Red yeast rice's therapeutic uses
Red yeast rice is a traditional Chinese product created by fermenting rice with the yeast Monascus purpureus, used for over a millennium both as food and in traditional medicine. It contains natural compounds similar to statin medications, which are commonly prescribed to lower cholesterol levels. Numerous studies suggest that red yeast rice effectively lowers total cholesterol, LDL (bad cholesterol), and triglycerides, with some evidence indicating it may also improve the LDL/HDL ratio and reduce cardiac risks. Clinical trials have reported significant reductions in heart attack rates and mortality among participants taking red yeast rice; however, concerns about the reliability of these findings exist.
While generally well-tolerated in clinical settings, red yeast rice can cause side effects similar to those of statins, including muscle pain and liver issues. The variability in the statin content of different red yeast rice products poses safety risks, leading to recommendations for its use under medical supervision, especially for specific populations like pregnant women and those with liver or kidney disease. Individuals on certain medications should also exercise caution, as red yeast rice may interact adversely with them. Overall, red yeast rice represents a potential natural therapeutic option for cholesterol management, but it requires careful consideration of its risks and interactions.
Red yeast rice's therapeutic uses
Definition: Natural plant product used to treat specific health conditions.
Principal proposed use: High cholesterol
Other proposed use: Heart attack prevention
Overview
Red yeast rice is a traditional Chinese substance made through the fermentation of a type of yeast called Monascus purpureus over rice. Various formulations of this product have been used in China since at least 800 CE as a food and as a medicinal substance within the context of traditional Chinese herbal medicine. This ancient preparation contains naturally occurring substances similar (in some cases, identical) to cholesterol-lowering prescription drugs in the statin family.
Therapeutic Dosages
The dosage of red yeast rice used in most studies is 1.2 to 2.4 grams (g) of red yeast rice powder daily. However, owing to patent-infringement suits by the manufacturer of a statin drug that is naturally present in red yeast rice, the most-studied red yeast rice product has been taken off the market, and it is not clear whether the remaining products have greater or lesser potency. The herb St. John’s wort is known to reduce the effectiveness of drugs in the statin family. There is every reason to believe it would have the same effect on the action of red yeast rice.
Therapeutic Uses
Red yeast rice is thought to be effective for lowering cholesterol, presumably because of its statin constituents. There is evidence to support this use.
Scientific Evidence
An eight-week double-blind, placebo-controlled trial of eighty-three people with high cholesterol evaluated red yeast rice. At the end of the treatment period, levels of total cholesterol had decreased significantly in the red yeast rice group compared with the placebo group. Benefits were also seen in LDL (bad cholesterol) and triglycerides as well. No significant differences were noted in HDL (good cholesterol) levels from baseline or between groups. In an eight-week study of seventy-nine people, use of red yeast rice was noted to improve the LDL/HDL ratio, along with several other measures of cardiac risk.
In a carefully conducted review of ninety-three randomized trials involving almost ten thousand persons, researchers concluded that red yeast rice can significantly lower levels of total cholesterol, LDL, and triglycerides and raise levels of HDL, compared with placebo.
A double-blind study performed in China compared an alcohol extract of red yeast rice (Xuezhikang) against placebo in almost five thousand people with heart disease. In a four-year study period, the use of the supplement reportedly reduced the heart attack rate by about 45 percent compared with placebo and total mortality by about 35 percent. However, these levels of reported benefit are so high as to raise questions about the study’s reliability. At least three other studies, all from this same original population of participants, have found similar results in diabetics with heart disease and in patients with previous heart attack, with surprisingly large reductions in the rates of coronary events (for example, heart attack) and mortality. These levels of reported benefit, however, are so high and so similar as to raise questions about their reliability.
Safety Issues
In clinical trials, use of red yeast rice has not been associated with any significant side effects. However, red yeast rice contains naturally occurring statin drugs, and use of statin drugs can cause side effects ranging from minor to life-threatening. Some of the most common include muscle pain, joint pain, liver inflammation, and peripheral nerve damage; severe breakdown of muscle tissue (rhabdomyolysis) leading to kidney failure has also occurred. It is almost certain that red yeast rice can cause the same problems if it is used by enough people, and there are at least two case reports in the literature of muscle injury caused by red yeast rice; in one case, rhabdomyolysis developed. Due to the relative lack of regulation of supplement manufacture, the statin content of red yeast rice products is unpredictable, and this could increase potential risk. In addition, red yeast rice may, at times, contain the toxic substance citrinin.
Based on the known effects of statins, pregnant or nursing women, women likely to become pregnant, young children, and people with liver or kidney disease should not use red yeast rice. Furthermore, red yeast rice should not be combined with fibrate drugs, cyclosporine, erythromycin-family drugs, antifungal drugs, or high-dose niacin. Finally, it does not make sense to combine red yeast rice with standard statin drugs.
Statin drugs are known to interfere with the body’s ability to produce the natural substance CoQ10, and one animal study found the same effect with red yeast rice. For this reason, people taking red yeast rice could conceivably benefit from CoQ10 supplementation; however, this has not been proven.
Because red yeast rice is essentially a drug supplied by a natural product, and this drug has many potential side effects, it is recommended that red yeast rice be used only under physician supervision.
Important Interactions
People taking fibrate drugs, cyclosporine, erythromycin-family drugs, antifungal drugs, or high-dose niacin should not use red yeast rice. Individuals using red yeast rice to keep their cholesterol levels down or taking the herb St. John’s wort may impair the effectiveness of red yeast rice and cause cholesterol levels to rise.
Bibliography
Andrén, L., A. Andreasson, and R. Eggertsen. “Interaction Between a Commercially Available St. John’s Wort Product (Movina) and Atorvastatin in Patients with Hypercholesterolemia.” European Journal of Clinical Pharmacology 63 (2007): 913-916.
Du, B. M., et al. “The Beneficial Effects of Lipid-Lowering Therapy with Xuezhikang on Cardiac Events and Total Mortality in Coronary Heart Disease Patients With or Without Hypertension.” Zhonghua Xin Xue Guan Bing Za Zhi 34 (2006): 890-894.
Huang, C. F., et al. “Efficacy of Monascus purpureus Went Rice on Lowering Lipid Ratios in Hypercholesterolemic Patients.” European Journal of Cardiovascular Prevention and Rehabilitation 14 (2007): 438-440.
Liu, J., et al. “Chinese Red Yeast Rice (Monascus purpureus) for Primary Hyperlipidemia.” Chinese Medicine 1 (2006): 4.
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