Red Yeast Rice: What is it? Is it safe to take to reduce your total cholesterol? (August 2024)

Red yeast rice is a product created by fermenting rice with the yeast Monascus purpureus, or other derivatives of the same fungal family, which turns the rice red. This “traditional” medicine has been used in China for many years to lower cholesterol, improve blood circulation and improve digestion.

Fermentation with some Monascus strains produce substances called monacolins. One of these, monacolin K, has the same makeup as the statin drug lovastatin, known by the brand names Mevacor, Altocor and Altoprev. Like lovastatin, monacolin K can stop the action of an enzyme in the body that helps make cholesterol. However, red yeast rice contains other substances that may lower cholesterol, and the actual amount of monacolin K is often low. For this reason, more research is needed to understand red yeast rice’s effects.

As a former inpatient cardiac dietitian, clients ask me about herbs or non-medication ways to manage their lipid panel. However, because I am not a cardiologist or internist, I recommend they discuss with their doctor the idea of taking red yeast rice extract instead of a prescribed medication.

There are two forms of monacolin K—K and KA—and clinical studies have tested doses of red yeast rice ranging from 1,200 to 4,800 mg/day. The European Society of Cardiology and European Atherosclerosis Society has recommended the use of red yeast rice in patients with intolerances to statins, while other professional organizations have varying opinions and recommendations.

In clinical trials, supplements that contain monacolin K have been shown to reduce total cholesterol levels, as well as blood sugar and blood pressure levels. However, the red yeast rice formulation used in many clinical studies is no longer available in the U.S.

In eight-week randomized, open-label (researchers and participants knew who was receiving which treatment) study in China, selected participants were prescribed either 600 mg of red yeast extract twice per day, or 1,200 mg once per day. The results showed reductions in blood pressure, blood sugar and lipids, without any safety concerns.

That’s important, because safety has been a concern with this supplement. I have seen some clients on red yeast rice experience elevated liver enzymes, joint aches, gastrointestinal distress, headaches, dizziness, and similar side effects as some people experience from statins.

Because the Food and Drug Administration (FDA) doesn’t regulate supplements, anyone can put one out. I often recommend www.consumerlab.com as a way to see if the supplement truly contains what it claims on the label, if it’s absorbed well, and if it’s free from lead contamination. Some red yeast rice products have been found to be contaminated with citrinin, which can damage the kidneys.

Also, some commercial red yeast rice products contain little-or-no monacolin K, while others contain large amounts. The FDA considers products with significant amounts of monacolin K to be unapproved drugs, and they can’t be sold legally as dietary supplements in the U.S. Also, some manufacturers add actual lovastatin to their products, which is illegal.

After consulting with your doctor, if you choose to take red yeast rice extract it’s still important to make dietary changes to support your cardiovascular health, whether it be embracing a Mediterranean Diet or the DASH Diet.

References 

• NIH National Center for Complementary and Integrative Health. Red Yeast Rice: What You Need to Know. https://www.nccih.nih.gov/health/red-yeast-rice
• Heber D, Yip I, Ashley JM, Elashoff DA, Elashoff RM, Go VL. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr. 1999;69(2):231-236.
• Red yeast rice supplements review. ConsumerLab website. https://www.consumerlab.com/reviews/red-yeast-rice-supplements-review/red-yeast-rice/. Published May 19, 2022. Updated September 27, 2022.
• Gordon RY, Cooperman T, Obermeyer W, Becker DJ. Marked variability of monacolin levels in commercial red yeast rice products: buyer beware! Arch Intern Med. 2010;170(19):1722-1727.
• Uzzelli L, Segreti A, Di Gioia D, et al. Alternative lipid lowering strategies: state-of-the-art review of red yeast rice. Fitoterapia. 2024;172:105719.
• Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337.
• Hu D. Han Y, Ning G, Ma C. Chinese guideline on the primary prevention of cardiovascular diseases. Cardiology Discovery. 2021;1:70-104