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Q. My last two blood tests showed that my cholesterol is too high. My doctor wants me to take a statin drug, but I'd rather use a natural remedy. I saw an ad for red yeast rice that says that it's as effective as the statins, and I can get it without a prescription -- but should I?
A. "All-natural" products have an obvious appeal. Remember, though, that natural products are composed of chemicals -- and in the case of red yeast rice, these chemicals may surprise you.
Red yeast rice is formed by a chemical reaction between rice and a particular yeast (Monascus purpureus). The fermentation reaction produces a family of chemicals called monacolins, which can lower cholesterol by inhibiting the liver enzyme HMG-CoA reductase. That makes this natural product sound pretty medicinal -- and it should, since the statins lower cholesterol in exactly the same way. In fact, one of the most potent monacolins is mevinolin, which was named lovastatin when it became the first statin drug to be approved in the U.S. in 1987.
Since the active ingredients in red yeast rice products are basically statins, it's no surprise that they really live up to the claim that they lower blood cholesterol levels. But red yeast rice products can also produce statin-like side effects, including muscle damage and liver inflammation.
Assuming you need a statin to reduce your cholesterol and cardiac risk, should you get it from red yeast rice or a prescription medication? In my view, the answer is clear. Because red yeast rice is sold as a "dietary supplement," the U.S. Food and Drug Administration does not regulate its contents. The monacolin content can vary from brand to brand and batch to batch, so it's impossible to know how well a particular product may work. Similarly, some products may contain harmful contaminants, so it's impossible to be sure a particular product is safe.
Red yeast rice is a medication, but because it's disguised as a dietary supplement, it does not play by the same rules that govern over-the-counter and prescription drugs. That makes it risky. The FDA has proposed banning red yeast rice as an unapproved form of the approved medication lovastatin. That makes sense to me. And if cents and dollars are on your mind, consider this. Many insurance plans cover statins, and some pharmacies sell generic lovastatin for as little as $4 a month, which is considerably less than most red yeast rice preparations.
Like you, I'm attracted to all natural remedies as long as they are safe, effective, and affordable. In the case of cholesterol, the natural remedies that meet this standard are diet, exercise, and weight control. --- Harvey B. Simon, M.D., Editor, Harvard Men's Health Watch
