The Ongoing Debate of Red Yeast Rice Lowering Cholesterol

Red yeast rice has been a mainstay of Asian food and medicine for at least a thousand years. It is made by growing a type of yeast, Monascus purpureus, on rice. The resulting product is used just as white rice or as an ingredient in other products. In traditional Chinese medicine it was used for poor circulation and indigestion. Human studies have confirmed the use of red yeast rice as a cholesterol-lowering substance and advocates of natural healing see it as a natural and safe alternative to prescription statins for reducing cholesterol.  

Red yeast rice contains monacolins. Statins, such as monacolin K,  occur naturally in red yeast rice, and whether natural or synthesized, statins inhibit HMG-CoA reductase, an enzyme that triggers cholesterol production.

The use of red yeast rice is not without controversy and some forms of the product have been removed from the market place by the FDA because of the naturally occurring lovastatin which is identical to the active ingredient in a prescription statin, Mevacor, marketed by Merck. The basis for prohibiting the sale of the products was that they were unlicensed pharmaceuticals.

A new study reported in the Annals of Internal Medicine followed 62 people for 12 weeks. The members of the study had stopped taking statins because of side effects. The group participated in a life style change program, including nutrition education and exercise and relaxation techniques. Half of the group took 1,800 milligrams of red yeast rice twice a day, and the other half of the group took a placebo. “In the group that took red yeast rice the average drop in cholesterol was 43 points at 12 weeks,” said Dr. Ram Y. Gordon, a cardiologist in private practice who was a member of the research group.  “The drop in the placebo group was only 11 points. In the longer run, the drop was 35 versus 15 points. We think the difference narrowed because after 12 weeks we told people to keep on doing it, but maybe some stopped.”

The red yeast rice product used in the study contained one milligram of lovastatin per dose, not enough to explain the cholesterol reduction seen in the trial according to Gordon. Lovastatin is one of the weaker statins, and the drop in cholesterol exceeded what would be expected from that low dose of lovastatin. According to Gordon there are other monacolins in red yeast rice and they may have also had an effect on lowering cholesterol. Two people who took the red yeast rice and one who took the placebo reported some statin-related side effects, such as muscle pain, but they were not severe Gordon said.

Even though this was a small study the researchers are hopeful that a product may be available for use by patients and clinicians that will reduce cholesterol and eliminate the statin related side effects.  One of the problems of using red yeast rice remains, the consumer has no idea if a commercially purchased product really has the amount of cholesterol lowering product on its label. Laboratory analysis indicated that there were vast differences in effective medicinal value between products and this did not always agree with what the label said.  Some red yeast rice products tested in laboratories actually contained ingredients that could be harmful.

A patient considering using red yeast rice as an alternative to prescription statins should discuss the change with their health professional.