Problems with Supplement Reliability

Q. In a recent column, a reader wanted to avoid medication and you mentioned red yeast rice to lower cholesterol. I was surprised to read this, since red yeast rice has the same active ingredient as prescription statins, but is completely unregulated as to amount of active ingredient.
The reader might expect all of the possible side effects of a statin from red yeast rice, with none of the quality control available in a tested and regulated medication.
A. You are quite right that lack of regulation means that red yeast rice supplements are highly variable. A recent study analyzed 12 different products (Archives of Internal Medicine, Oct. 25, 2010). One ingredient, lovastatin, ranged from 0.1 mg to 10 mg per capsule. One-third of the products contained the contaminant citrinin.
Side effects appear less common with red yeast rice than with statin drugs (Annals of Internal Medicine, June 16, 2009), but the unreliability of commercial products poses a problem for patients. An analysis of such supplements is available for a fee at www.consumerlab.com.