How to Use Red Yeast Rice Safely

June 17, 2009

If you’ve been taking a statin drug to lower cholesterol, you’re probably aware of the potential side effects of these drugs. They’ve certainly been in the news. A recent review of medical literature on the side effects of statins, which included more than 900 studies, showed that the most common side effects include: muscle pain, fatigue and weakness, cognitive problems, including some that are dementia-like, and peripheral neuropathy, which causes tingling, pain and numbness in the feet and hands. Other side effects are less frequent but wide ranging, from blood-glucose increases to sleep disruption and sexual dysfunction. Statins may have some benefits, but the side effects should give us all pause to consider other options. (Golumb, BA and Evans, MA. Am J Cardiovasc Drugs. 2008;8(6):373-418. doi: 10.2165/0129784-200808060-00004.)

And that’s where red yeast rice comes in. It actually is a red yeast, grown on rice, that contains a number of cholesterol-lowering substances, including one, monacolin K, that is identical to the cholesterol-lowering drug lovastatin. Red yeast rice has been used in China for centuries for poor circulation. It’s gained popularity in the U.S. as the side effects of statins become more widely known.

Research is showing that red yeast rice can do the job. A new study from China showed that red yeast rice lowered the risk for heart disease by about 30% after an average of 4.5 years of use. It also decreased the need for bypass surgery, lowered triglycerides and raised beneficial HDL. It was safe and well-tolerated. (Lu, Z., et al Am J Cardiol. 2008 Jun 15;101(12):1689-93. Epub 2008 Apr 11.)

Research conducted in the U.S. showed that people who were intolerant of statin drugs due to muscle pain were able to tolerate red yeast rice. They took 1,800 mg of red yeast rice twice a day for 24 weeks and had an average decrease in LDL cholesterol of 35 mg/dl, a drop comparable to statin drugs. Patients taking a placebo had a 15 mg/dl drop. (Both groups were also enrolled in a lifestyles changes program.) (Becker, DH, et al. Ann Intern Med. 2009;150:830839.)

David J. Becker, M.D., the study’s main investigator, noted that participants’ tolerance of red yeast rice was better than expected.

“Usually, about half the people who are intolerant of one statin drug are also intolerant when they switch to a different one,” he says. “But people who switched to red yeast rice were able to tolerate it better. Only three people (about 10%) on red yeast rice dropped out of the study because of muscle pain.”

Researchers think red yeast rice may be safer than statin drugs because it works at a lower dosage, perhaps because of a synergistic effect among its cholesterol-lowering compounds. Because of that, it may interfere less with the body’s metabolic pathways, especially its CoQ10 pathway.

But because red yeast rice is so similar to statin drugs, Dr. Becker suggests several precautions if you’re going to use it to lower cholesterol, or switch from a statin drug you’re currently taking.

Don’t take both red yeast rice and a statin drug without medical supervision.
Take CoQ10, 100-200 mg a day, to prevent the depletion of this important energy-producing biochemical. Both statins and red yeast rice interfere with the body’s production of CoQ10.
Get your liver enzymes checked about six weeks after starting red yeast rice, and then, every six months thereafter, as long as you take it.
Consider also taking phytosterols to further reduce LDL cholesterol.
Dosages ranging from 600 – 1,800 mg twice a day have been shown to be effective. Don’t take more than 1,800 mg twice a day of red yeast rice. Taking more doesn’t lower cholesterol further.
Support your efforts with a healthy lifestyle: exercise 30 minutes a day, reduce saturated and trans fats, drink green tea or take a supplement, eat garlic or take supplements, eat fish or take fish oil supplements, and eat plenty of leafy greens and fresh fruit.
Tell you doctor if you are having symptoms such as those listed above. You’ll have to stay off red yeast rice for about six weeks to see if the symptoms go away.

The Anti-Aging Bottom Line: Learn as much as you can about all the options at your disposal, and then work with your doctor to arrive at the choice that makes sense for you. If you decide to use red yeast rice, it’s important to choose a high quality red yeast rice product, since the amounts of active ingredients can vary widely.