Many people with high cholesterol take red yeast rice supplements as a “natural” alternative to statin drugs. The main compound in red yeast rice, monacolin K, lowers production of cholesterol in the liver and is marketed in purified form as the drug lovastatin (Mevacor and generics).
But how much active ingredient do the supplements contain? As much as prescription lovastatin? Or too little to have much effect?
In the largely unregulated world of supplements, it’s anyone’s guess. Labels rarely list this information, and products are not standardized or their labeling verified. In fact, products that do disclose lovastatin levels would be considered unapproved—and thus illegal—drugs. That’s what happened a decade ago to the supplement Cholestin, and its manufacturer had to remove the lovastatin.
Taking out the guesswork
Working with the testing company ConsumerLab.com, researchers from the University of Pennsylvania analyzed 12 red yeast rice products from major manufacturers. The results, published in the Archives of Internal Medicine in late 2010, indicated “dramatic variation in active ingredients” among the capsules. The amount of lovastatin in a daily recommended dose ranged from 0.2 to 14 milligrams.
Not only are those low doses, compared to the 20 or 40 milligrams in each prescription lovastatin pill, but the extreme variability in lovastatin levels means the manufacturers’ recommendations are quite arbitrary. In addition, one third of the products were contaminated with citrinin, a potential kidney toxin.
A statin by any other name
Red yeast rice, made by fermenting red yeast (Monascus purpureus) on rice, has been used for centuries in China as a heart remedy. But that doesn’t mean it is reliable or safe. It may seem more natural because it comes from a plant and is sold in health food stores—but it really is a drug.
Moreover, because it is not standardized and contains substances besides lovastatin, its effects are less predictable. As with statins, muscle and liver problems, though rare, are possible, and grapefruit juice may interact with it. Bloating and gas can be side effects. Red yeast rice should not be taken with other cholesterol drugs.
Bottom line: If you need a statin, stick with a prescription one. You know what you are getting, and the benefits are well documented. If you do take red yeast rice, you’ll need to have your blood tested regularly—as you would with prescription statins—to make sure it is working and not having adverse effects. Red yeast rice capsules are cheaper than most statin drugs, but generic lovastatin is often even cheaper. Plus, health insurance that covers prescription drugs will pay for statins.