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Red Yeast Rice to Lower Cholesterol

The Medical Letter,  a highly respected source of reliable independent evaluations of drugs and therapeutics, has just published an evaluation of red yeast rice (Vol 51, Issue 1320, P 71-2, Sept 7, 2009). It has been widely promoted as a “natural” alternative to prescription medications for lowering blood LDL cholesterol levels. Studies have indeed shown that red yeast rice reduces LDL cholesterol levels and reduces the rate of major coronary events. The Medical Letter consultants concluded that it works, but they don’t recommend it. Why?

It’s Just Another Statin

When rice is fermented with the yeast Monascus purpureus, the resulting product contains numerous monacolins, which are naturally occurring HMG-CoA reductase inhibitors. One of these is identical to the prescription drug Mevacor (lovastatin). So it isn’t an alternative to prescription drugs, it’s just an alternative way of providing the same thing.

It Has Side Effects

Since red yeast rice contains statins, it can cause the same adverse effects as statin drugs, including myopathy. There have been reports of rhabdomyolysis and hepatitis. Red yeast rice contains many other components besides the active ingredients. Those other components are not necessary and may be harmful – it is quite possible that new side effects from those other components would be recognized if large numbers of patients were as carefully monitored as patients on statin drugs have been.

It May Be Contaminated with a Toxin

Some red yeast rice products contain citrinin, a mycotoxin that can cause kidney failure in animals. In one study, measurable amounts of citrinin were found in 7 out of 9 products tested. and in another study citrinin was found in four out of ten products tested, with the highest level found in a supplement sold by a major pharmacy chain.

 It’s a Less Reliable Way to Get the Benefit of Statins

Under DSHEA rules, red yeast rice products are not regulated as drugs. They are not standardized and may contain unlabelled ingredients. In one study of 9 brands, the amount of active ingredient in red yeast rice varied from 0% to 0.58% . In another study of 10 products, the content varied 100-fold. The Medical Letter says

The FDA has tried, apparently unsuccessfully, to remove red yeast rice products from the US market as unapproved formulations of an approved drug (lovastatin).

It’s More Expensive

A common argument in favor of natural medicines is that they are less expensive than Big Pharma profit-making drugs. In this case, that’s not true. According to The Medical Letter, the cost of a month’s treatment with red yeast rice is $16-37, and the cost of generic lovastatin is as low as $4 at discount pharmacies.

Why Would Anyone Choose Red Yeast Rice Over a Prescription Statin?

There is no logical reason to do so. Those who choose it are making an irrational decision based on the belief that “natural is better” – a fallacy that Steven Novella demolished here.

Among all the different kinds of complementary and alternative medicine, natural and herbal medicines have the highest prior probability. The history of pharmacology is full of examples where a natural medicine was found to be effective and the active ingredient was isolated, standardized, and became a mainstream treatment. There are few if any examples of a whole natural medicine that was found to be superior (or even equivalent) to a purified pharmaceutical containing the active ingredient. Even in a case like this, where natural red yeast rice was shown to be effective, there are compelling reasons to prefer the regulated pharmaceutical version.

Posted in: Herbs & Supplements

Leave a Comment (12) ↓

12 thoughts on “Red Yeast Rice to Lower Cholesterol

  1. Tsuken says:

    Oh noes! the t0x1ns!

    … but wait

    … said toxins are in the natural product, not the the eebil pharmaceutical? Say it ain’t so!

    Laugh. Out. Loud.

  2. theobroma_cacao says:

    Those who choose it are making an irrational decision based on the belief that “natural is better”

    Or, instead of assuming folks who obtain RYR are irrational, you could observe RYR doesn’t require a prescription. Your cost estimates don’t take into consideration the cost of the doctor’s appointment and blood test. If you don’t have insurance and know you have high cholesterol, what’s worse — doing nothing or taking RYR?

  3. Joe says:

    @ theobroma_cacao,

    If you read carefully, you will see that the dose of drug you receive from RYR is uncontrolled, it could even be zero. What’s worse, spending money for a too small or too high dose, or getting things right?

  4. marilynmann says:

    The Science-Based Pharmacy blog had a post on RYR recently:

    http://sciencebasedpharmacy.wordpress.com/2009/08/06/red-yeast-rice/

  5. Scott says:

    Or, instead of assuming folks who obtain RYR are irrational, you could observe RYR doesn’t require a prescription. Your cost estimates don’t take into consideration the cost of the doctor’s appointment and blood test. If you don’t have insurance and know you have high cholesterol, what’s worse — doing nothing or taking RYR?

    Even if we were to assume that RYR and lovastatin were equivalent, I’d still have to say that taking RYR is probably worse. Without proper monitoring by a physician, how are you going to properly protect yourself from the risk of myopathy, just as one example?

    Even leaving cost completely aside, RYR is more dangerous and less reliably efficacious. Not justifiable at all.

    Anyway, if you can’t afford to see a doctor, there are such things as free clinics. And people who can’t afford to see a doctor are PRECISELY those who can least afford to pay through the nose for RYR!

  6. trrll says:

    Or, instead of assuming folks who obtain RYR are irrational, you could observe RYR doesn’t require a prescription. Your cost estimates don’t take into consideration the cost of the doctor’s appointment and blood test. If you don’t have insurance and know you have high cholesterol, what’s worse — doing nothing or taking RYR?

    But if you are taking any statin, including red rice, you should be getting periodic blood tests anyway to check your liver enzyme levels, because hepatitis is a known side effect of statins. So you need a relationship with your physician, anyway. And since you need to get blood tests anyway, why not check to see how well your statin is working?

  7. Sam says:

    It’s certainly true that anyone wishing to avoid the well-documented side-effects of statins should stay away from Red Yeast Rice. There are other, clinically tested, cholesterol-lowering supplements which are safer, like sytrinol and niacin. Even high-dose niacin should be used under medical supervision because of the potential for liver damage.

    One supplement which some doctors recommend to patients is pantethine, the biologically active form of vitamin B5. Several small studies in the 1980s showed it to be very effective at raising HDL while lowering LDL cholesterol. It appears to be virtually free of harmful side-effects.

  8. Newcoaster says:

    A very timely article, as I have a new patient who told me he was on RYR, and I’d never heard of it before.

    Besides the fallacy that natural is better and safer, I’ve found that most sCAM treatments are more expensive than SBM. I have patients who claim not to like taking pills, but are swallowing handfuls of supplements and vitamins everyday to avoid taking a pill.

  9. marilynmann says:

    @Sam

    The purpose of cholesterol medications such as statins and niacin is to reduce the risk of cardiovascular events. Statins are more effective at doing that than niacin so should always be first-line therapy.

    Sytrinol is a dietary supplement. Looking at the manufacturer’s website, it appears there have been three small trials funded by the manufacturer, only one of which was placebo controlled. The trials measured Sytrinol’s effect on lipids. So far as I know, there is no morbidity and mortality data for Sytrinol. For all we know, it may increase morbidity and mortality.

  10. Sam says:

    @ marilynmann:

    The purpose of finding a natural alternative to statins (or RYR) is because of their well-documented side-effects. A 2008 review cites nearly 900 studies on the adverse effects of statins:

    “Muscle problems are the best known of statin drugs adverse side effects”, said co-author Beatrice Golomb. “But cognitive problems and peripheral neuropathy, or pain or numbness in the extremities like fingers and toes, are also widely reported.”

    For some doctors niacin is a first line treatment for high cholesterol.

    Sytrinol is in phase 3 of a long-term trial. Early results are positive and reinforce the earlier, smaller trials. According to one source:
    “Toxicity studies have shown that Sytrinol is well tolerated, with no toxic effects following consumption of polymethoxylated flavones in amounts of up to 1% of total dietary intake, or the equivalent of a 150-pound individual consuming almost 14 grams per day—that’s nearly 50 times the recommended daily dosage of 300mg/day.”

  11. Joe says:

    @Sam on 27 Sep 2009 at 3:47 am “The purpose of finding a natural alternative to statins (or RYR) is because of their well-documented side-effects.”

    Sam, you seem to be missing a few things. First, statins (some at least) are natural products. Second, there is no reason to think “natural is safer.” Third, while natural products still provide leads for drugs, there is a long history of improving natural products in the lab. For example, salicylic acid (found in meadowsweet) is an analgesic drug for arthritis; but it is difficult to take because it is hard on the stomach lining. When it is modified by acetylation, it becomes the much more tolerable drug- aspirin.

    BTW, there is nothing in the medical literature to support the product you are plugging.

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