Red Yeast Rice Supplements

I have never thought much about over the counter supplements.  I take none and the medical science around them has been fairly poor.  Patients waste a lot of money buying these items and I occasionally convince them to reconsider their use.

Two supplements though have caught my attention:  Omega 3 fatty acids and Red Yeast Rice.   Both compounds impact arterial health and seem to have improving science behind them.  Last month I wrote about Omega 3 fish oil compounds.

Red Yeast Rice (RYR) is created by fermenting different species of yeast with red rice.  The fermentation produces a complex of substances called monacolins that lower lipids( blood fats).  One monacolin subtype, monacolin K, is quite similar to the cholesterol drug lovastatin (Mevacor).  Both inhibit an enzyme in the liver that makes cholesterol.

Red Yeast Rice preparations that provide 3-10mg of monacolin K/day have been shown over three months to lower the blood fat “LDL” with the same success as moderate dose statins drugs such as daily pravastatin 40mg (Pravacor) or lovastatin (Mevacor) 20mg.

Unfortunately, the only clinical cardiovascular outcome study of Red Yeast Rice was performed 10 years ago in China enrolling nearly 1500 post MI patients who took Red Yeast Rice over four years.  Death from all cause mortality was reduced 32% and death from coronary heart disease was reduced 30%.  I am not sure of the quality of this study and there is not much more out there that shows Red Yeast Rice actually reduces heart attacks and stroke.

The safety of Red Yeast Rice though is generally accepted.  However, any drug that inhibits the liver enzyme CYP450, and there are many, (grapefruit juice does this too) will elevate plasma concentrations of monacolin K.  A recent large European study that specifically looked at this issue concluded that use of monacolin K is not associated with adverse events. One rare exception to this conclusion is a yeast fermentation product in Red Yeast Rice called citrinin.  This kidney toxin is also found in small quantities in the world’s food supply, primarily in stored grains and cereals.  Therefore Red Yeast Rice products should state the amount of citrinin they contain and according to the European Food Safety Authority, ingesting more than 20 micrograms/kg/day should be avoided.

The role of Red Yeast Rice should be as an alternative to low or moderate dose anti-cholesterol drug (statin) therapy in patients who are truly statin allergic or who refuse to take a statin.  While there is little question that Red Yeast Rice lowers the blood fat LDL, (when LDL is increased there is an elevated risk of heart attack and stroke)  cardiovascular research studies on the benefit of this supplement are still scarce.  Accordingly, Red Yeast Rice cannot be recommended as a primary or first choice medication for blood fat (lipid) management.