The Color of Rice and the Chinese Paradox.

ples [7] . This FDA report was not a peerreviewed study but part of an investigation into the status of over-the-counter red rice yeast dietary supplements. One article in the literature that specifically measured total statin content in traditional Chinese red rice yeast for 2 different food products reported 20 and 25 μg/g [6] . These concentrations of total statins are far below those found in commercially available food supplements, but given the range of estimated daily red rice yeast intake, would calculate to 1–2 mg/day of total statin intake per person. Could this be significant? Clinical trials of commercially available red rice yeast supplements, prepared under optimal conditions of temperature, pH and specific Monascus purpureus strain to enhance monacolin K content (5–10 mg lovastatin per capsule), have demonstrated efficacy in lowering total and LDL cholesterol [5, 8, 9] . One trial reported greater-thanexpected reduction in total and LDL cholesterol based on monacolin K content [5] . Subjects received supplements with an equivalent of 5 mg/day of monacolin K (lovastatin) but experienced cholesterol reductions that were similar to lovastatin daily dosages of 20–40 mg [5] . This finding led to the possibility that other components of red rice yeast, which include other statin metabolites and phytosterols, may have additional favorable effects on lipid metabolism [9] . Phytosterols have been demonstrated to have lipid-lowering properties [10] . A randomized secondary prevention trial in China of red rice yeast supplements Dear Editor, A recent article by Dong et al. [1] , ‘White Rice Intake Varies in Its Association with Metabolic Markers of Diabetes and Dyslipidemia Across Region among Chinese Adults’, revealed a peculiar finding in central China: an inverse relationship exists between rice consumption and LDL cholesterol among the people in the central provinces. The Chinese food composition table, as stated in the Discussion Section, did not include brown rice. Our assumption is that this study also did not include red rice. Jiangsu province, which is included in central China, is one of several eastern Chinese provinces where the fermentation of white rice with the species of yeast called Monascus purpureus originated (other provinces include Fujian, Jiangxi, Zhejiang, Shanghai). Red yeast rice is a dietary staple in these provinces to this day. Interestingly, these same provinces have the lowest cardiovascular mortality in China [2–4] . Red rice yeast is a natural source of monacolins, which inhibit cholesterol biosynthesis. Monacolin K, the predominant monacolin in red rice yeast, is identical to prescription lovastatin [5] . Estimates of between 14 and 80 g of red rice yeast are consumed per person per day in these eastern Chinese provinces [5, 6] . The quantification of total statin content in traditional red rice yeast food products has not been extensively studied. The FDA reported red rice yeast food products contained small quantities of monacolin K (lovastatin) or none at all in numerous off-the-shelf samPublished online: January 27, 2016