Red Yeast Rice in Management of Cholesterol

Alternative Medicine , Knowledge Base / October 7, 2016

Red Yeast Rice is a bright reddish purple fermented rice, which acquires its color from being cultivated with the mold Monascus purpureus. It is referred to in Japanese as koji, meaning “grain or bean overgrown with a mold culture”.

Red Yeast Rice has been used in China for many years as a traditional remedy for improving blood circulation, and for alleviating indigestion and diarrhea. It has relatively recently been developed by Chinese and American scientists as a product to lower blood lipids, including cholesterol and triglycerides. Other uses of Red Yeast Rice include being used as a food additive, colorant and preservative.

The use of Red Yeast Rice appeals to many as it is “natural”, although care must be exercised since extensive studies have not been conducted on the extract, which are necessary to determine its ideal dosing and long-term safety.

Red yeast rice naturally contains several ingredients that may help control cholesterol levels. These include a number of monacolins, most importantly monacolin K. It also contains cholesterol, isoflavones, and monosaturated fatty acids, or “healthy fats”.

There are three major preparations of Red Yeast Rice:

  • Zhitai:
    • Produced by the fermentation of a mixture of different strains of Monascus purpureus on whole grain rice
    • Mainly rice and yeast
  • Cholestin or Hypocol:
    • Produced by the fermentation of selected strains of Monascus purpureus, using a proprietary process that produces a certain concentration of monacolin K
  • Xuezhikang:
    • Produced by mixing the rice and red yeast with alcohol and then processing it to remove most of the rice gluten
    • Contains 40% more cholesterol-lowering ingredients than Cholestin or Hypocol

The monacolin K contained in HypoCol is lovastatin, the active ingredient in the popular lipid-lowering statin drug Mevacor. The difference is that while the lovastatin in Mevacor is highly purified and concentrated, that in HypoCol is not. The result is that HypoCol contains a lower amount of lovastatin (2.4 mg) than that found in Mevacor (10 mg or more).

Because none of the components are purified and concentrated, HypoCol and Cholestin (marketed outside of the US) contain a mixture of the eight yeast-produced monacolins, unsaturated fatty acids, and certain anti-oxidants. Some scientists believe that these other monacolins, unsaturated fatty acids, and anti-oxidants may work together favorably with lovastatin to enhance its cholesterol-lowering effects, as well as its ability to lower triglycerides and increase HDL cholesterol. Further studies in animals and humans will be necessary to test these theories, however.

Chinese scientists conducted most of the animal and human studies on this issue, using either Zhitai or Xuezhikang. The results of some 17 studies involving approximately 900 Chinese subjects with modestly elevated cholesterol levels have been published. In eight of these studies, there was a control group that received a placebo (a pill with no active ingredients) for comparison purposes. In nine of the studies, there was no placebo control group.

These studies consistently showed that Zhitai and Xuezhikang:

  • Lower total cholesterol (by an average of 10% to 30%),
  • Lower LDL cholesterol (by an average of 10% to 20%),
  • Lower triglycerides (by an average of 15% to 25%), and
  • Increase HDL (by an average of 7% to 15%)

Lowering LDL and increasing HDL cholesterol prevents atherosclerosis (a build-up of plaque) of the heart’s arteries. Since atherosclerosis causes heart attacks, lowering the LDL and increasing HDL cholesterol should lower the risk of heart attacks. In fact, several large, long-term, placebo-controlled clinical trials have shown clearly that lowering LDL cholesterol with diet and statin drugs [pravastatin (Pravachol), lovastatin (Mevacor), and simvastatin (Zocor) reduces the risk of heart attacks. No large, long-term studies of red yeast rice products for the prevention of heart attacks have yet been conducted. However, animal studies are underway at UCLA comparing red yeast rice to a statin drug (such as Mevacor) for the prevention and treatment of atherosclerosis.

Animal studies have been conducted in China using high doses of red yeast rice products. No damage to the kidneys, liver, or other organs were demonstrated in these studies.

Human trials in China and in the United States reported only rare and minor side effects of heartburn or indigestion with the use red yeast rice products. No liver, kidney, or muscle toxicity has been reported. These trials, however, generally lasted only a few weeks to a few months. Thus, conclusive proof of long term safety (over a period of many years) will have to await further research data.

Scientists conducting the studies generally believe that red yeast rice is safe in the long-term since it has been a food staple for thousands of years in Asian countries without reports of toxicity. They attribute the safety of red yeast rice products to the process of preparation that does not involve the isolation and concentration of a single ingredient. Although it is true that isolation and concentration enhance the potency of a single ingredient, these factors also increase the risk of side effects.

Not all red yeast rice products contain the same concentrations of the cholesterol-lowering ingredients. Moreover, it is illegal in the United States to sell red yeast rice products that contain more than trace amounts of cholesterol lowering substances. Therefore, the red yeast rice products that are available in the United States do not contain levels of cholesterol lowering substances that are likely to cause side effects. Nevertheless, certain products also may contain unacceptably high levels of an undesirable and toxic substance called citrinic acid.

There is not yet consensus among scientists and doctors as to the role, if any, of red yeast rice in treating elevated cholesterol. Therefore a doctor familiar with a patient’s personal medical condition and his/her family history of heart diseases should be prescribing cholesterol-lowering measures. Generally in the United States, when diet, weight loss, and exercise are insufficient in lowering cholesterol to optimal levels, many doctors recommend using a statin drug since large long-term trials have consistently shown that statins [such as pravastatin (Pravachol), simvastatin (Zocor), lovastatin (Mevacor), and atorvastatin (Lipitor)] are safe and effective in lowering LDL cholesterol and decreasing the risk of heart attacks and strokes. Although similar studies are not available for red yeast rice products, given the minimal amounts of cholesterol lowering substances that they are allowed to contain in the U.S., it would be expected that legal red yeast rice products would not be very effective at lowering cholesterol levels.

Patients with moderate to severe cholesterol abnormalities, and patients who are at high risk of developing heart attacks or strokes are not candidates for red yeast rice. Examples of patients that are at high risk of heart attacks include patients who had prior heart attacks and strokes, patients with diabetes mellitus, and patients with atherosclerosis in the arteries that supply blood to the brain and to the extremities (peripheral artery disease). In these patients, red yeast rice containing legal amounts of cholesterol lowering substances (along with weight loss, diet, and exercise) is not potent enough to achieve the degree of cholesterol lowering desired.

Red Yeast Rice is available by name on the Egyptian Market as a dietary supplement produced by Spring Valley, USA.

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