by Craig Weatherby
Statin-type drugs, such as Mevacor, Lipitor, and Zocor, reduce two risk factors for cardiovascular disease: inflammation and high cholesterol levels.
Statins lower cholesterol levels by inhibiting an enzyme called HMG-CoA reductase, which is needed to produce cholesterol in the liver.
It’s less clear how statins reduce inflammation, but research suggests that this once-overlooked property may be as much or more responsible for these drugs’ apparent—if oversold—cardiovascular benefits.
(The roles of cholesterol and statins in cardiovascular health are increasingly controversial… see our sidebar, “Cholesterol, statins, and seafood.”)
Few people realize that statins are simply synthetic, patentable versions of the active compounds in red yeast rice… a traditional Chinese remedy that dates back to the Tang Dynasty, circa 800 A.D.
Red yeast rice is a staple food in some Asian countries, made by growing a special yeast (Monascus purpureus) on reddish-purple rice.
It contains several compounds collectively known as monacolins, known to reduce cholesterol synthesis in the liver by inhibiting the same enzyme (HMG-CoA reductase) that statins interfere with.
When Japanese scientists discovered that red yeast rice lowers cholesterol very effectively, Western drug companies rushed to patent synthetic versions of its monacolins, which became known as “statins”.
Red yeast rice supplements vs. statin drugs
Red yeast rice extract has been sold as a natural cholesterol-lowering agent in over the counter supplements, such as Cholestin™.
Doctors sometimes recommend it to patients who can't tolerate statin drugs, and some people see red yeast rice extract as a safer natural alternative to statins.
But there has been a battle with FDA over the legal status of red yeast rice (drug or dietary supplement), and the producers of pharmaceutical statins have sued to halt sales of red yeast rice supplements.
Regardless of its legal status, many have thought that it might be safer to take a traditional remedy seemingly proven safe over thousands of years of human use.
The researchers began their report by affirming that red yeast rice can be an effective alternative to statin drugs, in terms of lowering blood levels of “bad” LDL cholesterol:
“Several studies have shown that specific formulations of red yeast rice reduce LDL cholesterol significantly compared with placebo. This is likely related to the effects of monacolin K and the 13 other monacolins in the supplement, which… lower the production of cholesterol in the liver” (Gordon RY et al. 2010).
But then they delivered the bad news: tests showed very wide variations in the levels of monacolins found in various red yeast rice supplements.
Tests find 36- to 100-fold variation among red yeast rice supplements
Researchers from the University of Pennsylvania and ConsumerLab.com measured monacolin levels in 12 commercial red yeast rice supplements… and looked for citrinin, a fungal toxin that can harm the kidneys.
Across the 12 products, levels of total monacolins ranged from 0.31mg to 11.15mg per capsule… a 36-fold difference.
Levels of monacolin K—the most potent monacolin, which is patented and sold by prescription as lovastatin (Mevacor)— ranged from 0.10 milligrams to 10.09 milligrams per capsule… a 100-fold variance.
And four of the formulations had “elevated” levels of citrinin, though probably not high enough to pose an actual health threat.
Sadly—because we deplore pharmaceutical firms’ unearned monopoly on selling statins for heart health—it seems hard to disagree with the authors’ conclusions:
“Although RYR may have potential as an alternative lipid-lowering agent, our findings suggest the need for improved standardization of RYR products and product labeling.”
As they said, “Until this occurs, physicians should be cautious in recommending RYR to their patients for the treatment of hyperlipidemia and primary and secondary prevention of cardiovascular disease” (Gordon RY et al. 2010).
Buyer beware, indeed.
Gordon RY et al. Marked Variability of Monacolin Levels in Commercial Red Yeast Rice Products: Buyer Beware! Arch Intern Med. 2010;170(19):1722-1727. doi:10.1001/archinternmed.2010.382
McGowan MP, Proulx S. Nutritional supplements and serum lipids: does anything work? Curr Atheroscler Rep. 2009 Nov;11(6):470-6. Review.
Venero CV, Venero JV, Wortham DC, Thompson PD. Lipid-lowering efficacy of red yeast rice in a population intolerant to statins. Am J Cardiol. 2010 Mar 1;105(5):664-6.