Many people are now choosing to take red yeast rice supplements over prescription medication for cholesterol control. This motivation can be due to a lack of response to, or inability to tolerate, prescription medications such as statins.
When choosing which red yeast rice to take, does the brand matter? Can the brand impact your reduction of total and LDL cholesterol levels? To answer these questions, it might be helpful to first review what red yeast rice is and how it differs and is similar to statin drug lovastatin.
What is Red Yeast Rice?
Red yeast
rice is produced when a mold call Monascus purpureus colonizes and ferments the
rice turning it dark red. This fermentation
process also produces a medicinal compound called monacolin K. It has been used in traditional Chinese
medicine since the first century AD and is currently sold today as a health
supplement worldwide. {1}
What is Monacolin K?
Monacolin K
is a naturally source of lovastatin. The
chemical structure of monacolin K in red yeast rice is “identical” to
lovastatin, which is the primary ingredient in several cholesterol lowering
drugs. Known “statin,” drugs such as
Mevacor or Altoprev, whose active ingredient is lovastatin, are widely
prescribed to lower cholesterol in people with elevated levels. {2}
The FDA
The FDA, who
regulates lovastatin, challenged a red yeast rice product in late 1990s. It determined that the red yeast product
containing lovastatin (monacolin K) was an unapproved drug, and ordered its
removal, while still allowing other red yeast rice supplements to be sold in
US. The FDA guidelines only allow for
trace amounts of lovastatin in red yeast rice supplements, and warns companies
not to promote its cholesterol lowering effects. So, most products in US are labeled as
600mg/capsule of red yeast rice, but do not disclose the levels of monacolin K
in each capsule. Currently there is no
way of knowing the level of monacolin K without testing a supplement in a lab.
Are the levels of Monacolin K different between brands?
In a study reviewing the variability of the monacolin K levels in 12 red yeast rice products, the difference
was marked. The level of monacolin K
in the tested brands ranged from a low level 0.10mg/capsule to a high range of
10.09 mg/capsule. (See: table below) This range was also noted in the total
monacolins and the monacolin KA levels; other bioactive compounds produced by
monascus purpureus yeast. {3,4}
Red yeast rice brands
with only 0.10mg and other low levels of monacolin K (lovastatin) would
probably have little if any cholesterol lowering properties, so would not be a
viable treatment to reduce total or LDL cholesterol.
Lovastatin vs monacolin K dosing
Looking at the
recommended dosing range for generic drug lovastatin, it is 10-80mg/day in a
single or divided dosage. Patients needing a 20% reduction in LDL are usually
started on a 20mg dosage, while a starting dosage of 10mg may be considered for
patient needing smaller reductions. {5}
If we compare this to the table two in the above-mentioned study, only one red
yeast supplement had 10mg/capsule of monacolin K. However, it should be noted that several
brands recommended taking 2 tablets twice daily, which would also place them
close to this range.
But
is a higher dose of red yeast rice needed?
There have been
numerous studies that show red yeast rice significantly reduces both total and
LDL cholesterol. However, several reviews,
attribute the results to “substantial amounts of monacolin K” (what they
determine as substantial is never stated) used in these studies, but recent
clinical trials contradict this statement. {6} Studies conduct after, as well as before, 2008 have use less
than 18mg monacolins K and as low as 5mg of monacolin K with significant
results. {7,8,9}
So
why is red yeast rice effective in lower dosage?
Although more research
is needed in this area, a possible explanation is red yeast rice does not just
contain monacolin K, but other monacolins which may assist in its cholesterol
lowering mechanism.
Red Yeast Rice Safety Concerns
A wide variability of monacolin K in available red yeast rice supplements sold in US.
Citrinin is a toxin that can cause damage to the heart, liver, kidney and reproductive system was present in some red yeast rice supplements.
Pregnant women should not use red yeast rice
Because monacolin K is chemically the same as lovastatin, people may have the similar side effects, such as muscle pain to severe muscle breakdown, nausea, heartburn, headache and memory loss.
May interact with other drugs
Do not drink grapefruit, since it contains an enzyme that prevent statins from breaking down and could cause a dangerously elevated level that could than cause serious muscle problems.So, what can the statin intolerant do?
RED
YEAST RICE SHOULD NOT BE TAKEN UNLESS SUPERVISED BY MEDICAL PROVIDER. Follow your physician recommendation. Lab test are required to see if the red
yeast rice supplementals are lowering your cholesterol.
Read the labels.
Certain supplements are now addressing the real concern over citrinin, and
advertises on the bottle that they are citrinin free.
Read the research. The article above and others (Consumer Labs) identify how much monacolin K is available in different brands. (i.e., Two tablets twice daily of citrinin free brand, Cholestene will provided you with 12.9mg of monacolin K daily.)
Seek a holistic
provided who may provide an alternative or other supplements that work in
concert with red yeast rice, such as CoQ10 or berberine.