Given the fast pace of modern life and increasingly unhealthy and irregular eating habits, we are witnessing an epidemic of obesity. Obesity, in itself, causes numerous health issues, one of the most prominent being high cholesterol.
Many believe that high cholesterol is not only linked to diet and genetic inheritance but also a consequence of stress. The most prominent risk factors for cardiovascular diseases are elevated levels of LDL cholesterol and increased triglyceride values.
Cholesterol is one of the essential components of our body; it is a fundamental part of the cell membrane and ensures the normal functioning of every cell in the organism. However, like any molecule in the human body, its level must be regulated by homeostatic mechanisms, as prolonged states of elevated or reduced cholesterol can lead to the development of various diseases. 
One of the most common questions is how to control or lower elevated cholesterol levels through diet. Dietary recommendations for high cholesterol have emphasized the importance of strict control over saturated fatty acid intake for decades. In recent years, fats have often been blamed as the primary culprit for many diseases in modern society, leading to an emphasis on removing them from the diet. Contrary to the expected outcome, drastic reductions in fat intake have resulted in an increasing number of obese individuals, as reduced energy intake was compensated by an increased intake of carbohydrates. This leads to excessive insulin secretion and, consequently, to increased synthesis of endogenous fats. The correct recommendation is not to drastically reduce fat intake but to focus on reducing the intake of saturated fatty acids, which 
are most prevalent in dairy products, palm and coconut oils, butter, and meat. An appropriate ratio of omega-3 to omega-6 fatty acids is also important. The ideal ratio would be 1:5 (omega-3:omega-6). Therefore, emphasis should be placed on more frequent consumption of fish and seafood. Trans fats are unsaturated fatty acids created through chemical processes (e.g., hydrogenation) of vegetable oils to improve the physical properties of products (e.g., spreadability of margarine) and shelf life as preservatives. For example, chips or French fries from fast food can last for months without changing color, shape, or taste. Trans fats increase cholesterol levels and are even more concerning as they are carcinogenic
You are probably familiar with many of these claims: fat makes us fat, contributes to heart disease, leads to diabetes and excess weight, saturated fats are bad… None of these beliefs about fats are accurate! High-quality fats can help you become lean, healthy, and vibrant. For decades, dietary fats have been unfairly demonized, and we have persistently followed low-fat diets, which almost always have the opposite effect—raising blood sugar levels. In simple terms: sugars, not fats, are the real culprits that undermine our health and sabotage our efforts to regulate body weight.
Quality fats boost metabolism, promote fat burning, reduce hunger, optimize cholesterol levels, and lower the risk of heart disease. Sugars, not fats, cause weight gain. Higher sugar intake makes cells less sensitive to insulin, causing the body to pump out more and more insulin to lower blood sugar levels. When people eat fewer quality fats, they compensate by consuming more starch or sugar. To get rid of excess sugar, the body calls on insulin, which halts fat burning and orders the conversion of sugar into fat. This actually increases levels of low-density cholesterol, which ultimately leads to heart attacks. So, when we consume bad sugars and bad fats, fats accumulate as body fat, and bad sugars convert into additional fat.
Did you know there are 3 essential fatty acids? Arachidonic, linoleic, and linolenic acids.
These are fats that the body cannot produce on its own, so we must obtain them through food or supplements. These essential fatty acids in the body create omega-3 and omega-6 fatty acids. 
Do you know which essential sugars the body needs and which the body cannot produce on its own, so we must obtain them through food? The answer is that no sugar is essential! Did you know that the body can only produce glucose? This process is called gluconeogenesis, or the creation of glucose anew. What the body can produce on its own is not essential, meaning it does not need to be consumed from external sources. The body signals whether it is receiving enough quality fats.
Some warning signs of this deficiency include dry skin, peeling skin, and soft, damaged, or brittle nails.
Fermented Red Rice (Monascus purpureus) has gained significant popularity in recent years for its use in managing elevated cholesterol levels. Monacins are substances that reduce elevated cholesterol levels, with monacolin K, a compound similar to lovastatin, being particularly noteworthy. In addition to its monacins content, a potential comparative advantage of fermented red rice extract is its significant amounts of antioxidants, which have strong antioxidant activity that plays a role in maintaining cardiovascular health.
Some studies have shown that fermented red rice has the same therapeutic effectiveness as statins, whether used alone or in combination with other supplements. Clinical and statistically significant reductions in LDL cholesterol have been observed, suggesting that this phytopharmaceutical could be used as a safe and effective therapy, particularly for patients who cannot tolerate statin therapy.. 
After considerable uncertainty in the regulations regarding the allowable level of lovastatin in non-registered herbal preparations, EFSA (European Food Safety Authority) has approved a daily level of 10 mg, at which we can expect effects in reducing elevated cholesterol concentrations.
Currently, there is no clear clinical guideline for the threshold of elevated blood cholesterol, but in practice, for individuals whose total cholesterol exceeds 6.5 or 7 mmol/L, it is advisable to consider a red rice-based dietary supplement if, for some reason, statin medications will not be used.
To achieve results, therapy should be started even with mild increases in cholesterol, and better outcomes are observed in patients with a normal body mass index.
When using dietary supplements to lower cholesterol, consulting a doctor is recommended, especially for those already taking cholesterol-lowering medications, as well as for pregnant or breastfeeding women. The use of red rice is not appropriate when statin-based medications are also being used. During the fermentation of rice, red yeast produces a byproduct called citrinin, which is nephrotoxic. Citrinin is a mycotoxin that is toxic and has harmful biological effects on humans and animals. The upper allowable limit of citrinin is 50 ppb (parts per billion) so attention should be paid to the potential presence of this toxic compound in the preparation and its quantity. Lovastatin at a dose of 10 mg usually does not cause severe side effects and can be considered a minimal effective dose for maintaining optimal cholesterol levels.
