Physician Q&A: Red Yeast Rice
Do you struggle keeping your LDL cholesterol levels at bay? Are you looking for a holistic alternative to statins? Michael Chapman, MD, Cooper Clinic Platinum Physician and preventive medicine physician, discusses why red yeast rice might be worth exploring as a statin substitute.
Q: What reasons would one take red yeast rice?
A: Statin drugs are normally recommended and administered to patients with cardiovascular disease and high cholesterol, given their high effectiveness in reducing cholesterol and preventing cardiovascular events. Recently there has been increased interest in the role of nutraceuticals, such as red yeast rice, as a substitution for statins. Red yeast rice is known to reduce serum cholesterol and has been advocated as an alternative therapy for hypercholesterolemic patients who refuse statin medication, cannot tolerate statin side effects or prefer a “naturopathic” approach. In general consuming 2 grams of red yeast rice per day can reduce total cholesterol and LDL cholesterol by 30-40 points. Keep in mind that statin medications will continue to be the primary recommendation for patients with elevated cholesterol and/or cardiovascular disease. Only 3-5 percent of patients have complete statin intolerance and up to 95 percent of patients with statin associated muscle symptoms can still use statin medication using the stepped approach of statin drug modification.
Q: What is red yeast rice made from?
A: Red yeast rice is a commercially available food supplement extracted from red rice and fermented with a fungus, Monascus purpureus, which was used in the original production of lovastatin, an FDA-approved statin drug. Being identical in chemical properties explains the similarity and therapeutic side effects of red yeast rice and lovastatin. The red yeast ingredient that blocks cholesterol conduction is called monacolin K.
Q: Does red yeast rice interact with any other supplements?
A: Limit alcohol due to increased risk of liver damage while taking red yeast rice. Grapefruit or grapefruit juice may increase the effects of the red yeast rice. Red yeast rice has also been reported to cause occasional side effects such as myopathy (muscle pain and weakness), liver toxicity and temporary elevation of liver enzymes. I generally recommend 50-100 mg of coenzyme Q10 on a daily basis to reduce the risk of muscle aches that can be associated with red yeast rice. These side effects are generally rare and studies suggest red yeast is well-tolerated; however, long-term safety studies have not been conducted.
As a reminder, your physician understands your health profile best, so it’s important to talk to him or her about which supplements are best for you.