ConsumerLab.com Answers
Question:
If I already take red yeast rice, would adding high-dose niacin help further reduce my cholesterol levels, and would this be safe?
Answer:
Red yeast rice is effective because it naturally contains cholesterol-lowering "statin" compounds, such as lovastatin. However, studies in which statin drugs have been given with high-dose niacin therapy suggest that this is not a helpful combination for most people and there are safety concerns. The same issues are likely to arise with the combination of red yeast rice and high-dose niacin therapy, so this combination should be carefully evaluated. For more details about the effects of statins given with high-dose niacin, see the Niacin section of the B Vitamins Product Review (which includes our tests of niacin and other B vitamins) >>
For more information about red yeast rice (including ConsumerLab.com's product tests), see the Red Yeast Rice Supplements Review >>
ConsumerLab.com Answers
Question:
When taking a statin drug like Lipitor or Crestor, are there supplements I should avoid, or be taking?
Answer:
Atorvastatin (Lipitor), rosuvastatin (Crestor), and other cholesterol-lowering statin drugs can be affected by taking supplements and can affect your ability to absorb certain vitamins and minerals. Certain herbal supplements, such as St. John's wort, may decrease blood levels of some statin drugs, and when taken with atorvastatin, may actually result in increased cholesterol levels. Certain forms of magnesium may also decrease blood levels of statin drugs -- particularly Crestor. Red yeast rice, which contains a naturally occurring statin, should not be combined with prescription statin drugs without medical supervision.
Berberine should be avoided or used with caution when taking certain statin drugs, such as atorvastatin (Lipitor), lovastatin (Mevacor) and rosuvastatin (Crestor).
While high doses of niacin may help to lower cholesterol, studies show that if you already take a statin drug, adding high-dose niacin does not appear to provide additional benefit and may carry serious risks. Nevertheless, some physicians believe taking niacin in addition to statin medication may be helpful for certain people; however do not try this combination without consulting your physician.
Some fruit juices can also be a problem, particularly grapefruit juice, which impairs the body's normal breakdown of certain statins, allowing them to build up to potentially excessive levels in the blood. Since the effects of grapefruit juice may last as long as 3 days, it should be avoided if you are taking atorvastatin (Lipitor), lovastatin (Mevacor, Altoprev) or simvastatin (Zocor). However, some other statins do not seem to be affected by grapefruit juice, including pravastatin (Pravachol), fluvastatin (Lescol) and rosuvastatin (Crestor).
Although green tea can help lower cholesterol, it can also decrease absorption of some, but not all, statin drugs. To play it safe, it may be best to take statins at least a couple of hours before consuming a green tea supplement or beverage.
On the other hand, CoQ10 and fish oil may offer particular benefits to people on statin drugs.
These interactions are explained in the Statin Drugs article, which is part of the extensive Drug Interactions section of our website (where you can look up interaction for other drugs you may be taking), and in other reports (linked to above) on ConsumerLab.com.
ConsumerLab.com Answers
Question:
How much should I expect to pay for supplements? Are higher-priced supplements any better than low-priced brands?
Answer:
You certainly don't need to pay the highest prices to get good quality supplements. In fact, ConsumerLab.com has found that some of the most economical products, costing pennies a day, are of better quality than premium-priced supplements costing more than a dollar a day. For the past several years ConsumerLab.com has included price and cost comparisons along with its test results and quality ratings. Here are some examples of how much (or little!) you need to spend to get top-quality supplements based on the products we have tested. Use the links to go to the reports and see the products and learn more about them.
Type of Supplement
(Serving Size Compared)
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Lowest Cost for
Approved-Quality Product
(Highest Price)*
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Calcium
(500 mg)
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10 cents (11 cents, or up to $1.44 for combination products) |
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CoQ10
(100 mg)
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9 cents (78 cents)
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Fish Oil
(500 mg EPA and DHA)
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5 cents ($1.05)
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Garcinia cambogia
(1,500 mg HCA)
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74 cents ($2.08)
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Green Tea
(200 mg EGCG)
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10 cents ($1.65)
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Iron
(25 mg)
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2 cents (59 cents)
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Krill Oil
(100 mg EPA and DHA)
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19 cents (54 cents)
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Lutein
(10 mg)
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9 cents ($1.19)
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Magnesium
(200 mg)
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2 cents (83 cents)
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Melatonin
(3 mg)
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4 cents (1.36)
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Multivitamin
(Daily serving)
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3 cents ($1.83)
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Probiotic
(1 billion organisms)
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1 cent ($1.00)
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Protein Powder
(20 g protein)
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61 cents ($2.06, or up to $5.14 for meal replacement products) |
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Red Yeast Rice
(600 mg)
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7 cents (43 cents)
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Resveratrol
(100 mg trans-resveratrol)
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6 cents ($3.33)
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Turmeric
(500 mg Curcuminoids)
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13 cents (52 cents)
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Ubiquinol
(100 mg)
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43 cents ($1.33)
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Valerian
(2.4 mg valerenic acids)
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12 cents ($1.14)
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Vitamin C
(500 mg)
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1 cent (78 cents)
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Vitamin D
(400 IU of D3)
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1 cent (37 cents)
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*Costs based on products reviewed at the time this answer was posted (12/6/2013).
ConsumerLab.com Answers
Question:
What is lunasin and does it really reduce cholesterol?
Answer:
Lunasin is a protein peptide first identified in soybean, and later confirmed to be present in barley, triticale and oats. Lunasin is sold as a branded ingredient (LunaRich and Lunasin XP, both by Soy Labs LLC) in capsules and soy protein drinks and is promoted for lowering cholesterol. (Other proposed benefits include reducing inflammation, cancer prevention and overall immune health).
There is good evidence that soy, in general, can help lower cholesterol: studies show an average daily dose of 47 g daily can reduce LDL, or "bad" cholesterol, by about 13% (Anderson, NEJM 1995, Reynolds, Am J Cardio 2006). The FDA allows companies to make the claim that "25 grams of soy protein daily, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease." [For more information about supplements used to lower choletesterol levels (such as sterols, stanols, and policosanol), see ConsumerLab.com’s Review of Cholesterol-Lowering Supplements. Also see the Review of Red Yeast Rice Supplements. For more informration about soy, see the Soy article in the encyclopedia.]
For comparison, the makers of LunaRich XP state that one 125 mg capsule contains the same amount of lunasin as is found in 25 grams of soy protein. They also point to lunasin as "the active component in soy protein responsible for reducing LDL cholesterol." This is based on research conducted by Soy Labs which found that lunasin reduces the expression of the gene that produces a key enzyme (HMG-CoA Reductase) needed for the liver's production of cholesterol. (Prescription statin drugs act to block this same enzyme after it has been produced by the gene, rather than slowing down the gene's production.) Lunasin was also found to increase the number of receptors available in liver cells to remove LDL cholesterol from the bloodstream (Galvez, Circulation 2012).
While promising, its important to note that this study, like most of the studies on lunasin, was not conducted in humans, but in cell lines (in vitro) and in animals. The only clinical study to date involved just five men, and was designed to determine the bioavailability of lunasin from soy protein consumption (Gonzalez, FASEB J 2009). More clinical studies are needed to confirm lunasin’s ability to lower cholesterol in humans.
Although there are no reported side-effects from taking lunasin, people with an allergy to soy should not take this supplement. Be aware that soy drink powders and mixes made with lunasin (Reliv NOW with LunaRich, ProVantage Sports Performance Powder, Carefast Soy Protein Drink Mix with Lunasin XP) may also contain soy isoflavones, which are not recommended for pregnant and nursing women, and women with estrogen-receptor positive breast cancer.
The bottom line: There is good evidence that soy is generally safe to take and can help to lower cholesterol. Preliminary research on lunasin, a component of soy, shows that it may play important roles in this cholesterol-lowering effect: slowing the production of a cholesterol-producing enzyme in the body and helping to clear LDL cholesterol from the bloodstream. While more clinical studies are needed to confirm lunasin's ability to lower cholesterol in humans, this supplement may be worth a try if you are looking for natural, low-risk way to reduce cholesterol. Women who are pregnant, nursing, or who have been diagnosed with estrogen-receptor positive breast cancer should not take lunasin.
ConsumerLab.com Answers
Question:
Which supplements can help lower cholesterol and keep my heart healthy? Are there any to avoid?
Answer:
Heart disease remains the leading cause of death for both women and men in the U.S. Some supplements may help keep your heart healthy, but others may potentially contribute to heart disease.
Heart Healthy Supplements:
There is strong evidence that sterol esters (like the phytosterol beta-sitosterol) and stanol esters, available in supplements and in some "heart healthy" margarines and spreads, can significantly lower LDL cholesterol. (There is also some evidence that taking curcumin may increase the cholesterol-lowering effects of phytosterols.) You can get more information about this, plus our tests and reviews of products in the Cholesterol-Lowering Supplements Review >>
Garlic has been shown to reduce total cholesterol and triglycerides, and may slow the development of atherosclerosis. One brand of garlic in particular has been shown to lower triglycerides more than others. You can get more information about these, including our tests and reviews of products in the Garlic Supplements Review >>
Red yeast rice can significantly lower cholesterol, but products vary widely in their amounts of natural, active statin compounds. You can get more information and our tests and comparisons of products in the Red Yeast Rice Supplements Review >>
High-dose niacin has been shown to lower LDL cholesterol. However, it should not be taken with statin-containing supplements (red yeast rice), or with statin drugs, which could increase the risk of serious events like stroke. You can get more information about niacin, including our tests and reviews of products in the B Vitamin Supplements Review >>
Replacing some saturated fat in the diet with olive oil may help lower risk factors for heart disease, such as high blood pressure and high cholesterol. You can get more information about extra virgin olive oil and see our Top Picks among products in the Extra Virgin Olive Oil Review >>
Oats and oat-based cereals can be a good source of soluble fiber, which can help to lower cholesterol reduce the risk of heart disease. See our Oat Cereals Review for the clinical evidence, including how much you need to consume in order to significantly reduce cholesterol.
Soy protein, in adequate dosage, has been shown to modestly lower total cholesterol and improve LDL/HDL ratio. Preliminary research suggests lunasin, a specific protein peptide isolated from soy, may play a major role in soy's effects. Our Review of Cholesterol-Lowering Supplements includes information about these and other supplements for reducing cholesterol — also see the Soy article.
Some, but not all studies suggest that pantethine (which is not a B vitamin but is often included as an ingredient in B vitamin supplements) may help to lower LDL cholesterol.
CoQ10 has been shown to significantly reduce the risk of adverse cardiovascular events by 50% in people with moderate to severe heart failure, and may be helpful in reducing some of the side-effects of cholesterol-lowering statin drugs. You can get more information about CoQ10 (and ubiquinol, a related compound), including our tests and reviews of products, in the CoQ10 and Ubiquinol Supplements Review >>
Vitamin D may lower the risk of cardiovascular disease in those with low blood levels of vitamin D but not be of benefit for people who do not have a vitamin D deficiency. You can get more information about vitamin D, including our tests and reviews of products in the Vitamin D Supplements Review >>
Similarly, improving magnesium to adequate levels can slightly reduce blood pressure, and magnesium blood levels in the mid to high normal range have been associated with a lower risk of death from cardiovascular disease, as noted in the Magnesium Supplements Review >>
Berberine may help to reduce blood pressure, triglycerides and total and LDL cholesterol (as well as blood sugar) in people with type 2 diabetes; however, be aware that it may interact with several cholesterol-lowering medications, potentially increasing blood levels (and the risk of side effects) of these drugs.
Cocoa powders and dark chocolate rich in flavanols can improve vascular function and blood pressure, and even raise levels of HDL ("good") cholesterol. You can get more information about these, as well as our tests and reviews of products in the Cocoa Powders, Extracts, Nibs, Supplements, and Chocolates Review >>
Certain probiotics may modestly lower systolic and diastolic blood pressure, and "bad" LDL cholesterol — although they do not appear to increase "good" HDL cholesterol. There is mixed evidence as to whether probiotics reduce triglyceride levels. More information, plus our tests of popular products, is found in the Probiotic Supplements and Kefirs Review >>
Supplements That May Be Harmful:
Vitamin E supplements, once touted for heart health, have not been found to provide a benefit for people with cardiovascular disease, and could actually be harmful for some heart disease patients, since they could reduce the effectiveness of cholesterol-lowering agents.
There is reason to believe that L-carnitine and lecithin could actually contribute to atherosclerosis in certain people, and it may be wise to avoid long-term supplementation with either one.
Supplements That May Not Help:
Calcium -- Although getting sufficient calcium may decrease your risk of dying from cardiovascular disease, too much may be harmful. A study found that calcium (800 mg) given once daily to post-menopausal women with high cholesterol caused a significant increase in serum cholesterol (up by about 50 mg/dL) and an increase in the thickness of lining of the carotid artery - changes associated with heart disease. Only if you don't get enough calcium should you consider a supplement, and it generally recommended that calcium supplementation not exceed 500 mg per dose, or more than 900 mg per day. You can get more information about these supplements, including our tests and reviews of products, in the Calcium Supplements Review >>
Fish Oil -- Despite the fact that omega-3 fatty acids that have been linked to some heart healthy effects, it seems that the benefits come from consumption of fish, and not supplements. Only if you don't eat fish might fish oil supplements provide some heart benefit. Also, because fish oil supplements can have a blood-thinning effect, they should be used with caution in people taking other blood-thinning supplements or medications. You can get more information about these supplements, including our tests and reviews of products, in the Fish/Marine Oil Supplements Review >>
Multivitamins have not been found to reduce (nor increase) the risk of heart attack, stroke or death from cardiovascular disease. You can get more information about these supplements, including our tests and reviews of products, in the Multivitamin and Multimineral Supplements Review >>
Policosanol -- Although there is some evidence from several studies from Cuba suggesting a cholesterol-lowering effect, other studies have failed to find this effect, as noted in our Cholesterol-Lowering Supplements Review>>
ConsumerLab.com Answers
Question:
I have been having dizziness for the past few months and am wondering if it could be a side effect of supplements I take. Which supplements cause dizziness?
Answer:
Dizziness has been reported as potential side effect of using supplements such as garlic, melatonin, saw palmetto, red yeast rice, policosanol and black cohosh. Vertigo, a particular form of dizziness, has been reported with the use of some weight loss supplements that contain stimulants, such as caffeine.
On the other hand, there is evidence that Ginkgo biloba may improve symptoms of vertigo. Vitamin D may improve balance and reduce the risk of falls in older adults.
You can learn more about each of these supplements by clicking the links.
ConsumerLab.com Answers
Question:
Are red yeast rice supplements legally permitted to contain statins, like lovastatin, since these are drugs?
Answer:
Red yeast rice naturally contains lovastatin and related statin (or monacolin) compounds which can dramatically lower LDL ("bad") cholesterol. The statins are produced by a special yeast as it digests rice (creating a red color). In fact, it was from yeast cultures that lovastatin (also known as monacolin K) was originally discovered and later marketed as the brand name drug Mevacor. The regulatory problem is that a dietary supplement label cannot indicate that it contains a drug, nor list the amount of that drug. So, while red yeast rice can be legally sold as a supplement, the amount of lovastatin cannot appear on the label — otherwise it could be subject to removal from the market as an unauthorized drug. Technically, it is not even legal for a supplement to contain a drug, so some red yeast rice supplements do not contain lovastatin, despite the fact that it should, naturally, be there.
To help consumers, ConsumerLab.com has been periodically purchasing and testing red yeast rice supplements since 2008 and reporting the amounts of statin compounds they contain. It also reports the amounts of a contaminant, citrinin, which may be toxic to the kidneys. ConsumerLab.com has found an enormous range in the amounts of lovastatin compounds among products. In 2014, for example, it found these amounts to range as little as 0.05 mg to 25.1 mg per daily suggested serving — a 500-fold difference. This means some products are likely to be effective while others are not, and there is no way to tell from the labels alone.
To find out how much lovastatin (and citrinin contaminant) ConsumerLab.com has found in red yeast rice supplements and which ones are, therefore, likely to be effective, see ConsumerLab.com's Red Yeast Rice Supplements Review >>
ConsumerLab.com Answers
Question:
For two years, I used a red yeast rice brand which ConsumerLab.com's report showed to contain the highest amount of lovastatin. With just one pill per day, it kept my cholesterol lower (down to 205 from 260 before starting). I switched to a supermarket store brand because it was cheaper and my cholesterol jumped to 278 (taking 2 pills per day)! I don't think the store brand had anything in it -- is that possible? Can you test it?
Answer:
Yes, it is quite possible that the red yeast rice brand to which you switched contained little or no lovastatin. As shown in our Red Yeast Rice Supplements Review, even though products may list the exact same amount of red yeast rice per pill (typically 600 mg), those pills may contain less than 0.1 mg or more than 10 mg of lovastatin compounds, depending on the brand. That's more than a 100X difference and this will have a big impact in terms of efficacy.
You can compare the amounts of lovastatin compounds which we found in different brands, and learn more about using red yeast rice, in our Red Yeast Rice Supplements Review >> We will consider purchasing and testing the brand you took (name removed above) in a future review.
ConsumerLab.com Answers
Question:
I started taking red yeast rice and soon after developed insomnia. Could my red yeast rice supplement be the problem?
Answer:
As discussed in the Red Yeast Rice Supplements Review, red yeast rice could potentially cause difficulty sleeping in some people — although this does not appear to be a commonly reported side-effect. See the "Cautions and Concerns" section of the Red Yeast Rice Supplements Review for more information >>
Be aware that if you also take CoQ10 (levels of which may be reduced in people taking red yeast rice or a prescription statin medication), this may also cause insomnia in some people.
ConsumerLab.com Answers
Question:
My doctor warned me that red yeast rice can cause liver damage - is that true?
Answer:
Red yeast rice naturally contains lovastatin, the same key ingredient found in the cholesterol-lowering "statin" drug Mevacor. Increases in liver enzymes and rare cases of liver injury are associated with lovastatin, and the same is true with red yeast rice. Red yeast rice supplements also have the potential to be contaminated with a toxin which may be damaging to the liver and kidneys, which is why ConsumerLab.com tests products for this toxin. For more details, see the "Concerns and Cautions" section of the Red Yeast Rice Supplements Review >>
ConsumerLab.com Answers
Question:
When is the best time of day to take red yeast rice?
Answer:
As with certain prescription statin drugs, bedtime is likely the best time to take red yeast rice, as explained in the ConsumerTips section of the Red Yeast Rice Supplements Review >>
(However, be aware that rarely, taking red yeast rice at night has been reported to cause insomnia in some people.)
ConsumerLab.com Answers
Question:
What are the side effects of red yeast rice?
Answer:
Red yeast rice supplements contain naturally-occurring statin compounds (or monacolins), such as lovastatin, that can help lower elevated cholesterol and triglyceride levels. Like prescription statin drugs, red yeast rice supplements can cause side effects such as altered liver enzymes, muscle pain, and digestive upset. However, studies suggest certain side effects may be less likely to occur or less severe with red yeast rice than with prescription statins, likely due to the natural combination of statins in red yeast rice as opposed to a single statin compound in prescription drugs. (Be aware that combining red yeast rice with prescription statin drugs increases the risk of side effects and should be avoided.)
It's important to keep in mind that ConsumerLab.com has found the amount of lovastatins in red yeast rice varies widely across products. Some also contain citrinin, a potential kidney toxin. This likely affects potency and the potential for side effects.
To get ConsumerLab's test results for red yeast rice supplements, as well as more details about side effects, potential drug interactions, and the best way to take red yeast rice, see the Red Yeast Rice Supplements Review >>
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Product Review: Red Yeast Rice Supplements Review |
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Initial Posting: 8/15/14 Last Update: 6/24/17
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Choosing the Right Red Yeast Rice SupplementSome Red Yeast Rice Supplements Up to 500X Stronger Than Others. Lack of Potency and/or Contamination Common.
Find Out What's in Your Red Yeast Rice Supplement. You Can't Tell From the Label.
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Clinical studies show that red yeast rice products can dramatically lower LDL ("bad") cholesterol. But our tests reveal that the amounts of cholesterol-lowering compounds in suggested daily servings can be as much as 500 times greater for one product than another, despite labels suggesting they provide the same amount of red yeast rice.
Which are the best red yeast rice supplements? We identified at least three that have the amounts and types of compounds shown to work in clinical trials. Unfortunately, we found many others that provide only small amounts of these compounds and seem unlikely to have any significant effect on cholesterol levels. What's equally concerning, we discovered a potential toxin, citrinin in a well-known brand.
Several of the red yeast rice products we purchased for this review are the same ones tested in our last review but, as we discovered, now contain as much as 88% more, or 33% less, lovastatin (a natural cholesterol-lowerer) -- suggesting they may now be more, or less, effective than before.
Red yeast rice supplements don't list their amounts of lovastatin and related monacolins, so there's no way for you to know what's really in these supplements. ConsumerLab.com tested them, providing you with invaluable, head-to-head comparisons. This is a must-see report for anyone using or interested in red yeast rice. Results of an earlier report on red yeast rice by ConsumerLab.com were deemed so important to the medical community that they were published in the prestigious Annals of Internal Medicine. Our latest red yeast rice results may be even more important!
You must join to get the full test results for red yeast rice supplements along with ConsumerLab.com recommendations. You will get results for eight supplements selected by ConsumerLab.com.
In this comprehensive report, you'll discover:
- How much cholesterol-lowering lovastatin and related compounds are in each product
- Which products are most similar to those shown to work in clinical trials
- Which red yeast rice supplements are contaminated with citrinin and which are not
- Usage and dosage information for red yeast rice
- Potential side effects of red yeast rice and cautions with this popular supplement
Learn More About Red Yeast Rice SupplementsQuestion:
If I already take red yeast rice, would adding high-dose niacin help further reduce my cholesterol levels, and would this be safe? Get the answer >>
Question:
When taking a statin drug like Lipitor or Crestor, are there supplements I should avoid, or be taking? Get the answer >>
Question:
How much should I expect to pay for supplements? Are higher-priced supplements any better than low-priced brands? Get the answer >>
Question:
What is lunasin and does it really reduce cholesterol? Get the answer >>
Question:
Which supplements can help lower cholesterol and keep my heart healthy? Are there any to avoid? Get the answer >>
Question:
I have been having dizziness for the past few months and am wondering if it could be a side effect of supplements I take. Which supplements cause dizziness? Get the answer >>
Question:
Are red yeast rice supplements legally permitted to contain statins, like lovastatin, since these are drugs? Get the answer >>
Question:
For two years, I used a red yeast rice brand which ConsumerLab.com's report showed to contain the highest amount of lovastatin. With just one pill per day, it kept my cholesterol lower (down to 205 from 260 before starting). I switched to a supermarket store brand because it was cheaper and my cholesterol jumped to 278 (taking 2 pills per day)! I don't think the store brand had anything in it -- is that possible? Can you test it? Get the answer >>
Question:
I started taking red yeast rice and soon after developed insomnia. Could my red yeast rice supplement be the problem? Get the answer >>
Question:
My doctor warned me that red yeast rice can cause liver damage - is that true? Get the answer >>
Question:
When is the best time of day to take red yeast rice? Get the answer >>
Question:
What are the side effects of red yeast rice? Get the answer >>
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Update:
(2/24/16): A CL member informed us that a certificate of analysis included with bottles of one of the products in this review is not authentic and appears to have been altered by the company. Details are found in the Update in the full Review.
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