Overview
Red Yeast Rice — as effective as ‘statin’ drugs, cheaper, and with fewer side effects
The red-colored yeast Monascus purpureus is a traditional
Chinese food coloring and herbal remedy. The yeast is grown on wet
white rice, which becomes permeated with the colored yeast. The
rice is dried and pulverized and the powder sold for a variety
of medical purposes.
Red yeast rice is a dietary staple in many Asian countries and may account for the low level of cardiovascular disease found
in Asian populations.
Modern RYR supplements are usually extracts of Red Yeast Rice called “Xue Zhi Kang” — unneeded starches and gums have been
removed to make the powdered product more potent, less perishable, and easily dosed.
The dried yeast contains a family of compounds (‘monacolins’) that are similar in chemical structure to the expensive ‘statin’
drugs for high cholesterol. It also contains other medically active compounds that contribute to its benefits.
Clinical studies have shown that RYR supplementation can
reduce LDL cholesterol and triglycerides by at least 30% in patients
with high lipid levels. In a 2003 animal study an extract of
RYR actually reduced the size of atherosclerotic plaques in arteries.
RYR, like the statin drugs, suppresses the body’s levels of CoQ10 (coenzyme Q10, a substance required for metabolism). Users
of RYR should therefore also use a CoQ10 supplement (such as LifeLink’s CoQ10 capsules).
Read Red Rice Yeast Extract Monograph
The red-colored yeast Monascus purpureus is a traditional Chinese food coloring and herbal remedy. It has been used medicinally in China for at least several hundred
years and has been a food ingredient for about 2000 years.
The
yeast is grown on wet white rice, which becomes permeated with the
colored yeast. The resulting red rice is dried and pulverized and the
powder sold as a traditional remedy for promoting blood circulation,
soothing upset stomach, and for other medical purposes.
Modern RYR supplements are usually extracts of Red Yeast Rice — unneeded starches and gums have been removed to make the powdered product more potent, less perishable,
and easily dosed. The Chinese name for such extracted RYR products is Xue Zhi Kang (aka ‘Xuezhikang’).
Red yeast rice is “a dietary staple in many Asian countries, including China and Japan, with typical consumption ranging from
14 to 55 g/person/day (0.5 to 2 oz).” This substance could plausibly account for the low level of cardiovascular disease found in Asian populations.
What we can’t tell you
In
the U.S. and some other industrialized countries, government agencies
like the U.S. Food and Drug Administration have adopted censorship as a
method for intensifying their control over the supplement industry and
its customers. Thus, FDA regulations prohibit us from telling you that
any of our products are effective as medical treatments, even if they are, in fact, effective.
Accordingly, we will limit our discussion of Red Yeast Rice to a brief summary of recent research, and let you draw your own
conclusions about what medical conditions it may be effective in treating.
How RYR affects cardiovascular disease
- RYR inhibits the body’s synthesis of cholesterol
- RYR inhibits the body’s production of C-Reactive Protein
The dried yeast contains a family of compounds (‘monacolins’) that inhibit HMG-CoA reductase (an enzyme responsible for making cholesterol in the body).
These inhibitors are similar in chemical structure to the expensive
‘statin’ drugs that are sold as prescription remedies for high
cholesterol. In addition, the red yeast contains a variety of other
medically active compounds, including flavonoids and sterols, that may
contribute to the yeast’s cholesterol-regulating activity.
The
monacolins in RYR also suppress the body’s production of C-Reactive
Protein (‘CRP’). CRP is a protein involved in inflammation, and
inflammation is considered to be the primary process that causes
plaques to develop in arteries. By suppressing CRP, red yeast rice
appears to be helping to suppress the inflammation responsible for
atherosclerosis.
The efficacy of RYR
Ten
or more clinical studies of RYR have been performed; all have shown
that RYR supplementation brings about significant reductions in LDL
cholesterol and triglycerides — reductions of at least 30% are
achievable in patients with high lipid levels. HDL (‘good cholesterol’) increased slightly in at least one study. In a 2003 animal study an extract of RYR actually reduced the size of atherosclerotic plaques in arteries.
No clinical studies have directly compared RYR and statin drugs with regard to their maximum
potential for improving cholesterol profiles. The results found in
separate studies, however, have convinced clinical researchers that RYR
is at least as effective as statin drugs, while causing far fewer side
effects. Why should this be? The explanation usually given is that the
dose of lovastatin provided by RYR supplements is far less than the
dose used in prescription lovastatin drugs — consequently RYR users
typically experience no lovastatin side effects. As for efficacy: the
small size of the lovastatin dose provided by RYR is more than made up
for by the presence of small amounts of various other substances which
dramatically enhance this supplement’s effectiveness.
Miscellaneous facts about RYR
- In
a recent experiment with rabbits, a profound suppression of
atherosclerosis development was achieved by a supplement combination
consisting of RYR, policosanol, and the carotenoid ‘astaxanthin’ (the
red substance in salmon and shellfish).
- Vitamin E has many of the same effects on cardiovascular disease as RYR, as has been shown in a number of clinical trials. But vitamin E acts through a different mechanism than RYR. It therefore makes sense to use these two supplements together
to take advantage of synergistic effects.
Cost comparison
The
expensive way to lower the body’s LDL cholesterol levels is to use
brand-name ‘statin’ drugs. There are six prescription statins currently
on the market in the U.S. Although prices vary dramatically depending
on who is selling them, the following prices represent the low end of
the price range for non-generic statins:
- Lipitor® (atorvastatin) — $78/month
- Lescol® (fluvastatin) — $64/month
- Mevacor® (lovastatin) — $60/month
- Pravachol® (pravastatin) — $95/month
- Zocor® (simvastatin) — $83/month
- Crestor® (rosuvastatin) — $91/month
Several of these are now available as generic drugs, at prices around $20/month.
Red Yeast Rice extracts cost even less than generic statin drugs. For example, LifeLink’s Red Rice Yeast Extract costs about
$17/month.
These
cost comparisons do not take into account the cost of dealing with side
effects. It should be kept in mind that the statin drugs, whether
brand-name or generic, contain fairly high dosages of single substances
and therefore have more serious side effects than RYR which contains
low doses of many active substances.
Cautions
RYR, like the statin drugs, suppresses the body’s levels of CoQ10 (coenzyme Q10, a substance required for metabolism). Users of RYR should therefore also use a CoQ10 supplement.
Pregnant women should avoid using RYR or any statin drug.
Sudden
termination of RYR usage can have a significant rebound effect on
C-Reactive Protein, LDL and HDL. (The same is true for statin drugs.)
RYR users who want to stop using RYR — especially those with severe
cardiovascular disease — should therefore reduce the dosage of RYR
gradually over a period of about a week.
Contraindications for lovastatin: pregnancy, nursing, liver or kidney impairment, co-administration with niacin, gemfibrozil,
cyclosporin, azole antifungals, erythromycin, clarithromycin, nefazodone, protease inhibitors.
Recommended reviews about RYR
For a good overview of the subject of Red Yeast Rice, LifeLink recommends the following review articles: footnotes: Patrick, Heber, Raloff, Wikipedia, Lee, Zarkov.
Conclusion
Are Red Yeast Rice supplements effective for preventing or treating cardiovascular disease? We aren’t allowed to tell you,
so you should take a look at some of the references cited here, and then decide for yourself.
References
[1] Red yeast rice Wikipedia article
[2] Red Yeast Rice University of Maryland Medical Center website
[3] Methods and compositions employing red rice fermentation products U.S. Patent #6,632,428 Mao Liang Zhang, et al.
[4] Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr. 1999 Feb;69(2):231-6 Heber D, Yip I, Ashley JM, Elashoff DA, Elashoff RM, Go VL
[5] Serum C-reactive protein as a marker for wellness assessment. Ann Clin Lab Sci. 2006; 36(2):163-9 Kao PC, Shiesh SC, Wu TJ
[6] Red yeast rice (Monascus purpureus) Mayo Clinic website
[7] Cholestin inhibits cholesterol synthesis and secretion in hepatic cells (HepG2). Mol Cell Biochem. 2002 Apr;233(1-2):153-8 Man RY, Lynn EG, Cheung F, Tsang PS, O K.
[8] Effects of withdrawal of Xuezhikang, an extract of cholestin, on lipid profile and C-reactive protein: a short-term time course
study in patients with coronary artery disease. Cardiovasc Drugs Ther. 2006 Jun; 20(3):185-91 Hu CL, Li YB, Tang YH, Chen JB, Liu J, Tang QZ, Zhang QH, Huang CX
[9] Cardiovascular
disease: C-reactive protein and the inflammatory disease paradigm:
HMG-CoA reductase inhibitors, alpha-tocopherol, red yeast rice, and
olive oil polyphenols. A review of the literature. [PDF, 143KB] Altern Med Rev. 2001 Jun; 6(3):248-71 Patrick L, Uzick M
[10] Plasma clearance of lovastatin versus chinese red yeast rice in healthy volunteers. J Altern Complement Med. 2005 Dec; 11(6):1031-8 Li Z, Seeram NP, Lee R, Thames G, Minutti C, Wang HJ, Heber D
[11] Effects of xuezhikang, an extract of cholestin, on lipid profile and C-reactive protein: a short-term time course study in
patients with stable angina. Clin Chim Acta. 2005 Feb; 352(1-2):217-24 Li JJ, Hu SS, Fang CH, Hui RT, Miao LF, Yang YJ, Gao RL
[12] [Intervention of xuezhikang on patients of acute coronary syndrome with different levels of blood lipids] Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004 Dec; 24(12):1073-6 Wang WH, Zhang H, Yu YL, Ge Z, Xue C, Zhang P
[13] Hypolipidemic
and anti-atherogenic effects of long-term Cholestin (Monascus
purpureus-fermented rice, red yeast rice) in cholesterol fed rabbits. J Nutr Biochem. 2003 Jun; 14(6):314-8 Wei W, Li C, Wang Y, Su H, Zhu J, Kritchevsky D
[14] Antiatherosclerotic efficacy of policosanol, red yeast rice extract and astaxanthin in the rabbit. Arzneimittelforschung. 2005; 55(6):312-7 Setnikar I, Senin P, Rovati LC
[15] Dietary supplement or drug? The case of Cholestin [Editorial] American Journal of Clinical Nutrition, Vol. 69, No. 2, 175-176, February 1999 Richard J Havel
[16] Warning Letters for Products Containing Red Yeast Rice FDA archives
[17] [FDA forces Global Source and Consulting, Inc. to destroy RYR products] FDA archives, 2003
[18] [Transcript of Advisory Committee meeting to discuss OTC approval for low-dose lovastatin] [PDF, 5.7MB] FDA website. July 13, 2000
[19] FDA panel rejects sales of Mevacor over counter Boston Globe website. January 15, 2005 Diedtra Henderson
[20] Muscle coenzyme Q10 level in statin-related myopathy. Arch Neurol. 2005 Nov; 62(11):1709-12 Lamperti C, Naini AB, Lucchini V, Prelle A, Bresolin N, Moggio M, Sciacco M, Kaufmann P, DiMauro S
[21] Acute administration of red yeast rice (Monascus purpureus) depletes tissue coenzyme Q(10) levels in ICR mice. Br J Nutr. 2005 Jan; 93(1):131-5 Yang HT, Lin SH, Huang SY, Chou HJ
[22] Mechanistic and epidemiologic considerations in the evaluation of adverse birth outcomes following gestational exposure to
statins. Am J Med Genet A. 2004 Dec 15;131(3):287-98 Edison RJ, Muenke M
[23] The role of maternal toxicity in lovastatin-induced developmental toxicity. Birth Defects Res B Dev Reprod Toxicol. 2004 Jun;71(3):111-23. Lankas GR, Cukierski MA, Wise LD.
[24] Herbs and atherosclerosis. Curr Atheroscler Rep. 2001 Jan; 3(1):93-6 Heber D
[25] Cholesterol medicine for eggs? Science News 2003 July 12 Janet Raloff
[26] Red Yeast Rice and Cholesterol - A Critical Review MedicineNet.com website Dennis Lee, M.D.
[27] [Red Yeast Rice questions] iLifeLink.com website Alexis Zarkov, Ph.D.
