Native to China, red yeast rice extract is the byproduct of Monascus purpureus Went (red yeast) fermenting on rice. Part of the Monascaceae family, Monascus purpureus is identified by its ascospores. The color of the mycelium is initially white, but soon changes to pink and then yellow-orange due to an increase in acidity and the development of hyphae. They explain that as the culture ages, it is characterized by a dark crimson color at the substratum.
General use
Documented as early as 800 A.D., Chinese red yeast rice was used in the preserving, flavoring, and coloring of food and wine. However, in addition to red yeast rice's culinary properties, it was soon discovered that red yeast rice possessed medicinal properties as well. The ancient Chinese pharmacopoeia, Ben Cao Gang Mu-Dan Shi Bu Yi, published during the Ming Dynasty (1368–1644), recorded a detailed description of red yeast rice and its manufacture. According to the pharmacopoeia, red yeast rice promotes blood circulation and stimulates the digestive system and spleen. Recent studies of red yeast rice indicate that it contains substances similar to those found in cholesterol-reducing (statin) prescription medications. In addition, research indicates red yeast rice may contain other cholesterol-reducing and be itself an agent useful in lowering cholesterol.
Traditional red yeast rice can be purchased in typical Chinese groceries. However, in this form, the extract possesses negligible to very low levels of statin compounds. Instead, manufacturers grow and process the M. purpureus Went under controlled conditions to increase the levels of statin. The powdered extract is then sold in capsule form.
In 2001, the Food and Drug Administration (FDA) determined that standardized red yeast rice extract (in this case, Cholestin®; developed by Pharmanex) possessed strong chemical similarities to the drug lovastatin, another cholesterol-reducing drug. Unfortunately, a pharmaceutical company, Merck & Co., trademarked lovastatin as Mevacor®. Because of the similarity, the FDA classified standardized red yeast rice extract as a drug. Under the Dietary Supplement Health Education Act of 1994, it could no longer be sold as a dietary supplement under penalty of law. As such, standardized red yeast rice extract has virtually disappeared from the United States marketplace.
Recent studies have indicated that taking the standardized dose (600 mg) of red yeast rice extract orally, two to four times per day, may assist in a significant reduction of total cholesterol (TC), low-density lipoprotein (LDL) cholesterol ("bad" cholesterol), and triglycerides (TG). It can also slightly increase levels of high-density lipoprotein (HDL) cholesterol ("good" cholesterol). Red yeast rice appears to achieve these benefits by reducing the production of cholesterol in the liver. This cholesterol synthesis reduction stems from one ingredient in particular, monacolin, which acts as an inhibitor of the enzyme responsible for cholesterol production. (The enzyme is known as hepatic hydroxy-methyl-glutaryl coenzyme A (HMG-CoA) reductase.) By lowering high cholesterol levels and promoting blood circulation, red yeast rice may help reduce the risks of heart, coronary, and cerebral vascular diseases. As such, people suffering from high cholesterol (240 mg/dl or above) could benefit from using red yeast rice extract. According to the Natural Dietary Supplements Pocket Reference, a 20% decrease in total cholesterol has been documented for treatments longer than one month. Additionally, red yeast rice extract possesses antioxidant qualities.
Preparations
Although there have been several studies on red yeast rice extract, there remains little information regarding its safety for long-term usage. There are also certain medical risks associated with this extract. As such, it is strongly suggested that anyone considering using red yeast rice extract for the prevention and treatment of high cholesterol consult with their physician before doing so. This is particularly important for people suffering from high cholesterol and/or heart disease. A baseline liver enzyme check is recommended beforehand, in addition to subsequent checks thereafter. In general, however, the recommended dose for adults is 600 mg (oral dose), two to four times per day.
Additionally, due to the 2001 FDA decision, only a doctor may legally prescribe standardized red yeast rice extract. As such, health-food stores now selling this product are doing so illegally. There are, however, several dietary supplements available to the public, which can be as effective as red yeast rice extract. Pharmanex, for example, has removed red yeast rice extract from their supplement, Cholestin®, and replaced it with other cholesterol-reducing, natural substances. It is advisable to consult with a physician regarding the available options.
Precautions
Due to the lack of medical evidence regarding red yeast rice extract's safety for use by youths and children, it is recommended that it not be given to people younger than age 20. Those at risk of or suffering from liver disease shouldn't take red yeast rice extract, as it may affect liver function. Due to the product's statin content, usage is also contraindicated for people with serious infections or physical disorders, who are pregnant or breastfeeding, or have had an organ transplant.
Side effects
Although the risks are low, usage can result in liver damage, kidney toxicity, and rhabdomyolysis (disintegration of skeletal muscle). Side effects are mild, including headache, dizziness, flatulence, heartburn, and stomachache. When the extract is no longer being taken, any side effects fade quickly.
Interactions
Because of its statin content, red yeast rice extract should not be taken with other HMG-CoA reductase inhibitors, such as atorvastatin and lovastatin. This interaction would increase the effects of these medications, thus increasing the risk of liver damage. However, niacin supplements can be safely used to enhance the cholesterol-lowering effects.
Due to the increased risk of rhabdomyolysis, red yeast rice extract should not be taken with high-dose nicotinic acid (more than 1,000 mg/per day). A physician should be contacted immediately if any muscle pain, tenderness, or weakness is experienced.
Alcohol consumption while using red yeast rice extract should not exceed two drinks a day. Also, grapefruit, grapefruit juice, and grapefruit products (like marmalade) should be strictly avoided. Grapefruit enhances the blood concentration of HMG-CoA reductase inhibitors by as much as 15 times, thus greatly increasing the risk of side effects and liver damage.
BOOKS
Burnham, T. H., S. L. Sjweain, and R. M. Short (eds.). The Review of Natural Products. Facts and Comparisons, 1997.
Kuhn, Winston. Herbal Therapy and Supplements: A Scientific and Traditional Approach. Lippincott, 2001.
McKenna, Dennis J., Kerry Hughes, and Kenneth Jones (eds.). Natural Dietary Supplements Pocket Reference. Institute for Natural Products Research, 2000.
PERIODICALS
Changling, Li, Zhu Yan, Wang Yinye, Jia-Shi Zhu, Joseph Chang, and David Kritchevsky. "Monascus Purpureus-fermented rice (red yeast rice): A natural food product that lowers blood cholesterol in animal models of hypercholesterolmia." Nutrition Research (February, 1998): 71–81.
Havel, Richard. "Dietary supplement or drug? The case of Cholestin." American Journal of Clinical Nutrition (February, 1999): 175–176.
Heber, David, A. Lembertas, Q. Y. Lu, S. Bowerman, and V. L. Go. "An analysis of nine proprietary Chinese red yeast rice dietary supplements: Implication of variability in chemical profile and contents." The Journal of Alternative and Complementary Medicine (April, 2001): 133–139.
Heber, David, Ian Yip, Judith Ashley, David Elashoff, Robert Elashoff, and Vay Go. "Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement." American Journal of Clinical Nutrition (February, 1999): 231–236.
Juzlova, P., L. Martinkova, and V. Kren. "Secondary metabolites of the fungus Monascus: a review." Journal of Industrial Microbiology (March 1996): 163–170.
Wang, Junxian, Zongliang Lu, Jiamin Chi, et al. "Multicenter clinical trial of the serum lipid-lowering effects of a Monascus Purpureus (red yeast) rice preparation from traditional Chinese medicine." Current Therapeutic Research (December 1997): 964–978.
OTHER
"Red Yeast Rice." Health and Age. [cited June 5, 2004]. <http://www.healthandage.com/html/res/com/ConsSupplements/RedYeastRicecs.html>.
"Red Yeast Rice." Whole Health MD. [cited June 5, 2004].<http://www.wholehealthmd.com/refshelf/substances_view/1,1525,10054,00.html>.
Sharpe, Ed. "Red yeast rice: Cholesterol-busting superfood or just another pharmaceutical?" [cited June 5, 2004]. <http://www.delano.com/referencearticles/red-yeast-rice-sharpe.html>.
