The Role of Red Yeast Rice for the Physician

Abstract

Red yeast rice is an ancient Chinese dietary staple and medication used by millions of patients as an alternative therapy for hypercholesterolemia. In recent years, the use of red yeast rice has grown exponentially due to increased public interest in complementary and alternative medications and the publication of several randomized, controlled trials demonstrating its efficacy and safety in different populations. The most promising role for red yeast rice is as an alternative lipidlowering therapy for patients who refuse to take statins because of philosophical reasons or patients who are unable to tolerate statin therapy due to statin-associated myalgias. However, there is limited government oversight of red yeast rice products, wide variability of active ingredients in available formulations, and the potential of toxic byproducts. Therefore, until red yeast rice products are regulated and standardized, physicians and patients should be cautious in recommending this promising alternative therapy for hyperlipidemia.

Evidence of Lifestyle Modification in the Management of Hypercholesterolemia

“…Red yeast rice has been shown to have significant cholesterol lowering properties [77] however issues over standardized manufacturing practices have been limiting factors to wider promotion [78]. The varying preparations are also an issue when comparing studies of the efficacy of red yeast rice [79]. …”

Statin Alternatives: A Review of Over-the-Counter Lipid-Lowering Supplements

“…Isolated via fermentation of red yeast (Monascus purpureus), on rice, red yeast rice has been cited for its "digestion and circulation" benefits as early as 800 ad during the Tang dynasty in China. 33 This supplement's current popularity is largely driven by numerous studies that have headlined its potent lipidlowering effect. The fermentation process used to culture red yeast rice produces 14 monacolins, which are understood to be inhibitors of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase, which is responsible for cholesterol synthesis.…”

“…Merck & Co. marketed this particular monacolin under the trade name MevacorÔ in 1987, establishing the first Food and Drug Administration(FDA)-approved line of HMG-CoA reductase inhibitors. 33 Although monacolin is found ubiquitously in red yeast rice, a 2010 study by Gordon et al found marked variability of monacolin concentrations in 12 OTC formulations, including monacolin K. 34 Manufacturers of these supplements each claimed that they contained 600 mg of red yeast rice. The findings, based on third-party laboratory analyses, detected monacolin K levels ranging variably from 0.10 to 10.09 mg per 600-mg capsule.…”

Therapeutic properties of rice constituents and derivatives (Oryza sativa L.): A review update

“…This rice derivative is used as a traditional Chinese food and a dietary additive against hypertension, altered lipidemia and glycemia, and osteoporosis (Dong and Cai 2011). Red yeast rice is frequently used by patients with intolerance for standard anticholesterolemic drugs like statins (Gordon and Becker 2011;Musselman, Pettit et al 2012). The active principles of red yeast rice include a class M A N U S C R I P T…”

“…Moreover, red yeast rice production can affect the formation of unwanted compounds, particularly the nephrotoxic citrinin (Childress, Gay et al 2013). Hence, physicians and patients should be cautious in recommending or adopting this alternative therapy for hyperlipidemia (Gordon and Becker 2011).…”