1977, a Japanese researcher found that a chemical in red yeast inhibited HMG-CoA reductase, the enzyme that the liver uses to make cholesterol. The chemical, originally called Monacolin-K and mevinolin, is chemically identical to the generic, fat-reducing statin-based drug, lovastatin, which was developed from a strain of fungus (Aspergillus terreus) and introduced in 1987.  Lovastatin, mevinolin, and other statins-based drugs reduce by cholesterol which blocking the activity of HMG-CoA reductase deprives the liver of an essential component in cholesterol manufacture. An estimated 80 percent of cholesterol found in the blood is produced by the liver (only 20 percent is contributed by diet), so HMG-CoA reductase inhibitors go a long way toward reducing blood cholesterol levels. But not surprisingly, then, effects demonstrated in the Chinese studies suggest that red yeast rice may be useful in controlling moderately elevated cholesterol. It may also cause some problems, and its effect on high-density lipoprotein (HDL), a factor in overall cholesterol reduction, is still to be determined.

Garlic is another herb for cholesterol. The therapeutic effects of Garlic have been scientifically validated in the area of cholesterol and triglyceride lowering, as well as its strong antimicrobial properties. Research in Germany, India, France, China, England and the United States demonstrate consistent results proving the efficacy and safety of Garlic even in high doses. Known as a yang tonic in Chinese medicine, Garlic will stimulate appetite and metabolism, clear toxins, and act as an antimicrobial agent of the mucous membranes. A great deal of recent work has been done on the sulphur bearing amino acids in Garlic.

 
bulletHDL Cholesterol: Aim High

Researchers have estimated that for each one percent decrease in low-density lipoprotein (LDL) cholesterol, heart attack risk drops by two percent. By comparison, each one percent increase in HDL levels causes a three to four percent drop in heart attack risk. For these reasons, investigators have tried to find out what effects red yeast rice has on HDL levels. In one prominent study in China, the conventional statin-based drug simvastatin (Zocor) was slightly better at reducing total blood cholesterol than the red yeast rice concentrate Xuezhikang. However, simvastatin was significantly better than Xuezhikang at raising HDL levels. Similarly, an American clinical trial showed that Xuezhikang caused predictable reductions in total cholesterol, LDL cholesterol, and triglyceride levels, but had little effect on HDL. However, in a study presented at a March, 1999 American Heart Association conference, red yeast rice increased HDL levels by an average of 15 percent.

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A number of studies have supported the claims that guggul extracts can help to reduce heart disease risk factors, with reductions in both blood fats and total cholesterol of 15-30 percent over three months. Guggul extracts have been shown to lower overall blood fats, reduce "bad" LDL cholesterol, and raise "good" HDL cholesterol.  Buy Gugulipid More Infor on Guggul

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In clinical studies garlic has been shown to lower serum cholesterol and help maintain circulatory efficiency. The greatest effect resulted from garlic products with standardized amounts of allicin release in doses of 5,000 mcg per day.
 
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bullet 
Safety Issues
While effective in reducing cholesterol, statins carry risks for liver damage. Patients using statins should have periodic liver enzyme tests to make sure their liver activity is normal. Persistent increases in liver enzymes suggest liver dysfunction and occur in almost two percent of all patients after three to twelve months of lovastatin use. In addition, combining lovastatin with other cholesterol-reducing drugs such as gemfibrozil or with lipid-lowering doses (such as 1 gram or more per day) of nicotinic acid may cause rhabdomyolysis, a condition that involves muscle tissue deterioration. Rhabdomyolysis may also result from lovastatin alone. Because red yeast rice contains statins, it too may trigger these types of adverse effects. Red yeast rice is recommended in China for the treatment of moderately high cholesterol levels (200-240 mg/dl). Dietary supplements have been developed that are standardized to deliver 0.4 percent lovastatin/mevinolin per dose, or 2.4 mg, at a frequency of one to four times daily, providing a total daily intake of 2.4 to about 10 mg statins. In comparison, the recommended dosing range for lovastatin, as the prescription drug Mevacor, is 20-80 mg per day. See Supplements Program
bulletThe FDA's Regulatory Concerns

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The FDA and the dietary supplement industry have been debating for some time whether red yeast rice is a drug or a supplement. For a while the FDA banned imports of red yeast grain and powder, but in February 1999, a Federal District Court declared a red yeast rice product a dietary supplement and not a drug. The FDA is appealing this ruling, but for now consumers can purchase red yeast rice supplements if they so choose. The basis of the FDA's complaint is that red yeast rice contains substances that are used as drugs, and that, because of the health risks associated with these drugs (liver and muscle tissue damage), red yeast rice should be regulated as a drug. In effect, the agency sees red yeast rice as a statin compound. However, mevinolin occurs naturally in red yeast rice and is not a separate chemical that is isolated and dispensed by itself, as are lovastatin and the other five statins used in the United States to lower cholesterol. Mevinolin is not added to red yeast rice during the manufacturing process, and it is not the only element at work in a red yeast rice product. Other ingredients, such as essential fatty acids, may have therapeutic, balancing, or synergistic effects on the way red yeast rice products work.

More studies are needed to clarify the effects of red yeast rice on HDL and to test its safety. If you decide to give it a go, remember not to use it along with other cholesterol-lowering substances, especially high doses of niacin (1 gram or more per day), because this may increase the risk for developing rhabdomyolysis. Like lovastatin, it may reduce coenzyme Q10 levels, and it may interact adversely with grapefruit juice, which interferes with the metabolism of various drugs that pass through enzyme systems in the liver and/or small intestine for detoxification. In one study, three servings of double-strength grapefruit juice (each dose about 7 fluid ounces) for two days increased the concentration of lovastatin in the blood by 15 times, in patients undergoing lovastatin therapy. Such increases are dangerous.

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References
Chu PH, et.al. Rhabdomyolysis, acute renal failure and hepatopathy induced by Lovastatin monotherapy. Jpn Heart J 1997;38:541-5.
Fuhr H. Drug interactions with grapefruit juice. Extent, probable mechanism and clinical relevance. Drug Saf 1998;18:251-72.
Heber D, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231-6.
Kantola T, et.al. Grapefruit juice greatly increases serum concentrations of Lovastatin and Lovastatin acid. Clin Pharmacol Ther 1998;63:397-402.
Kou W, et.al. [Effect of xuezhikang on the treatment of primary hyperlipidemia.] Abstract; article in Chinese. Chung Hua Nei Ko Tsa Chih 1997;36:529-31.
Veerkamp JH, et.al. Effects of MHG-CoA reductase inhibitors on growth and differentiation of cultured rat skeletal muscle cells. Biochem Biophys Acta 1996;1315:217-22.
Wilson PWF. High-density lipoprotein, low-density lipoprotein, and coronary artery disease. Am J Cardiol 1990;66:7A-10A.
Zhiwei S, et.al. A prospective study on Zhitai capsule in the treatment of primary hyperlipidemia. Natl Med J China 1996;76:156-7.
Zhu Y, et.al. Effects of xuezhikang on blood lipids and lipoprotein concentrations of rabbits and quails with hyperlipidemia. Chin J Pharmacol 1995;30:4-8.
Wang J, Zongliang L, Chi J, et al. Multicenter clinical trial of the serum lipid-lowering effects of a Monascus Purpureus (Red Yeast) rice preparation from traditional Chinese medicine. Current Therapeutic Research 1997;58(12):964-78.

 
 
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