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Dear Dr. Roach: I read of a man who took niacin to lower his cholesterol, which resulted in diabetes. Are you aware that red yeast rice, which I have been taking, is supposed to cut cholesterol? To my knowledge, it has no side effects. My doctor said my last tests were good. You might mention this as a way of cutting cholesterol. It can bought over the counter.

J.D.

Dear J.D.: Red yeast rice is a fermented rice product that has been used in China to promote “blood circulation.” One well-done but short study from UCLA showed that red yeast rice does indeed lower cholesterol with very few side effects. However, there are several issues that must be considered before recommending the product.

The first is that a chemical analysis of red yeast rice shows that it contains monacolin K, the very same active ingredient in lovastatin, one of the statin drugs. Although there are other compounds in red yeast rice as well, many experts think its primary effectiveness is through the same enzyme that the statins work on, which would imply that red yeast rice has risks similar to all the bad side effects of statins, including increased blood sugar and muscle aches.

Secondly, there have been no long-term safety studies of red yeast rice that would confirm or deny that implication.

The last is the same issue I bring up with any supplement: Most supplements are not standardized or independently tested, and contents may vary dramatically. The amount of monacolin K varied from 0.1 mg per capsule to over 10 mg, depending on the batch and manufacturer. Also, many of the brands tested contained citrinin, a fungus-derived kidney toxin.

Because of the 100-fold potential variability in effectiveness, potential for toxicity and lack of long-term safety studies, I can’t recommend it for general use.

Dear Dr. Roach: Can you please give me some information on Elhers-Danlos syndrome?

E.E.H.

Dear E.E.H.: Ehlers-Danlos syndrome is actually a group of uncommon genetic disorders, with very stretchy skin, flexible joints and tissue fragility as common features. There are six different kinds of Ehlers-Danlos, and each is different in regard to what tissues and organs it most affects. Most are caused by mutations in genes for collagen and related structural proteins. They can be inherited or not (in which case they are new mutations).

Flexible joints (often, but wrongly, called “double-jointed”) and excessively stretchy skin are almost universal in EDS. The excess joint movement can cause dislocations and chronic joint pain resembling fibromyalgia. Other associated conditions include prolapse of the mitral valve, hernias and, in the vascular type of EDS, aneurisms.

The prognosis in EDS depends to a great extent on the subtype. I would suggest that you go with your daughter and granddaughters to their doctor (if they agree) to learn more about their particular type.

Email questions to ToYourGoodHealth@med.cornell.edu.

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