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Dear Dr. Roach: I read your response to a recent question regarding drugs to reduce cholesterol levels. In your response, you talked about the risks of taking niacin and its potential side effects. You commented that statin drugs remain the first-line treatment for reducing heart disease risk and for people who are at an increased risk.
As a follow-up, my cardiologist recommended several months ago that I take something called red yeast rice. I've been taking this product for many months now, and it does seem to have reduced one of my cholesterol components. What do you think of red yeast rice for reducing cholesterol levels? -- S.
Answer: Red yeast rice is a compound that was developed as a food colorant and preservative in China about 1,500 years ago. It's been used for centuries as a traditional medication, especially for circulatory problems.
Red yeast rice contains a substance, monacolin K, which is exactly the same molecule that is in the active form of a prescription statin (lovastatin). At the right dose, this will absolutely drop total and LDL cholesterol levels. However, any batch of red yeast rice that you buy will have variable amounts of monacolin K.
Furthermore, a well-done trial comparing a prescription statin to several different supplements, including red yeast rice, didn't find any significant lowering of cholesterol levels when using commercial red yeast rice products -- probably because of the inadequate dosage.
While I understand that many people prefer their medications to come from natural sources, a substance like the monacolin K that is found in red yeast rice needs to be dosed precisely. If you use too little, it doesn't work, while too much increases the risk of side effects, whether it's red yeast rice or a prescription statin.
Since prescriptions are precisely dosed, your doctor can get the correct dose for you, and the dosage won't change from batch to batch.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.