Red Rice Yeast Instead of Statins?

Cardiologists David Becker, M.D., and Ram Gordon, M.D., Chestnut Hill Cardiology, studied 62 patients with high cholesterol in the first randomized, double-blinded placebo-controlled trial to evaluate red yeast rice in patients with a history of statin-associated myalgias (side effects that include muscle pain and weakness). Thirty-one of the patients took three 600-mg capsules of red yeast rice twice per day over the course of six months, and the other half received identical placebo tablets. The red yeast rice patients also participated in weekly meetings for the first three months, where they were taught about heart disease and how to incorporate heart-healthy nutrition, exercise and stress management into their lives.

At the conclusion of the study, the research found:

- Low-density lipoprotein cholesterol (also known as "bad cholesterol") levels decreased more in the patients receiving the red yeast rice (average decrease, 35 mg/dL) than in patients receiving the placebo (average decrease, 15 mg/dL).

- Total cholesterol levels improved more in the red yeast rice group than in the placebo group.

- Muscle pain scores, weight loss, HDL cholesterol (high-density lipoprotein or "good cholesterol") and liver or muscle enzyme levels did not differ between the two groups.

Red Yeast Rice, a staple of Chinese medicine for more than a thousand years, is derived from a fungus that grows on rice. A series of compounds within the red yeast rice have been found to slow the production of cholesterol in the liver. The medical community, however, has been slow to consider its potential use as an alternative treatment therapy for patients with statin-associated myalgias because the supplement is not regulated by the Food and Drug Administration.


Question to Andrew Weil M.D.:
Now that a scientific study has found that red rice yeast supplements work as well as statin drugs for cholesterol control I'm wondering if I should switch from the statin I now take. What's your recommendation?

Answer (Published 6/30/2009)

You're referring to a study published in the June 16, 2009 issue of the Annals of Internal Medicine showing that a red rice yeast supplement worked as well to lower LDL ("bad") cholesterol as prescription statin drugs. The study included 62 patients, all of whom quit taking statins because of muscle pain, the most common side effect of these drugs. Half the 62 patients in the study received a red rice yeast supplement; the other half were given a placebo. After three months, average LDL levels among those taking the red rice yeast had dropped an average of 27 percent compared with six percent among the placebo group. All the participants were taught how to eat well, exercise and otherwise maintain a healthy lifestyle. Only seven percent of the patients taking the supplement developed muscle pain; among statin users, at least twenty percent experience muscle pain initially but many improve once their bodies get used to the drug.

Red rice yeast (Monascus purpureus) is a natural source of statins, but unlike pharmaceutical products, it provides a mix of these compounds rather than a single one. The complex mixture interacts with the body more smoothly and is less likely to cause toxicity.

One active ingredient in red rice yeast extract, monacolin K, is the active component of the FDA approved statin Mevacor. The lead researcher of the new study, David Becker, M.D., of Chestnut Hill Cardiology in Pennsylvania, said that because the dose of monacolin K in the red rice yeast supplement used in the study was five times smaller than the amount in a typical Mevacor prescription, "something else is having a powerful lipid-lowering effect." Healthy lifestyle changes among the study participants probably didn't account for the difference.

This is a valuable study, but I wouldn't recommend switching from a statin to red rice yeast without your physician's approval and supervision. Because supplements are unregulated and the demand for quality ingredients is growing, some products will not actually contain any red rice yeast extract and, as a result, won't be effective.

I have put many patients on red rice yeast products with excellent results and have seen only two patients who could not tolerate them because of side effects. Note that anyone taking statins, either as red rice yeast or prescription drugs, should be on daily supplements of coenzyme Q10 (CoQ10). Statins inhibit the body's production of this coenzyme along with lowering cholesterol. CoQ10 is necessary for optimum function of muscles, including heart muscle.

Andrew Weil, M.D.

Berberine against Cholesterol

Berberine is a quaternary ammonium salt from the protoberberine group of isoquinoline alkaloids.

It is found in such plants as Berberis [e.g. Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), Berberis aristata (tree turmeric)], Hydrastis canadensis (goldenseal), Xanthorhiza simplicissima (yellowroot), Phellodendron amurense^[2] (Amur cork tree), Coptis chinensis (Chinese goldthread), Tinospora cordifolia, Argemone mexicana (prickly poppy), and Eschscholzia californica (Californian poppy). Berberine is usually found in the roots, rhizomes, stems, and bark

During the last few decades, many studies have shown berberine has various beneficial effects on the cardiovascular system and significant anti-inflammatory activities.^[18] A Canadian report suggested berberine can effectively reduce intracellular superoxide levels in LPS-stimulated macrophages. Such a restoration of cellular redox by berberine is mediated by its selective inhibition of gp91phox expression and enhancement of SOD activity.^[19]

Berberine exerts up-regulating activity on both the low-density-lipoprotein receptor (LDLR) and the insulin receptor (InsR). This one-drug-multiple-target characteristic might be suitable for the treatment of metabolic syndrome.^[20][21]

Berberine lowers elevated blood total cholesterol, LDL cholesterol, triglycerides and atherogenic apolipoproteins (apo B) (Apo B),^[41] but the mechanism of action is distinct from statins.^[42][43][44] Berberine reduces LDL cholesterol by upregulating LDLR mRNA expression posttranscriptionally while downregulating the transcription of proprotein convertase subtilisin/kexin type 9 (PCSK9), a natural inhibitor of LDL receptor (LDLR),^[45] and increasing in the liver the expression of LDL receptors through extracellular signal-regulated kinase (ERK) signaling pathway,^[46] while statins inhibit cholesterol synthesis in the liver by blocking HMG-CoA-reductase. This explains why berberine does not cause side effects typical to statins. Berberine and plant stanols synergistically inhibit cholesterol absorption in hamsters.^[47]

Berberine seems to improve the arterial endothelial function in humans.^[26][48] Berberine activates AMP-activated protein kinase (AMPK),^[49] specifically extracellular signal-regulated kinases (ERK),^[50] which plays a central role in glucose and lipid metabolism,^[51][52] suppresses proinflammatory cytokines,^[53] and reduces MMP-9 and EMMPRIN expression,^[54] which are all beneficial changes for heart health.