Most people probably know about the dangers of high cholesterol and its role in heart disease, but that knowledge doesn’t seem to change nutritional habits. New statistics predict that by 2035, 45 percent of Americans will have one issue or more associated with having heart disease. Such high numbers of people having heart disease puts a large strain on our healthcare system and the American Heart Association predicts costs could be around $1.1 trillion by 2035. Of increasing concern is the high levels of “bad” LDL cholesterol in young adults, which can lead to an irreversible increase in the risk of having a stroke or heart attack by middle age.
One of the major reasons for heart disease is a diet that contains too much cholesterol-laden foods. Consuming lots of fatty meats, dairy products, egg yolks, processed foods, and refined carbohydrates (breads, baked goods, pasta) raises the levels of bad cholesterol in your bloodstream. The excess bad cholesterol can be deposited in the walls of the heart arteries, eventually narrowing their diameter and limiting their ability for proper blood flow. Overtime and with sufficient cholesterol deposits in the heart arteries, the risk of stroke and heart attack becomes very high. The 2015-2020 Dietary Guidelines for Americans doesn’t give a set limit for daily cholesterol intake, but it does recommend that people should eat as little cholesterol as possible.
With so many people at potential risk for health issues from high cholesterol, the use of the supplement Red Yeast Rice (RYR) has become popular. But could there be a down-side to using this supplement? Let’s look at some of the similarities between prescription statin-based drugs and RYR.
Treatment of High Cholesterol to Prevent Heart Disease
Reducing high cholesterol usually starts with lifestyle changes such as:
- Eating a healthy Mediterranean-style diet
- Incorporating daily exercise
- Reducing stress to prevent eating unhealth foods
These first line of defense strategies may not be sufficient to reduce high cholesterol and your doctor may recommend taking medication. The choice of cholesterol-lowering medication depends on various factors such as personal risk factors, your age and if you are on other medications. Very often, a doctor will recommend a statin-based drug to lower high cholesterol.
Statin-based drugs have been in use for about 23 years and doctors write over 200 million prescriptions a year because they are successful in reducing high cholesterol. About 23% of Americans report using a statin medication and they spend approximately $17 million dollars a year on these drugs. Although there is volumes of information available to the public on the cholesterol-lowering effects of healthy diet and exercise, overall treatment of high cholesterol through the use of statins has increased in the last 15 years.
Statins work by blocking an enzyme in your liver that creates cholesterol. When there is reduced production of cholesterol by the liver, the total amount of cholesterol in the bloodstream is lowered. Statins also help reabsorb cholesterol that is already in your body. The body needs cholesterol to make hormones, help digest your food, absorb vitamin D, and is the building block for your tissues. If the body can’t get the cholesterol it needs from the blood stream because you are on a statin, it will go find other sources. It does this by reabsorbing cholesterol that has built up in the arteries and, thus, reducing life-threatening plaque.
Red Yeast Rice as a Natural Alternative
Most prescription drugs come with the potential for side effects and statin-based drugs have been shown to cause muscles aches and pains in about 10% of patients. People who have asthma have reported worsening symptoms when taking a statin, possible due to the statin boosting inflammation. Also, there can be drug interactions between statins and antibiotics with subsequent damage to the kidneys.
Once people develop what they believe is an adverse symptom to a statin drug, there is a tendency to quit taking it. As many as 50% of statin users do not take their medication withing months after filling their first prescription and nearly 75% of new users quit their statin therapy by the end of the first year.
In an effort to work with high cholesterol issues beyond just nutrition and exercise, many people have turned to using the supplement red yeast rice (RYR). Where did this supplement come from and how does it work to lower cholesterol? Let’s take a deep dive into this supplement.
What is Red Yeast Rice
RYR has been a part of Traditional Chinese Medicine for centuries and is also used in China as a food supplement. RYR is made by fermenting white rice with a mold called Monascus purpureus. The mold feeds off the rice and as it grows produces several compounds that seem to help reduce cholesterol, including beta-sterols, monosaturated fatty acids and the all important statin. The chemical name of the statin produced by RYR is called monacolin K, the same compound that is found in the pharmaceutical lovastatin (marketed as Mevacor). To be clear, supplements sold as RYR actually contain the same compound as a prescription drug. But is it as effective for lowering cholesterol as a pharmaceutical product?
Efficacy of RYR for Lower Cholesterol
The use of RYR to lower cholesterol has been studied for several decades, and a large meta-analysis in 2014 suggested that RYR is an effective and relatively safe approach for treating high cholesterol. Other studies conducted through the years also support the use of RYR for reducing not only cholesterol but total triglycerides. However, some of these studies were conducted before the FDA began to regulate RYR due to it containing a statin compound, which the FDA considers a drug and not a supplement.
Once the FDA starting regulating RYR, they required this supplement to contain only trace amounts of monacolin K. The FDA has repeatedly warned supplement companies that it is against the law to market RYR as a dietary supplement if the product contains monocolin K. In response, supplements manufacturers changed their labeling to show only the amount of RYR in their product and not whether is also contains monocolin K. Despite the actions of the FDA, there are many RYR products on the market that contain up to 50% the dose of monocolin K as would be found in the drug lovastatin. Other products, however, contain only trace amounts of monocolin K and consumers have no way of knowing how much of this statin is present in the RYR supplement they are taking. Because of this issue, if you are taking RYR you don’t have the ability to know if the product you’re taking is safe, effective, or even legal.
RYR Can Have Same Side-Effects as Statin Drugs
A large study was conducted in 2010 to examine a variety or over-the-counter RYR supplements to determine the range of monocolin K found in each of the supplements. The study found a wide range of variation of this statin from almost zero to 10 mg per RYR capsule, which would be about a pharmaceutical therapeutic dose. Again, if you are taking a RYR supplement you have no way of knowing what level of statin you are taking. But if you are seeing a drop in your overall cholesterol level having taken RYR over a period of time, you can be certain that particularly brand of RYR contains a substantial level of monocolin K.
As discussed earlier in this article, the use of statins needs to be approached with caution due to potential side effects. There has been significant recent research that states the safety profile of RYR is similar to that of prescription statin drugs, and thus, consumers should probably not consider RYR a safer alternative to a prescription drug. If the RYR supplement you are taking does have high levels of monocolin K, you are still at risk for muscle pain, liver injury, and kidney damage with long-term use. In addition, RYR as with other statin drugs can interfere with other medication such as immunosuppressants and antibiotics. If you have been or are considering taking RYR, please consult with your health care provider to let them know so they can advise you on any personal risks.
All of us who want to achieve better health usually look to a more natural, healthy approach for keeping our bodies in optimal condition. While there are many supplements that should be a part of your daily routine, such as a B-complex, vitamin D, and curcumin, the daily and long-term use of RYR should probably be avoided.