Tuesday, June 7, 2011

Red Yeast Rice

I was asked recently about red yeast rice. This is what I wrote:
I do recommend Red Yeast Rice. It does lower cholesterol in small trials. Here's an example of one:

BACKGROUND: We examined the cholesterol-lowering effects of a proprietary Chinese red-yeast-rice supplement in an American population consuming a diet similar to the American Heart Association Step I diet using a double-blind, placebo-controlled, prospectively randomized 12-wk controlled trial at a university research center.

OBJECTIVE: We evaluated the lipid-lowering effects of this red-yeast-rice dietary supplement in US adults separate from effects of diet alone.DESIGN: Eighty-three healthy subjects (46 men and 37 women aged 34-78 y) with hyperlipidemia [total cholesterol, 5.28-8.74 mmol/L (204-338 mg/dL); LDL cholesterol, 3.31-7.16 mmol/L (128-277 mg/dL); triacylglycerol, 0.62-2.78 mmol/L (55-246 mg/dL); and HDL cholesterol 0.78-2.46 mmol/L (30-95 mg/dL)]who were not being treated with lipid-lowering drugs participated. Subjects were treated with red yeast rice (2.4 g/d) or placebo and instructed to consume a diet providing 30% of energy from fat,<10% from saturated fat, and<300 mg cholesterol daily. Main outcome measures were total cholesterol, total triacylglycerol, and HDL and LDL cholesterol measured at weeks 8, 9, 11, and 12.

RESULTS: Total cholesterol concentrations decreased significantly between baseline and 8 wk in the red-yeast-rice-treated group compared with the placebo-treated group [(x+/-SD) 6.57+/-0.93 mmol/L (254+/-36 mg/dL) to 5.38+/-0.80 mmol/L (208+/-31 mg/dL); P<0.001]. LDL cholesterol and total triacylglycerol were also reduced with the supplement. HDL cholesterol did not change significantly.

CONCLUSIONS: Red yeast rice significantly reduces total cholesterol, LDL cholesterol, and total triacylglycerol concentrations compared with placebo and provides a new, novel, food-based approach to lowering cholesterol in the general population.
(PMID 9989685)

So it works in populations. There are three questions
1. Does the lowering of cholesterol lead to lower heart attacks and strokes like statins? Zetia for example may possibly lower cholesterol without preventing heart attacks and strokes. So while it does lower cholesterol, in reality that isn't the goal.
2. How does one know that the red yeast rice obtained is of equal quality to that found in studies?
3. What are long term safety issues?

These are the same questions of any herbal/alternative/complementary supplement.

It's worth considering using Red Yeast Rice because not everyone tolerate statins. And it can be used with statins possibly (it does possibly work by blocking the same enzyme in the liver however).


Ann said...

Hi, Josh.

I shared some of my concerns regarding red yeast rice with you via email, and per your response, am posting them here.

You cited the following publication to support your recommendation of red yeast rice extract:

Heber D, Yip I, Ashley JM, Elashoff DA, Elashoff RM, Go VL. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am. J. Clin. Nutr. 1999; 69(2):231-236.

This particular study was highly controversial, due in part to the nature of the "proprietary" supplement, and in part to what many considered to be its unsubstantiated claims and conclusions. See, e.g.:

Note that the product that was used in this study differs significantly from traditional Chinese red yeast rice extracts, especially with regard to its much higher statin content.

In fact, this "proprietary" supplement contains so much monacolin K (lovastatin) that it was ultimately adjudged to infringe on U.S. patents protecting the drug lovastatin and can no longer be sold in the U.S.

The American College of Cardiology (a) recommends that red yeast rice extract should be treated as an HMG-CoA reductase inhibitor, "with all the possible side effects, drug interactions, and precautions associated with this class of drugs", and (b) recommends against its use, due to the highly variable nature of products containing this unregulated "natural supplement".

The FDA recommends against the use of red yeast rice extract, and published a formal Consumer Safety Alert against red yeast rice products in 2007.

Such recommendations are based on studies such as:
- http://archinte.ama-assn.org/cgi/content/abstract/170/19/1722
Gordon RY, Cooperman T, Obermeyer W, Becker DJ. Marked Variability of Monacolin Levels in Commercial Red Yeast Rice Products: Buyer Beware! Arch Intern Med 2010 170: 19 1722-1727
- http://www.ncbi.nlm.nih.gov/pubmed/15631525
Liu BH, Wu TS, Su MC, Chung CP, Yu FY. Evaluation of citrinin occurrence and cytotoxicity in Monascus fermentation products. J Agric Food Chem. 2005 Jan 12;53(1):170-5.

There have been many published reports of serious side effects, such as myopathy and symptomatic hepatitis, from red yeast rice extracts. (And I, personally, quickly developed joint pain, tremors, and muscle spasms on a low dose of it, plus CoQ10.)

A recent meta-analysis concluded that traditional Chinese red yeast rice products have only modest effects on hyperlipidemia, and are considered to be equal to or less effective than non-statin treatments such as fenofibrate and gemfibrozil.

This meta-analysis, like pretty much every other study I've found, notes that long-term safety and efficacy studies are essential before red yeast rice products are recommended as an alternative treatment for hyperlipidemia.


joshuy said...

Thanks Ann. Appreciate the literature search.

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