It is well known that high levels of LDL cholesterol, the “bad” cholesterol, are a risk factor for the cardiovascular system. Diet and physical activity are the basis for keeping them under control, but sometimes you may need a little more help. “Given an improvement in lifestyle, in cases of mild hypercholesterolemia in primary prevention (i.e. in the absence of atherosclerotic events) it may be sufficient to take red yeast rice – he explains to Salute Bruno Passaretti, head of the Rehabilitation Cardiology Unit of Humanitas Gavazzeni in Bergamo (among the structures of excellence in the cardiology area). A supplement, therefore. But what is it really about? Who is it recommended for? And is it really a natural alternative to statins, the most well-known and used drugs for controlling “bad” cholesterol? “It depends on the characteristics of the patient and his lifestyle – says the expert – but it is a great deception to think that red yeast rice is a natural alternative to statins, because it itself contains a statin”.
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Red rice: a story that starts from afar
The beneficial properties of fermented red rice have been known since 1500: we find traces of it in the book written by Li Shizhen, an expert in Chinese medicine, in which it is described as capable of “promoting blood circulation and dissolving stasis”. In a certain sense, the Asian pharmacologist was right: the active ingredient in red rice, produced by a fermenting fungus, helps maintain normal cholesterol levels. As Passaretti explains, “this type of modified cereal is produced by letting rice boiled with the mushroom ferment A purple monk which, in addition to giving a purple-red color, also produces a substance called monacolin K, a molecule that has a chemical composition identical to lovastatin, a light-acting statin.”
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Statins and red yeast rice: differences in use
Monacolin K, therefore, is the active ingredient of red yeast rice, the consumption of which therefore allows you to lower LDL cholesterol levels in the blood and the risk of cardiovascular events. Just like statins do. But while statins are drugs that can only be prescribed by doctors after an appropriate visit to people with increased cardiovascular risk, products based on red yeast rice are supplements according to the law. “To be considered as such, they must contain a maximum of 3 mg of monacolin K (indicated as the maximum daily dose, ed.) – specifies Passaretti – In these products, to obtain a synergistic effect, monacolin K is combined with other hypocholesterolemic substances, such as Omega 3, berberine and oilseeds”.
As prevention, when cholesterol levels slightly exceed the reference values, it may be sufficient to take supplements based on red yeast rice, if in the meantime you also improve your lifestyle, continues the expert: “However, in case of worsening of hypercholesterolemia or events such as the onset of heart attack, angina or carotid disease, it will be necessary to take a statin”. Statins, in fact, not only have the effect of lowering cholesterol, but reduce inflammation and stabilize the atherosclerotic plaque, which otherwise could evolve towards rupture and closure of the vessel with consequent heart attack: “They are, therefore, fundamental for patients at increased risk”.
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A necessary guide
Over the years there has been a progressive demonization of statins: due to some scandals and inaccurate information. It is not correct to say, for example, that once you have started treatment with a statin you can no longer stop, while it is true that if you stop the therapy your cholesterol levels start to rise again, also raising the risk of incurring cardiovascular events. For these reasons some patients have become reluctant to take them, and for this reason they prefer supplements, thinking they are different molecules. “But the distinction between the active ingredient of red yeast rice and statins makes no sense” – reiterates Passaretti, also recalling that in 2018 the European Food Safety Agency (EFSA) introduced a different regulation for red rice-based supplements fermented, lowering the maximum daily dose from 10 to 3 mg, after reports of adverse effects on various tissues and systems (from the musculoskeletal tissue to the liver, from the nervous system to the gastro-intestinal system) similar to those relating to taking statins.
There are different types of supplements on the market today with slightly different compositions and dosages. “We now know exactly how many milligrams per deciliter of blood cholesterol is lowered both with red yeast rice and with each statin. Furthermore, even monacolin K can cause allergies or unwanted effects in some patients, such as myalgias – concludes Passaretti – Therefore, it is important to always be followed by a doctor to obtain the desired effect.”