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Red Yeast Rice Instead of Statins for Cholesterol Reduction?

Statins are too commonly prescribed medications for lowering cholesterol. However, up to 40% of patients discontinue therapy within 1 year, with their reasons including: fear of adverse effects, cost, and reluctance to take prescription medications. Instead, many patients often adopt alternative therapies to manage their cholesterol levels.

Two popular lipid-lowering supplements are phytosterols and red yeast rice (RYR). Phytosterols, which include stanols and sterols, are present in plant-based foods and reduce low-density lipoprotein cholesterol (LDL) by decreasing its intestinal absorption. However, the average Western diet provides only 20-50 mg/day of phytosterols, but studies show one would need about 1600-3000 mg/day to lower LDL by 4.1 - 15%.

RYR is made by culturing a yeast, Monascus purpureus on rice, which produces compounds called monacolins (that act in the same way as statins). Studies have demonstrated the safety and efficacy of RYR, with LDL-C reductions of 22 - 28%.

Another important method to lower cholesterol is lifestyle modification. The combination of diet, exercise, and weight loss can reduce LDL by 5 - 15%.

Since RYR has statin-like properties, researchers wanted to evaluate its effects when used in combination with phytosterols or lifestyle changes. To do this, a total of 187 participants with high LDL took 1800 mg of RYR twice daily (3600 mg/day) and were randomized to take phytosterol tablets (900 mg twice daily) or placebo. Participants were also randomized to a 12-week lifestyle change (LC) program or usual care (UC).

Results showed that RYR + phytosterols did not significantly improve LDL over RYR alone. Compared with the UC group, the LC group had greater reductions in LDL and lost more weight. However, because all participants took RYR, they all saw significant decreases in LDL, total cholesterol, triglycerides, high-sensitivity C-reactive protein, and even an increase in high-density lipoprotein (HDL) cholesterol after 1 year when compared with baseline. This was a high dose of RYR, and four participants stopped supplements because of myalgia (muscle pain).

So based on this study, it looks like RYR alone works in lowering LDL, but its effects are enhanced with lifestyle changes. However, before you go out and start self-medicating with RYR, please understand that because it works in the same way as statins, you're best to also take CoQ10 and vitamin D3 at the same time (to minimize the risk of adverse effects).

Source: Phytosterols, red yeast rice, and lifestyle changes instead of statins: A randomized, double-blinded, placebo-controlled trial

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1 comment:

  1. I tried phytosterols (900 mg 3x a day) and I suspect it caused both my Vitamin D and testosterone to plummet. Two days after I stopped and I felt so much better, like a rush of calm.

    I think it blocked my vitamin D supplement (my level was 43 instead of the expected 70) rather than directly causing it to go down. Who knows what else it might have been blocking.

    I don't think phytosterols are worth it for most people, if anyone.


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