What Is It?
Red yeast rice, an Asian dietary staple made by fermenting red yeast (Monascus purpureus) on rice, is rapidly gaining recognition as a cholesterol-lowering agent in the United States. Supplements are now available here that contain an extract imported from China, where a particular strain of M. purpureus is grown on rice under careful fermentation conditions. This yields specific amounts of statins–the compounds largely held responsible for reducing cholesterol levels. In contrast, the red yeast rice long used in Asia to flavor, preserve, and color food, and to make rice wine, contains negligible amounts of statins.
Red yeast rice extract may help to reduce total cholesterol levels, lower levels of LDL (“bad”) cholesterol, increase levels of HDL (“good”) cholesterol, and lower the levels of unhealthy fats called triglycerides. It appears to accomplish this by restricting the liver’s production of cholesterol itself. Interestingly, the compound responsible for this effect–mevinolin–is chemically identical to the cholesterol-lowering compound lovastatin, sold as the prescription drug Mevacor. Mevinolin is also similar to the active ingredients in such cholesterol medications as Zocor (simvastatin) and Lipitor (atorvastatin). Unsaturated fatty acids in red yeast rice extract are also believed to help, possibly in lowering triglycerides.
By lowering cholesterol concentrations, red yeast rice extract may help to prevent heart disease and other complications. Individuals with moderately elevated cholesterol levels (200 to 239 mg/dL) may benefit from a dietary supplement such as red yeast rice extract. However, those with very high cholesterol levels (240 mg/dL or above) are at considerable risk for heart disease and should stick to prescription drugs with proven ability to rapidly and effectively reduce cholesterol levels.
The best way to achieve and maintain a healthy cholesterol level is to take red yeast rice extract as part of an overall regimen that includes exercise and a low-fat diet that is high in soluble fiber. Most studies that showed a substantial cholesterol-lowering effect (reduction of 25 to 40 points) for the extract included such measures. Always select products made from strains of Monascus purpureus yeast, not other Monascus strains.
There are no known drug or nutrient interactions associated with red yeast rice. However, there are interactions associated with lovastatin. Prescription statin drugs such as lovastatin can reduce levels of coenzyme Q10, an antioxidant that the heart and other tissues produce to protect cells from damage. Some experts recommend supplementing a regimen of red yeast extract (or other statin drugs) with this nutrient.
Don’t mix red yeast rice extract with other cholesterol-lowering medications, or you may expose yourself to excessive concentrations of particular ingredients.
Note: For information on interactions with specific generic drugs, see our WholeHealth Chicago Drug/Nutrient Interactions Chart.
Consult your doctor before taking this or any other cholesterol-lowering dietary supplement. This is particularly important if your cholesterol is high or if you have heart disease; conventional medicines have been proven to rapidly and effectively lower cholesterol levels, directly lowering your heart attack risk.
Take red yeast rice extract with food to reduce the risk of digestive-system upset.
Side effects with red yeast rice extract have been reported but tend to be mild and resolve quickly upon discontinuation. These include headache, dizziness, heartburn, gas, and digestive tract discomfort. Stop taking red yeast rice extract and consult a doctor promptly if you experience any side effects that seem more severe or persistent than these do.
Keep in mind that in theory, the statins in red yeast rice extract pose the risk of rare but serious reactions, including skeletal muscle damage, liver damage, and kidney toxicity. Approximately 1% to 2% of people taking the drug lovastatin have such reactions. Symptoms may include unexplained weakness, muscle pains and tenderness, and other flulike symptoms. It’s still unclear whether these types of reactions occur with people taking the standardized red yeast rice extract, however. In a recent, 12-week clinical trial, for example, liver and kidney function in the participants remained normal.
More information on possible side effects should become available as results of studies on red yeast rice extract are completed in the coming years.
To avoid possible complications because of the statin content in red yeast rice extract, don’t take the supplement if you are pregnant or breast-feeding, or if you have liver disease, a serious infection, or a transplanted organ. Also avoid it if you have recently had major surgery.
Don’t take red yeast rice extract if you’re under age 20.
Avoid drinking more than two alcoholic drinks a day or large amounts of grapefruit juice while taking red yeast rice extract.
High Cholesterol Take 2 pills (600 mg each) twice a day. Also take 50 mg coenzyme Q10 twice a day.
David Edelberg, M.D.
Red yeast rice extract is a by-product of fermenting rice in a certain species of yeast. In Chinese medicine, red yeast is mainly recommended for digestive ailments and, because of its color, it’s also used as a food coloring agent (consider Peking duck).
HOW IT HELPS HIGH CHOLESTEROL
Red yeast rice extract lowers cholesterol by precisely the same mechanism as a whole group of statin drugs (Mevacor, Pravachol, Lipitor, and others). These are all called HMG-CoA inhibitors because they inhibit the ability of the liver to synthesize cholesterol.
WHAT TO LOOK FOR
In fact, so alike is red yeast to the prescription drug Mevacor that the manufacturer of Mevacor sued the manufacturer of Cholestin, the first brand of red yeast rice extract to appear on the U.S. market. They didn’t succeed at having the herbal product taken off the shelves, and red yeast rice extracts from a number of companies are now readily available.
If you decide to use this natural cholesterol-lowering agent, just be sure to follow all the warnings that are attached to the other statin drugs, namely: Check your liver enzymes periodically. Don’t combine it with another statin drug. Use some caution with niacin or gugulipid, other cholesterol-lowering agents. Have some food with your red yeast as it enhances the supplement’s effect. Avoid grapefruit juice when taking red yeast rice extract; some experts think the combination will increase your risk of developing side effects. Don’t use red yeast with a variety of drugs metabolized in the liver, such as theophylline, certain antihistamines, and certain antifungal drugs. Overall, the statins (in drug or in supplement forms such as red yeast rice extract) are widely used and remarkably safe.
David Edelberg, MD