My dad tore his biceps a few years ago. It was just the short head on his left arm, but it was a full (distal tendon) tear nonetheless. He wasn’t as unhappy about it as his bodybuilding son might have been, but he wasn’t overjoyed in the least.

As a good (retired) doctor would, he talked it over with his prescribing physician, who thought it wise that he considered coming off the statin medication he had been prescribed to improve his lipid profile. Now some of you might be wondering, “What does Scott’s dad’s cholesterol medication have to do with a biceps tear?” Allow me to explain.

Statins: The Good

Statin medications (like Lovastatin or Simvastatin) inhibit an enzyme called HMG-CoA reductase, which reduces cholesterol biosynthesis along with a multitude of other effects on blood lipoproteins (1). Presumably via improving one’s blood lipid profile, statins thereby reduce the risk of dying from cardiovascular disease or other causes (2) from middle age onward (3) in both low (4, 5) and high risk individuals (6, 7).

Statins: The Not So Good

While statins do what they are prescribed for, these effects are not without controversy. For instance, the findings of one study that found statin use to be medically beneficial (8) has been criticized because of data under reporting (9). Moreover, the reported effects, albeit statistically significant (8), actually suggested that 86 people would need to be treated over five years to prevent only one non-fatal cardiovascular event (10). Similarly, practical significance of treating 200 people per year to prevent just one fatal or non-fatal heart attack, unstable angina or sudden cardiac death has been called into question (11). Statins are also frowned upon because they may increase the risk of diabetes (in those predisposed) and have been associated with erectile dysfunction, chronic obstructive pulmonary disease and renal injury, among other side effects (12). As you might have guessed, because statins mean big bucks for pharmaceutical companies, the potential for conflict of interest in medical research has not gone unnoticed (13).


Statins: The Not Good at All

Back to the case at hand. What does this have to do with the biceps muscle my dad tore while warming up? It’s become increasingly known that statins increase the risk of myopathy (pathological muscle tissue) with up to 5 percent of subjects in clinical trials registering complaints (14) and as many as one in five patients reporting this side effect in medical practice (15). The symptoms may range from simple muscle pain (myalgia) to quite severe (sometimes exercise-related) muscle breakdown (i.e. rhabdomyolysis).

Unfortunately, it’s uncertain exactly how statins may be causing this myopathy (15). One suggestion (15) is that statin interference CoQ10 metabolism (14) may cause myopathy (16). As if the risk is myopathy isn’t bad enough for a gym rat, disrupting CoQ10 synthesis also impairs mitochondrial function (17). Additionally, statin use can actually prevent the normal increase in muscle mitochondria brought on by endurance training (18). None of this bodes well for getting bigger, stronger or more fit, not to mention the longevity of my dad’s remaining biceps mass.

Alternative Medicine (Red Yeast Rice) to the Rescue?

Given my background as an acupuncturist and Chinese herbalist, an alternative medical route for keeping my dad’s lipids within range sprang to mind. Enter red yeast rice (RYR).

Red yeast rice (Monascus Purpureus) is a fungus-fermented, rice-based product that is actually sold as a patented Chinese herbal medicine product (19). The RYR patent “formula” is known as Xuè Zhī Kāng (血脂康) or “blood fat healthy” (20) and has been sold under other brand names such as cholestin (21) and cholestrix (19, 22). Indeed, scientific studies have suggested that RYR improves blood lipids similarly to statin therapy (23, 24) and can also protect against adverse cardiovascular events (25). Chalk one up for RYR.

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Is Natural Better?

The efficacy of RYR is highly plausible. RYR actually contains a number of HMG-CoA reductase inhibiting compounds called monacolins (26). Indeed, one of these is actually monacolin K, which is chemically identical to the prescription statin drug Lovastatin (19). Unfortunately for those seeking a pharmacological effect, the monacolin content in store-bought RYR may vary over a 20-fold range (19) and be miniscule in some products (21). RYR earns one demerit.

But It’s Natural!

So your RYR could be “under-dosed,” but are there any advantages in using a natural statin source? Indeed, one study suggested that RYR may be effective in individuals who previously had statin-induced myalgia (27). However, this study has been criticized on the grounds of poor experimental design (28) and, of course, that simply containing Lovastatin (29) means that RYR is an illegal drug if sold over the counter (26).

A follow-up study, again in patients with previous statin-related myalgia, found that these patients tolerated RYR as well as the prescription statin Pravastatin (24). Still, overall, 7 percent of patients had to withdraw due to myalgia. The main monacolin in the RYR used in this experiment was Lovastatin (24), and the levels of fungal toxin citrinin (19) were below the detection limit. Unfortunately, citrinin is found in many over-the-counter RYR products (30). Citrinin is particularly harmful to the kidneys (31) and may even cause genetic mutation (32).

To wit, the FDA made it known in 2007 that RYR may contain Lovastatin and cause renal harm (22). Jokes about spare kidneys aside, medically documented case studies (19) do in fact demonstrate an association between RYR and myopathy (33–35) as well as hepatitis [just like with other statins (19, 36)]. Add in at least one more demerit for RYR.


A Natural Perfect Storm?

Imagine an unsuspecting iron game aficionado (perhaps like yourself) who focuses on over-the-counter (OTC) and/or “natural” supplementation. He might use RYR to combat a poor lipid profile brought on by the use of other OTC supplements such as designer steroids (DS). The recent Designer Steroid Control Act of 2014 may have minimized this likelihood, but it’s been documented that previously widely available DS (37) such as Superdrol (38) can cause cholestatic jaundice and thus elevated cholesterol (39). [Similarly, non-OTC oral anabolic steroids can be rough on blood lipid profiles (40–42).] Considering that both DS and RYR can cause liver dysfunction and that someone pounding the weights could perhaps mistake pathological muscle pains (myalgia) for delayed onset muscle soreness (43), taking both of these supplements simultaneously could create a perfect storm of OTC supplement-related health issues. The demerit count rises.

The Choice Is Yours, Naturally

Of course, we’re still left with good old exercise (44) and dietary and other supplementation practices (like increasing fiber intake or taking omega-3 fatty acids or garlic supplements) to improve cardiovascular risk profile (45, 46). In fact, a simple dietary strategy designed around high levels of plant sterols, almonds, fiber and soy protein has been shown to be as effective for reducing LDL levels as a low fat control diet with added Lovastatin [20mg/d (47)].

Naturally, the decision is yours to include red yeast rice in your lipid-lowering supplement regime, but take heed. Doing so may also increase the chances that you also get to make a decision regarding the repair of a torn biceps.


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