Many people have the perception that all dietary fat is bad for your health. For years we have been trained and taught by the media, health professionals and even our friends and family that one of the most important things we can do to stay healthy and disease free is to avoid dietary fats. As we get older, often the first warning sign of cardiovascular disease that is flagged by our family doctor is elevated cholesterol. There is little disputing that cholesterol, particularly low density lipoprotein (LDL), has been called the driving force of atherosclerosis.1 However, there is emerging research
Cardiovascular diseases are serious, life-threatening disorders that affect the heart and blood vessels.
THE MOST COMMON ONES INCLUDE THE FOLLOWING
- Coronary heart disease, which affects the blood vessels serving the heart itself. This leads to heart attacks.
- Cerebrovascular disease, which affects the blood vessels that supply the brain. This leads to strokes.
- Hypertension, or high blood pressure, which worsens other forms of cardiovascular disease.
- Congestive heart failure, which happens when the heart becomes damaged or weakened.
According to the World Health Organization, more people die from cardiovascular disease every year than any other natural cause1. One in three American adults, and 1 in 12 Canadian adults has at least one form of cardiovascular disease2,3. Each year, it claims the lives of 63,000 Canadians, and 130,000 people receive a first diagnosis4. These sobering numbers highlight just how widespread the dangers of cardiovascular disease are in our daily lives.
A major problem with cardiovascular disease is that many people are unaware that they have it – a stroke or heart attack is the end result of many years of ongoing disease. The early stages have no warning signs or symptoms, and are not detectable even with modern testing methods. Most cases of cardiovascular disease result from lifestyle-related risk factors, and are thus preventable.
Given that 9 in 10 Canadians over 20 have at least one risk factor for cardiovascular disease5, almost everyone can benefit from preventative lifestyle strategies to manage their heart health.
RISK FACTORS FOR CARDIOVASCULAR DISEASE
The major risk factors for cardiovascular disease include: smoking, stress, high blood pressure, and high blood cholesterol. In different ways, these factors increase the risk of developing congestive heart failure, heart attacks, and strokes.
Thousands of research studies over the last 60 years have shown that the risk of developing heart attacks and strokes is related to levels of low-density lipoprotein (LDL) cholesterol, or “bad cholesterol”, in the blood7. LDL is a spherical protein package that transports most cholesterol around the body. In spite of its negative image, cholesterol is actually very important for normal health – we literally could not live without it. All cells make cholesterol to help maintain their shape and function, and to withstand stress. Cholesterol levels are at their highest in the brain, where brain cells use cholesterol to ensure that nerve signals travel quickly across the body. The liver produces most of our cholesterol from dietary fat, after which cholesterol is sent through the blood to the body’s cells. These cells take as much cholesterol as they need from the blood, and produce the rest themselves.
LDL cholesterol turns “bad” when there is more of it available in the blood than the body needs. The excess cholesterol collects in the walls of major arteries, forming aggregates and clogs known as plaques. Over time, an artery clogged with cholesterol starts to look exactly like a pipe clogged with lime scale. Since this slows the flow of blood through blood vessels, the heart has to work harder to send blood around the body. This leads to high blood pressure, which puts extra stress on the heart and damages the blood vessels. Meanwhile, the cholesterol plaques are more likely to form blood clots that close off circulation altogether. The outcome of such clotting, depending on where it happens, is a life-threatening heart attack or a stroke. This potentially disastrous chain of events begins with elevated LDL cholesterol in the blood, making the management of cholesterol the focus of most treatment efforts.
MANAGING CHOLESTEROL – STATINS AND RED YEAST RICE
From a medical standpoint, the most common way to reduce cholesterol in the blood is to force cells to use more of it. This is possible by keeping cells from making their own cholesterol. Doing this is a complex problem in chemistry; however, as is the case with many complex chemistry problems, nature provided a ready-made solution.
Red yeast rice has been used for over a thousand years in Traditional Chinese Medicine to treat circulatory disorders. The “yeast” used to ferment the rice is usually a mold from the Monascus family, with Monascus purpureus being among the most common of these. In 1979, a Japanese scientist named Akira Endo purified a molecule from Monascus that lowered blood cholesterol very effectively. This molecule, which he named monacolin K, became the first drug – generically known as lovastatin – used in humans for cholesterol management.
Lovastatin and other members of the “statin” class of drugs have the same mode of action, which is to block the function of a protein called 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) synthase (Figure 3).
Blocking this protein prevents most cells from making their own cholesterol. These cells in turn take up more cholesterol from the blood, leaving less circulating cholesterol available to be oxidized and to form artery-blocking plaques.
Statins effectively reduce the risk of death due to cardiovascular disease. Nevertheless, there are many cases in which the use of statins is either not enough or not suitable. For instance, some patients cannot lower their cholesterol sufficiently with statins or similar treatments. Others have to stop using statins when they develop serious side effects such as liver and muscle damage8. Statins also cause heart and kidney failure by reducing levels of coenzyme Q10, an important antioxidant that is needed for proper heart and kidney functioning. Finally, people at high risk for cardiovascular disease due to family history or lifestyle may wish to reduce that risk by managing their cardiovascular health.
Since statin use is not appropriate in such situations9, there remains a need for safe, well-tolerated supplements to help people attain such health goals.
Red yeast rice supplements are not legal for sale in the USA and Canada if they contain more than trace amounts (one part per million of a 1.2 mg dose) of the natural statin, monacolin K. These supplements were banned by the FDA in the late 1990s because they contained variable and often dangerously high levels of monacolin K10. Some unscrupulous manufacturers even added the pharmaceutical form of monacolin K, lovastatin, directly to their supplements11. There is also the concern that such unregulated supplements may contain citrinin, a toxic by-product of the fermentation process. Importantly, all the disadvantages that apply to statins, including the possible serious side effects, applies to red yeast rice containing monacolin K, since the active agent is the same.
In spite of the prohibition against the sale of red yeast rice containing monacolin K, several supplements containing this statin are still on the market.
A 2017 analysis of 28 red yeast rice supplements showed that almost all of them contained monacolin K, in highly variable quantities that were generally above the legal limit12. Such supplements are also frequently contaminated with high levels of the kidney toxin citrinin13.