Statins are commonly prescribed medications for people with uncontrolled high cholesterol. While statins are tolerated well by most people, about 10% experience elevated liver enzymes and muscle-related pain (myalgia) as side effects. Reportedly, up to 57% of people who experience statin-associated myalgia (SAM) will experience symptoms when rechallenged with another statin. The dilemma lies in how to treat cholesterol in people who experience SAM.
Red Yeast Rice Helps Lower Cholesterol
Red yeast rice has been used medicinally by the Chinese for indigestion, diarrhea and blood circulation. Published reports dating back to the Tang Dynasty (800 AD) state that red yeast rice is made by fermenting red yeast (Monascus purpureus) over cooked white rice. In 1979, monacolin K, a lovastatin analogue, was isolated from a strain of M. purpureus. In 1987, lovastatin was the first cholesterol-lowering statin approved by the FDA.
Since the early 1990s, many companies have marketed red yeast rice as a natural cholesterol lowering supplement. In 2007, certain supplements were found to contain a high quantity of lovastatin. As a result, the FDA banned red yeast rice by Swanson Healthcare Products, and Cholestrix by Sunburst Biorganics from being sold in the U.S., warning people to avoid buying these over the internet. However, many products are still easily accessible over the internet and in retail stores.
Red Yeast Rice for Statin-Associated Myalgia
Many clinical studies are now targeting the beneficial effects of red yeast rice in SAM. Apparently, consumer spending on red yeast rice increased in the U.S. up to 80% between the years of 2005 and 2008. Likewise, 19% to 50% of U.S. adults are using natural products in addition to or in place of prescribed medications. Many physicians are unaware of the patient's use of natural supplements.
In the past few years, several clinical trials have studied the cholesterol-lowering effects of red yeast rice in people who experienced SAM. In most studies, participants took red yeast rice and were required to participate in a therapeutic lifestyle program or diet plan. Daily total dosages of red yeast rice ranged from 1.2 g to 4.8 g which is the equivalent of approximately 5 mg to 10 mg of lovastatin. Normally, doctors prescribed dosages of 20 mg to 40 mg of lovastatin for cholesterol. Researchers found that significant reductions in low-density lipoprotein (LDL) cholesterol and triglycerides, with no apparent effects on HDL. Myalgia was experienced by approximately 8% to 12% of the participants in several of the studies. Researchers speculate it may be due to a low dose of lovastatin. However, most of the studies only lasted eight to 24 weeks. Generally, myalgia is experienced between one to six months after starting treatment, but it can occur at anytime, usually between one week to 48 months. Additionally, the studies tend to be relatively small, ranging from approximately 20 to 40 people. Likewise, other components in red yeast rice such as phytosterols, isoflavones, and other monacolins may play a major role in the lowering effect of cholesterol.
The availability of marketed natural remedies like red yeast rice make them preferable to many people. Nonetheless, adverse effects due to red yeast rice are still reported such as excessive rises in liver enzymes and cases of hepatitis. Additionally, manufacturing of red yeast rice is not regulated, leading to different brands having varying concentrations of monacolin K. Contamination with citrinin (toxic to the kidneys) has been reported as well. It is very important to inform a doctor and pharmacist when using red yeast rice in order to monitor liver function, cholesterol levels and other components.
References:
Heber D et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231-6.
Becker DJ et al. Red yeast rice for dyslipidemia in statin-intolerant patients. Ann Intern Med 2009;150:830-839.
Venero CV et al. Lipid-lowering efficacy of red yeast rice in a population intolerant to statins. Am J Cardiol 2010;105:664-666.
Halbert SC et al. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Am J Cardiol 2010;105:198-204.
Kolpakchi A, Vannacci A, Couteur D, Becker D et al. Red yeast rice for dyslipidemia in statin-intolerant patients: to the editor. Ann Intern Med 2010;152(2):133-135.
fda.gov, "FDA warns consumers to avoid red yeast rice products promoted on internet as treatments for high cholesterol products found to contain unauthorized drug " Accessed July 22, 2010.
Disclaimer
The information in this article is for educational purposes only. Always seek the advice of your healthcare provider prior to starting or stopping any medicine or treatment.
Katrin Holt - My name is Katrin Holt, and I am a pharmacist that loves to write about disease states and the medicines used to treat them. I graduated ...
