Red yeast rice is rice that has been fermented by the red yeast, Monascus purpureus. It has been used by the Chinese for many centuries as a food preservative, food colorant (it is responsible for the red color of Peking duck), spice, and ingredient in rice wine. Red yeast rice continues to be a dietary staple in China, Japan, and Asian communities in the United States, with an estimated average consumption of 14 to 55 grams of red yeast rice per day per person.
Red yeast rice also has been used in China for over 1,000 years for medicinal purposes. Red yeast rice was described in an ancient Chinese list of drugs as useful for improving blood circulation and for alleviating indigestion and diarrhea.
Recently, red yeast rice has been developed by Chinese and American scientists as a product to lower blood lipids, including cholesterol and triglycerides.
What are the different preparations of red yeast rice?
There are three major preparations of red yeast rice; Zhitai, Cholestin or Hypocol, and Xuezhikang.
Zhitai is produced by the fermentation of a mixture of different strains of Monascus purpureaus on whole grain rice. Zhitai contains mainly rice and yeast, but is mostly rice by weight.
Cholestin or HypoCol is produced by the fermentaion of selected strains of Monascus purpureaus, using a proprietary process that produces a certain concentration of monacolin K (monacolin K is lovastatin, which is believed to be the major cholesterol-lowering ingredient).
Xuezhikang is produced by mixing the rice and red yeast with alcohol and then processing it to remove most of the rice gluten. Xuezhikang contains 40% more cholesterol-lowering ingredients than Cholestin or Hypocol.
In the United States, red yeast rice is available as a food supplement called Cholestin (Pharmanex, Inc.). In Singapore, red yeast rice is available as Hypocol (NatureWise, Wearnes Biotech & Medicals (1998) PTE LTD). Cholestin in the United States and HypoCol in Singapore contain similar ingredients.
In China, Xuezhikang is available under the same name (Beijing WBL Peking University Biotech., ltd.).
What is the composition of HypoCol and Cholestin?
Scientists at Pharmanex and the UCLA Center for Human Nutrition analyzed the properties of Cholestin. The composition by weight is starch (73%), protein (5.8%) moisture (3-6%), unsaturated fatty acids (1.5%), monacolins (0.4%), ash (3%), and trace amounts of calcium, iron, magnesium, and copper. There are no additives, preservatives, heavy metals, or toxic substances, such as citrinic acid.
In 1977, Professor Endo in Japan discovered a natural cholesterol-lowering substance that is produced by a strain of Monascus yeast. This substance inhibits HMG-CoA reductase, an enzyme that is important for the production of cholesterol in the body. Professor Endo named this substance moncacolin K. Since then, scientists have discovered a total of 8 monacolin-like substances that have cholesterol-lowering properties.
Monacolin K is lovastatin, the active ingredient in the popular statin drug, Mevacor, which is used for lowering cholesterol. Lovastatin also is believed to be the main cholesterol-lowering ingredient in HypoCol and Cholestin. The lovastatin in Mevacor is highly purified and concentrated, while the ingredients in Cholestin and HypoCol are not. Thus, they contain much lower concentrations of lovastatin than Mevacor. For example, each 600-mg capsule of Cholestin contains less than 2.4 mg of lovastatin whereas tablets of Mevacor contain 10 mg or more of this ingredient.
Because none of the components are purified and concentrated, HypoCol and Cholestin contain a mixture of the 8 yeast-produced monacolins, unsaturated fatty acids, and certain anti-oxidants. Some scientists believe that these other monacolins, unsaturated fatty acids, and anti-oxidants may work together favorably with lovastatin to enhance its cholesterol-lowering effects, as well as its ability in lowering triglycerides and increasing HDL cholesterol. (HDL is considered the "good" form of cholesterol since high levels of HDL cholesterol protect against heart attacks.) Further studies in animals and humans will be necessary to test these beliefs.
How effective are HypoCol, Cholestin, and Xuezhikang in lowering lipids?
Chinese scientists conducted most of the animal and human studies on this issue, using either Zhitai or Xuezhikang. The results of some 17 studies involving approximately 900 Chinese subjects with modestly elevated cholesterol levels have been published. In 8 of these studies, there was a control group that received a placebo (a pill with no active ingredients) for comparison purposes. In 9 of the studies, there was no placebo control group.
These studies consistently showed that Zhitai and Xuezhikang lower total cholesterol (by an average of 10-30%), lower LDL cholesterol (by an average of 10-20%), lower triglycerides (by an average of 15-25%), and increase HDL (by an average of 7-15%).
Scientists at the UCLA Center for Human Nutrition studied Cholestin in a 12-week, double blind, placebo-controlled trial involving 83 American adults with borderline-high to moderately elevated cholesterol. They found that Cholestin reduced total cholesterol, LDL cholesterol, and triglyceride levels but had no effect on HDL cholesterol. This study was published in the American Journal of Clinical Nutrition (1999; 69:231-7).
Lowering LDL and increasing HDL cholesterol prevents atherosclerosis (a build-up of plaque) of the heart's arteries. Since atherosclerosis causes heart attacks, lowering the LDL
How safe are red yeast rice products?
Animal studies have been conducted in China using high doses of red yeast rice products. No damage to the kidneys, liver, or other organs were demonstrated in these studies.
Human trials in China and in the United States reported only rare and minor side effects of heartburn or indigestion with the use red yeast rice products. No liver, kidney, or muscle toxicity has been reported.
However, human trials in the United States and China have generally lasted only a few weeks to a few months. Thus, conclusive proof of long term safety (over a period of many years) will have to await further data (such as from data received after the products have been marketed or long-term clinical trials).
Scientists conducting the studies generally believe that red yeast rice is safe in the long-term since it has been a food staple for thousands of years in Asian countries without reports of toxicity. They attribute the safety of red yeast rice products to the process of preparation that does not involve the isolation and concentration of a single ingredient. Although it is true that isolation and concentration enhance the potency of a single ingredient, these factors also increase the risk of side effects.
Are there any precautions in consuming red yeast rice products?
Not all red yeast rice products contain the same concentrations of the cholesterol-lowering ingredients. Some red yeast rice products may have little or no cholesterol-lowering effects. Certain products also may contain unacceptably high levels of an undesirable substance called citrinic acid. Therefore, it is important to choose a product that is made with stringent quality control and standardization.
Scientists at the UCLA Center for Nutrition are studying the consistency and composition of numerous red yeast rice products. Their findings should help consumers choose products more knowledgeably.
Who are suitable candidates for red yeast rice products?
There is not yet consensus among scientists and doctors as to the role of red yeast rice in treating elevated cholesterol. When diet and exercise are ineffective, many doctors recommend using a statin drug to lower LDL cholesterol since large long-term trials have consistently shown that statins (such as pravastatin, simvastatin, lovastatin) are safe and effective in lowering LDL cholesterol and decreasing the risk of heart attacks.
Other scientists and doctors favor red yeast rice (in a properly selected-product) in patients with borderline-high cholesterol levels (200-240 mg/dl). Although the statin drugs are generally safe and well tolerated, they still may rarely cause liver and muscle damage.
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