Red Yeast Rice Helps Lower Blood Cholesterol - and More

Red Yeast Rice
The Natural Way to a Healthy Heart
Why take statin drugs when nature has provided the real thing?

he "weakest link" is currently a hot (or cool, depending on your generation) concept, owing to the TV quiz show of that name. As children, we all learned the lesson that it takes only one weak link to break a chain. That lesson has been put to good use by grownup scientists who have figured out where the weak links are in some of the chains of chemical reactions that constitute our bodies' metabolic processes.

The next trick is to find ways to use that knowledge to our advantage. One powerful and productive way is to supplement with an extract of red yeast rice, an ancient food from Southeast Asia, to inhibit cholesterol production. Growing evidence suggests that there's much more to red yeast rice than that, but for now, let's focus on cholesterol.

A Chinese rice paddy. There is evidence that rice has been cultivated in this manner for at least 11,000 years.

Most of our cholesterol comes from our liver, which normally churns out about 600 mg of the much-maligned stuff every day. That's actually a good thing, however, because cholesterol is a molecule that's as vital to life as, say, insulin. Without it, we would soon die - but unless you're on a pathologically low-fat diet (less than about 10% fat), you'll never need to worry about inadequate cholesterol levels. The real problem is that with cholesterol - with too much of it clogging our arteries, to be more accurate - we also die, although that takes longer. It can take several decades, and then, one fateful, too-soon day - Boom! - a heart attack or stroke. RIP.

So, like the fairytale Goldilocks, who always had three choices in the bears' home, what we really want is for our cholesterol levels to be not too low and not too high, but Just Right. And that's where red yeast rice comes in.

Red yeast rice originated over a thousand years ago in China. It is produced when a purple-colored yeast, Monascus purpureus, is added to steamed rice and the mixture is fermented. The resulting product has been used as a food (and a food-coloring agent) since at least the year 800 A.D. Its use in winemaking in East Asia goes back more than 600 years, and it has a long history of use as a folk medicine for improving digestion and blood circulation.1

Among its many other constituents, red yeast rice contains molecules called statins, which have a particular affinity for one of our molecules, an enzyme called HMG-CoA reductase (whenever you see a chemical name that ends in "-ase," you know it's an enzyme). Despite its ungainly name, this molecule plays an important role at a certain stage in the long, complex chain of reactions by which fats are converted to cholesterol in our livers. In that chain, HMG-CoA reductase is . . . you guessed it: the weakest link.

An enzyme is a protein that acts as a catalyst, i.e., it speeds up a particular chemical reaction without itself participating in that reaction. If the structure or chemical properties of an enzyme are altered significantly, the enzyme is said to be inhibited - it can no longer catalyze the reaction, and the chain is broken. That is what statins, the main active ingredients in red yeast rice, do to HMG-CoA reductase.2

The most prevalent of the statins in red yeast rice is called lovastatin. If that name sounds familiar, it's because lovastatin, along with several others, such as simvastatin, pravastatin, and mevastatin, are best-selling drugs, by far the most widely prescribed medications in the world for lowering cholesterol levels. They are considered to be extremely effective in this regard and are taken by about 12 million Americans. That number could soon soar, because in May 2001, the National Institutes of Health issued new cholesterol guidelines that call for tripling the number of Americans taking cholesterol-lowering drugs. What a bonanza that would be for the drug companies that sell statins!

Here, however, we wish to discuss another kind of bonanza: the health bonanza that you might be able to reap by taking powerful, effective, inexpensive statins in their natural, not synthetic, form, and with virtually no side effects to worry about. That's what red yeast rice offers, according to several studies done in China during the last few years.3-5 Now these results are supported by a study recently performed in the United States and published in the American Journal of Clinical Nutrition.6

The researchers, at UCLA, designed a randomized, double-blind, placebo-controlled clinical trial to evaluate the cholesterol-lowering effect of a commercial red yeast rice supplement over a 12-week period. The participants were 83 otherwise healthy adults (46 men and 37 women aged 34-78) who were diagnosed with hypercholesterolemia, or high blood cholesterol. Divided into two groups, they received either placebo or 2400 mg per day of red yeast rice powder. They were all requested to adhere to a standardized diet approved by the American Heart Association.

The subjects' blood was tested periodically for LDL (low-density lipoprotein,the "bad" form of cholesterol), HDL (high-density lipoprotein, the "good" form of cholesterol), total cholesterol, and triglycerides (fats). In our blood, cholesterol and triglycerides are the two major types of fatty substances, which are known generically as lipids.

The results of the study confirmed what had long been known in China: red yeast rice sharply reduces cholesterol levels. In the treatment group, LDL levels dropped by an average of 22% after 12 weeks, whereas the control group saw only a 1% drop. This is very significant, because LDL is the type of cholesterol chiefly implicated in the formation of artery-clogging plaque, which can lead to atherosclerosis and, ultimately, a heart attack. The red yeast rice also caused a significant drop in triglycerides, but it had no effect on HDL levels. No significant adverse effects were noted.

Plaque formation is a complex process involving the subtle interplay of many factors. In this deadly drama, it is actually the oxidized forms of LDL and triglycerides, not the lipids in their native forms, that are the chief villains. Oxidation is brought about by the destructive action of free radicals in the blood. That is why it is so important not just to keep our cholesterol and triglyceride levels in check to begin with, but also to keep our antioxidant defenses fully mobilized at all times, so as to prevent the conversion of these lipids to the forms that can kill us.

A statistical link has been established between total cholesterol levels in the blood and the risk of heart attack: For every 1% reduction in total cholesterol, there is a 2% reduction in the risk of fatal and nonfatal heart attack.7,8 In the UCLA study, total cholesterol levels dropped 16% after 12 weeks. By this formula, therefore, the risk of heart attack in those individuals should have dropped about 32% - not bad! Where else can you get a two-for-one deal like that?

An unexpected feature of the study results was that the magnitude of red yeast rice's cholesterol-lowering effect was greater than could be accounted for solely on the basis of its content of lovastatin and other statins. The authors speculated that other compounds naturally present in red yeast rice (there are many different kinds) may also have an effect on cholesterol biosynthesis. Other researchers have speculated that some components of red yeast rice may have antioxidant effects, which, as we have just seen, would make this food product that much more beneficial to our health.9

The possible role of other, perhaps unknown, compounds in the action of red yeast rice illustrates an important point about natural products vs. the synthetic drugs that are derived from them. The synthetics are manufactured as pure compounds that are either chemically identical to a naturally occurring one (lovastatin, e.g., which is sold as Mevacor®)or closely related (simvastatin, e.g. - a methyl derivative of lovastatin, with similar properties, and sold as Zocor®). Although synthetics often have the advantage of higher potency than their natural counterparts, and they may be easier to ingest, they also suffer from some significant disadvantages - which is to say that the natural products have significant advantages.

In addition to the direct health benefits that natural products offer, they have certain advantages over synthetic drugs that make them ideally suited to a preventive health care program. Prevention, after all, is always preferable to therapy.

Minimal Side Effects
One advantage of natural products, such as red yeast rice, is that they tend to have minimal side effects. By contrast, when the body is confronted with a synthetic drug, it may see the drug as a foreign agent and decide that it's hostile, despite the beneficial role the drug is playing. (It's as though the body is saying, "OK, thanks for the help, but I still hate the fact that you're an alien. Get out!")

It's common for synthetic drugs to have a number of side effects, often quite serious. That happens not to be the case with the statins, however, which enjoy a good reputation in this regard: they're not only safe and effective, but relatively free of side effects as well. Nonetheless, natural red yeast rice is still preferable to the statin drugs, on principle and for the following reasons too.

Biochemical Richness
Another advantage of natural products (plant products such as red yeast rice, or herbal extracts) is that nature has typically endowed them with a rich mix of chemical compounds - many of which we have not even identified, in most cases - that can work together like a symphony orchestra, adding up to more than the sum of their parts. This is what appears to have occurred in the UCLA study with red yeast rice. Often we cannot fathom these interlocking webs of interactions, because they're far too complex.

The magnitude of red yeast rice's
cholesterol-lowering effect
was greater than could be
accounted for solely on the
basis of its statin content.

By contrast, when synthetic drugs are chemically isolated from the parent natural product, they're isolated as well from the many beneficial interactions that would have been possible between them and the compounds they left behind. Their action, therefore, despite its clear focus, may lack the rich texture of nature's way. (A solo violin is nice, but a violin with an orchestra . . . )

Low Cost
Yet another advantage of the natural products is that they're typically inexpensive compared with their synthetic counterparts. For example, treatment with cholesterol-lowering drugs currently costs about $120-300 per month (average $187), whereas a monthly regimen of red yeast rice supplements costs less than 20% of that amount.11

And that's with a daily serving of only 2400 mg (2.4 grams), the amount used in the UCLA study. By comparison, the typical daily consumption of red yeast rice in many Asian countries is 14-55 grams - roughly ten times as much. Not coincidentally, perhaps, cholesterol levels are low in that part of the world, and so is the rate of atherosclerosis, which in our part of the world is the leading cause of premature death.

The cost factor prompted one of the UCLA authors to remark, "As a society, we are faced with rapidly increasing health care costs, including significant amounts of money spent for prescription drugs. Dietary supplements such as Chinese red yeast rice provide an alternative to prescription drugs. Because they may cost less and do not require a prescription, they are more accessible and may be used more widely."12 To this we could add that they can appropriately be viewed as preventive agents, as mentioned earlier.

As we have seen, red yeast rice puts the brakes on cholesterol biosynthesis, reducing our levels of it and giving our poor, put-upon arteries a much-needed break. By itself, this is a fine thing, for those who have a cholesterol problem. Even for those who don't, however, red yeast rice may have a bowl of tricks up its sleeve that is only now coming to be appreciated, owing to new discoveries regarding the statins. Recent research, e.g., has shown that statins help prevent heart attacks and strokes by a mechanism that is unrelated to their cholesterol-lowering action.13

For those who care about their heart health, red yeast rice may be a wise choice in a dietary supplement.

Buyer Beware!
When you see the words "No Cholesterol!" on a food product, hang onto your wallet, get out your eyeglasses, and have a close look at the package's Nutrition Facts chart (one of the greatest-ever boons to consumers). Chances are there will be oodles of fat - and probably sugar as well - in the product. Look especially at the Saturated Fat category (saturated fats come from meat and other animal products), because that will affect your cholesterol levels much more than the cholesterol, if any, that's in the product to begin with. In your body, some of that fat will wind up as cholesterol, and some of that cholesterol will wind up stuck to the insides of your arteries. Yuck.

So the "No Cholesterol!" slogan, even if it's truthful, is often but a ruse to make you think you're getting a heart-healthy product, when in reality you may be getting something that's the nutritional equivalent of a slug of cholesterol injected right into your heart. What you should be on the lookout for is the slogan, "No Fat!" or at least, "Low Fat!" In the latter case, you then have to ask yourself a crucial question: "How do they define "low"? Don't take their word for it. Check the numbers.

  1. Ma J, Li Y, Ye Q, Li J, Hua Y, Ju D, Zhang D, Cooper R, Chang M. Constituents of red yeast rice, a traditional Chinese food and medicine. J Agric Food Chem 2000;48:5220-5.
  2. Istvan ES, Deisenhofer J. Structural mechanism for statin inhibition of HMG-CoA reductase. Science 2001 May 11;292:1160-4.
  3. Shen Z, Yu P, Sun M, Chi J, Zhou Y, Zhu X, Yang C, He C. Treatment of primary hyperlipidemia with Zhitai (Xuezhikang) capsule: a clinical study. Natl Med J China 1996;76:156-7.
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  7. Downs JR, Clearfield M, Weiss S, et al. Preliminary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998;279:1615-22.
  8. Pearson TA. Commentary: lipid-lowering therapy in low-risk patients. JAMA 1998;279:1659-61.
  9. Patrick L, Uzick M. Cardiovascular disease: C-reactive protein and the inflammatory disease paradigm: HMG-CoA reductase inhibitors, alpha-tocopherol, red yeast rice, and olive oil polyphenols. A review of the literature. Altern Med Rev 2001 Jun;6(3):248-71.
  10. Pedersen TR, Berg K, Cook TJ, Foergeman O, Haghfelt T, Kjekshus J, et al. Safety and tolerability of cholesterol lowering with simvastatin during 5 years in the Scandinavian Simvastatin Survival Study. Arch Intern Med 1996;156:2085-92.
  11. Perreault S, Hamilton VH, Lavoie F, Grover S, Treating hyperlipidemia for the primary prevention of coronary disease: are higher doses of lovastatin cost-effective? Arch Intern Med 1998;158:375-81.
  12. Heber D. Letter: reply to Bliznakov. Am J Clin Nutr 2000;71:153-4.
  13. Lefer AM, Scalia R, Lefer DJ. Vascular effects of HMG-CoA reductase inhibitors (statins) unrelated to cholesterol lowering: new concepts for cardiovascular disease. Cardiovasc Res 2001;49:281-7.

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