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Red Yeast Rice

Pharmaceutical prescriptions are the mainstay treatment for dis-ease within conventional medicine. They have in fact altered the lives of many; a true medical marval. However, prescription medications do not come without risk and themselves, are one of the leading causes of death. Many healthcare consumers prefer natural products to pharmaceuticals, when appropriate options exist, but the challenge is finding a practitioner who can offer you these options. This is one of our passions, utilizing botanical medicine in our treatment regimens.



Botanical medicine has long been known to have healing properties, but they have remained on the outskirts of modern medicine for a variety of reasons, one being that herbal products can not be patented so there is little profit in these remedies. When the literature offers strong support for any particular nutraceutical then, there will be efforts to undermine these benefits and guide treatment back to pharmaceuticals.


Integrative health practitioners are the clinicians who more readily integrate healing modalities beyond the more common conventional therapies; these clinicians may offer nutraceuticals or botanicals more commonly than their conventional colleagues for example. This training and experience though, in botanical medicine, is almost entirely outside of their academic and clinical training so not only do they lack the ability to make these recommendations, but your doing this yourself is outside their comfort zone, appropriately so.


While I am eager to share what we understand about red yeast rice for the treatment of high cholesterol, keep in mind, as much as I appreciate all that Mother Earth has to offer and am a huge advocate of empowering consumers of healthcare, there is significant risk to higher cholesterol. This evaluation is quite complex (again, a bit beyond what the typical conventional practitioner even considers, such as Lp(a) and APO evaluations), so I do recommend consulting with your local functional and integrative provider.


Cardiovascular Health


High levels of cholesterol is among the most important risk factors for cardiac disease. Members can read further about APO and Lp(a) in our member forum, as these too are important considerations, if not more so than standard cholesterol measurements which conventional practitioners have yet to fully appreciate.


Current treatment for elevated cholesterol includes lifestyle modifications, which really doesn't get the attention it deserves, but when this fails, largely because clients lack the resources and support they need to implement these lifestyle changes, then medications are initiated. These lipid-lowering drugs though have even come under review by conventionally-minded experts so much so that they have discontinued treating some with higher levels of cholesterol due to the risk. Unfortunately this is often perceived as the normal being adjusted rather than the medication being more risky than beneficial for this group of individuals.


Lipid-lowering nutraceuticals are another option for treatment for those with elevated levels yet not quite elevated enough to assume the risk of statin medications. The nutraceutical, red yeast rice, is considered the nutraceutical for lipid management so much so that it is chemically equivalent to lovastatin. Why isn't this often utilized then in clinical management of high cholesterol?


Red Yeast Rice for High Cholesterol


Red yeast rice is created by fermenting yeast in red rice. It becomes red from the pigments produced by secondary fermentation. Monacolins are the end-product created from the fermentation process which is utilized for its lipid-lowering qualities. The monacolin concentration in the red yeast rice nutraceuticals on the market today is only about 1.9 percent, yet incredibly effective.


Several types of monacolins have been identified based on the strain of yeast used and the fermentation conditions. One type, monacolin K, was found to be structurally identical to lovastatin. It's primary mechanism of action is its ability to inhibit HMG-CoA reductase, the rate-controlling enzyme of the cholesterol synthesis pathway.


Although monacolin K and lovastatin have the same structure, their pharmacokinetic profiles and bioavailability are different. Red yeast rice works more synergistically. While a pharmaceutical will work to extract the "active ingredient," assuming nothing else played a role whatsoever, red yeast rice incompassess all else that was offered from this fermentation process. This would be similar to extracting orange juice from the orange. Yes, you get a higher concentration of vitamin C, but you also get more sugar which isn't balanced by the fiber removed from the orange that was eliminated.


One study found doses varying from 1,200mg to 4,800mg each day can reduce the LDL-C by an average of 39.4mg/dL after two to 24-months of treatment. This did not vary from the results of moderate-intensity statin such as pravastatin 40mg and lovastatin 20mg. The authors of this research also found higher levels of HDL-C and a decrease in triglycerides. Impressive.


Red yeast rice has also been shown to improve endothelial function in humans and reductions in cRP, which is a measurement of inflammation. This is improved even further with the addition of enzyme CoQ10 at 30mg or a mix of other antioxidants such as 100mg green tea extract or resveratrol at 20mg.


This nutraceutical is one of the rare botanical medicines which has long-term studies for its effect on cardiovascular disease. A Chinese study found a 31 percent reduction in cardiac health disease after just four years of supplementation and all-cause mortality by 31.9 percent, as well as a decrease in stroke by 44.1 percent. The need for coronary artery bypass graft was reduced by 48.6 percent and malignancies by a whopping 51.4 percent.


Valid Alternative for Preventing Cardiac Health Disease


The International Lipid Expert Panel has suggested that consuming combinations of nutraceuticals with different lipid-lowering actions, especially in conjunction with a health lifestyle, could be a valid alternative for preventing CHD in clients with moderate hypercholesterolemia (high cholesterol) and in those with statin intolerance. Admittedly, few will appreciate this in conventional medicine when clients do visit the hospital or cross paths with a practitioner less familiar with integrative medicine. This just isn't in their toolbag so it is dismissed.


A clinician knowledgeable in botanical medicine can choose to offer red yeast rice for clients with elevated cholesterol knowing RYR inhibits the HMG-CoA reductase enzyme and then choosing another nutraceutical which maybe increases the lipid excretion from the bowel, such as a plant sterol, a soluble fiber, probiotic, or glucomannan. The liver's role in lipid management may be improved with a soybean protein or berberine. LDL-C excretion can also be enhanced with chlorogenic acid, soy proteins, and berberine.


If you're interested in discussing the potentials here, reach out to your local functional medicine clinician or contact our office for a consultation. We do offer primary care with a functional and integrative mindset for individuals of all ages and health status. We can also offer a functional consult, or second opinion for those who have already established care with a PCP. Visit our book online page.

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