Adding red yeast rice extract to your diet can help lower your cholesterol levels, which reduces your risk of cardiovascular disease, like heart attack. Red yeast rice extract is a form of fermented rice developed in China.

Studies showing the benefits of red yeast rice extract

Studies in the United States have shown that high doses of red yeast rice extract (2.4 gm/day) can reduce your total cholesterol level as much as 20-25%, although usually less.

The effects of red yeast rice extract were also tested in China in a study that included almost 5,000 patients. All patients had coronary artery disease (CAD), and the study looked at how many people had a major cardiovascular event, like a heart attack, or died from CAD. Patients were randomly chosen to take at least 600 mg of red yeast rice extract twice a day or a placebo. Patients took part in the trial for an average of 5 years. The study showed that patients who took red yeast rice were 30-33% less likely to die from CAD or any other cause. They were also about a third less likely to need revascularization, such as angioplasty.

Stanley Hazen, MD, PhD, Section Head of Preventive Cardiology & Rehabilitation at Cleveland Clinic, says, “To my knowledge, this trial is the only one of its kind monitoring hard outcomes like heart attack, stroke and death risk in a randomized trial with red yeast rice extract. For this reason, the study is significant. However, the fact that the study only involved Chinese patients makes it difficult to know if the results would be the same for people of other races and cultures who eat a different diet than the Chinese."

Why does red yeast rice extract work to lower cholesterol?

Red yeast rice extract naturally contains lovastatin, which keeps the body from making cholesterol. The lovastatin in the extract has the same chemical make-up as Mevacor, a cholesterol-lowering drug (statin) first developed by the drug company Merck. But, the amount of lovastatin in the extract is much lower than the amount in the prescription drug.

Risks of red yeast rice extract

Because red yeast rice extract contains lovastatin, it can cause the same side effects as chemically created statins. These side effects include higher than normal liver function test results and muscle weakness (myopathy). Because the extract contains less lovastatin than prescription statins do, side effects are less common with the extract.

Red yeast rice extracts are not monitored by the FDA. The lack of FDA regulation means the product could contain ingredients besides the extract that could cause side effects or safety issues. In the past, some manufacturers of red yeast rice extract added chemically created lovastatin to boost the power to reduce LDL cholesterol levels. The FDA made the companies stop this practice, as the altered product was no longer completely natural. Also, different brands of the product may work better than others; and there can even be differences among batches from the same manufacturer. A higher cost does not guarantee a better product.

It is important to talk to your doctor before taking red yeast rice extract or any other medication or supplement and to have regular follow-up visits with your doctor. It is not recommended to take red yeast rice extract and prescription statins together.

Using red yeast rice extract instead of prescription statins

Dr. Hazen states, “When I have a patient who is adamant about not wishing to take an FDA-cleared drug, but is agreeable to taking a "natural" intervention to lower LDL cholesterol, I have, on these rare occasions, used red yeast rice extract and monitored the patient for side effects and ordered liver function tests. In general, when a patient takes a large amount of supplements, I also recommend getting a complete blood cell count with differential to check for eosinophilia − higher than the normal level of a type of white blood cells called eosinophils − or other abnormalities. If there is a significant jump in eosinophils, I recommend that the patient stops taking the supplements."

Plant stanols to lower cholesterol levels

Dr. Hazen recommends plant stanols as another nonprescription way to help lower LDL cholesterol levels. Unlike statins and red yeast rice extract, which prevent the body from making cholesterol, plant stanols keep the body from absorbing cholesterol. In one study, plant stanols (up to 9 gm/day, taken throughout the day with meals), helped reduce LDL levels by 15-18%. However, a typical range is 4-14%.

How do plant stanols help lower cholesterol levels?

When we digest food, the gallbladder releases bile into the intestines. The bile contains cholesterol and other compounds that help us digest and absorb lipid nutrients in the food we eat. The bile and cholesterol are reabsorbed in the lower parts of the intestines. Plant stanols keep the intestines from absorbing the cholesterol, and the cholesterol leaves the body through the stool.

Plant stanols work best when they are combined with a diet low in saturated fat and cholesterol. Even patients who eat a 100% plant-based diet with very limited amounts of cholesterol can lower LDL cholesterol levels by taking these supplements.

Plant stanols are most effective when they are taken with food. It is recommended to take them 3 times a day with meals.

Products that contain plant stanols

Benecol®, Benecol Light® and Take Control® are margarine substitutes that contain plant stanols. It is not recommended to cook with Take Control because cooking causes the stanols to break down. Benecol can be heated.

CholestOff is a capsule form of plant stanols. You can buy it over the counter at many stores. Many patients find this the easiest way to take plant stanols. The recommended dose is 2 g with each major meal (for a total of 4g/day).

Using red yeast rice extract and plant stanols

Taking red yeast rice extract and plant stanols together is an effective way to lower LDL cholesterol levels because the supplements work together to fight cholesterol in two different ways.

It is important to know that taking these supplements comes at a cost, literally. You will need to take fairly high doses, and many times a day. The supplements are more expensive than prescription statins that are widely available in generic form now such as simvastatin, lovastatin, atorvastatin and rosuvastatin.

Talk to your doctor about your prescription and other options to lower your cholesterol, and decide which treatment is best for you or if you want to try switching your treatment.

Reviewed by a Cleveland Clinic medical professional.

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