Author: Myles Spar

Have you heard of red yeast rice? Made by culturing rice with strains of yeast, red yeast rice has been used in Chinese medicine and cooking for over 1,000 years. Because it contains cholesterol-lowering substances called monacolins—most notably monacolin K, which has the same chemical structure as the prescription drug lovastatin—red yeast rice is often used as a supplement. According to USA Today, sales of this product topped $40 million in 2014. But does red yeast rice really work as a natural statin? Let’s examine the evidence.

What’s wrong with prescription statins?
First off, why would someone take red yeast rice instead of medication for cholesterol? Aside from those who simply prefer a natural product, many people worry about the potential side effects of prescription statins. The Mayo Clinic says statins have been linked to muscle pain—which 29 percent of people who start statins report experiencing. They are also linked with digestive issues, elevated blood sugar and brain fog. Very rarely, statins may even cause potentially deadly muscle damage and/or liver problems. They also interact with many other prescription drugs. While people may turn to red yeast rice supplements to avoid these side effects, it should be noted that they work in the same way and can therefore cause similar problems.

Does red yeast rice work as a natural statin?
Research suggests red yeast rice is an effective treatment for high cholesterol and other heart problems. In one clinical trial of nearly 5,000 people over 4.5 years, researchers looked at the effects of an extract derived from red yeast rice, Xuezhikang (XZK), on patients who’d had a heart attack within 60 months of enrollment. They found XZK demonstrated efficacy in decreasing cholesterol, recurrent coronary events, and mortality rates compared to placebo. In another, smaller study, 79 patients with high cholesterol were given either a red yeast supplement or placebo for eight weeks. At week eight, those in the red yeast group saw significant reductions in their LDL concentrations, triglycerides, and total cholesterol.

So what’s the catch?
While red yeast rice has been shown to lower cholesterol, the quality of commercial products varies widely. A 2001 analysis of nine Chinese red yeast rice dietary supplements found a wide range of monacolin content, and only one of the products had all 10 of the compounds an effective supplement should include. Seven of the nine products also contained measurable concentrations of citrinin, a byproduct of the fermentation process that’s toxic to the kidneys. And a brand new study published in the European Journal of Preventive Cardiology that examined 28 brands of red yeast rice showed some contained no monacolin K at all, while others had as much as prescription medication. Since the FDA doesn’t allow supplement companies to list potency on product labels, there’s no way to know how much monacolin K is in a given product. The FDA also considers any red yeast rice product with more than a trace of monacolin K an unapproved drug and won’t allow it to be sold, leaving consumers in a bind—the only supplements available are ones that don’t work very well because if they work too well they’re not allowed on the market.

The bottom line? Red yeast rice does work to lower cholesterol, but the only way to precisely control the amount of monacolin K you’re getting is with a prescription statin. If you’re thinking about taking a red yeast rice supplement, the National Center for Complementary and Integrative Health cautions against using it to replace or postpone conventional care. They also advise telling your health care provider about any supplements you may be using, and to be judicious about information found online. (They even offer a handy fact sheet, Evaluating Web-Based Resources, here.)

What can I do instead?
Besides red yeast rice, there are still plenty of drug-free ways to manage your cholesterol and cardiovascular health. As I explain here and here, basic diet changes can make a huge difference when it comes to protecting your heart from heart attack and stroke. Other supplements can also help, such as Omega-3 fatty acids EPA and DHA and plant sterols. Garlic lowers cholesterol, but the dose you need may cause stomach irritation. Niacin also helps, but be sure to get the low-flush type.

Want to take care of your heart? Start with your plate. As I explain here, making diet changes can affect heart health. And it’s not just about cutting out junk—adding certain foods to your dietary rotation can have a big impact on your cardiovascular system, even protecting you from disease. Here are my top 5 foods for heart attack and stroke prevention.
 

1. Oatmeal
Research shows starting your day with a big bowl of fiber-rich oatmeal can lower your risk of heart disease, helping to lower your LDL (bad) cholesterol and keep your arteries clear. One analysis of 24 studies looking at blood lipids in people who ate whole-grain foods versus a control group who didn’t found an oat-heavy diet dropped cholesterol by an average of 6.5 points compared to control. To reap the heart-protecting benefits of oatmeal, opt for rolled or steel-cut oats instead of the instant variety. Can’t stomach hot cereal in the morning? Add some oat bran, another whole grain full of soluble fiber, to a smoothie or yogurt.
 

2. Salmon
There’s a reason super-fit people frequently choose fish over steak. Cold-water fish like salmon contain omega-3 fatty acids that have been shown to reduce the inflammation that can lead to cardiac events like heart attack and stroke. According to a recent American Heart Association advisory, omega-3s may be especially beneficial for people who’ve recently had a heart problem. Their study showed a daily 1,000 mg dose of fish oil could reduce the risk of death from cardiovascular disease by 10% in heart attack and heart failure patients. Try eating salmon a couple times a week—wild is best, but even the canned stuff may give your heart a boost. Not sure how to prepare fish and/or don’t want to stink up your kitchen? Fire up the grill! The Food Network has collected some of their best grilled salmon recipes here.
 

3. Broccoli
Eating more vegetables in general is a good way to protect your heart—an analysis published in the journal Stroke shows you can decrease your stroke risk by 11 percent for every extra 200 gm of vegetables you eat—broccoli appears to be particularly cardio-protective. Along with other cruciferous vegetables like cabbage and kale, broccoli contains a compound called sulfurophane that may prevent heart disease. According to researchers at Imperial College London, sulfurophane can activate Nrf2, a protein that helps keep arteries clear. Eating these veggies raw or lightly steamed is your best bet for maximizing their heart-healthy potential.
 

4. Lentils
Legumes like lentils can have a huge impact on your blood pressure. A landmark international study following nearly 13,000 people for 25 years found an 82 percent reduction in the risk of death from heart disease was associated with legume consumption. In addition to cholesterol-lowering soluble fiber, lentils are an excellent source of magnesium and folate, nutrients that are crucial for cardiovascular health. While high in fiber, lentils are fairly low-cal so adding lentil soup to your menu on a regular basis might lead to weight loss, too.
 

5. Olive oil
A key component of the Mediterranean diet, which has been consistently shown to improve heart health, olive oil is rich in “good” fats like monounsaturated oleic acid. Many studies indicate consuming olive oil can improve cholesterol and keep blood vessels healthy. And, much like fish oil, olive oil seems to be of special help to people at risk of developing heart problems. One randomized clinical trial found a link between olive oil consumption and reduced risks of cardiovascular disease and mortality in individuals at high cardiovascular risk. Olive oil makes a tasty addition to salad dressing recipes or as a dip for your (heart-healthy) whole grain bread. Just make sure you’re getting the real deal—The Dr. Oz Show recommends the cold-pressed, extra-virgin variety.
 

Lest you think being heart smart means a sad life of lentils and oatmeal, I’m adding a bonus item to this list of 5 foods for heart attack and stroke prevention: red wine. According to the Mayo Clinic, antioxidants in red wine called polyphenols may help protect the lining of blood vessels in your heart. A specific polyphenol, resveratrol, could also reduce LDL cholesterol and prevent clotting. Feel free to enjoy a glass or two knowing you’re boosting your cardiovascular health in the process. Want a few more heart-healthy superfoods to work into your diet? Check out a few of these simple smoothie ingredients here.
 

 
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About Myles Spar, MD

Myles Spar, MD, MPH is board-certified in Internal Medicine and in Integrative Medicine. As a clinician, teacher and researcher on faculty of two major medical centers, he has led the charge for a more proactive, holistic and personalized approach to care that focuses on cutting edge technology and preventative care. Dr. Spar has traveled with the NBA, presented a TEDx Talk, appeared on Dr. Oz, and been featured in publications such as the Men’s Journal and the Los Angeles Times.

You’ve heard about unhealthy foods causing heart problems—some restaurants even give decadent menu items names like “the heart attack burger”. But diet can also positively affect your heart and health? Tweaking your eating habits can improve your blood pressure and cholesterol, and it’s a powerful weapon for heart attack and stroke prevention. As I explain here, food choices can even lessen your chances of developing genetically inherited conditions like heart disease. Here are some dietary tips for keeping your ticker in top form.

Start with oatmeal.
There’s a reason that canister of oats in your cupboard has a heart on it. One serving of old fashioned (not instant) oats provides two of the three grams of soluble fiber you need every day to reduce your risk of heart disease. Whole grains in general can help lower your cholesterol, but research suggests oats are especially effective. In an analysis of 24 studies looking at blood lipids in people who ate whole-grain foods versus a control group who didn’t, an oat-heavy diet dropped cholesterol by an average of 6.5 points compared to control, while diets featuring other whole grains lowered cholesterol by about 4.6 points. An added bonus to breakfasting on oatmeal: all that fiber fills you up, making you less likely to grab some less healthy carbs a little later in the morning.

Eat your vegetables (and fruit).
Not only are these foods high in nutrients and low in calories, but many of them contain heart-healthy compounds. Consider kale: topping the index of nutritionally-dense foods created by Joel Fuhrman, MD, bestselling author of Eat to Live, this powerhouse plant contains a protein called Nrf2 that can prevent plaque from sticking to your arteries. If leafy greens aren’t your thing, studies show pomegranates may keep arterial walls clear (and their juice makes one heck of a cocktail).

Focus on fat.
Once considered a nutritional villain, fat started making a comeback in 2013 after a high-profile study found people who ate a diet high in unsaturated fats drastically reduced their risk of cardiovascular disease. Since then, research supporting the heart and health benefits of “good” fat has continued to pile up. According to the Mayo Clinic, the omega-3 fatty acids found in cold water fish like salmon, sardines, and tuna have been shown to be particularly cardio-protective. Try swapping your steak—which contains “bad” saturated fat often linked to heart disease—for fatty fish a couple of times per week.  If you don’t eat meat or can’t stand fish, walnuts and almonds are another good source of omega-3s. Plant-based fats in avocados and olives are particularly heart-healthy.

Have some wine.
Not only does alcohol bump up your HDL (also known as “good” cholesterol), red wine is chock full of antioxidants like resveratrol and compounds called polyphenols that may help keep your blood vessels supple and inhibit clotting. Don’t go too crazy, but know that research supports the moderate consumption of red wine for heart health.

Spice things up.
In addition to adding flavor to food, garlic has also been shown to significantly slow the buildup of plaque in the arteries. And turmeric, the bright yellow spice commonly found in Indian food, contains a strongly anti-inflammatory compound called curcumin that may support the cardiovascular system. Even spicy cayenne pepper can help your heart by improving blood flow.

Look into legumes.
Beans, lentils, peas, and other legumes are an excellent source of low-fat protein. In one study, participants who ate legumes at least four times per week had a 22% lower risk of heart disease than those who had them less than once a week. Beans are also high in fiber, which has been shown to lower cholesterol.

Go green (tea).
When you’re not drinking red wine, have a cup of green tea. A 2013 study published in the American Heart Association journal Stroke found green tea drinkers who consumed four cups a day had an almost 20% lower stroke risk compared to people who rarely drank green tea. Prefer coffee? The same study showed just one cup a day produced a similar reduction in stroke risk. Researchers attribute green tea’s heart-healthy effects to catechins, compounds that help regulate blood pressure and improve blood flow.