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Red Yeast Rice – Properties and Benefits against Cholesterol

Red Yeast Rice – Properties and Benefits against Cholesterol

Red yeast rice has become a great ally against cholesterol, a main concern of most of the population. According to the Spanish Study of Nutrition and Cardiovascular Risk (ENRICA), a 50.5% of the adult population has high cholesterol levels. In other words, their total cholesterol is over 200mg/dl.

In the last few years, people have started to use red yeast rice as a natural supplement against bad cholesterol (LDL). This product should not be combined with medication to lower the cholesterol levels, since it can trigger negative interactions.

What is Red Yeast Rice?

This product is a natural substance extracted from rice, which has been fermented with a type of yeast called Monascus purpureus. From it, we can extract a substance called monacolin K or lovastatin. Said substance belongs to statins, which are used in the filed of medicine to lower the cholesterol.

Therefore, we can see that it is a completely natural remedy against a serious health problem: high cholesterol and triglyceride levels. In fact, this pathology can trigger unfortunate consequences in terms of cardiovascular health.

That is why its use is being increasingly taken into account. All its properties and benefits are an effective alternative to medicines which can have unwanted side effects.

Red Yeast Rice (RYR), produced through the fermentation of Monascus purpureus, has been used for a long time in Asian cuisine and traditional medicine. Monacolin K, which is chemically identical to lovastatin, is responsible for its positive effect on the cholesterol. However, there seem to be different opinions throughout the world. On the one hand, the European Authority of Food Safety supports the use of at least 10mg of monacolin K in RYR products can lower the blood cholesterol. On the other hand, the American Food and Drug Administration (FDA) forbids the commercialization of products with monacolin.

Wooden spoon with red yeast rice

Origin of the product

The use of red yeast rice in China was first recorded during the Tang dynasty (800 A.C). Actually, the detailed description comes from the BEn Cao Gang Mu, the ancient Chinese pharmacopoeia that was published during the Ming dynasty (1368-1644).

The ability of RYR to lower the cholesterol is partly due to its Monacolin content. In fact, monacolin can inhibit a key enzyme that is involved in the synthesis of cholesterol.

Eating the resulting product in all its forms has scientifically proven benefits for our health. In fact, these benefits were reported and written in ancient Chinese documents that praised the many virtues of the rice. To the point that it is still used today, after spreading to the rest of the countries.

At that time, it was already being advised to treat the so called “mucus” diseases. Some of their symptoms are overweight, feeling of satiety or chronic fatigue. Moreover, a cholesterol increase can also be due to a “mucus” disease.

RYR is a basic product in ancient Chinese diet and a medicine used as a natural alternative against hypercholesterolemia. In the last years, the use of Red Yeast Rice has grown exponentially due to the growing interest in alternative medicines. Moreover, there are many controlled random studies that show its efficacy and safety in different patients.

In 1986, the scientists Joseph L. Goldstein and Michael S. Brown won the Nobel Prize for its discovery of the chemically identical mevinolin. Later on, the active ingredient was isolated and synthesized to produce several chemical products known as statins.

Monacolin K – the active ingredient of red rice

Monacolin K is an active ingredient from the monacolin group and they have the same chemical structure as lovastatin and mevinolin.

This product can be an alternative therapy in order to lower the lipid levels for those who refuse to take statins. Moreover, some patients cannot stand a statin therapy due to the myalgia associated with statins. However, this is quite unlikely thanks to the government supervision, the wide range of active ingredients and formulas.

Nevertheless, doctors and patients should be careful until Red Yeast Rice products are regulated and standardized.

The Angkak has been traditionally used in Asia to treat gastrointestinal and cardiovascular disorders. Moreover, it is used to add color and preserve foods. In Europe, the use of RYR in common products is still unknown. However, some States from the E.U. sell this product as a food supplement.

Uses of Monascus Purpureus

Red Yeast Rice has proven that it can lower the serum lipid levels effectively in studies with animals and humans. Also known as Monascus purpureus, Red Yeast Rice is obtained from the yeast M. purpureus Went. Its manufacturing consists of a traditional method of rice fermentation.

Said yeast contains compounds which are capable of inhibiting the HMG-CoA reductase. Therefore, it is in charge of inhibiting the cholesterol synthesis in the liver. Apart from rice starch, protein, fiber, sterols and fatty acids, this product has other active ingredients. For example, Monacolin K, dihydromonacolin and Monacolin I to VI.

Red yeast rice crops

The researchers have determined that monacolin K inhibits the production of cholesterol. This is due to the fact that it inhibits a key enzyme in the liver (HMG-CoA reductase), responsible for producing cholesterol. Said red yeast contains at least nine similar substances to the active ingredients from statins in terms of structure.

These substances inhibit the activity of the enzyme necessary to produce cholesterol in the body (Heber et al. 1999). In addition, Red Yeast Rice also has unsaturated fatty acids that can lower the serum lipid levels (Wang, 1997). Red yeast rice extract can help to lower the LDL (bad) cholesterol levels and increase the HDL (good) cholesterol. Moreover, it can reduce the amount of unhealthy fats called triglycerides.

It seems that this is due to its ability to inhibit the production of cholesterol in the liver. In fact, the compound responsible for the mevinolin effect is chemically identical to the cholesterol-inhibiting compound from statin. It is usually sold as a prescribed medication called Mevacor. Mevinolin is also similar to the active ingredients from cholesterol medicines like Zocor (simvastatin) and Lipiton (atorvastatin).

Other components

It is also thought that the unsaturated fatty acids from Red Yeast Rice could help to lower the triglyceride levels (Heber, 1999; Wang et al. 1997; Qin et al. 1998).

But there is still another reason why we should add it to our diet. This product contains many other synergistic nutrients with properties to reduce the lipids apart from monacolin. For instance, it contains sterols like beta-sitosterol and campesterol (Heber et al. 1999). Both compounds interfere in the cholesterol absorption that takes places in the small bowel (Moghadasian y Frohlich, 1999).

There is clinical and experimental evidence about the effects of this phytosterols on the cholesterol and atherosclerosis. In fact, combining these sterols with statin medicines is a much more effective way of lowering the cholesterol (Plat and Mensink, 2001). So it would make sense to use just a single product that naturally combines both elements.

Red Yeast Rice also contains fiber, magnesium, unsaturated fatty acids like oleic, Linoleic and Linolenic acids (Ma et al. 2000) and Vitamin B like Niacin (Palo et al. 1960). All of them have renowned benefits to lower the serum lipids like triglycerides and cholesterol.

Pharmacological effects of fermented Monascus

Scientific research has confirmed the pharmacological effects on fermented Monascus (Endo and Monacolin, 1980) isolated from Monascus ruber. It has managed to regulate artificially induced hyperlipoproteinemia in rats. The reduced Monacolin K , Mevinolin is a pharmaceutical cholesterol reducer /by Merck, Sharp and Dohme). Fermented Monascus purpureus simple extracts lower the cholesterol, HDL and triglyceride levels in rats with induced hyperlipoproteinemia (Fink-Gremmels and Leistner, 1989).

The effect is weaker than in medication and we could compare it to some spices like garlic for example (Hansel and Haas, 1984). A Japanese patient (Japan Kokai, 1985) reported a lower blood pressure after taking fermented Monascus and an alcohol extract. In fact, Monascus extract is sold in Japan as a dietary supplement (Monacolin by Maruzen). This effect has also been proven in scientific studies.

On the one hand, red yeast rice cultures inhibit the bacteria of the genera Bacillus, Streptococcus and Pseudomonas (Wong and Bau, 1977; Wong and Koehler, 1981; Bau, 1977). Moreover, two yellow pigments from this yeast have a bacteriostatic effect against Bacillus subtilis (Wong and Koehler; 1981). Chen (1993) reported a particular inhibitory effect against Staphylococcus aureus. Fink-Gremmels et al. 1991 and Leistner and Dresel, 199 conducted more research about the bacteriostatic effect of fermented Monascus. Positive gram bacteria are generally stronger when inhibited than negative gram bacteria. On the other hand, Lactobacillus is not affected. All these information has lead to the use of fermented Monascus to replace nitrite in order to preserve meat (Fink-Gremmels et al., 1991).

Woman doing yoga by the sea

Using Red Yeast Rice to Preserve food

The red yeast rice from meat products had a better flavor in general than other similar products without Monascus (Fink-Gremmels et al., 1991). We can speculate and say that the flavor could be due to the oligopeptides. Since they partially hydrolyze the rice protein due to the enzymes from Monascus.

The strong color of fermented Monascus is due to a number of pigments: yellows, reds and oranges. Said pigments are secondary metabolites from the fermentation of the product. They belong to the chemical group of azaphilones, which are common metabolites in fungi. In fact, we know the chemical structure from most of them. If the yellow or red pigments are abundant or missing, the colors of Monascus purpureus will go from orange-yellow to scarlet and purple-red. Actually, the color can be affected by the cultivation conditions, like the pH and source of phosphorus and nitrogen from the soil (Meyer, 1990).

Composition of Red Yeast Rice

Monacolin K is identical to statin which is present in prescribed medicines in Germany (for example, Lovahexal®, Lovastatin® AL). Like all statins, it inhibits the synthesis of cholesterol.

Red Yeast Rice is a nutraceutical product obtained through the fermentation of white rice with the yeast Monascus purpureus and other fungi. RYR is made up of many compounds including polycides, unsaturated fatty acids, phytosterols, pigments and monacolines. The latter inhibit the HMG CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase. At least 13 monacolines have been isolated from RYR of which monacolin K is similar to lovastatin.

What is a nutraceutical product?

It is a food or part of a food, either of vegetable or animal origin, that has a potential pharmaceutic activity.

Actually, the term was coined in 1989 by Stephen DeFelice, founder and president of the Foundation for Innovation in Medicine.

In general, any food has the potential to go beyond its nutrient value due to its active ingredients. In fact, it can be used as a medicine depending on the dose. However, we need to pay attention to the potential risk factors of using this type of products. For example, the safety of the raw ingredient, presence of allergens, absence of toxicity, lack of exogenous and endogenous contaminants that could potentially threaten our health.

Benefits of Red Yeast Rice

  • Regulating the bad cholesterol levels (LDL) thanks to its monacolin K content
  • Lowering high triglyceride levels
  • Supporting the lipoproteins and CRP (C-reactive proteins)
  • Providing antioxidant and anti-inflammatory properties
  • Improving the digestion and regulating the blood pressure

Benefits for Cholesterol

Red yeast rice has monacolin K, which has proven to effectively block the cholesterol production. Basically, it inhibits the HMG-CoA reductase from the liver. In fact, several studies have proven that this product could considerably lower the LDL levels. Moreover, red yeast rice also provides sterols, isoflavones and monounsaturated fatty acids and healthy fats.

Before continuing, let’s explain what is cholesterol all about and its types. Hypercholesterolemia is a very common problem in developed countries. Actually, it is a fatty molecule that binds to lipoproteins. There are two types of cholesterol: the one that binds to high density lipoproteins (HDL) or good cholesterol; and the one that binds to low density lipoproteins (LDL), known as bad cholesterol.

A high HDL cholesterol will take LDL to the liver in order to be excreted. However, LDL has to be as low as possible, otherwise it could trigger arteriosclerosis after oxidizing.

Causes of a high LDL cholesterol

This cholesterol increase can be due to dietary factors, specially if we eat a lot of animal fat. For instance, butters, plenty of oil, pork or sweets. Moreover, it could also be due to alcohol, obesity and sedentarism. That is why people with high LDL levels will start changing eating habits and taking medicines or supplements. However, many will not experience any improvement, which may be due to the fact that the body is not functioning properly.

Branched cholesterol molecule

LDL is necessary to produce vitamin D and some hormones, to build cell membranes and produce bile salts to digest fat. The cholesterol production mainly takes place in the liver cells. There, the HMG-CoA reductase will regulate the amount our body produces according to its needs.

When this enzyme does not work properly, the cholesterol production goes out of control. The liver will keep on producing it even if the blood levels are enough. Consequently, this will result in an excess or hypercholesterolemia. In these cases, the only effective remedy will be to regulate the enzyme activity once again.

The function of Red Yeast Rice against Cholesterol

It is natural substance that works in synergy with the body. In fact, it is one of the best remedies to lower the cholesterol since it does not trigger side effects like medicines (capsules) and other artificial treatments. But even though Red Yeast Rice is effective, we need to take it regularly since the body cannot regulate cholesterol without it. Actually, its effect is similar to that of fish oil, even though it is more effective still.

However, there is a problem, by blocking the CoA reductase enzyme, it can lower the production of Coenzyme Q10. This molecule provides energy to the body cells and stimulates the proper functioning of the cardiovascular system. That is why it is advisable to take Q10 for chronic treatments to lower the cholesterol. Moreover, it is also advisable to take vitamins (specially D vitamins) to reduce these effects.

Many studies have focused on Red Yeast Rice as a remedy to lower the cholesterol. One of them lasted for eight weeks and its aim was to assess its effect on the lipid profile.

During those eight weeks, the patients took 5mg of Red Yeast Rice standardized extract. This intake managed to considerably lower (p <0.001) the LDL cholesterol (-20.5% vs. base line). The researchers concluded that combining phytosterol and red yeast rice is more effective when it comes to lowering the cholesterol. In fact, they reached a clinically significant reduction of LDL in patients with mild hypercholesterolemia.

How can we combine Red Yeast Rice?

Several studies have proven that Red Yeast Rice can be combined with other food supplements. Moreover, they will enhance the benefits from this product, apart from preventing potential side effects.

The main ones are:

Coenzyme Q10

The statins spend the CoQ10 from the body. This molecule is an endogenous antioxidant that ensures the energy balance from our cells. Organs like the heart need more energy and, therefore, more coenzyme Q10. Moreover, it is also important when it comes to neutralizing an excess of free radicals. As the body runs out of coenzyme Q10, we will feel fatigue, muscle weakness, pain and, eventually, heart failure. That is why it is advisable to take coenzyme Q10 if you are also taking statins. In the case of red yeast rice, it inhibits the synthesis of CoQ10 to a lesser extent, although we should also take coenzyme Q10.

Around a 5 and 10% of those who take statins, even up to a 22% according to the studies, suffer muscle alterations. They can be just a simple pain or be as serious as rhabdomyolysis (muscle tissue degeneration).

When statins inhibit the HMG-CoA reductose, they do not only block the endogenous cholesterol production in the liver. In fact, they also block the synthesis of coenzyme Q10. This explains why this fat-soluble endogenous antioxidant is low in people who take these medicines. Red yeast rice, policosanol and rice bran oil also affect the enzyme which is key for the lipid metabolism. In the long term, it can even cause a drop in the plasma Co-Q10 levels.

A little bit of history

At the beginning of the 90s, the cardiologist Peter Langsjoen from the Tyler medical center published a study. In it, he showed how statins did not only lower the cholesterol, but it also inhibited the synthesis of endogenous CoQ10. According to him, this was a clear risk for heart disease, since CoQ10 is indispensable for the cardiovascular system.

In the following years, more than a dozen controlled trials showed he has right. Taking statins could drop the plasma CoQ10 levels between a 19 and 54% and trigger mitochondrial dysfunction.

During a study in the University hospital from Praga in 2012, they gave Q10 to the participants for six month. The results were less muscle pain (myalgia) around 54% approximately and less muscle weakness in a 44% with the intake of statins.

It is advisable to take coenzyme Q10 during a treatment with red yeast rice. Like we said, its intake can lower the levels of this coenzyme in the body. In fact, the studies have determined that a positive dose would be taking 30mg of coenzyme Q10 per 10mg of monacolin K.

Woman holding a heart made with thread

Moreover, another effective combo would be 3g of monacolin k with 500mg of berberine, which also lowers the cholesterol. Other studies have combined it with other statins successfully, although we should always follow the advice from a professional. Otherwise, this combination can cause an overdose.

Omega 3

Omega 3 fatty acids keep the LDL levels under control. As we know, LDL or bad cholesterol is in charge of transporting cholesterol from the liver to other parts of the body. A high LDL level is not good because it can trigger cardiovascular diseases.

Omega 3 increases the HDL or good cholesterol and eliminates the plaque from the arterial walls. Low HDL levels have more chances of triggering cardiovascular diseases.
Triglycerides, along with HDL and LDL make up the total cholesterol in the body. High triglyceride levels are a symptom of possible heart problems. But omega 3 has proven to lower said levels successfully.

Omega 3 fatty acids and cholesterol have been studied in depth. In fact, the clinical studies have found that omega 3 fatty acids are a dietary supplement that supports our heart health.

Moreover, omega 3 fatty acids lower the formation of plaque in the arteries and risk of suffering a heart attack or stoke.

That is why omega 3 is a supplement that can and should be combined with other product to lower the cholesterol. For instance, red yeast rice since together they would produce substances that our body cannot synthesize in order to regulate the cholesterol.

Side effects and contraindications

Over 5 mg/day needs prescription

Due to the potential problems of taking Red Yeast Rice with Statins, a committee of experts from the BVL and BfArM published a statement. This independent committee is in charge of classifying commercial foods or food ingredients. They reached the conclusion that products with more than a daily dose over Red Yeast Rice of 5mg of monacolin K need to be regarded as medication. Therefore, we will need authorization due to their important pharmacological effect.

According to the legal regulation, pharmacological effects are exclusively reserved to medicines. Medicines are subject to prescription and they can only be sold if they have proven their quality, efficacy and safety. Consequently, these Red Yeast Rice products cannot be sold in Germany as food supplements.

On the other hand, the Regulation (CE) n 432/2012 authorizes a declaration of healthy properties for a great number of products. Apart from trivial substances like common vitamins and minerals, Monascus purpureus also appears in the present regulation. Therefore, Red Yeast Rice products can be sold stating the following healthy properties:

“Monacolin K from Red Yeast Rice contributes to regulating the blood cholesterol levels”. Moreover, it also includes an statement for those products that reach a daily intake of 10mg of Monacolin K.

A supplement or a medicine?

According to BfArM, this regulation from the E.U. does not interfere with its classification as a medicine. This is due to the fact that the regulation only applies if the product is classified as a food in the country.

Despite all the studies that prove how Red Yeast Rice can lower the bad cholesterol, we need to be aware that it also has harmful substances for our health. For instance, citrine which is a toxic molecules for the kidneys and liver in different conditions.

Many have asked to classify this products as medicines for many years due to its side effects. However, it has never been registered as such and it can still be purchased at herbalist’s shops and parapharmacies.

What are statins and which are its side effects?

Statins are one of the most powerful products to lower the cholesterol that are currently available. In fact, statins inhibit the HMG-CoA reductase, reducing the cholesterol synthesis in the liver. To compensate for this loss, the liver increases the absorption of LDL cholesterol, contributing to lower blood levels of LDL cholesterol.

In the last few years, statin treatments have reduced the morbidity and mortality due to coronary disease. This has been documented in several controlled clinical trials. However, the therapy with statins was first used in patients who suffered severe hypercholesterolemia. But most recent essays have also shown benefits for patients with moderately high cholesterol. Moreover, apart from the better lipid profile, statins seem to provide other benefits. For instance, they improve the endothelial function, reducing the formation of platelet thrombocytes, improving the fibrinolytic activity and reducing the frequency of transient myocardial ischemia.

Capsule and softgel supplements

Even though statins are effective when it comes to regulating the LDL cholesterol, they have serious side effects. Statins inhibit the 3-hydroxy-3-methylglutaryl-coenzyme A reductase.

A little bit of history

In 1990, Folkers and his colleagues theorized about how inhibiting this key enzyme would also inhibit the intrinsic biosynthesis of coenzyme Q10. The researchers stated that “if lovastatin lowered the CoQ10 levels, this reduction would be a new risk for heart disease. Since CoQ10 is indispensable for the heart function”.

The researchers informed about the protocols that involve five hospitalized patients, between 43 and 72 years of age. Moreover, the researchers monitored a volunteer for CoQ10, cholesterol levels and heart function. All this information revealed how lovastatin can effectively lower the CoQ10 levels. In fact, the five hospitalized patients who took lovastatin experienced a higher risk of heart disease. Consequently, this was potentially lethal for those who suffered type IV cardiomyopathy before of after taking lovastatin. In the end, the oral intake of CoQ10 increased its blood levels, improving the heart function in general.

The researchers concluded that “even though it is a successful medicine, lovastatin has side effects, particularly including hepatic dysfunction. Presumably, it can be due to a lovastatin-induced CoQ10 deficiency”.

The second study was meat to assess the effects of statins on the serum coenzyme Q10 levels and mitochondrial function. The researchers measured the serum ubiquinone and lactate/pyruvate proportions from 80 patients diagnosed with hypercholesterolemia. At the end of the study, the lactate/pyruvate proportions were considerably higher in those who took statins when compared to the control group. Therefore, this resulted in a lower mitochondrial function. Moreover, the serum Co-Q10 levels were lower in the group that took statins (0.75mg l-l) than in the control group (0.95mg l-l).

Possible side effects

Its contraindications are quite similar to those of statins:

  • Pain
  • Liver disorders
  • Renal deterioration

Who should not take Red Yeast Rice?

  • Do not combine the supplements with medication (capsules or other formats) to treat the cholesterol. You need to choose one of those remedies.
  • Only those patients who do not have more than 15% of cholesterol can use a treatment with Red Yeast Rice.
  • Pregnant women
  • People over the age of 70
  • Do not use it if you are eating grapefruit or products that contain this ingredient. This is due to the fact that grapefruit increases the statin levels in the body. Therefore, it would increase the statin levels way too much since medicines also contain this substance.
  • People with hepatic problems

Bibliography

  • 1. Panda BP, Saalem Javed, and Mohd Ali. Production of Angkak Through Co-Culture of Monascus Purpureus and MONASCUS RUBER2010 Jul-Sep; 41(3): 757–764.
  • 2. Ma J, Li Y, Ye Q, Li J, Hua Y, Ju D, Zhang D, Cooper R, Chang M. Constituents of red yeast rice, a traditional Chinese food and medicine. 2000 Nov;48(11):5220-5.
  • 3. Becker DJ, Gordon RY, Halbert SC, French B, Morris PB, Rader DJ. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. 2009 Jun 16;150(12):830-9, W147-9.
  • 4. Heber D, Lembertas A, Lu QY, Bowerman S, Go VL. An analysis of nine proprietary Chinese red yeast rice dietary supplements: implications of variability in chemical profile and contents. 2001 Apr;7(2):133-9.
  • 5. Jianping Liu, Jing Zhang, Yi Shi, Sameline Grimsgaard, Terje Alraek, Vinjar Fonnebo. Chinese red yeast rice (Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials. 2006 Nov 23. doi: 10.1186/1749-8546-1-4
  • 6. De Pinieux G, Chariot P, Ammi-Said M, Louarn F, Lejonc JL, Astier A, Jacotot B, Gherardi R. Lipid-lowering drugs and mitochondrial function: effects of HMG-CoA reductase inhibitors on serum ubiquinone and blood lactate/pyruvate ratio. 1996 Sep;42(3):333-7.
  • 7. Gerards MC, Terlou RJ, Yu H, Koks CH, Gerdes VE. Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain – a systematic review and meta-analysis. 2015 Jun;240(2):415-23. doi: 10.1016/j.atherosclerosis.2015.04.004. Epub 2015 Apr 12.
  • 8. Cicero AF, Derosa G, Parini A, Maffioli P, D’Addato S, Reggi A, Giovannini M, Borghi C. Red yeast rice lipid C-reactive protein vascular remodeling parameters in moderately hypercholesterolemic Italian subjects. Aug;33(8):622-8. doi: 10.1016/j.nutres.2013.05.015. Epub 2013 Jul 12.
  • 9. Hargreaves IP, Duncan AJ, Heales SJ, Land JM. The effect of HMG-CoA reductase inhibitors on coenzyme Q10: possible biochemical/clinical implications. 2005;28(8):659-76.

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