A traditional rice-based remedy may become an alternative to drug treatments for high cholesterol.

Statin medications lower your cholesterol, but they can also make your muscles ache and leave you with a case of brain fog; some men even report sexual dysfunction. It’s no surprise, then, that 40 to 50 percent of those prescribed a statin drug quit taking it within a year of starting it. However, there is another way to lower levels of “bad” LDL cholesterol—and some people may be able to control their cholesterol levels by making dietary changes.

For a study published in the Annals of Internal Medicine, researchers worked with 62 patients with high cholesterol who had a history of quitting statin therapy because of the muscle ache side effect. Half were given daily capsules of powdered red yeast rice, a fermentation by-product produced by growing red yeast on certain types of rice. The other half received a placebo. All 62 patients enrolled in a 12-week therapeutic lifestyle-change program, where they met for 3½ hours a week to learn about exercise, tai chi, yoga, acupuncture, and other stress-reducing activities. The participants were told to exercise aerobically for 35 to 45 minutes a day on their own time.

After 12 weeks, those taking the supplement, on average, saw a 27 percent drop in bad cholesterol levels; after 24 weeks, the levels remained significantly lower than the placebo group’s. That cholesterol reduction is comparable, if slightly lower, to the typical effects of statins. Two people in the red yeast rice group dropped out because of muscle ache complaints, and one dropped out of the placebo group for the same reason. The study was funded by the Commonwealth of Pennsylvania.

Further study will be needed to confirm and clarify the effect of the supplement on cholesterol levels. But people looking for an alternative to statin drugs may benefit from trying the red yeast rice supplement, or from switching to an overall healthier diet and lifestyle. Remember that in addition to taking the supplements, the subjects in the study were all participating in an exercise and stress-reduction program.

Here’s what you should consider to control cholesterol:

• Set goals. Cholesterol is one word, but there two main types. The villain is known as low-density lipoprotein, or LDL. Too much of this character in the body means fatty layers on your artery walls, making it harder for blood to push through. On the other hand, meet the hero form of cholesterol—high-density lipoprotein, or HDL. Think of HDL as a street-scrubbing garbage man, pulling the fatty LDL from your arteries.

Your LDL level should be under 100. Aim to keep your total cholesterol level, which is the sum of HDL, LDL, and other blood fats, below 200. Simple blood tests can help you figure out where you stand. Then, it’s up to you and your doctor to talk about improving those numbers. The good news is, in many cases, you can get control of your cholesterol without using medications, by eating better and busting out into a sweat every once in a while.

• Know what you’re doing. If you are thinking about trading in a statin prescription for red yeast rice supplements, you need to do these things, Dr. Becker says.

1. Respect the red. “It has been around for more than 1,000 years,” says study author David Becker, MD, a cardiologist at Chestnut Hill Hospital in Philadelphia. “It’s a Chinese remedy used originally for general health, but for the last several years, it’s been used for cholesterol.” One of red yeast rice’s active ingredients is chemically the same as that in Lovastatin, a prescription drug. So treat red yeast rice with the respect you’d give a drug, because it has druglike qualities. Talk to your doctor about using it.

2. Understand it’s not regulated. The U.S. Food and Drug Administration does not regulate over-the-counter supplements. Not all red yeast rice products are the same, and there are problems with variations, says Dr. Becker. The study used a product made by Pennsylvania-based company, Sylvin, and Dr. Becker prescribed a moderately strong dose of three 600-milligram capsules a day.

3. Don’t overdo it. “People should never take a statin and red yeast rice at the same time, or it could increase liver or muscle problems,” Dr. Becker warns.

• Modify your diet. Eat a fiber-rich diet to help lower your cholesterol while eliminating sugars, white bread, and pastas that crank up your triglyceride levels—that’s another blood fat that affects your cholesterol level. Eat lots of fruits and vegetables, and eliminate as much red meat as possible, says Dr. Becker, who calls this a modified Mediterranean diet.