Can Red Yeast Rice really lower cholesterol ?

If you are diabetic, you have at least an 80% chance of also having issues with the levels of your cholesterol. Adding red yeast rice to your diet as a foodstuff or a dietary supplement may make sense. Here’s the lowdown.

Image of Rice fields
Photo by Koes nadi on Unsplash

Red yeast rice (RYR) has been used in traditional Chinese medicine for over 1,000 years, to improve circulation and digestion.

But, in the Western world, RYR has a well-earned reputation for its ability to lower cholesterol levels. Most type 2 diabetics have problems with their cholesterol levels.

RYR is also known as Went rice, red fermented rice, red rice koji, akakoji, red koji rice or anka. ‘Koji’ in Japanese means ‘grain or bean overgrown with a mould culture’, which is an apt description.

Red yeast rice is created by fermenting a type of yeast called Monascus purpureus with rice. Once the rice is combined with the fermenting yeast, it becomes a bright reddish-purple colour.

In Asia, people eat between 15 to 55 grams of naturally occurring RYR every day. In Chinese communities around the world, powdered RYR is used to colour foodstuffs such as tofu, meat, fish, cheese, vinegar and pastries.

It is also added to alcoholic drinks, such as Japanese Saki and Korean rice wines, to impart a reddish tinge.

Red yeast rice extract (RYRE) is used to make red yeast rice supplements.

The problem with statins

Statins are a class of drugs often prescribed by doctors to help lower cholesterol levels in the blood in order to prevent heart attacks and stroke.

Studies show that, in certain people, statins reduce the risk of heart attack, stroke, and even death from heart disease by about 25% to 35%.

There are two kinds of cholesterol, LDL (‘bad’ cholesterol) which builds up plaque in your arteries, increasing your risk of heart attacks and strokes significantly, and HDL (‘good’) cholesterol which prevents plaque build-up by transporting the bad (LDL) cholesterol out of the blood to the liver, where it is eliminated from the body.  

Some people find it difficult to take statins, including this writer, due to side-effects. Instead I take 1000mg of cod-liver oil and 10mg of Ezetimibe Teva every day.

Ezetimibe Teva is another medicine to lower increased levels of cholesterol.

The side-effects of statins include muscle pain and weakness, neuropathy, heart failure, dizziness, cognitive impairment, cancer, pancreatic rot and depression.

In my experience, statins slowed my thinking which I found intolerable.

The side-effects of RYR are less nasty and much more acceptable.

RYR contains naturally occurring chemicals called monacolins. Monacolins block the production of cholesterol.

One of these, monacolin K, sometimes found in RYR supplements, is an active statin-like compound with the same chemical makeup as prescription statins such as lovastatin and mevinolin. 

Despite this, the side-effects of RYR different and more tolerable than the side effects of statins.

How red yeast rice lowers cholesterol

The monacolin in red yeast rice is less than the equivalent compounds found in medical statins, so it is highly unlikely that monacolin is the sole reason why RYR is able to lower cholesterol.

RYR contains other plant compounds such as phytosterols and isoflavones as well as unsaturated fatty acids. Thus, it is likely that these substances play a role in red yeast rice’s ability to decrease cholesterol.

What is certain is that the red yeast (monacus purpureus) used to make RYR stops the action of an enzyme that helps in the formation of cholesterol in the human body, thus reducing cholesterol overall.

The benefits of red yeast rice stretch way beyond reducing high cholesterol levels:

  • Reducing high cholesterol
  • Reducing muscle fatigue
  • Improving insulin sensitivity
  • Reducing obesity
  • Reducing oxidative stress

Cholesterol reduction and red yeast rice

Supplements of red yeast rice are most often taken to lower hyperlipidemia, ie high cholesterol.

There are lots of studies proving the effects RYR extracts have on cholesterol. The average benefits found by comparing the results of dozens of studies are (inconsistencies aside) as follows:

  • 1.2 grams a day lowers LDL cholesterol levels by 26% in 8 weeks
  • 2.4g a day lowers LDL levels by 22% and total cholesterol by 16% in 12 weeks

A study published in the American Journal of Cardiology in 2010 examined how RYR supplements affected 25 patients who couldn’t tolerate statins.

The results? … on average total cholesterol went down by 13% and LDL dropped by 19%. And the RYR was well tolerated.

Another study from 2007 in the European Journal of Cardiovascular Preventions and Rehabilitation described the effects of RYR on 79 patients aged 23 to 65 years with high cholesterol.

Some subjects took 600mg of RYR twice a day for 8 weeks, others were administered a placebo. The subjects who got the RYR showed significantly lower LDL cholesterol and total cholesterol, at the end of two months, compared to those who were given the placebo.

Muscle fatigue and red yeast rice

Many statin users complain about muscle fatigue, pain in the muscles and a real sense of muscle weakness as this writer can attest. Estimates suggest that 10% to 15% of users of statins experience muscle fatigue.

A study published in May 2018 by the National Institutes of Health in the USA examined the effects of taking simvastatin or RYR on 60 patients with high cholesterol levels and low to moderate risk of cardiovascular disease.

The muscle fatigue score, the physical activity, the serum lipid profile and the safety profile were then evaluated.

After 4 weeks of taking either the statin (33 patients) or the RYR (27 patients), the fatigue score was significantly increased in patients treated with simvastatin, whereas no significant change was observed in patients receiving red yeast rice.

In addition, the physical activity level was significantly decreased in patients from simvastatin group when compared to those from red yeast rice group.

Similar lipid-lowering effects were observed in both groups. The safety profile was not affected after the treatments.

The study concluded that RYR worked just as well as the statin but with less fatigue.

Improving insulin sensitivity with red yeast rice

RYR can help maintain normal blood glucose levels.

A study published in 2012 in the World Journal of Cardiology showed that RYR extract can contribute to the maintenance of normal levels of blood glucose when delivered in a dietary supplement that also contains berberine and policosanol to people with metabolic syndrome compared to those who were just given a placebo.

Metabolic syndrome is a health disorder that involves having a combination of any three of the following … abdominal obesity, hypertension, high blood glucose, elevated triglyceride levels, or low HDL (‘good’) cholesterol.

After 18 weeks, subjects who took the supplement had a significant decrease in insulin resistance, as well as both LDL and overall cholesterol, compared to subjects who had been taking a placebo. 

Using red yeast rice to reduce obesity

Obesity and high cholesterol are two common health concerns that often are found together.

Research using animals has found that RYR is effective when used to treat both these conditions.

In a study published in the Journal of Medicinal Food in 2015, researchers segregated animal subjects into 5 groups … normal diet, high fat diet with no RYR, and three high fat groups given differing amounts of RYR.

The researchers found that the added RYR prevented weight gain and also improved the atherogenic index of subjects.

The atherogenic index of plasma provides information about cholesterol ratios in the body. It is used as a marker to predict the risk of atherosclerosis and coronary heart disease.

The researchers concluded that RYR has therapeutic potential in treating obesity and hyperlipidaemia, ie too much fats (lipids) in your blood such as cholesterol.

Reducing oxidative stress with red yeast rice

Oxidative stress is an imbalance between free radicals and antioxidants in your body.

Free radicals are oxygen-containing molecules that can react easily with other molecules. These reactions are called oxidation. They can be beneficial or harmful. Oxidative stress plays a major role in the formation of disease.

In July 2017, results were published by the US Library of Medicine (NIH) of a double-blind, placebo-controlled, randomized trial involving 50 patients with metabolic syndrome and the effects of a supplement containing both RYR and an extract of olives.

The trial found that supplementing with RYR and olive extract greatly decreased two significant biomarkers of oxidative damage or stress.

The reduction of these two markers has been associated with a lower risk of heart disease with persons who have metabolic syndrome … which includes most of us diabetics.  

How to use red yeast rice

Finding RYR supplements online or in your health food store is easy. But deciding what is the best daily dosage is not so easy.

Most studies use a standard 2,400mg of extract a day, broken into two or four doses a day of 1,200mg twice a day or 600mg four times a day.

I have never seen any clinically verified reasons why this ‘standard’ is justified. But, as an alternative suggestion is not available, these can be viewed as the recommended doses.

Any RYR supplement should be taken with food. It is also best taken with at least 90-120mg of CoQ10 to prevent you getting a deficiency of CoQ10.

Different manufacturers of RYR supplements use differing strains of yeast and different fermentation processes.

This means that the amount of monacolins will vary between brands, ranging anywhere from zero to 0.6% of the final supplement.

The trick … read the labels closely.

Possible side effects of red yeast rice

Side effects from taking red yeast rice are usually mild (if there are any at all). These can include … headache, upset stomach, heartburn (acid reflux), gas, or dizziness.

Aching muscles and muscle weakness are also possible, especially if the RYR supplement contains high levels of monacolin. If you experience such problems, stop taking the supplement and contact you doctor.

Received medical opinion is that you should not take RYR if you are already taking … statins or other cholesterol-lowering drugs … antifungal drugs … drugs that suppress your immune system … the antibiotics erythromycin and clarithromycin … protease inhibitors used to treat HIV

You should also avoid red yeast rice if you have … kidney disease … liver disease … thyroid issues … musculoskeletal disorders … a high risk of cancer … a serious infection … had an organ transplant … more than two alcoholic drinks a day … an allergy or sensitivity to rice, red yeast or any yeast.

Anyone under 20 years of age should not take RYR supplements.

Nor should woman, irrespective of age, if they are breastfeeding, pregnant or trying to become pregnant.

Perhaps it would be wise to consult your doctor before you start taking RYR supplements. If he is already prescribing statins, you should ask him about switching to RYR supplements.

Author: Paul Kennedy

Paul D Kennedy is a qualified accountant and an international business consultant who used his skills as a researcher to uncover the mysteries of type 2 diabetes and gain control over his health and wellbeing.

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