More on red yeast rice and cholesterol

The Archives of Internal Medicine published a study which evaluated different red yeast rice supplements and found them highly variable in the amount of monacolin (sometimes spelled monocolin) they contained. This ingredient is the active ingredient lowering cholesterol, which is similar to that in lovastatin. They also found that some of the supplements contained a compound toxic to the kidneys.

The important distinction here is between red yeast rice and red yeast rice supplements. This study evaluated 12 supplements in capsule form. While the study raises a caution about purchasing extract supplements in capsule form, I stand by my previous post on the subject with respect to the whole grain. Buying the whole grain red yeast rice and preparing it just as one would prepare any other type of rice should not be subject to regulation as a drug.

Ineffective: glucosamine and chondroitin for arthritis

A new meta-analysis (a synthesis of many randomized cinical trials) by Juni and colleagues published in the British Medical Journal this week has found that glucosamine and chondroitin supplements, popularly prescribed and taken for arthritis,are not significantly effective in reducing the joint space narrowing that comes from arthritis nor the pain intensity of arthritis.

10 years ago I was asked to answer a question on a Johns Hopkins "Intellihealth" question and answer site about whether glucosamine and chondroitin were effective for arthritis. I said that taking these things for arthritis would be expected to be about as effective as eating kidney would be for kidney disease, or brains for neurodegenerative disorders. I was very surprised, then, when some trials showed an effect of these compounds and I had to retract my answer. So I guess I can feel a little less concerned that I misled anyone in the past, seeing from this meta-analysis that the industry-independent studies show very little or no effect and even the ones funded by the pharmaceutical and supplement industries show very tiny effects of no clinical significance.

While there doesn't seem to be anything toxic about taking these compounds, and they may have very small effects, they are expensive. I agree with the authors that insurers probably should not pay for them given the hundreds of more effective preventive interventions in medicine which right now are not being paid for by health insurance which should take higher priority, which for arthritis would include exercise or yoga classes.

Vitamin D insufficiency and deficiency

Vitamin D deficiency is less than 20 but 20-30 is considered "vitamin D insufficiency". I've not found very impressive data on how prevalent various symptoms are with vitamin D insufficiency as opposed to vitamin D deficiency. A National Institutes of Health fact sheet is available. http://ods.od.nih.gov/factsheets/vitamind.asp#en13It appears that "insufficient" folks can have cognitive problems, mood problems, and reduced calcium absorption, so it seems best to get more Vitamin D if your level comes back in this range. Current guidelines say to aim for a level of 50 to 80, so if you're below 50 you may wish to take a Vitamin D supplement to get your level up.

What's the right supplement? You should take Vitamin D3 since Vitamin D2 does not bind as well to the binding proteins in the blood and does not store as well in the body to increase total body stores. If you are insufficient, take 2000 IU per day of Vitamin D3 until your level comes up to the desired region. A recent study showed that people who were given one high dose of Vitamin D3 instead of a daily dose to bring up their level actually had more falls and fractures than a control group. So high single dose supplmentation is not recommended.

How can you increase it in your diet? Sardines and wild salmon are two good sources.

And, of course, 20 to 30 minutes of sunshine between 10 and 2 on bare skin, especially if you live in a climate like California's, will give you a nice dose of Vitamin D. Be careful not to burn, and if you don't want wrinkles, put it on your face and the back of your hand, and let the Vitamin D metabolism happen in the arms and legs.

What's too high? In the study in which people fell more after high doses, their levels were up to 120, and as their levels came down, the fall and fracture risk came down too. So it's recommended to keep the level between 50 and 80.

This post was written on 6/3/2010. New information may come available, so this information should not be relied upon as state of the art. A blog is no substitute for a doctor. Before acting on advice on any post on this website, check with your physician. If you wish to consult me for advice, please go to www.myadvicedr.com and follow the instructions to get a free 15 minute consultation and subscribe to the practice.