DEAR DR. ROACH: I read your response to a recent question regarding drugs to reduce cholesterol levels. In your response, you talked about the risks of taking niacin and its potential side effects. You commented that statin drugs remain the first-line treatment for reducing heart disease risk and for people who are at an increased risk.

As a follow-up, my cardiologist recommended several months ago that I take something called red yeast rice. I’ve been taking this product for many months now, and it does seem to have reduced one of my cholesterol components. What do you think of red yeast rice for reducing cholesterol levels? — S.

ANSWER: Red yeast rice is a compound that was developed as a food colorant and preservative in China about 1,500 years ago. It’s been used for centuries as a traditional medication, especially for circulatory problems.

Red yeast rice contains a substance, monacolin K, which is exactly the same molecule that is in the active form of a prescription statin (lovastatin). At the right dose, this will absolutely drop total and LDL cholesterol levels. However, any batch of red yeast rice that you buy will have variable amounts of monacolin K.

Furthermore, a well-done trial comparing a prescription statin to several different supplements, including red yeast rice, didn’t find any significant lowering of cholesterol levels when using commercial red yeast rice products — probably because of the inadequate dosage.

While I understand that many people prefer their medications to come from natural sources, a substance like the monacolin K that is found in red yeast rice needs to be dosed precisely. If you use too little, it doesn’t work, while too much increases the risk of side effects, whether it’s red yeast rice or a prescription statin.

Since prescriptions are precisely dosed, your doctor can get the correct dose for you, and the dosage won’t change from batch to batch.

DEAR DR. ROACH: I’m a 64-year-old woman with restless legs syndrome (RLS). What natural supplement can I take? Is it Nidra? — B.M.

ANSWER: Nidra isn’t a supplement; it’s a brand name of a tonic motor activation device — a nondrug solution for RLS. It has been tested in studies (and in the “real world”) and is moderately effective. It is worn at bedtime and works by stimulating the peroneal nerve. Studies have shown it to be 60% to 70% effective. The Nidra device is cleared by the Food and Drug Administration and is only available through a prescription.

Since iron deficiency is a cause of RLS, iron replacement is a natural supplement that can help RLS, but it should only be used when iron deficiency has been diagnosed through blood testing. Additionally, the underlying cause of the iron deficiency should be identified. An unexplained iron deficiency should always raise the concern for unexpected blood loss in the colon — perhaps by a polyp, inflammatory bowel disease, or even colon cancer. A colon exam should always be considered.

Vitamin C helps iron get absorbed, so they are often given together. Vitamin E may have some benefit in reducing symptoms in people who are on hemodialysis with RLS. Otherwise, there isn’t strong evidence to suggest the benefit of supplements in RLS. I’ve had readers tell me that magnesium has been helpful for them, but no well-done studies have confirmed this.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.

All Rights Reserved