Here is an email I wrote to my cousin a couple days ago, about it; from which y’all can excerpt the pertinent info:
"I am on Lipitor, a statin medication to reduce cholesterol. When I first was prescribed the meds 3 years ago, I was told to no longer eat grapefruit, because it counters the med. I am only now finding out that other foods which counter statin meds are those made of ‘red yeast rice.’ They are primarily Asian, though some manufacture is now coming out of Europe. It is white rice which is then fermented which causes reddish-colored mold to grow all over the exterior of it. Not only is it dished out as rice, but the reddish-purplish mold is removed and powdered and used as a coloring for quite a few Asian foods. Below is a starter list, not comprehensive. Serious illness can result, including kidney failure:
Bagoong alamang (Filipino fermented shrimp)
Balao-balao (Filipino fermented rice & fish)
Burong isda (Filipino fermented rice & shrimp)
Char siu (i.e. bbq pork, etc.)
Chinese pastries that are colored red
Fujian red wine chicken
Koji
Peking duck
Pickled tofu
Red rice vinegar
Red rice: beware of any rice which is red. It may be coated with the colorant.
Red yeast rice
Red yeast rice sauce
Sake - certain types that are reddish
Tofu that has been colored red
For maximum safety don’t eat anything Asian which has been colored reddish."
I’m not sure where you’re getting this from. If anything, it enhances the effects (including the side effects) of statins.
In addition to what @honkman posted, there is this from the Mayo Clinic.
Nowhere does the Mayo Clinic page state that red rice yeast “counters” the effects of a statin. It is also unclear if reports of kidney failure were secondary to a contaminant.
Red rice yeast may not be particularly healthy, but it does NOT inhibit the action of statins.
Grapefruit juice contains Cyp3A4 inhibitors (Cyps in general make sure that any drugs doesn’t stay forever in your body.) There are a number Cyps in your body but the main one for drugs is Cyp3A4 and so when you drink grapefruit juice with your drug it takes much longer for your drug to get eliminated from your body and you can unintentionally “overdose” and have more significant side effects.
… the studies showing dangerous effects used massive amounts of furanocoumarins, the amount found in a quart or more of the juice. What’s more, eating half a grapefruit is even less risky than drinking grapefruit juice, since it takes several fruits to make a single glass of juice.
No I do not have it backwards and to answer your question, “who” told me to not consume red yeast rice products is Kaiser Permanente Pharmacy, in the instructions which came with the statin med they administered me earlier this month. Here I’m posting Kaiser’s instructions with the applicable blurb highlighted in yellow, for you to see.
You misread it. They say not to take read yeast rice products because they may contain lovastatin. They don’t say it counters your atorvastatin. It’s more like they’re afraid you’ll get a statin overdose.
They’re probably talking about red yeast rice supplements, which typically contain 600 to 1200 mg of red yeast rice. I’m skeptical that one serving of char siu contains a significant enough quantity that it would matter.
The primary monacolin in red yeast rice is monacolin K, which has the same chemical structure as lovastatin. Although levels of lovastatin vary in the product, 2.4 g of red yeast rice daily may contain about 4.8 mg of lovastatin, or 0.2% of the total dose. Red yeast rice supplements may also contain isoflavonoids, monounsaturated fats, and sterols that help to reduce cholesterol levels even further.3
So if char siu contains 10 grams of red yeast rice per pound of pork, a four-ounce serving would contain less than five mg of lovastatin, or 1/240th of what you’d get from one of those supplement pills.
When I used the word “counters,” I was generalizing in terms of something that one should not take or do in concurrently with a medication. I’m on a steady 40mg Lipitor per day; to ingest more of the same, i.e. from any source including food, would effectively increase my dose. Not good.
Maybe that explains why I ate some char siu at Hong Kong BBQ in LA Chinatown last December and did not promptly croak. The prescription instructions do not specify whether it means supplements, or foodstuffs from which the supplements originate…but to me, I see them in a similar light. As it’s my health, my body and my decision what to consume, I am now choosing to refrain from anything made with red yeast rice, just like I steer clear of any form of grapefruit.
I am now done posting to and reading this thread, but for those of y’all continuing with it, enjoy.
Kaiser’s handout says not to take “red yeast rice products.” Would anyone call red fermented tofu a “red yeast rice product” because it contains as much red yeast rice as it does salt? Woud anyone call char siu a “red yeast rice product” because its glaze contains some red fermented tofu?
I might actually know the person who wrote that handout.
If Kaiser were concerned about legal liability for not warning people to avoid char siu, they should have said “do not take red yeast rice supplements or eat anything containing even small amounts of red yeast rice” rather than “do not take any red yeast rice products.”
You have your own interpretation of what the text in the form means. That is quite different from my own interpretation. To me, the text serves the purpose of having appropriately informed a patient that a drug-food interaction may exist.
I personally have no clinical or legal interest in quibbling over what the term “product” means in this context. And I doubt the Kaiser pharmacists or lawyers do, either. ::shrug::
I’m a tech writer, so I know how the sausage gets made.
If somebody gave me that sheet, I’d ask my doctor if they really mean to avoid anything that might have a few milligrams of red yeast rice because it was glazed with red fermented tofu, or if they’re just talking about supplements and Chinese traditional medicine, which might double your statin intake.
I’m not really sure how being a tech writer gives one insight into cytochrome P450 phenotypes, the likely complete absence of empiric data regarding a dose effect of red rice yeast and statin interactions, how FDA regulation of supplements is different than it is for drugs (which, to quote a line from the article you’ve linked, means that “product uniformity, purity, labeling, and safety cannot be guaranteed”), the complicated organizational dynamics of a large and highly visible healthcare entity, and how all of that influences public-facing documents and what a healthcare provider might document in the progress note about their response to the question you posed to protect themselves in the event of an adverse reaction but… okay.
I don’t know if there’s really anymore juice to be squeezed out of this fruit.
