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Update on Cholesterol and Red Yeast Rice

If you've been waiting for solid scientific evidence before trying red yeast rice extract (original brand name, Cholestin) to lower your cholesterol, there's good news and bad news, as doctors like to say. The good news first. A rigorous trial from the UCLA School of Medicine, published in the American Journal of Clinical Nutrition in 1999, confirmed that a supplement known as red yeast extract reduces cholesterol levels by an average of 40 points in 12 weeks when combined with a low-fat diet. That's about the same result you'd expect from a low dose of the popular cholesterol drug, Mevacor.

Red yeast extract contains a number of cholesterol-lowering compounds known as statins, among them lovastatin, the same active ingredient that's in Mevacor. Other red yeast compounds are similar to those in other cholesterol medications, such as Lipitor (atorvastatin) and Zocor (simvastatin). Which brings us to the bad news. Because red yeast extract contains lovastatin, the Food and Drug Administration (FDA) has successfully banned red yeast rice from open store shelves, arguing that it's really a drug, needing a doctor's prescription. Therefore, red yeast rice can no longer be sold an unregulated supplement. Should it return to the market, it will require full FDA oversight, as do all other prescription drugs.

The original distributor of red yeast rice, NuSkin International, recalled Cholestin, their brand containing the red yeast rice, and reformulated it, replacing red yeast rice with policosanol, which also has a cholesterol-lowering effect. Policosanol, an substance derived from sugar cane or beeswax, has undergone considerable clinical testing. Like red yeast rice, policosanol acts on the liver to reduce cholesterol production. However, it is a unique molecule, and sufficiently different from the "statins" that it's likelihood of being reclassified as a drug is remote.

In addition, because of the FDA action, all other manufacturers stopped using red yeast rice, so any supplements containing this effective substance have disappeared. Some people have been able to locate supplies of red yeast rice on the Internet; it is possible that red yeast rice may return some day, but it will require a doctorís prescription. But for now, this very effective natural product is history.

Who Might Benefit

For people with high cholesterol (240 mg/dl or above), the choice among conventional physicians is usually to prescribe one of the statin drugs. "It's particularly important to talk to your doctor about drugs if you have very high cholesterol or heart disease," advises Michael Cirigliano, M.D., associate professor of medicine at the University of Pennsylvania School of Medicine. Not only do these drugs quickly and effectively lower cholesterol levels, but studies show that they directly lead to a reduced risk of heart attack. They also tend to be safe, although there is a slight risk of serious side effects, such as liver problems or severe muscle aches.

For those with borderline cholesterol (200 to 239 mg/dl), the decision is trickier. A five-year study showed that statin drugs cut the risk of heart disease in this group, too. But some experts believe that natural supplements may offer similar benefits, with fewer adverse effects. However, long-term studies are lacking. Several trials in China have shown that red yeast products have no toxic effects, and in the UCLA study, the liver tests of people taking the supplement remained normal. A five-year study of the safety of red yeast extract is underway.

Cost may be a deciding factor as well. A month's supply of lovastatin runs about $100, compared with $25 for red yeast extract.

Alternatives for Red Yeast Rice

Additional supplements may also be beneficial for those taking a statin drug. Chief among these are the plant sterols and stanols, which prevent the body's absorption of the cholesterol found in food. These substances are structurally almost, but not quite, identical to cholesterol. They are very poorly absorbed through the intestines, and interact with "regular" cholesterol in a way that also blocks its absorption. Afterwards, they simply pass out of the body in bowel movements. Two commercially available margarines, Benecol (a plant sterol) and Take Control (a stanol), may lower LDL cholesterol levels as much as 10% to 14%. Basikol, a vanilla-flavored powder sold in health-food stores, is a plant sterol, and if used according to package instructions (2 scoops daily), should provide a 14% drop in cholesterol.

The B vitamin niacin has been used as a cholesterol-lowering agent for decades. In fact, niacin is the only therapy that positively affects virtually all cholesterol abnormalities. Niacin will lower total and LDL cholesterol and triglycerides, raise HDL cholesterol, and lower lipoprotein (a) [Lp(a)], another blood fat associated with heart disease.

And, of course, consider policosanol, which is now appearing among cholesterol-control supplements from several different manufacturers under a variety of brand names.

Other Heart-Healthy Supplements

Certain nutritional supplements should also be included in any program designed to protect your heart. One of the most important is coenzyme Q10, a cell-protecting antioxidant normally produced in the heart and other tissues. "Statins can deplete CoQ10 levels," warns David Edelberg, M.D., WHMD Advisor's chief medical consultant. "And low levels of this nutrient can damage the heart, especially if you already have heart disease."

In addition, those concerned about high cholesterol can benefit from the antioxidant vitamins, vitamin C and vitamin E, which together help to prevent the "bad" (LDL) cholesterol from converting to a form that can clog arteries. An herbal supplement to consider is milk thistle, which protects the liver from damage caused by various chemicals, including possible toxicity induced by statin drugs or red yeast extracts.

Suggested dose for red yeast rice substitutes:
Policosanol: 10 mg, once or twice a day with food; plant sterols: 800 mg a day (2 scoops) Basikol powder, with food. In addition, to help lower cholesterol take coenzyme Q10 (50 mg twice a day), inositol hexaniacinate (500 mg two or three times a day), vitamin E (400 IU a day), and vitamin C (500 mg a day). Add milk thistle (150 mg twice a day) if you're concerned about liver problems.


Date Published: 04/30/2001
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