Red Yeast Rice Vs. Statin Drugs For Cholesterol

Q: I have high cholesterol, and I am wondering about using red rice yeast. Does it work? Also, I read somewhere that red rice yeast acts like a statin drug. Is taking red rice yeast the same as taking a prescription statin?

A: Red rice yeast has been used for more than 2,000 years in China as medicine and food. In fact, it provides that rich red coloring for Peking duck.

Based on at least six controlled studies, red rice yeast does lower LDL cholesterol (otherwise known as your "bad" cholesterol). Although some studies suggest that red rice yeast can also improve your "good cholesterol" — or HDL — I have not seen that happen very often in practice.

How does it work? Well, for one thing, red rice yeast does contain some lovastatin, which is also used as a prescription drug for lowering cholesterol. Some people argue that this makes red rice yeast a "statin drug." These people assume that the "natural statins" in red rice yeast are entirely responsible for its cholesterol-lowering effects.

I think this is too simplistic a theory for several reasons. One is that although red rice yeast does contain some natural statins, including lovastatin, the amount is much too low to account for the level of cholesterol-lowering seen in the studies. A total daily dose of 2,400 mg, for example, contains about 9.6 mg of natural statins, of which about 7.2 mg is lovastatin. As a comparison, when prescribing lovastatin, we usually use at least 20 mg per day.

As it turns out, red rice yeast has several other compounds that probably also have cholesterol-lowering effects. These include sterols, monounsaturated fatty acids and isoflavones. In isolation, none of these chemicals — including the natural statins — causes a big drop in LDL. But taken together, they seem to work better than you might expect if you just looked at the individual components.

On the other hand, some people have gotten "statin-type" side effects with red rice yeast, such as muscle aches and increased liver enzymes. So even though the statin levels seem lower than what we might use for a prescription, they may still be too high for some people.

It would be hard to say that taking red rice yeast is equivalent to taking a prescription statin drug. To start with, red rice yeast has nowhere near the number of studies on it that prescription statins do. There are huge studies, for instance, showing that prescription statins lower the risk of dying from heart disease. They also may improve outcomes for people with heart failure and lower the risk of diabetes. Red rice yeast simply does not have this level of data analysis behind it. Which is not to say that it doesn't have potential benefit — but in terms of proof, they're definitely not in the same league.

Dr. Astrid Pujari is a Seattle M.D. with an additional degree as a medical herbalist; she practices at the Pujari Center and teaches as part of the residency programs at Virginia Mason and Swedish/Cherry Hill hospitals. Send questions to apujari@seattletimes.com for possible use in future columns. All information is intended for education and not a substitute for medical advice. Consult your doctor before following any suggestions given here.