Is Red Yeast Rice Right for You?
- Posted on: Oct 1 2013
Is It A Reasonable Alternative to Statins to Lower Cholesterol or A Risky Unregulated Natural Substance?
For the millions of Americans with high cholesterol, heart disease is a big concern. While many people may choose to stick with traditional treatments to lower their cholesterol, some seek a more natural heart health treatment. One alternative treatment option is red yeast rice (RYR).
Some patients are attracted to the idea of lowering their cholesterol with natural methods. This should always include a prudent diet and regular exercise. If lifestyle changes alone do not lower the cholesterol adequately, some prefer to try dietary supplements like red yeast rice instead of prescription medications. The most commonly used prescription medications to lower cholesterol and to help revent heart disease are statins. RYR is marketed as a natural dietary supplement to reduce cholesterol. It has been used in Chinese cooking and medicine for centuries. The first documented use of RYR was in the Tang Dynasty in 800 A.D. An ancient Chinese pharmacopoeia recommended using RYR for the treatment of indigestion, diarrhea, blood circulation and spleen and stomach problems.
Let’s take a look at the most commonly-asked questions about RYR.
- What exactly is RYR? RYR is a fermented rice, cultivated with the fungus Monascus purpureus, a type of red yeast. This fungus gives the fermented rice its bright red color. It has been used in Chinese cooking and medicine for centuries, and now comes in both capsule and powder form.
- How does RYR lower cholesterol? The fermenting process of the red yeast with rice releases compounds called monacolins. Monacolins slow the production of cholesterol in the liver. One of these compounds is monacolin K which is chemically very similar to the first statin discovered for lowering cholesterol called mevastatin which itself is naturally produced by Penicillium citrinum.
- Is RYR a “natural” statin? Sort of. To enhance the potency in lowering cholesterol with a low side-effect profile, several decades ago, pharmaceutical scientists isolated a similar but slightly different chemical from mevastatin. It was called lovastatin and was isolated from Aspergillus terreus and Monascus ruber. After approval by the FDA in 1987, this naturally fermented chemical was marked as Mevacor by Merck and forever changed the face of preventive cardiac care. Monacolin K, mevastatin, lovastatin and all subsequent prescription statins [simvastatin (Zocor), pravastatin (Pravachol), atorvastatin (Lipitor), fluvastatin (Lescol), rosuvastatin (Crestor)] work by inhibiting HMG Co-A reductase, an enzyme that helps synthesize cholesterol and that is found in the liver. By the way, commercially available RYR has been processed from the actual natural red yeast rice and put into capsule or powder form, arguably making it less “natural” than just eating fresh fruits and vegetables that are rich in natural minerals, vitamins and anti-oxidants that have been shown to be an important part of a heart-healthy daily diet.
- Is RYR effective. Possibly. There have been controlled studies demonstrating that monocolin K reduces cholesterol. A study in China of 4870 patients given red yeast over 4.5 years found the incidence of major coronary events (heart attack and death from coronary heart disease) was 5.7% in treated patients and 10.4% in patients given placebo. The active ingredient in red yeast rice appears to be effective in both lowering cholesterol and decreasing the incidence of major coronary events if given in adequate but safe amounts but the overall number of patients tested pales in comparison to those studies done with statins over the last three decades.
- Is it safe to use? Probably. However, one should not mistake “natural” for safe. RYR has been used for thousands of years as both a dietary supplement and medical treatment, and is considered to be safe and effective by Chinese herbalists. Monacolin K, lovastatin and all statins can cause muscle and liver injury although statins have proved to be very safe when properly dosed and monitored. Very rarely statins and monacolins can cause severe kidney damage. Muscle pains can results from RYR and statins. While side effects from the supplement are generally mild, and may include headaches, the suplement should be stopped immediately for severe muscle pains and/or sudden very dark urine. Individuals taking RYR should have periodic blood tests to monitor for liver injury just as patients on statins should. While there theoretically should be no difference in risk or efficacy from taking RYR and statins, the lack of regulation in the naturaceutical industry means it is buyer beware with RYR as to whether one is getting the right amount of cholesterol lowering medicine (i.e. you might end up with not enough and have a higher risk of heart attack or stroke or too much and risk dangerous side effects). Not only can supplements’ strength vary greatly in non-prescription preparations, they might also contain ingredients that are not listed in the label.
- How much RYR should be taken? Unclear. RYR is usually marketed in 600 mg capsules with a recommendation of taking 2 tablets twice a day. The effective amount of Monacolin K is probably about 2.5 to 3.2 mg a day. The amount of monacolin K in RYR preparations has been reported to vary by as much as 100-fold (Product review: Red yeast rice supplements. ConsumerLab.com). RYR is sold as a supplement and the FDA does not regulate supplements. The labels on red yeast rice often give no information about content. The amount of Monacolin K in a red yeast rice preparation, the consistency from capsule to capsule or batch to batch is in the unmonitored hands of the manufacturer.
- Are there any advantages to using red yeast rice over statins? Generally not. Most often, statin dosages can be accurately adjusted by a physician to attain the desired therapeutic effect with a low risk of side effects. Given the unclear dosing properties of RYR, this does not hold true for RYR. Mevacor is now available in a generic preparation called lovastatin. It is all but identical to the active ingredient in RYR and is based on a natural substance and production method. Generic preparations of lovastatin and all prescription statins are FDA regulated and physicians can prescribe them with confidence in dosing. The cost for 30 days of RYR is between $16 and $37 per month. Lovastatin costs about $ 22 a month and some discount sotres charge as little as $4 for a 30-day supply.
- Is RYR right for me? RYR is primarily recommended for patients who absolutely cannot tolerate any of the statins– the drugs that doctors prescribe for lowering cholesterol. Additionally, RYR should not be taken by patients who are pregnant, or have kidney or liver disease. In our experience, it is truly very rare that someone is totally statin-intolerant. Many people can tolerate statins either by changing the medication type of by staggering their doses. It is important to work with a specialist who has experience in creative ways of dosing to find the best tolerated dose for you. So aside from the comfort of taking a natural product or in specific rare instances where prescription statins truly cannot be tolerated, it is our opinion that there is little to favor taking RYR over statins as the latter have been tested in tens, if not hundreds of thousands of patients in a controlled and randomized manner to assess efficacy and safety. Statins offer consistency in dosing, low overall risk with proven life-saving efficacy and (in the case of generic lovastatin) equivalent price to red yeast rice. It is important to consult with your doctor to determine which treatment is right for you.
Cardiologists in Los Angeles
If you want to learn more about high cholesterol, red yeast rice supplements or heart medications in general, contact our office at (310) 659-0714 to schedule an appointment. You can also fill out our online contact form or visit us on Facebook, Twitter, or Google+. We look forward to serving you.
Written by and/or reviewed by Mark K. Urman, M.D. and Jeffrey F. Caren, M.D.
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Posted in: Heart Health Blog