Should some people avoid red yeast rice?

Jackpot:

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. :wave:

The handout says “do not take any red yeast rice products,” not “avoid all foods containing small amounts of red yeast rice.”

Yeah, the thing is that I think that very few other people would use it that way (I certainly wouldn’t, and I’m a healthcare provider).

But, yes, you “shouldn’t” take products containing red rice yeast. I think that would be the most general (but still accurate) way to put it.

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.

I’m sure a lawyer somewhere would…

Patient-information forms, especially at large institutions, are not simply for educational purposes.

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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.”

IANAL.

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::

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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.

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I already posted the math.

Being a tech writer just makes me sure that by “product” they were thinking of supplements, which the FDA has warned against.

https://www.consumerreports.org/vitamins-supplements/the-truth-about-red-yeast-rice-for-lowering-cholesterol/

https://www.consumerreports.org/dietary-supplements/red-yeast-rice-supplements-may-contain-dangerous-surprises/

https://www.fda.gov/science-research/fda-science-forum/using-carbon-isotope-ratios-detect-adulteration-red-yeast-rice-supplements

You might be a writer but FDA related texts are very different from technical texts. There is no “sausage” to be made but very strictly regulated with very limited room for interpretation

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My point is that the FDA has said nothing about red fermented tofu, only about red yeast rice supplements. The sausage (Kaiser handout) shows none of the usual signs that the authors were concerned about regulatory compliance.

There will be most likely some clear guidance documents from the FDA about statin drugs and other drugs which will be the foundation of any further documentation also available to the public (through health care providers). The FDA tends to be very clear about it and it is part of the NDA submission document of the drug company

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Given the other links you’ve provided, it does seem that the actual warning really is more for supplements and that, for whatever reason, that wording didn’t make it into the Kaiser doc. Rather unfortunate (on Kaiser’s end).

Supplements aren’t regulated like drugs. Thanks to the Dietary Supplement and Education Act of 1994 they’re hardly regulated at all A few years ago an expert from UC Berkeley visited a local supplement store and found that some products that were so toxic that in his lab they wore gloves and respirators to handle them.

But atorvastatin is highly regulated and so what is written in the original post and the photo later is regulated by the FDA

The bit in the Kaiser handout about avoiding “red rice products” does not come from the FDA.

That’s what docs look like when the tech writers have to worry about regulatory compliance.