Cholesterol-lowering statin medications (marketed as Lipitor, Crestor, Pravachol, Zocor, Atorvastatin, Pravastatin, and Simvastatin, and natural forms of statin drugs—such as red yeast rice extract) are widely used. They have clear benefits for men with both high cholesterol and established cardiovascular/heart disease, yet they are less effective for women and they also have a variety of side effects.

Unfortunately, not only do these medications decrease cholesterol, they also reduce the production of compounds in the body that are derived from cholesterol, such as testosterone, coenzyme Q10 (CoQ10), and other substances that repair muscle.

Most people assume the benefit from taking a statin medication is related to its cholesterol-lowering effects, but other important benefits are due to the fact that statins also decrease artery inflammation and they make your blood less sticky, so it’s less likely to clot.

Statin medications cause multiple side effects, so let’s discuss the most common ones:

• a rise in blood sugar,
• short-term memory loss,
• a reduction in CoQ10 levels,
• muscle aches and muscle breakdown,
• liver inflammation,
• Decreased testosterone levels.

All of these have health and nutritional implications. You can offset some of the side effects by eating less sugar and refined carbs and taking a Co-Q-10 supplement daily. But if you experience muscle aches, liver inflammation, or memory loss, then likely you should talk to your physician about stopping the medication and considering alternatives.

As I’ll discuss shortly, if you have any of these side effects, you may find that taking red yeast rice extract provides some of the same statin benefits, but with fewer side effects.

Memory Loss with Statins

Memory loss often described as brain fog, has also been noted by the FDA recently with statin medication use. Adding CoQ10 may help some people with these symptoms, but clearly, it does not help all. There are no studies linking an increased dementia risk with statins, yet I recommend that if you notice memory loss while on a statin medication, you should discuss with your doctor whether stopping it is appropriate. You might consider other cholesterol-lowering options, such as healthier eating, as a start, but red yeast rice extract is another option.

Muscle Aches with Statins

Perhaps the most common complaint when taking a statin medication is muscle aches. Very rarely, this can progress to major muscle tissue breakdown, leading to kidney failure and/or death.

Much more common are diffuse muscle aches that are associated with decreased muscle repair and muscle atrophy. If you notice these symptoms, which occur in nearly 10% of people taking these drugs, talk to your doctor about potentially stopping the medication. In people who don’t tolerate statins due to muscle aches, red yeast rice has been shown in clinical studies to be better tolerated and still be effective.

Reduction in Testosterone Levels with Statins

Finally, drug companies typically fail to mention that statin medications lower testosterone levels. After all, your body uses cholesterol to make testosterone. With less cholesterol available, testosterone levels decrease as well. This drop has been reported in several medical studies. On many occasions, I have seen a man start a statin medication for a cardiac problem and note his testosterone level dropping 50 or more points. For someone with a completely normal testosterone level, say 700 mg/dL, this is unlikely to be a problem.

But a man with a borderline testosterone level (say 340 mg/dL) who begins a statin could lose erectile function, energy, and drive. This person may need to have his physician prescribe testosterone in order to tolerate the statin. Consider talking to your doctor about checking your testosterone level if you take a statin drug— in particular, if you have noticed a drop in energy, libido, drive, and mental sharpness.

This applies to women as well, as both men and women require an adequate amount of testosterone for a normal sex drive.

What Is the Difference Between a Statin Medication and Red Yeast Rice Extract?

A red-pigmented yeast, called Monascus purpureus, can be grown on rice. An extract from this yeast has been shown in numerous studies in China and the United States to help maintain healthy blood cholesterol levels. The red yeast rice extract produces chemical compounds, called monacolins, which decrease cholesterol production in the liver. The first statin cholesterol medication, lovastatin, was isolated from red yeast rice extract.

In contrast to a drug that contains a high dosage of one type of statin, red yeast rice extract may contain 10-20 or more cholesterol-lowering ingredients. Small dosages of multiple compounds seem better tolerated than a single large dosage of one. In fact, some patients who cannot take a statin medication due to muscle aches or liver inflammation are able to tolerate red yeast rice extract and lower their cholesterol levels.

With my patients, I refer to red yeast rice extract as a cholesterol-lowering drug and I use the same safety concerns as any other medication. The biggest difference between it and a statin medication is that it is available over the counter, while drugs are prescribed by physicians and sold through pharmacies.

Please remember that red yeast rice extract has the potential to have all the same benefits, side effects, and complications as any of the other statin medications if it is given at the same dosage.

The biggest challenge with using red yeast rice extract is finding a high-quality product that is contaminant free and contains the same “drug” dosage with every package. Due to quality concerns with production, my approach is to prescribe a medication first, and if there are side effects, to use the best quality red yeast rice I can find as a second option. An option that I use with my patients can be found here, use code: DFH38082 for 25% off your 1st order.

When Should You Take Red Yeast Rice Extract or a Cholesterol-Lowering (Statin) Medication?

Obviously, I can’t address this adequately here on a personal level for you without knowing your medical history, and the decision to start or continue a medication should be focused on the person as well as the risks and benefits. But below are a few guidelines I use in my practice to help my patients decide when it might be warranted.

• I invariably recommend that my patients follow my dietary and activity recommendations first and recheck their cholesterol profile. With an optimal eating plan, many people won’t need a statin therapy. I am often amazed at how well optimal eating works.
• If you have established cardiovascular disease (meaning you have already had a heart attack or stroke, or an abnormal test, such as treadmill stress test), and you still have high cholesterol despite your best efforts, I believe the benefits of using a statin medication, or red yeast rice extract, are greater than the risks.
• If you have an elevated carotid IMT (intimal medial thickness) plaque score, a high LDL cholesterol level, and your plaque score keeps growing despite your best efforts, talk to your doctor about statin therapy options.
• In clinical studies, women have been shown to benefit less from taking a statin medication than men, so women should have a stronger reason (such as multiple risk factors for heart disease) to begin this type of therapy, and because of this limitation, they have more to gain from following a healthy lifestyle.
• A variety of doctors have advocated putting everyone on a statin medication. I think this would be crazy. We need to do more to help people make lifestyle changes so they don’t qualify for these medications. Putting everyone on them would cause tremendous side effects for many people who might not benefit from using them.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, FAAFP, CNS