Department of Health and Human Services' logo Department of Health and Human Services

Public Health Service
Food and Drug Administration
Southwest Region
Denver District Office


Bldg 20, Denver Federal Ctr
PO Box 25087
6th Ave & Kipling St
Denver, CO 80225-0087
Telephone: 303-236-3000
FAX: 303-236-3100

June 19, 2001

Daniel P. Howells, President & CEO
Nature's Sunshine Products, Inc.
75 E 1700 S
Provo, UT 84605

Dear Mr Howells:

This letter concerns your firm's marketing and distribution of "Cholester-Reg," a product promoted as a cholesterol lowering agent. Labels collected during our inspection of your firm on February 6, 2001, bear your Internet website address Claims found on your Internet site cause your product to be in violation of several provisions of the Federal Food, Drug, and Cosmetic Act (the Act). Our investigators noted that the name of the product "Cholester-Reg" was formerly "HongQu," and that some materials still use this name. For the purposes of this Warning Letter, the product "Cholester-Reg" will refer to both products.

The claims found for "Cholester-Reg (HongQu)" on your Internet website and the product label for "Cholester-Reg" include "supports optimal balance of HDL to LDL levels…" and "This premier red rice extract is standardized to contain 3 mg of natural HMG-COA reductase inhibitors (including mevinolin)." In addition, the product name, "Cholester-Reg" may be considered a drug claim in that it implies the product affects the structure/function of the body by regulating cholesterol levels.

"Cholester-Reg (HongQu)" contains lovastatin, a prescription drug that is not approved for over-the-counter (OTC) use and requires monitoring by a physician. The presence of lovastatin in your product is demonstrated by:

In 1998, the Food & Drug Administration sought to regulate Cholestin, a red yeast rice product, containing lovastatin, as a drug. This product was marketed by Pharmanex, Inc., 203 Thomas Dr, Egg Harbor Twp, NJ 08234. The firm sued the Agency under the argument that their product, Cholestin, was a dietary supplement and was therefore not subject to regulation as a drug. Despite an initial ruling in favor of Phanmanex, the decision was remanded by the United States Court of Appeals and returned to the District Court in the District of Utah. In its dismissal of the lawsuit, the decision of the US District Court for the District of Utah on March 30, 2001, case number 2:97CV262K, affirmed that red yeast rice products which contain lovastatin are subject to regulation as drugs and are not dietary supplements.

"Cholester-Reg" is a "drug" within the meaning of section 201(g) of the Act. Moreover, it is also a "new drug" [section 201(p) of the Act] because there is no evidence that this product is generally recognized as safe and effective for its intended use. Since this product is a "new drug", it may not be legally marketed in the United States without an approved new drug" application [section 505(a) of the Act].

Furthermore, this drug is misbranded [section 502(f)(1) of the Act] because its labeling fails to bear adequate directions for use, for the conditions for which it is offered. The drug is also misbranded because the labeling is false and misleading as it suggests that the product is safe and effective for its intended use when this has not been established [section 502(a) of the Act].

This letter is not intended to be an all inclusive review of all labeling and products your firm markets. It is your responsibility to ensure that all products marketed by your firm are in compliance with the Act and its implementing regulations.

We request that you take prompt action to correct these violations. Failure to promptly correct violations may result in enforcement action being initiated by the Food & Drug Administration without further notice. The Federal Food, Drug, and Cosmetic Act provides for the seizure of illegal products and for injunction against the manufacturer and/or distributor of illegal products.

Please notify this office in writing within fifteen (15) working days of receipt of this letter as to the specific steps you have taken to correct the stated violations. You should also include an explanation of each step being taken to identify and make corrections to assure that similar violations will not recur. If corrective action cannot be completed within 15 working days, state the reason for the delay and the time within which the corrections will be implemented.

Your reply should be sent to the attention of Ms Shelly L. Maifarth, Compliance Officer, above letterhead address.

Thomas A. Allison
District Director

This page was posted on August 20, 2006.

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