Red yeast rice

Dear Dr. Roach: In a recent column, you said that red yeast rice acts as a kind of natural statin. Can natural and synthetic statins be used together? — M.P.A.

Answer: Red yeast rice is a traditional Chinese food and medicine used for circulation. It was found to decrease cholesterol by about 15 percent, and analysis of the product shows that it contains a chemical called monacolin K, which is the active ingredient of the statin drug lovastatin.

I don’t recommend red yeast rice for most people because, like any natural product, the amount of the active compound varies. I prefer to give a known amount of the purified compound, so the person gets the same amount every day and I can adjust the dose if needed. I have patients who prefer natural products, so I recommend red yeast rice only for people who insist on this.

However, I would not combine it with another statin. In general, combining drugs of the same class — statins, blood pressure medicines, depression medicines or nonsteroidal anti-inflammatory medicines — does not increase the beneficial effect much, but it does dramatically increase the risk of toxicity and side effects. It’s generally better to use a complementary class. In the case of cholesterol treatment, people who need more than a statin usually need a better diet and more exercise.

There are few people I treat for cholesterol with a medication other than a statin these days, but some may benefit from ezetimibe or one of the newer PCSK-9 inhibitors.

Dear Dr. Roach: I am a diabetic and take gabapentin for symptoms of diabetic neuropathy. My family doctor suggested I use a rolling pin: I put it under my feet and roll it back and forth for about five minutes while sitting in a chair. It takes away the tingling. — K.