Red yeast rice: Does it lower cholesterol naturally and effectively?

Red yeast rice (Monascus purpureus) is a fermented rice that has been used in Traditional Chinese Medicine for various health conditions (e.g. blood circulation). In Japan, fermented red rice is called Koji or red rice Koji and is a food product. Red yeast rice naturally contains chemicals called monacolins. Monacolins act in the same way as statin drugs. In fact, analytical studies have shown that monacolin K and lovastatin are the same molecule. Consequently, Monacolins and red yeast rice have become subjects of vigorous research with regard to their natural cholesterol-lowering ability.

Monacolin K and Lovastatin

In the 1990s, a California company called Pharmanex produced and sold a product called Cholestin. Cholestin, derived from red yeast rice, was effective in reducing LDL or “bad” cholesterol levels. People who took four 2.4 g capsules of Cholestin for 12 weeks had 22% lower LDL cholesterol levels than those who did not take the supplement. No adverse effects were reported in people taking the extract. One of the substances extracted from red yeast rice, and found in Cholestin, is monacolin K, which is identical to the pharmaceutical drug lovastatin. Monacolin K comprises about 0.2% of whole red yeast rice and 2.4 g of a commercial preparation of the red yeast rice extract is the equivalent of 4.8 mg of lovastatin. Treatment doses of lovastatin are between 20 and 40 mg per day; thus, a person would need to consume 10 to 20 g of red yeast rice extract to equal the prescribed dosage of lovastatin.

Red Yeast Rice Controversy

The FDA initially ruled that Cholestin was not a dietary supplement but an unapproved drug under the terms of the federal Food, Drug and Cosmetic Act, since it contained 0.4% by weight of the drug lovastatin. This action was later overruled in a Federal appeals court. In order to avoid potential legal and regulatory problems, companies that sell red rice yeast extracts often claim their products do not contain significant amounts of the lovastatin molecule or other monacolins. It is important to note, however, that commercial preparations of red yeast rice extract may contain low amounts of monacolins, despite their packaging claims.

Red Yeast Rice, Monacolins, Statins, and Cholesterol

Other molecules in red yeast rice may reduce cholesterol levels, as well. While monacolin K is lovastatin, red yeast rice actually contains nine different monacolins, all of which can block the HMG-CoA reductase enzyme. Thus, there are potentially nine statin-like molecules within red yeast rice. Red yeast rice also contains plant sterols with names like beta-sitosterol, campesterol, stigmasterol, and sapogenin along with isoflavones and monounsaturated fatty acids.

Additional Evidence That Red Yeast Rice Lowers Cholesterol

There have been nearly 100 double blind, randomised, clinical trials studying red yeast rice and cholesterol. Liu and colleagues evaluated these trials in by using a comparative examination called a meta-analysis. These researchers determined that extracts of Chinese red yeast rice consistently and repeatedly lowered total serum cholesterol levels, triglyceride levels, LDL cholesterol levels and increased HDL cholesterol levels. In fact, the effects on blood cholesterol were “similar to pravastatin, simvastatin, lovastatin, atorvastatin, and fluvastatin.”

Beyond Cholesterol Effects

While lowering cholesterol levels is an important part of reducing the risk of atherosclerosis, heart attack, and stroke, it is important to test whether these treatments can actually affect these endpoints. Red yeast rice appears to be able to do just that. Researchers performed a double-blind, randomised, prospective study on 5000 people who had experienced a heart attack and put them on either red yeast rice extract or a placebo. They followed these individuals for 4.5 years and measured cholesterol and cardiovascular events such as additional heart attacks or other coronary artery events. People in the red yeast rice group had 13% lower total cholesterol levels than the placebo group and LDL levels drop by 20%. More impressively, major coronary events decreased by 45% in people taking red yeast rice and nonfatal heart attacks were 62% less common in the treated group. Furthermore, people taking red yeast rice extract had 32% fewer fatal coronary events than those in the control group. Therefore, it appears that red yeast rice not only beneficially affects cholesterol levels but has a direct effect on cardiovascular disease.

Red Rice Yeast Safety

Not all commercially available red yeast rice supplements are the same. In fact, one of the nine supplements tested in a recent study was found to contain toxic levels of a fungus that could be harmful to the kidneys if consumed chronically. 

Because of the legal limbo, red yeast rice that contains substantial amounts of monacolins may be in violation of FDA regulations. Thus there is an incentive for manufacturers to be guarded about the precise ingredients contained in red yeast rice products. Unfortunately, it is difficult for a consumer to determine if a red yeast rice extract contains sufficient amounts of the necessary active ingredient (monacolins) without also containing harmful substances. 

Nevertheless, careful studies of red yeast rice in animals have demonstrated that four months of heavy use causes no identifiable toxicity. When pure versions of these substances have been used in human clinical trials, there have been no detectable increases in liver enzymes or negative effects on the kidneys, two feared consequences of statin use. People taking red yeast rice have simply reported headaches and gastrointestinal discomfort. It is also important to keep in mind that red yeast rice has been used in Asian cultures for at least 600 years.

Red vs. Brown Rice

Because of the success with red yeast rice, some have considered substituting brown rice since it is easier to obtain for most people. There is some evidence that consuming brown rice reduces inflammatory markers and cardiovascular risk factors; however, this appears to occur through mechanisms completely different than red yeast rice. For example, germinated brown rice has cholesterol-lowering effects that are unrelated to the way in which statins work (by blocking HMG-CoA reductase). In addition, brown rice may also be helpful in treating diabetes and in managing obesity where red yeast rice is not known to be helpful. In fact, brown rice appears to be particularly helpful in people with metabolic syndrome. Therefore, red yeast rice and brown rice should not necessarily be considered substitutes for one another. Instead, each may be helpful in different ways.

Reference

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