Qi Spot

The latest “food fad” for health – at least in the media – is fermented red rice.  Known as hong qu mi (what else? red yeast rice), this popular oriental garnish was featured in an article (http://featuresblogs.chicagotribune.com/features_julieshealthclub/2009/10/red-yeast-rice-for-high-cholesterol.html) for (as you can read in the link) high cholesterol.

When Chicago’s Adele Simmons discovered she had high cholesterol and a blocked artery, she chose a drug-free treatment approach that included red yeast rice, the product of yeast grown on white rice.

The powdery yeast-rice mixture, a dietary stable in many parts of Asia that’s used in traditional Chinese medicine, contains monacolin K, the same ingredient as in the prescription cholesterol drug lovastatin (Mevacor).

But while red yeast rice is available over the counter, don’t take it unless you’re under the care of a physician, said Simmons’ doctor, preventive cardiologist Steve Devries, who is on staff at Northwestern Memorial Hospital.

The drug-like supplement can have side effects (though they’re less likely than with prescription statins) and patients need blood tests to monitor safety.

In fact, Devries said that red yeast rice is a good cholesterol-lowering option in only two situations: “in those who are absolutely philosophically opposed to taking a prescription statin, or in those who have tried to take prescription statins but cannot tolerate them.”

Other key points to remember:

Don’t take red yeast rice when you’re pregnant.The same is true for any prescription statin.

Brands vary by dosage and purity. Devries recommends a specific brand that has been tested by an independent lab and asks patients to use only this brand.

Red yeast is only one option. “Prescription statins are an excellent choice for those in need of cholesterol lowering when lifestyle changes have been tried and found to be inadequate to achieve the desired cholesterol result,” Devries said.

Red Yeast Rice

Now before I go on to cite other studies I’d like to point out that I believe that the process of fermentation does a lot in terms of preserving what I call “digestive energy.”  This is my personal term for Spleen Qi, which in Chinese medicine is in charge of digestion.  (Hmmm, perhaps another time I’ll talk about the Spleen and western pancreas…)

The thing about Chinese dietary theory is that you can’t just eat anything you want.  Well, you can if your Spleen Qi is as strong as a bull on steroids – but you’ll still wear it down.  The key to maintaining long term health is to make things easier on the Spleen.  This is why raw foods is a no-no in oriental medicine because it takes more fuel to light the fire to burn it down (or is the proper term burn it up?)

Hmmm, another future article idea – Spleen health.

Anyway fermentation is seen as a precursor to digestion.  In fact, the classical chinese words for digestion can be literally translated as “rotting” and “ripening”.  Of course, that doesn’t mean that you should go ahead and ferment everything you eat – Chinese medicine never encourages excessive consumption of one type of flavor or taste.  Variety is the spice of life, as the old saying goes.

So what we have here is a fermented foodstuff, making it easier to digest food, and thus, maintaining Spleen Qi.  I think.

But on to the modern studies.  There is a prepared Chinese medicine made from Red Yeast Rice, known as Xue Zhi Kang:

Xue Zhi Kang

Derived from red yeast rice, Xue Zhi Kang has been the subject of many a study.  Here are some sample excerpts:

Liu ZG and Yu XY. “Effects of Xuezhikang capsule on blood lipids, platelet activation and coagulation-fibrinolysis activity in patients with hyperlipidemia” Chinese Journal of Integrative Medicine Volume 10, Number 4 / December, 2004 pp. 259-262. 27 October 2009 <http://www.springerlink.com/content/d474443332748t6v/>

Abstract    Objective: To investigate the effects of Xuezhikang capsule (XZK) on blood lipids level, platelet activation and coagulation-fibrinolysis activity in patients with hyerlipidemia.Methods: Seventy-six patients of hyperlipidemia were randomly divided into two groups, the XZK group (n = 38) treated with XZK 600mg, taken two times per day and the Simvastatin (SIM) group (n = 38) treated with SIM 20mg per day, with the treatment lasting 8 weeks for both groups. Levels of fasting serum lipids, including total cholesterol (TC), triglyceride (TG), high and low density lipoprotein cholesterol (HDL-C and LDL-C), plasma GMP-140, fibrinogen (FIB), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-) and prothrombin time (PT) were all measured before and 8 weeks after treatment. Data were compared before and after treatment and also compared with those measured in 20 healthy subjects of control.Results: Before treantment the levels of TC, TG and LDL-C were obviously higher and HDL-C level was significantly lower in hyperlipidemia patients than those in healthy subjects (P<0.05 orP<0.01). After 4–8 weeks of XZK treatment, the levels of TC, TG, LDL-C and FIB and activities of GMP-140 and PAI-1 were obviously lowered (P<0.05 orP<0.01). But in the SIM group there was no obvious change in FIB (P>0.05), instead it showed obvious increase of HDL-C and decrease of TC and LDL-C after treatment (P<0.05 orP<0.01).Conclusion: XZK could inhibit platelet activity and improve coagulation-fibrinolysis function, besides its lipids lowering effect. (emphasis mine)

This shows that Xuezhikang works by preventing formation of atherosclerotic plaques, as also seen in this study published in the American Journal of Cardiology:

Lu et al. “Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction.” Am J Cardiol. 2008 Jun 15;101(12):1689-93. Epub 2008 Apr 11.  accessed 27 October 2009 (http://www.ncbi.nlm.nih.gov/pubmed/18549841)

Results of well-controlled prospective clinical trials showed the efficacy of lipid-lowering therapies in the reduction of cardiovascular (CV) events in western populations, but they were not reported with a Chinese population. This multicenter study was conducted to determine the effects of Xuezhikang (XZK), a partially purified extract of red yeast rice, on lipoprotein and CV end points in Chinese patients who experienced a previous myocardial infarction. Nearly 5,000 of these patients with average low-density lipoprotein cholesterol levels at baseline were randomly assigned either to placebo or to XZK daily for an average of 4.5 years. The primary end point was a major coronary event that included nonfatal myocardial infarction and death from coronary heart disease. Frequencies of the primary end point were 10.4% in the placebo group and 5.7% in the XZK-treated group, with absolute and relative decreases of 4.7% and 45%, respectively. Treatment with XZK also significantly decreased CV and total mortality by 30% and 33%, the need for coronary revascularization by 1/3, and lowered total and low-density lipoprotein cholesterol and triglycerides, but raised high-density lipoprotein cholesterol levels. In conclusion, long-term therapy with XZK significantly decreased the recurrence of coronary events and the occurrence of new CV events and deaths, improved lipoprotein regulation, and was safe and well tolerated. (emphasis mine)

Some news articles report similar side effects as statins.  This makes me wonder if there are any differences in side effect profile if taken in raw form as opposed to processed with alcohol into pill form.

Sources:

Deardorff, Julie.  “Red yeast rice: A natural approach to high cholesterol” Chicago Tribune.  26 October 2009.  Accessed 27 October 2009 <http://featuresblogs.chicagotribune.com/features_julieshealthclub/2009/10/red-yeast-rice-for-high-cholesterol.html>

Liu ZG and Yu XY. “Effects of Xuezhikang capsule on blood lipids, platelet activation and coagulation-fibrinolysis activity in patients with hyperlipidemia” Chinese Journal of Integrative MedicineVolume 10, Number 4 / December, 2004 pp. 259-262. 27 October 2009 < http://www.springerlink.com/content/d474443332748t6v/>

Lu et al. “Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction.” Am J Cardiol. 2008 Jun 15;101(12):1689-93. Epub 2008 Apr 11.  accessed 27 October 2009 (http://www.ncbi.nlm.nih.gov/pubmed/18549841)

Chinese Herbs

Ah yes, the sacred double blind study – the holy grail of western medicine.  It’s proponents mean well, and if used properly, it is an essential tool in the research of the effectiveness of interventions.  Again, the key phrase, as always, is “if used properly.”  The article I have cited does not use it properly. Feel free to read the whole article, as I have linked to it below, but let me quote the conclusion as follows:

“Overall the positive evidence in favour of Chinese herbal medicines for the treatment of impaired glucose tolerance is constrained by the following factors: a lack of trials that tested the same medicine, lack of details on co-interventions, unclear methods of randomisation, poor reporting and other risks of bias,”

So here are their “constraints”:

a) a lack of trials that tested the same medicine.

b) a lack of details on co-interventions

c) unclear methods of randomisation

d) poor reporting and other risks of bias

And here are my comments, first for letters b and d.

“lack of details on co-interventions” – I agree that this needs rectification.  Co-interventions are very important in Chinese Medicine as we believe that the human being is a microcosm of the universe.  Everything affects health – diet, lifestyle, work and play level, family relationships, etc.  What I find surprising is that western medicine is using this critique on Chinese medicine, considering how much less an emphasis western medicine puts on it.

“poor reporting and other risks of bias” – Considering that western medical studies are more often than not funded by the very companies that produce the drugs, poor reporting and bias risks is not something that we M.D.s should be throwing at our “alternative” counterparts.

And back to our main program:

Western medicine is heavily influenced by Robert Koch.  His idea was basically one pathogen per disease.  A logical corollary of that is that there is a tendency to go for one solution per problem, hence the comment “lack of trials that tested the same medicine”.  I can assume this means, in plain language, “why are there so many formulas (15 cited in the article) for diabetes? Can’t we just stick to a few and test those repeatedly?”

Also, there is the all powerful “randomisation” (or randomization in American).  Why can’t we give the same drug blindly to a group of randomly selected subjects and give a placebo to the other half?  (The essence of a double-blind study, btw, is that neither drug pusher nor drug addict to be knows they’re pushing/drinking).

The answer to these questions can be summarized in the Chinese medicine axiom: “One disease, many treatments; Many diseases, one treatment” and the idea of treating the root and not the branches of the tree.

I recall explaining this concept to a colleague of mine.  After I mentioned that “western medicine doesn’t care for the causes of migraine in terms of formulating treatment,” she replied, “but western medicine does!” and then she went on to elaborate different mechanisms of action for the pain, mostly elaborating on the dilation of cranial blood vessels.

Countering, I said, “no, what we mean by causes include: is the patient’s head constantly bombarded by wind?  Is the problem emotional? Is the problem mainly dietary?”  In other words, we’re not looking for what physiologic process leads to the pain, but what environmental or lifestyle cause is triggering the physiologic process.  The treatment must then look to treat THAT cause.  Hence, “One disease, many treatments.”

Secondly, the same cause might present as different diseases.  For example, a person who gets exposed to extreme (for that person) cold can present with a headache, or a runny nose, or the flu, or might have an old arthritic pain recur.  Treatment in Chinese medicine should look at the presentation (let’s use headache) and treat the root of that headache.  Acupuncture-wise, we might use points specific for the area of pain combined with points for treating cold.  Those points for treating cold may also be used in the other presentations, such as the runny nose, the flu, etc.  Hence, “many diseases, one treatment”.

How does that apply to our Diabetes studies?

Quite simply, Chinese medicine may recognize many causes for a patient’s high blood sugar.  The Diabetes is the branch – the presentation – which may have many roots.  Treat the root, not just the branch.  This is the essence of treatment customization in Chinese medicine.

As a western doctor, I was trained mainly to look at the blood sugar level.  As a chinese doctor, I’d ask the patient about sleep, appetite, waste management, and customize treatment appropriately.  Hence, if the patient improves after just one week, I might tweak the formula or even change the formula altogether; depending on the patient’s presentation at the time.  At the same time, the physician has in mind the root cause of the disease, so one must have both a long term and short term strategy in mind.

Given that summary, I hope the reader realizes why it is so difficult to study Chinese Medicine using double blind trials – because the very nature of Chinese medicine undermines the double blind study.

Sources:

From Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006690, as quoted by Endocrinology Update.

Corderoy, Amy. “Evidence Lacking in Chinese Medicine for Diabetes” Endocrinology Update 8 October 2009. 9 October 2009 <http://www.endocrinologyupdate.com.au/article/evidence-lacking-for-chinese-medicine-in-diabetes/501343.aspx>