Deal Your Heart a Winning Hand and Improve Your Cardiovascular Health

Red Yeast Rice Lowers Cholesterol
By Will Block

The nation's number one killer is cardiovascular disease. About 960,000 Americans die of this disease every year, representing more than 40% of all deaths. Although it is believed to afflict primarily men and older individuals, it is also a major killer of women and people in the prime of life. It is a disease from which none of us can hide, and we are all its potential victims. Studies show that often the first sign of heart disease is sudden death. According to one study, 70% of those who drop dead from a heart attack never had any prior warning that they were in serious trouble.1


"Red yeast rice provides a new,
novel, food-based approach to
lowering cholesterol levels."

Even so, there are a number of well-recognized risk factors for heart disease - including smoking, stress, lack of exercise, obesity, elevated cholesterol levels, and elevated homocysteine levels - that we can alter for the better. Indeed, ever since the incidence of heart disease hit its peak in the 1950s, the trend has been downward.2 No doubt this has been due to a widening public interest and many different approaches, some of which have been more successful than others.

RED YEAST RICE: A NATURAL STATIN-CONTAINING FOOD THAT LOWERS CHOLESTEROL
One approach, now becoming more widely known, is the use of red yeast rice, a traditional Chinese food that contains natural statins (statins are natural or synthetic compounds that block the synthesis of cholesterol in the liver). Red yeast rice - we will see later in the article what this food actually is - has been found in recent studies to lower cholesterol as much as prescription statin drugs, but without their side effects. It has long been consumed in many East Asian countries, with a current average intake ranging from 14 to 55 grams per person per day. Japan is the world's main consumer of red yeast rice, and it is there that scientists first isolated a principal active ingredient, a statin known as monacolin K, in the 1970s.3 Nine natural statin monacolins have been identified in red yeast rice. Their effect is to inhibit the action of an enzyme that promotes the formation of cholesterol in the liver. Because tens of millions of Americans have elevated cholesterol levels, the prospect of a new and safer approach to this major public health problem is welcome.

THE PROS AND CONS OF CARDIOVASCULAR DRUGS
Among the standard approaches for controlling cholesterol levels are lifestyle changes (including diet, exercise, nonsmoking, and stress management), drugs, and dietary supplements. Because of poor compliance, lifestyle changes have low success rates for most people. Exercise, for example, requires discipline, which is difficult to master. And if you're confused by all the contradictory information about what constitutes a healthy diet, and you realize how much effort it can take to achieve, you can imagine why most diets are flops. We hear constantly that we need to cut back on cholesterol consumption, which is true. However,because about half of our cholesterol is typically made in our liver (which can easily make all that our body needs) and is not directly derived from dietary sources, it is not possible to keep cholesterol levels low just by excluding cholesterol itself from our diet. Cholesterol is the necessary source from which our steroidal hormones are made. Cholesterol is also critical for bile, blood, brain tissue, myelin sheaths of nerve fibers, the liver, kidneys and adrenal glands. However, the real key is to curtail certain fats in our diet, because that is the culprit responsible for most of our excess cholesterol. But eschewing fat is also difficult to master, as we all know (chewing the fat is all too easy). Dietary supplements have been found to be valuable for improving cardiovascular health. They help to control weight (by burning fat), prevent diabetes, and lower blood pressure. Certain supplements are even able to lower cholesterol levels, in much the same way that prescription drugs do, but usually without the side effects of the drugs. Studies have shown, for example, that prescription therapy with statin drugs lowers cholesterol levels, although about 25% of users do not have their cholesterol lowered enough. Curiously, however, these drugs do not increase mean lifespan significantly, if at all. Although it is difficult to be sure, the adverse side effects of statin drugs may have consequences that affect death rates from other diseases.


Figure 1. Unstable arterial atherosclerosis. As plaque builds up, it
becomes either stable or unstable. Unstable plaque is more prone to sudden
rupture, a potentially life-threatening event.

THE ANTICHOLESTEROL POWER OF RED YEAST RICE
At the University of California's Center for Human Nutrition in Los Angeles, a recent review of various herbs with cholesterol-lowering abilities confirmed the value of red yeast rice.4 As an herb with natural antioxidant properties, red yeast rice has been known for centuries to improve blood circulation.5


The scientific literature shows that
red yeast rice,
with its low-to-no toxicity profile,
is equivalent to lovastatin in
cholesterol-reducing effects.

In a study of red yeast rice also undertaken at the Center for Human Nutrition the subjects were 83 outwardly healthy, untreated individuals (46 men and 37 women, aged 34 to 78) with total cholesterol levels from 204 to 338 mg/dL, LDL ("bad" cholesterol) levels from 128 to 277 mg/dL, and triglycerides from 55 to 246 mg/dL.6 They were given either three 800-mg servings (2.4 g) of red yeast rice per day or placebo, with a standardized diet. Over an 8-week period, total cholesterol concentrations decreased significantly in the experimental group compared with the placebo group, as did LDL and triglycerides. The authors wrote, "Red yeast rice significantly reduces total cholesterol, LDL cholesterol, and total triacylglycerol [triglyceride] concentrations compared with placebo and provides a new, novel, food-based approach to lowering cholesterol in the general population."

RED YEAST RICE: AN ORIGINAL HEALTH FOOD
Red yeast rice is the natural fermentation product of cooked premium rice with the yeast Monascus purpureus (purpureus means purple, the color of the yeast's pigments). Its use as a food dates back to the Chinese Yuan Dynasty (1260-1368 A.D.),7 and according to some reports, it has had a tradition in other East Asian countries dating back at least to the first century A.D. Because red yeast rice has been widely eaten to help with diarrhea, blood circulation, spleen function, and stomach distress, it may be thought of as one of the original health foods. Now research has confirmed the health benefits of red yeast rice with findings that show antioxidant activity and cardiovascular benefits.

RED YEAST RICE FOUND AS EFFECTIVE AS THE STATIN DRUG LOVASTATIN
If something is successful, imitation is inevitable, so it is not surprising that 25 years ago pharmaceutical companies began to develop synthetic statin drugs to emulate the qualities of the natural statins in red yeast rice. In all likelihood, Merck & Co. learned about natural statins from earlier Japanese studies and finally produced the synthetic - and patentable - statin mevinolin (now called lovastatin).* This was the first synthetic statin specifically offered as a cholesterol-reducing drug, in 1987.8 With a mechanism similar to that of red yeast rice and producing similar beneficial effects, the statin drugs have nearly monopolized the spotlight in the battle against cholesterol - but with a price to be paid, namely, side effects.


* The Merck Index lists lovastatin as a fungal metabolite derived from Monascus yeasts.


Yet the scientific literature shows that red yeast rice, with its low-to-no toxicity profile, is equivalent to lovastatin in cholesterol-reducing effects.9 If this were widely known, its popularity might grow to the point where it would vie for a significant share of the market now owned by the statin drugs. Moreover, if it were also widely known that red yeast rice is relatively free of side effects - unlike the various statin drugs, which have numerous side effects - it might compete for the crown.

STATIN DRUGS CAN HAVE SERIOUS SIDE EFFECTS AND TOXICITY
Statin drugs, unlike natural statin-containing red yeast rice, are associated with myalgia, muscle cramps, myopathy, arthritis, fever, chills, fatty changes in liver, cirrhosis, and kidney problems. They also affect other systems of the body, and their prolonged use is associated with significant toxicity, such as hepatitis and interference with the inhibition of proper membrane function, a disruption of which may lead to programmed cell destruction10 or even the promotion of cancer.11 In addition to cancer, some of the consequences can be deadly.12

In a study in which a number of different statin drugs were given to HIV-infected patients, the statins did reduce cholesterol levels, but they were also associated with myalgia and with liver enzymes three times higher than normal.13 High liver enzymes are often forerunners to liver disease.

The conclusion is that, although statin drugs are effective in reducing (but not returning to normal) cholesterol levels in HIV-infected patients, there is a tradeoff that may be unacceptable for some people. Because some commonly used drugs can cause skeletal muscle toxicity, the use of lovastatin may potentiate or exacerbate this problem and threaten life. Other statin drugs have also been found to be equally toxic, unlike herbs used for similar cholesterol-lowering effects, including red yeast rice.

Teamwork Between Red Yeast Rice and Arginine
At Massachusetts General Hospital, a teaching hospital of Harvard University, the amino acid L-arginine - a precursor of nitric oxide (NO) - was found to amplify and sustain blood flow, beyond its usual role, in the cerebrovascular system when the enzyme nitric oxide synthase (NOS) was activated by a statin drug.19 Arginine has been found to increase NO production throughout the arteries which relaxes the vascular smooth muscle tissues lining the arterial walls, thus reducing resistance to blood flow and enhancing cerebrovascular and cardiovascular effects.

The authors of the report concluded that statin-stimulated NOS activity, combined with arginine administration, provides a novel strategy to elevate cerebral blood flow in the normal and ischemic (obstructed blood flow) brain. In support of the complementary roles of arginine and the natural statins in red yeast rice,20 a recent study found that NO-mediated relaxation in the endothelial layer of cells that line the arteries could be induced by red yeast rice, just as the statin drug did. It might be a good idea to add, as a separate supplement for your cholesterol-reduction program, an arginine-containing product.

THE DRAMATIC CHOLESTEROL-LOWERING EFFECTS OF RED YEAST RICE
To understand the effectiveness of red yeast rice more fully, Chinese researchers performed a randomized trial with 502 patients who were diagnosed with elevated cholesterol.14 All patients had high levels of total cholesterol, LDL, or triglycerides at the start of the study.

The dose of red yeast rice was 600 mg twice a day (1200 mg/day). At 4 weeks, the results for those taking red yeast rice showed impressive improvement:

  • Total cholesterol was down by 17%
  • LDL (the "bad" cholesterol) was down by 25%
  • Triglycerides were down by 20%
  • HDL (the "good" cholesterol) was up by 13%

After 8 weeks of continued use, the improvement was even greater:

  • Total cholesterol down by 23%
  • LDL down by 31%
  • Triglycerides down by 34%
  • HDL up by 20%

The other herb was significantly outdistanced by every measure. Throughout the study, few adverse effects occurred, and even those were mild - they included mild heartburn, flatulence, and dizziness - and were quickly resolved.

OTHER ACTIVE AGENTS IN RED YEAST RICE CONTRIBUTE SIGNIFICANTLY
In the short time since supplements containing red yeast rice began to appear on the United States market, many believers have been created. Studies have found that red yeast rice with natural statins achieves results similar to those of the statin drugs, but with only about 12.5-25% of the amount of statins found in the drugs.6 To express the less-is-more aspect another way, the amount of the statin drugs used in most studies of their effects is about 4 to 8 times greater than that found in the red yeast rice studies - with equivalent benefits.

So either natural statins are fundamentally different from synthetic (drug) statins, or there is some other explanation.

An examination of other ingredients in red yeast rice has led researchers to believe that some have biological activity, such as inhibiting the oxidation of cholesterol, thereby curtailing its cholesterol accumulation on the lining of blood vessels. When antioxidant activity is low and accumulation occurs, the result can be a cascade of inflammatory processes, resulting in the formation of atherosclerotic plaque that adheres to the lining. These plaque deposits can severely obstruct blood vessels or break off, leading to a heart attack. Other active compounds found in red yeast rice have been found to inhibit cholesterol absorption from food in the intestine. And yet others have been shown to contribute to lowering cholesterol levels.15

SHOULD EVERYONE TAKE RED RICE YEAST?
For years, the press has lavished praise on statin drugs, while ignoring or dismissing the side effects. According to one typical report, statin drugs "are revolutionizing the treatment and prevention of heart disease."16 There have even been suggestions that everyone should take statin drugs as a preventive measure and that they should be sold, in low-dose form, over the counter. This is amplified by the fact that many doctors use statin drugs on themselves for treatment or prevention of cardiovascular disease. Dr. Antonio Gotto, a prominent cardiologist and statin drug proponent who is dean of the Weill Medical College at Cornell University, has said, "I typically ask a group of cardiologists how many are taking a statin [drug], and about 75 percent hold up their hands." Those doctors clearly understand the value of synthetic statins. However, they may not know that there is an alternative that's safer without the unacceptable side effects. Red yeast rice requires less concentration of statins for equivalent benefits, and it is substantially cheaper. That alternative is natural statin-containing red yeast rice. If it is plausible that many individuals should be taking statins for either the treatment or the prevention of cardiovascular disease, doesn't it make sense that the more intelligent choice is to take natural statins?

Red yeast rice is a traditional Chinese food containing natural statins, constituents that block the synthesis of cholesterol in the liver. Natural statins have recently been found to help lower cholesterol as much as prescription statin drugs, but without their side effects.

Inositol Hexanicotinate (IHN) is a non-flushing form of niacin, like vitamin B3, that has been shown to help reduce cholesterol levels significantly; it may even be superior to niacin. And when combined with red yeast rice, the results are likely to be additive.

CoQ10 plays a significant role in helping to promote and maintain proper cardiovascular function. Supplementing with CoQ10 can enhance the cholesterol-lowering effects of red yeast rice.

RED YEAST RICE IS COST-EFFECTIVE COMPARED TO STATIN DRUGS
Currently there are an estimated 13.6 million Americans using statin drugs, representing more than 6% of all drug prescriptions in the United States. It is estimated that up to 80 million Americans meet the criteria for taking statin drugs. If every one of those 80 million Americans did so, the cumulative cost would be staggering. With a one-month supply costing on average $100, the total cost would be at least $100 billion a year.

Some doctors are now recommending starting the use of statin drugs at age 30 to help prevent heart disease. Obviously, the lifetime cost for such a program would be enormous. By comparison, red yeast rice is far less expensive than $100/month: about $30/month. Thus, augmenting all the health benefits of this natural statin food is the added benefit of economy. It does everything that the statin drugs do, with the bonuses of greatly reduced side effects, a better health profile, lower cost, and a history of use by many millions of people over the last millennium.

Red yeast rice is a natural statin-containing food shown to support healthy cholesterol levels. It does not have the side effects of the statin drugs that lower cholesterol.

Inositol hexanicotinate (IHN) is a form of vitamin B3 (niacin) which, like niacin, has been shown to reduce cholesterol levels significantly. Because IHN does not produce the skin-flushing sensation of niacin, which many people find annoying, it is suitable for more people. Studies have reported that IHN is at least the equal to niacin in its cholesterol-lowering abilities, and possibly even superior. This is because the inositol part of it helps hasten the removal of (or decreases the deposit of) cholesterol in the liver.

Studies have shown that IHN lowers cholesterol17 and that it is even more effective than niacin in reducing blood pressure.18 Many research reports indicate that the combination of statins and niacin complement each other in support of healthy cholesterol levels. When IHN is combined with red yeast rice, the results are likely to be additive in lowering cholesterol. Interestingly, when cholesterol is lowered, blood pressure often follows suit.

Coenzyme Q10 (CoQ10) plays a significant role in helping to promote and maintain proper cardiovascular function. Since statins tend to lower CoQ10 (particularly statin drugs), it makes sense to add CoQ10 to compensate for any loss. Researchers have found that even for the deficiencies caused by statin drugs, supplementing with CoQ10 can completely make up for any decrease in CoQ10. As well, the latest thinking is that the use of CoQ10 along with statins is likely to provide the bonus of an additive or synergistic therapeutic effect.

PREVENTION, HEALTH, AND LONGEVITY
If you are serious about protecting yourself from cardiovascular disease - and who wouldn't be? - it may be a wise insurance policy to add red yeast rice to your supplement program. To widen your vision of what a supplement may be able to do, consider that in a recent study, high HDL and low LDL cholesterol were tied to living a very long time, more than 100 years. Cardiovascular disease is the greatest fear we face, and while it is possible to reduce the risk of heart attack by lifestyle changes, including a concerted exercise program and a healthy diet, taking supplements such as Chinese red yeast rice, IHN, and CoQ10 can help you in ways beyond what you could usually hope to achieve with the strictest discipline. By improving your cholesterol levels, it is even possible to help you live to be 100 years old.

[see editorial, "Live to Be 100 Years"]

References

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