“Dear Pharmacist,
My cholesterol is high, and my doctor is giving me 3 months before putting me on a statin, which I don’t want to do. Can you offer a natural solution?”
–C.H., Gainesville, Florida
Answer: You can maintain healthy cholesterol levels with diet and exercise alone, did you know that? Most people don’t, they assume they need a pill every day because that is what is prescribed to them. When you’re not pumping iron, blend baby blend. Juicing fruits and vegetables will support healthy cholesterol levels, detoxify the liver and suppress pain-causing chemicals. Try combining fresh carrots, pineapple, celery, parsley, ginger and green apples.
There are many dietary supplements to help you support healthy cholesterol levels. Just promise me you won’t lower it so much that you feel sick, that seems to be an American trend. You need some cholesterol to feel good, and I don’t think that lowering it to the levels currently suggested will necessarily stave off a heart attack. Studies show that it’s not so much cholesterol, but other factors like high-sensitivity C-reactive protein, fibrinogen and homocysteine that play a bigger role in your cardiovascular risk. There are books on the subject, the most recent eye-popping book is Ignore the Awkward by Uffe Ravnskov.
Cholesterol is a powerful antioxidant and it just so happens to be the backbone molecule of some crucial hormones that make us happy and healthy, namely estrogen, testosterone, DHEA, progesterone and brain hormones too. This is why I don’t think lowering it is such a good idea.
Let me focus on red yeast rice, or RYR. This is a dietary supplement and a food as the name implies. Red yeast rice is the product of yeast (Monascus purpureus) and it is grown on rice. Basically, it’s a fungus that grows on rice, but it’s a staple in traditional Asian diets. It contains several compounds known to inhibit cholesterol. The most popular one is known by two different names, either “mevinolin” or “monacolin K” and this particular fungal compound supports healthy cholesterol levels by blocking the action of HMG-CoA reductase enzyme in your liver. Years ago, one drug company saw green when they learned about red yeast rice and created the very first billion-dollar blockbuster statin out of it called “Mevacor” sold generically as “lovastatin.” Other names for drugs that contain lovastatin include Advicor, Altoprev and Altocor. Today, we have other sister drugs in the statin class that are stand-alone statins, or combination drugs that contain statins as part of the formula. Some of these include atorvastatin (Lipitor, Caduet), simvastatin (Zocor, Simcor, Vytorin, Lipex), pravastatin (Pravachol), fluvastatin (Lescol), or rosuvastatin (Crestor) just to name a few. More than 200 million prescriptions were written for statins in 2008, and it’s unfathomable to me the amount of money consumers have spent on drugs when Mother Nature makes her own statin! Obviously medications are stronger than RYR herb, and one advantage you might say is that they are more effective, and they are produced in a US FDA-approved lab under strict production protocols. All that is true.
Red yeast rice contains 14 naturally occurring compounds called monacolins, which block the production of cholesterol in the liver. This means blood levels of cholesterol are correspondingly reduced. The FDA has approved the medications above to do the same thing.
The question for many of you is “Will the Red Yeast Rice work as well as my statin drug?” Although RYR is a weaker statin than it’s pharmaceutical cousins, there’s no debate for me. One 2009 study published in the Mayo Clinic Proceedings found that the combination of RYR and fish oils lowered cholesterol just as well as Zocor over a 12-week period. The study details were such that the participants received either 40 mg of Zocor or the combination of fish oils (EPA total of 2,106 mg and DHA total of 1,680 mg) and RYR which contained 5.3 mg monacolin. After 12 weeks, LDL decreased significantly in both groups equally and impressively, the combination of fish oil/RYR group enjoyed a decrease in triglycerides by 29 percent whereas the statins did not lower triglycerides to any significant degree. Let me encapsulate this for you, the cheap dietary supplements outperformed the drug!
It gets better, a study led by two cardiologists, Dr. David Becker, MD and Ram Gordon, MD came up with some more interesting news about RYR. The randomized, double-blind placebo-controlled trial was published in the June 2009 issue of Archives of Internal Medicine and included 62 patients with high cholesterol. Half the group took 600 mg RYR twice daily for six months. The other half received placebo. After six months, LDL levels decreased on average by 35 mg/dL and total cholesterol went down as well, but only in the group receiving RYR. The placebo group did not see these benefits. Side effects common to statins such as muscle pain, cramps or liver enzyme elevations did not differ between the RYR and placebo groups. In other words, RYR did not cause statin-like problems as one might have expected since it behaves like a natural statin. Just to be clear, it may not have shown statin-like side effects in this one particular study, but that is still a real possibility, depending on the dose you take, and how long you take the RYR.
Red yeast rice is found in many over-the-counter natural healthy cholesterol-supporting supplements worldwide, however there has been constant legal dispute as to whether red yeast rice is a drug or a dietary supplement. I’m not sure why the FDA is so confused, let me clear this up, since my hands are clean. The only drug involved is the one sold at pharmacies! Please. Red yeast rice has been used in China as far back as the Tang Dynasty in 800 A.D. It was used to treat all sorts of ailments, including problems with blood flow, spleen, stomach ailments and pain relief.
The problem as I see it is getting a high-quality product! That’s tough to do because some products have a pretty label, but the tablets inside come up short. According to a study published in the American Medical Associations’ Archives of Internal Medicine 2008, there is a lot of variability in the actual content of monacolins in Red Yeast Rice products. Not only that, but according to this particular study, several formulas were contaminated with “citrinin” a mycotoxin (fungal poison) that is poisonous to man, and damages the kidneys according to animal studies.
There are hundreds of products available from health food stores, pharmacies and online web stores. Picking the right product is crucial, as with any dietary supplement. I spent a lot of money buying these products, and testing and sharing them with my friends and family. And researching my sources. This takes time, and of course it’s impossible to name every single brand that is good but I have done my best to find out what I can so I could share it with you.
My Opinion about Red Yeast Rice Products
If I had to take Red Yeast Rice, the following products are the ones that I would feel safe taking. They contain the active ingredient and withOUT the contaminant of fungal citrinin as far as I can tell. Obviously, I am human and I’ve done the best I can to make this list useful to you but if you know of a product that you are 100% sure to be high-quality and free of contaminants, feel free to email me with the name.
If I needed to take red yeast rice, the following products are the ones that I would feel best taking. These products contain the active ingredient and, as far as I can tell, DON’T contain the fungal contaminant citrinin (a natural by-product of the fermentation process used to produce red yeast rice). Obviously I’m human and I’ve done the best I can to make this list useful, but if you know of a red yeast rice product you are 100% sure to be high-quality and free of contaminants, feel free to email me its name.
These are Red Yeast Rice products I have personally tried and recommend, and I’ll tell you the reasons WHY. By the way, I get no backing from these companies, and the products are listed in no particular order:
“Choleast” by Thorne Research– Choleast is made by a GREAT company that I have written about for many years. Thorne appeals to folks with chemical sensitivities and food allergies, so Thorne never uses artificial colors, preservatives, or magnesium stearate (in case you are sensitive to that filler). A big advantage with this product is that it happens to contain CoQ10 so you don’t have to buy it separately. The disadvantage with Choleast is that you have to ask your doctor to order Thorne products for you, or ask him for his Patient-Assisted ordering password, or you can find a compounding/holistic pharmacy or doctor’s office in your local area that sells it off their shelf. In other words, Choleast is not found in health food stores, it has to be purchased through a doctor because that’s how Thorne operates – they offer their supplements only through physicians or pharmacists, not to general retail public.
“Best Red Yeast Rice” by Doctor’s Best– The advantage of this brand is that it is found easily at most health food stores and it contains a good amount of monacolins, the actual ingredient in RYR that does the work for you. Also, you only need to take it once per day for the typical dosage, which helps with compliance. I would take it with supper.
“Red Yeast Rice” by NOW Foods– This multi-tasking product contains high-quality RYR, plus some CoQ10, and Alpha Lipoic Acid, a powerful liver-loving antioxidant. If that isn’t good enough, it also contains Milk Thistle, a liver-nourishing herb and detoxifier. This is an intelligent combination if you want to reduce cholesterol while also protecting your liver with one single supplement. This product is also relatively easy to find in health food stores.
“NSI Red Yeast Rice” by Nutraceutical Life Sciences– I like a lot of the NSI products and you probably know that if you’ve read my Drug Muggers book or syndicated columns archived at my website. NIS makes formulas that are unique, very affordable, and pure. They are made by the folks who founded Vitacost.com, one of my favorite places to shop online because they discount everything – and who doesn’t love a bargain! I’ve met the people who head up Vitacost and they are very genuine in their quest to produce high-quality products that won’t break your bank. They make another specialty product called “NSI Red Yeast Rice with CoQ10 and No-Flush Niacin, which could add more punch to your efforts to support healthy cholesterol levels.
The following products are ones that I would personally avoid because, as far as I can tell, they might not contain the claimed amount of the natural active ingredient (monacolins), or they have been found to contain too high a level of the fungal contaminant citrinin, or both, so avoid these for the time being:
Red Yeast Rice imported from foreign countries– Manufacturing guidelines and cleanliness cannot always be assured, as with US labs that get FDA-inspected.
Red Yeast Rice by Swanson
Red Yeast Rice by Solaray
Red Yeast Rice by Nature’s Sunshine
Is Red Yeast Rice a Drug Mugger of any nutrients?
Since RYR is a natural statin, then yes, it is a drug mugger of Coenzyme Q10. This means you will need to take about 100 mg CoQ10 every day (or 50mg ubiquinol, the active version of CoQ10) along with the RYR in order to reduce the risk of muscle cramps, fatigue and other statin-induced side effects related to CoQ10 depletion. If you want to read more about the drug mugging effects of medications (in general) refer to my book “Drug Muggers” or read my article: How Drug Muggers Can Slowly Steal the Life Out of You.
Side Effects
RYR is not without side effects, after all, it may be plant-derived but it acts like a drug right? The compounds in RYR are chemically similar to HMG CoA reductase inhibitors (you call them “statins”) and so therefore RYR possesses a similar but weaker side effect profile to those of statin drugs. It’s not that common, but it’s possible that someone taking RYR (or statin drugs) could experience any of the following:
-Elevated hepatic enzymes
-Myalgia
-Myasthenia
-Teratogenesis (birth defects)
-Myopathy (muscle pain)
To be clear, the statins are more likely to cause these types of problems, as compared to RYR, but the point is that RYR acts like a statin and I want you to the potentials are. More likely with RYR, one could experience gastrointestinal complaints such as dyspepsia, nausea, diarrhea, constipation or flatulence. It’s best to take RYR with a little food and sometimes this mitigates the problem.
Before I end this article, I want to make one thing clear. I am not a doctor and I am not telling you to stop your statin, switch any type of medication or do anything different than what your doctor has ordered. That’s between you two. I’m only offering you information, for you to discuss with your team of health care practitioners, and decide what’s best. RYR is certainly an option that doctors should consider, especially in patients who are statin-intolerant, or who experience severe muscle cramps, or are at high-risk for rhabdomyolysis. Consumers may want to consider this too, as it has been shown in clinical trials to reduce cholesterol with fewer side effects than conventional drug therapy.
What Labs Do You Monitor While on Red Yeast Rice?
I would monitor the same exact ones that you do for statin drugs. Again, RYR is a natural statin, and while dangerous side effects are uncommon, I always want you to be on the safe side so monitor your cholesterol levels (which can be done with home test kits, or by your doctor) and also liver function. The reason is that your liver gets taxed when you take drugs that have to be metabolized by the liver. Think of it from the sense that your liver has to break down the drug (or herb) and so it gets taxed. Because statins and RYR work specifically along metabolic pathways in the liver cells, the organ is particularly sensitive to being overworked and taxed to the point of harm. Let’s talk about the “liver function test” for a moment because this is something your doctor has to do for you, using a blood draw from your arm. If you’ve ever taken a statin drug, this liver function test (LFT) has been performed on you. It’s important because the LFT is the test that will determine any kind of liver disease and it measures a few different parameters as part of its profile. So as part of the blood test, your LFT will measure a few things, among them:
Albumin- This is a protein that is made in the liver but floats around in the blood so it can be measured in the blood stream. When the liver is taxed, inflamed or ‘upset’ its ability to produce the albumin goes down. So low levels of albumin may be seen if your liver is taxed.
ALP (Alkaline phosphatase)- This enzyme will be high if you have liver or bone disease. ALP is just an enzyme that is found mainly in liver cells, next to bile ducts.
ALT (Alanine transaminase)- This is another enzyme that speeds up the breakdown of proteins in the body. When the liver is hurt or inflamed, ALT will go up.
AST (Aspartate aminotransferase)- Another enzyme in liver cells, that goes up if you have heart, muscle or liver damage.
Bilirubin- This chemical gives bile it’s yellowish/green color. When there is too much bile in the bloodstream, you can see it in the mirror because you will get jaundiced (that yellow-tint to the skin shows). Bilirubin or more specifically “conjugated’ bilirubin may be high for various intestinal disorders, and slight elevations are usually no big deal, but when it’s really high, it could mean liver injury (or other digestive disorders). This would be measured in the LFT test, or you can get a ‘bilirubin’ done all by itself.
Dosage of Red Yeast Rice
My motto has always been “Stay Low and Go Slow” meaning use the lowest effective dose. It’s better to use a dietary supplement in conjunction with exercise, healthy eating, juicing, and other supplements than to load up with big doses of the next best fad pill (drug or dietary supplement). So in this case, I suggest you start with a lower dose and see how you do. If you are going from a statin drug to RYR (and your doctor has approved you to stop the drug—because by all means I am not telling you to stop your drugs) then go with the dosage on the label or whatever he/she has indicated for you. Keep in mind, RYR is a natural, weaker statin-like herb, it’s not as strong as the drugs you’ve been taking. With that in mind, if you switch from a statin drug to RYR, you will need to do some additional work (as in exercise), this isn’t a magic pill like the drugs where it lowers your cholesterol in spite of what you eat.
For those of you who wish to take RYR, the typical dosage is about 2,000 – 2,400 mg total per day of red yeast rice. Remember, it’s the monacolins that do the work, and this is not always listed on the product.
What Else Can You Do to Lower Cholesterol?
Other amazing ways to keep cholesterol down (other than reducing cheeseburger intake) is to include some of the following natural supplements:
*1. Essential Fatty Acids- (you can take either fish oils such as those by Nordic Naturals or plant oils, a pure vegan brand is Essential Living Oils.
2. Policosanol- (several brands, some good ones are by Solgar, Swanson, NOW, GNC and NSI brand)
*3. Plant sterols– Just like the name says, this is from plants, it’s a natural type of cholesterol which prevents bad cholesterol molecules from being absorbed into your bloodstream. Studies say it can significantly lower LDL cholesterol. A good brand that is easy to find is CholestOff by Nature Made.
*4. Aged Garlic by Kyolic- which is an odorless supplement, but I recommend you eat it too 🙂
5. Guggul- a gummy resin from the guggul tree, how cool is that?! This herb can also lower fasting blood sugar, blood pressure, insulin levels and C-reactive protein. Doctor’s Best makes a brand called “Guggulow” which I found on Vitacost website and there are others.
*6. Probiotics- among the best is Dr. Ohhira’s and also take digestive enzymes “Digest Gold” by Enzymedica or KAL’s pancreatic enzymes.
*7. Cayenne Pepper- eat it in guacamole! The avocados give you glutathione, a powerful antioxidant and the dash of cayenne pepper improves blood flow and supports healthy cholesterol levels. You can also buy supplements.
*8. Niacin- there cannot be a discussion of cholesterol without mentioning this amazing B vitamin which can help improve blood flow (think Raynaud’s) and also support healthy cholesterol levels. It’s well known that niacin enhances the effects of statin drugs that’s why it can (and possibly should) be taken along with statins. But because it supports healthy cholesterol levels all by itself, maybe that’s all you need? One study found that niacin alone outperformed lovastatin because it also did wonderful things that the drug couldn’t do. This is all discussed in my Drug Mugger book. I have a whole chapter on the benefits of niacin in my Drug Mugger book sold at Amazon. In fact, niacin just so happens to be mugged by hundreds of drugs leaving you susceptible to rising levels of cholesterol.
There are hundreds of quality makers for niacin sold OTC, as well as a drug version called Slo-Niacin which is fine as well. Niacin as a non-flush formula and that’s fine to take too, but do not exceed recommended dosages on the label.
* These should be fine to take along with your statin cholesterol drug, and perhaps when the time is right, your physician will reduce or eliminate your medicine.
Did You Know?
A new April 2011 study by researchers at Florida State University has found that women who consume apples every day can lower their LDL cholesterol by up to 23 percent over 6 months.
Suzy Cohen, has been a licensed pharmacist for over 30 years and believes the best approach to chronic illness is a combination of natural medicine and conventional. She founded her own dietary supplement company specializing in custom-formulas, some of which have patents. With a special focus on functional medicine, thyroid health and drug nutrient depletion, Suzy is the author of several related books including Thyroid Healthy, Drug Muggers, Diabetes Without Drugs, and a nationally syndicated column.
