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Health Benefits Of Red Yeast Rice

Red yeast rice is a supplement made through the fermentation of mold on white rice that's primarily used to lower heart disease risk factors.

Studies show that red yeast rice may support health in several ways, including reducing cholesterol, blood sugar, and blood pressure.

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Red yeast rice is made by fermenting fungus, usually a mold called Monascus purpureus (M. Purpureus), with white rice. Though M. Purpureus is a mold, not a yeast, most supplements sold in the United States use the name "red yeast rice."   This fermentation process produces compounds called monacolins, which are the main active ingredients in red yeast rice. Monacolin K is a monacolin that works similarly to statin medications like lovastatin, which are used to treat high cholesterol. It inhibits cholesterol production in the liver, which reduces blood cholesterol levels. Red yeast rice is best known for its cholesterol-lowering properties but has also been linked to other health benefits. Most of the research on the health benefits of red yeast rice has been conducted on products that contain high levels of monacolin K. These products are available for purchase as dietary supplements in other countries. However, in the U.S., products that contain more than trace amounts of monacolin K are considered unapproved new drugs and cannot legally be sold as dietary supplements. Because of this, the following potential health benefits can't be applied to red yeast rice supplements sold in the U.S. Reduces Blood Lipid Levels  Red yeast rice supplements that contain high levels of monacolin K have powerful cholesterol-lowering properties and are commonly recommended to people with high cholesterol who aren't able to take statin medications, such as those who are intolerant to statins. People who are intolerant to statin medications are unable to take statins due to experiencing certain side effects. Statins often cause side effects, such as muscle pains, weakness, and cramps, which are collectively referred to as myalgias. Statins may also negatively affect liver function in some people. Statin intolerance is common, impacting up to 10% of those who are prescribed statins. Females, older adults, people with kidney disease, and those with a history of muscle-related symptoms are more likely to be intolerant to statins. When taken for at least four weeks, red yeast rice supplements have been shown to reduce low-density lipoprotein (LDL) cholesterol levels by 15–34% compared to placebo treatments in people with mild to moderate high cholesterol levels. Red yeast rice may also reduce other blood lipids, such as triglycerides. A review of 15 studies found that red yeast rice supplements in doses ranging from 200-4800 milligrams (mg) per day significantly lowered triglycerides, total cholesterol, and LDL cholesterol in people with elevated blood lipids. The review found that red yeast rice supplements more effectively lowered triglyceride levels than statin medications. These findings are related to products that contain more than trace amounts of monacolin K, which are prohibited from being sold as dietary supplements in the U.S. May Improve Blood Pressure   Though research is limited, some studies suggest that red yeast rice supplements containing monacolin K may effectively reduce blood pressure.  Red yeast rice contains gamma-aminobutyric acid (GABA), a neurotransmitter that regulates blood pressure by inhibiting vasopressin, a hormone that increases blood pressure levels.  A small study of 18 people with high LDL cholesterol found that treatment with 200 mg of red yeast rice containing 2 mg of monacolin K for eight weeks significantly decreased blood pressure, LDL cholesterol, and total cholesterol compared to a control group. However, other studies haven't found red yeast rice effective in reducing blood pressure levels. Because research findings are mixed, more studies are needed to fully understand red yeast rice's potential blood pressure-lowering benefits.   Has Blood Sugar-Lowering Effects  Red yeast rice supplements may benefit people with hyperglycemia (high blood sugar). Studies show that it may reduce high blood sugar levels by stimulating receptors in pancreatic cells called muscarinic M3 receptors, which play a key role in maintaining blood sugar levels. Red yeast rice may also support better blood sugar management by improving how the body uses insulin, a hormone that shuttles blood sugar into your cells for energy. A review of 30 studies found that red yeast rice supplements decreased fasting blood sugar and the long-term blood sugar control marker hemoglobin A1c (HbA1c). The review also found that red yeast rice supplements reduced insulin resistance, a condition where your cells become resistant to insulin, leading to high blood sugar levels. Some research suggests that red yeast rice may help protect against diabetes. A review of data on 34,504 people found that, compared to people who were prescribed the statin medication lovastatin, people who were prescribed red yeast rice were less likely to develop diabetes. However, this was related to prescription red yeast rice products, which are different from the red yeast rice supplements for sale in the U.S. Nevertheless, taking red yeast rice may support healthy blood sugar regulation.  Red yeast rice is available in several forms, including powders and capsules. It's commonly taken in divided doses, such as twice daily, but it can also be taken in a single dose. If you're interested in taking red yeast rice, you should speak with your healthcare provider to ensure you're using it appropriately and safely.  Dosage  The dosage of red yeast rice varies, but the most common dose used in studies is 600 mg twice daily. However, higher and lower doses have also been used in research. It's important to note that the content of monacolin K, the active compound in red yeast rice, in red yeast rice supplements varies widely. Studies of monacolin K may be effective for improving certain aspects of health, like cholesterol levels, when taken in doses of 3-10 mg daily. Most supplements don't disclose the amount of monacolin K they contain. In fact, a review that analyzed 28 red yeast rice products found that none of the included products disclosed the amount of monacolin K on the label. The study found that two of the products didn't contain any monacolin K, while the others contained varying doses of monacolin K. Some contained very high doses, and others contained very low doses. It's also illegal to sell red yeast rice products containing more than trace amounts of monacolin K in the U.S. It's currently unclear if taking supplements containing trace amounts of monacolin K provides any health benefits, including cholesterol-lowering benefits. When used appropriately, red yeast rice is considered safe. A review concluded that red yeast rice products that provide around 3 mg of monacolin K per day were well tolerated and had similar side effects as low-dose statin medications. Other studies have found that doses of between 3-10 mg of monacolin K taken for 4-24 weeks were safe and not associated with serious side effects. That said, red yeast rice supplements have been linked to a few safety concerns. Red yeast rice supplements can contain a toxic contaminant called citrinin, which can harm your kidneys and liver. If you're interested in taking a red yeast rice supplement, it's important to choose a product that's tested for contaminants and is certified citrinin-free. Although rare, some people may experience serious side effects, such as muscle breakdown and acute liver inflammation, when taking red yeast rice containing low amounts of monacolin K, as low as 3 mg per day. When buying a supplement, make sure the product is third-party tested. Unlike medications, supplements are not regulated by the FDA. This means their quality and safety can vary. Third-party testing confirms that the supplement contains the ingredients listed on the label and is free from harmful contaminants. Check for seals from reputable organizations such as NSF International, USP (United States Pharmacopeia), or ConsumerLab. Potential Drug Interactions Red yeast rice may interact with commonly prescribed medications, such as: Statin medications: Red yeast rice supplements contain monacolin K, which has the same chemical makeup as the statin medication lovastatin. Studies show that red yeast rice supplements have similar side effects as statin medication. Taking red yeast rice alongside statin medications may increase the risk of these side effects, including muscle aches. CYP450 3A4 and P-glycoprotein substrates: Some research suggests that red yeast rice may interfere with drugs metabolized by CYP3A4 and P-glycoprotein enzymes, such as high blood pressure medications, antibiotics, and pain medications. Because red yeast rice supplements could interfere with several commonly prescribed drugs, it's recommended to consult with your healthcare provider before taking red yeast rice, especially if you're taking one or more medications.  Can You Take Too Much Red Yeast Rice? Studies suggest that doses of red yeast rice with 3-10 mg of monacolin K taken for 4-24 weeks are safe and not associated with serious side effects. Though varying doses of red yeast rice have been shown to be relatively safe, there have been reports of adverse side effects, such as muscle breakdown and liver inflammation, associated with products providing 3 mg of monacolin K daily. Contact your healthcare provider if you have questions about safe dosing for red yeast rice products.  Red yeast rice supplements may cause several side effects, including: Though rare, red yeast rice supplements have been linked to more serious side effects, such as allergic reactions and muscle, liver, and kidney damage.  Because red yeast rice can cause side effects and may be unsafe for certain people, it's important to talk to your healthcare provider before adding it to your supplement regimen.  Red yeast rice is a dietary supplement made by fermenting a mold called M. Purpureus with white rice. It is high in compounds called monacolins, which function similarly to statin medications. Studies show that red yeast rice supplements may effectively reduce cholesterol and triglyceride levels and have blood sugar and blood pressure-lowering properties.  However, red yeast rice products contain variable amounts of monacolins and may be unsafe for some people. If you're interested in taking a red yeast rice product, it's best to consult with your healthcare provider to ensure it's a safe and appropriate choice for your health needs. 

Do Statins Cause Joint Pain?

Statins are prescription medications that lower blood cholesterol. Some people who use statins experience side effects, which can include joint pain.

If you or someone you know is trying to reduce their cholesterol, you've heard about statins.

According to the American Heart Association, statins are the most widely prescribed and evidence-based drug for lowering low-density lipoprotein cholesterol, or LDL.

According to the American College of Cardiology, high LDL cholesterol is one of the most common risk factors for atherosclerotic cardiovascular disease (ASCVD). The CDC estimates that 1 in 5 people died from heart disease in 2022.

Statins inhibit one of the first steps of cholesterol synthesis. They reduce the production of cholesterol by the liver by upregulating LDL receptors.

This can prevent extra cholesterol from building up on the inside of arteries, which could lead to heart attack or stroke. The end result is a 25 to 50% reduction in LDL cholesterol and a reduced risk of a future vascular event.

Generally, statins are well-tolerated. About 85 to 90% of patients report no side effects.

However, as with many people who take prescription medications, some people who use statins experience side effects. Keep reading to learn more about possible side effects, including joint pain.

There is little recent research on statins and joint pain. While muscle pain and joint pain are separate issues, if you're on statins and experiencing aches, it might be worth considering exactly where the pain is.

The most common complaint with statins is muscle pain. The rate varies significantly, between 0.3 to 33%. This is due to the different populations involved in studies and the vague categorization of muscle side effects.

Further, patients who take statins are often asked to keep an eye out for muscle problems. So the amount of muscle complaints is likely higher than its true value.

However, if you are feeling pain, symptoms can include:

In very rare cases, rhabdomyolysis, a potentially fatal condition, can occur. The vast majority of people who use statins will not have to worry about this condition, but you should discuss any aches and pains with your doctor.

Other reported side effects of statins include:

liver or digestive problems

high blood sugar

type 2 diabetes

memory problems

According to researchers, onset of type 2 diabetes is uncommon. It is suggested that there are 50 to 100 new cases for every 10,000 statin users over the course of 5 years.

Onset as a result of statin treatment is also more common in patients with preexisting risk factors. This can include obesity, pre-diabates, glycated hemoglobin, and impaired fasting glucose.

However, researchers say that the benefits of statin use outweigh the risk, even for high-risk patients who already have diabetes.

Memory problems are a debated topic in need of more research. A recent study has also shown that statins may reduce the risk of all-type dementia, Alzheimer's disease, and mild cognitive impairment.

It is recommended that liver enzymes are periodically monitored to prevent liver problems. If liver enzymes rise on statin medication, the dose can be adjusted. This normally resolves the issue.

Statins have been an important health development, but they aren't the only way to decrease your chances of heart attack and stroke.

According to research, lifestyle changes can reduce both LDL cholesterol levels and CVD risk. These include:

consuming a heart-healthy diet

maintaining a healthy weight

avoiding tobacco products

regular exercise

It is also important to keep these factors in mind while on a statin.

If your body initially reacts adversely to a specific statin, you still have options. Your doctor may want to rechallenge your body with the same statin or a different one.

This could be followed by a switch in statin type, step-by-step reduction in dose, and intermittent or alternate day statin dosing.

Statins have been shown to help prevent heart attack and stroke, especially in cases where those health issues are inherited. But statins are not the only way to reduce cholesterol. Simple changes in your diet and an increase in exercise can make a difference.

If you are starting on a statin, it is important to talk with your doctor about your individual risk factors and the benefits of the medication.

Demand Soars For Twice-a-year Jab To Lower Bad Cholesterol. Here's How It Works

While many cardiologists say it has been an excellent addition to their arsenal in fighting LDL-C, they also emphasise that the response to inclisiran in India may have been tempered by concerns over its high cost and potential side effects in the long term.

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Who can benefit from the drug

A large survey carried out by the Indian Council of Medical Research (ICMR) and the Madras Diabetes Research Foundation, published in The Lancet last year, had shown 81.2 percent Indians have dyslipidemia and 20.9 percent—or 185 million—have high levels of bad cholesterol.

Dyslipidemia is a disorder marked by abnormal levels of lipids, such as cholesterol, LDL-C, triglycerides, and high-density lipoprotein cholesterol (HDL-C), in the blood.

The Cardiological Society of India, in its first ever India-specific lipid management guidelines that came out in July this year, had said that high-risk individuals, such as those with diabetes or hypertension, should aim for an LDL-C level below 70 milligrams per decilitre.

Inclisiran is recommended for individuals whose cholesterol levels remain high despite being on statins, making it an alternative for those who struggle to control their LDL-C effectively with existing treatmenstts.

It may also be beneficial for people with a strong family history of cardiovascular events or those who have experienced recurrent heart attacks or strokes, where aggressively managing LDL cholesterol levels is crucial for reducing the risk of future incidents.

Additionally, inclisiran is advised for patients who experience significant side effects from statins, such as muscle pain or other adverse reactions, and are unable to tolerate them.

Dr Ashok Seth, interventional cardiologist and chairman of Fortis Escorts Heart Institute, New Delhi, said that inclisiran has been a tremendous addition in the therapies available to lower cholesterol for a significant number of Indians who are susceptible to adverse cardiovascular events due to high cholesterol.

"There are nearly 15 percent of all patients with high cholesterol who struggle to keep their cholesterol levels within limits despite trying the first two lines of treatment. For them, inclisiran has been a very potent tool and I have seen dramatic results in many of my patients who have tried it so far," he told ThePrint.

Despite the high cost of the drug—each injection costs nearly Rs 1.2 lakh—Seth said many patients with high LDL-C were asking for the drug, bypassing the first two lines of treatment.

"This, however, is not suggested at this point," he said.

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Specialists vouch for drug

Some other heart specialists, too, vouched for the drug.

Dr Sunil Dwivedi, consultant cardiologist with Manipal Hospital in Bengaluru, said he has used the drug in some of his patients who were either not responding to traditional cholesterol-reducing statins, couldn't tolerate statins, or who had multiple heart events.

"After the second injection, their cholesterol levels dropped to the target range, which is very promising, and none of them experienced any side effects. True to the clinical trial data, this drug has been very effective in such cases so far," Dwiwedi said.

In response to a query by ThePrint, Amitabh Dube, country president and managing director, Novartis India, said that it has been eight months since the launch of inclisiran in India and, over these months, the company has received positive feedback about the molecule from cardiologists across the country.

"We are happy to learn that doctors have been able to help their patients reach and sustain their target LDL-C or bad cholesterol levels and in turn improve their heart health," he said.

Dube added that the firm is witnessing a month-on-month increase in adoption of the molecule, but did not share the specific numbers.

"It is heartening to see our purpose of improving and extending people's lives come alive in the wake of the snowballing incidence of heart-related mortality and morbidity in India," he also said.

How it works

Statins are the most commonly used pharmacotherapies to lower cholesterol levels and work by inhibiting an enzyme called HMG-CoA reductase that is involved in the synthesis of cholesterol in the liver.

According to Dr Amit Bhushan Sharma, director and unit head of cardiology with Paras Health in Gurugram, inclisiran has shown promise due to its novel mechanism of treatment and convenient dosing regimen.

As a gene-silencing drug, it targets the PCSK9 enzyme, enhancing the liver's ability to remove LDL cholesterol, which could significantly benefit high-risk patients, especially those who do not respond well to statins or experience severe side effects.

With just two doses needed per year after an initial loading phase, inclisiran provides a convenient alternative to the frequent dosing required by other cholesterol-lowering medications, which may improve patient adherence and overall outcomes, he said.

The launch of inclisiran comes six years after Hyderabad-based pharmaceutical major Dr Reddy's Laboratories, under partnership with American biotech company Amgen, launched evolocumab—under the brand name Repatha—the first PCSK9 inhibitor in India.

Repatha, which costs nearly Rs 18,000 per injection, is also indicated for use by statin-intolerant patients or those with high bad cholesterol despite treatment with statins.

This drug, however, has to be administered as an injection every 15 days.

According to the American Heart Association, the main difference between evolocumab and inclisiran is that while the former delivers antibodies to block the PCSK9 gene, the latter switches it off. This means the PCSK9 protein is not made in the liver and more LDL receptors can return to the surface of the liver and continue to remove LDL cholesterol from the blood—thereby working for a longer period, nearly six months.

"Because inclisiran is effective for six months in high-risk patients, it has a clear advantage and can lead to a much higher degree of treatment adherence," Seth pointed out.

Dr J.P.S. Sawhney, chairman of the department of cardiology at Sir Ganga Ram Hospital in Delhi, underlined that while most of the patients have received only two doses of inclisiran so far, evidence from clinical trials has shown that it reduces LDL-C by 50 percent.

"The advantage of inclisiran is that it causes sustained reduction of LDL-C and there is no LDL-C variability. It has to be given only two times a year," he said.

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Cost, long-term safety data still concerns for many 

While many patients who have a high capacity to pay and have been prescribed the drug are opting for inclisiran, its affordability is also a concern for a large number of patients.

Sharma of Paras Health also emphasised that despite the benefit it promises, the response to inclisiran in India may have been tempered by concerns over its high cost and potential side effects in the long term.

"One its affordability is a major barrier, particularly in a country where cost-effective treatments like statins are widely available and preferred. Additionally, there are concerns about possible long-term side effects due to its extended duration of action, as any adverse effects could be challenging to reverse," he said.

To prevent high cholesterol, one should prioritise lifestyle changes, such as maintaining a healthy diet, engaging in regular exercise, and refraining from smoking, the cardiologist said.

Seth too, agreed, that long-term safety data on inclisiran is yet to be seen and as such it should not be hyped as a preferred treatment of bad cholesterol in all patients.

"Inclisiran is the latest kid on the block. Maybe in future, if it proves to be a safe alternative to the existing lipid-lowering drugs, it can go on to become a second line of treatment but for now, we have to reserve it for 15-20 percent of the patients who are not getting the desired result with other therapies," he said.

(Edited by Sanya Mathur)

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