Cholesterol and Metabolic Health:
Red yeast rice is the product of rice fermented with a various types of yeast. It has been used for a long time in Asian cuisine and traditional medicine for its powerful health-promoting qualities and it is currently popular as a supplement for its scientifically proven medicinal properties. The most common use of red rice yeast is to lower cholesterol [i]. The active ingredients of red rice yeast are similar to the prescription drugs known as “statins”, which are prescribed by doctors to lower cholesterol and to lower heart disease risk. The scientific explanation behind this action is that red rice yeast and statins work on the same pathway, known as the mevalonate pathway. In the use of red rice yeast or statins; the enzyme called HMG Co-A is inhibited, therefore less cholesterol is produced by the body. Red yeast rice contains the compound monacolin K, which is the same active ingredient found in prescription cholesterol-lowering medications like lovastatin [ii]. This action is known to be effective in the same way as statins and therefore a popular choice for those wanting to lower their cholesterol [iii] [iv] [v].
However, it is worth noting that CoQ10, vitamin D and selenoproteins including Glutathione Peroxidase, a powerful antioxidant produced by the body, all use this pathway. Therefore, it is recommended that levels of vitamin D and CoQ10 should be monitored closely with red rice supplementation, as is also the advice regarding statin use [vi] [vii].
Metabolic syndrome is the medical term for a combination of prediabetes or diabetes, high blood pressure (hypertension) and obesity. A small, 18-week study found that a supplement containing red yeast rice was able to reduce blood sugar levels, circulating insulin levels and blood pressure in people with metabolic syndrome [viii] [ix].
Another 8-week study looked at the effects of red yeast rice on mice fed a high fat diet compared with a control group. It was found that red yeast rice was able to prevent increases in cholesterol levels and body weight [x].
It was also found that red rice yeast has an anti-inflammatory effect due to its action against oxidative stress, which can cause damage in the body. A study in 50 people with metabolic syndrome showed that taking a supplement containing red yeast rice and olive extract for 8 weeks reduced levels of oxidative stress by up to 20%. Note that oxidative stress is a leading cause of chronic inflammation.
Red yeast rice that is not fermented correctly may contain citrinin. Citrinin is a poison that may cause kidney damage. Therefore, sourcing from a trusted brand is recommended [xii].
Pregnancy and Breastfeeding:
Some chemicals in red yeast rice have caused birth defects in animals in studies. There is insufficient evidence to confirm the safety data, therefore it is recommended to discontinue use during pregnancy or breast-feeding [xiii].
Red yeast rice contains chemicals that are similar to the statin drug lovastatin. Lovastatin can cause liver damage. Some research shows that red yeast rice might also cause liver damage to the same degree as lovastatin. Hence, red rice yeast should be avoided in liver disease [xiv].
Interactions with Red Rice Yeast:
[i] InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. High cholesterol: Overview. 2013 Aug 14 [Updated 2017 Sep 7]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279318/.
[ii] Nguyen, T. Karl, M. & Santini, A. (2017). Red Yeast Rice. Foods (Basel, Switzerland), 6(3), 19.
[iii] Cicero, A.F.G. Fogacci, F. Banach, M. (2019) ‘Red Yeast Rice for Hypercholesterolemia’. The Methodist DeBakey Cardiovascular Journal. 15(3):192-199.
[iv] . Xue, Y. Tao, L. Wu, S. et al. (2017) ‘Red yeast rice induces less muscle fatigue symptom than simvastatin in dyslipidemic patients: a single center randomized pilot trial’. BMC Cardiovascular Disorders. 17(1):127.
[v] Xiong, X. Wang, P. Li, X. et al. (2017) ‘The effects of red yeast rice dietary supplement on blood pressure, lipid profile, and C-reactive protein in hypertension: A systematic review’. Critical Reviews in Food Science and Nutrition. 13;57(9):1831-1851.
[vi] . Mortensen, S.A. Leth, A. Agner, E. et al. (1997) ‘Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors’. Molecular Aspects of Medicine =18:S137-S144.
[vii] . Patrick, L. & Uzick, M. (2001) ‘Cardiovascular disease: C-reactive protein and the inflammatory disease paradigm: HMG-CoA reductase inhibitors, alpha-tocopherol, red yeast rice, and olive oil polyphenols. A review of the literature’. Alternative Medicine Review. 6(3):248-271.
[viii] Affuso, F. Mercurio, V. Ruvolo, A. et al. (2012) ‘A nutraceutical combination improves insulin sensitivity in patients with metabolic syndrome’. World Journal of Cardiology. 26;4(3):77-83.
[ix] Hermans, N. Van der Auwera, A. Breynaert, A. et al. (2017). ‘A red yeast rice-olive extract supplement reduces biomarkers of oxidative stress, OxLDL and Lp-PLA2, in subjects with metabolic syndrome: a randomised, double-blind, placebo-controlled trial’. Trials, 18(1), 302.
[x] Lee, H.S. Lee, Y.J. Chung, Y.H. et al. (2015) ‘Beneficial Effects of Red Yeast Rice on High-Fat Diet-Induced Obesity, Hyperlipidemia, and Fatty Liver in Mice’. Journal of Medicinal Food. 18(10):1095-102.
[xi] Hong, M. Y. Henning, S. Moro, A. et al. (2011) ‘Chinese red yeast rice inhibition of prostate tumor growth in SCID mice’. Cancer prevention research (Philadelphia, Pa.), 4(4), 608–615.
[xii] Nguyen, T. Karl, M. & Santini, A. (2017). Red Yeast Rice. Foods (Basel, Switzerland), 6(3), 19.
[xiii] Guardamagna, O. Abello, F. Baracco, V. et al. (2011) ‘The treatment of hypercholesterolemic children: efficacy and safety of a combination of red yeast rice extract and policosanols'. Nutrition, Metabolism & Cardiovascular Diseases. 21(6):424-429.
[xiv] . Bmj.com. 2021. Red yeast rice supplement “has the potential to cause” liver damage, doctors warn | BMJ. [online] Available at: https://www.bmj.com/company/newsroom/red-yeast-rice-supplement-has-the-potential-to-cause-liver-damage-doctors-warn/ [Accessed 9 November 2021].
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