Red Yeast Rice: Does It Lower Cholesterol?

Red yeast rice has become popular as a supplement to lower high cholesterol levels. Does it work? What does science say? Find out!

Reviewed and approved by the doctor Leonardo Biolatto.

Written by Daniela Echeverri Castro

Last update: 02 October, 2022

Red yeast rice is a fermented product obtained from the mold known as Monascus purpureus. In East Asian countries – such as China, Japan and Korea – it’s used for gastronomic and medicinal purposes; in particular, it’s valued for its ability to lower cholesterol and improve cardiovascular health.

And, as detailed in a study shared in the journal Foods, it’s composed of polyketides, unsaturated fatty acids, phytosterols, pigments, and monacolins. Monacolin K is identical to lovastatin, a statin used for its lipid-lowering effect. Would you like to find out more about it?

What is red yeast rice?

Red yeast rice is considered a nutraceutical. It’s obtained from the fermentation of white rice with the yeast Monascus purpureus or other molds. At a culinary level, it has been used to flavor, color and preserve foods. However, its popularity is due to its medicinal effects.

In particular, it contains a substance known as monacolin K, which has a lowering effect on blood cholesterol levels. In addition, it’s an abundant source of pigments, organic acids, sterols, flavonoids and other bioactive compounds that are associated with positive health effects.

According to a review published in Frontiers in Pharmacology, its properties are as follows:

• Hypolipidemic
• Anti-atherosclerotic
• Neurocytoprotective
• Antitumor
• Antiosteoporotic
• Energetic
• Antidiabetic
• Antihypertensive

However, while entities such as the European Food Safety Authority recognize the potential of this supplement to lower high cholesterol levels, other authorities, such as the U.S. Food and Drug Administration (FDA), disapprove of the use of monacolin K and prohibit the marketing of products containing it.

The reason? It is feared that it may cause side effects similar to those caused by lovastatin. The FDA believes it should be strictly regulated as a drug and not as a dietary supplement.

Still, red yeast rice is available on the market and some people are confident of its cholesterol-lowering properties. Is there evidence? Let’s see.

Does red yeast rice help lower cholesterol levels?

The main active compound in red yeast rice, monacolin K, has shown positive effects in controlling high cholesterol and triglyceride levels. In a review shared through Critical Reviews in Food Science and Nutrition, it was determined that this product – in combination with statins – is effective in lowering total and LDL (bad) cholesterol levels.

Similarly, evidence suggests that it lowers triglycerides, blood pressure, and thus cardiovascular risk. Most interestingly, it appears to cause fewer side effects than drugs used for the same purpose.

A study in BMC Cardiovascular Disorders reported that supplementation with this rice helped improve lipid profile with fewer fatigue side effects compared to simvastatin. Evidence suggests that monacolin K acts by inhibiting the enzyme HMG-CoA reductase and endogenous cholesterol biosynthesis.

Similarly, a review published in Methodist Debakey Cardiovascular Journal explains that monacolin K improves endothelial function and blood vessel flexibility, which is key to reducing the risks associated with hypercholesterolemia.

Possible side effects and safety

There are concerns that consumption of red yeast rice may cause side effects similar to those of statins. The Mayo Clinic notes that a high intake of monacolin K can lead to liver damage or muscle disorders (myopathy).

However, the supplement is generally safe for most people. In fact, according to the same entity, some may have only small amounts of monacolin K, which tends to diminish its lipid-lowering effect.

In any case, the most common adverse reactions are as follows:

• Dizziness
• Constipation
• Headache
• Bloating and gas
• Abdominal pain or burning

For safety, it shouldn’t be used by the following people:

• Children and adolescents
• Pregnant and lactating women
• Adults over 64 years old
• People with muscular disorders
• Patients with kidney or liver disease

One concern with red yeast rice supplements is their possible contamination with citrinin, a toxin produced by molds, which is linked to kidney failure.

Interactions

Like drugs to treat cholesterol, red yeast rice can cause problems when used concurrently with certain foods and drugs, such as the following:

• Grapefruit juice. May increase the concentration of plasma levels of monacolin K.
• Hepatotoxic drugs, herbs, and supplements. Raises the risk of liver damage.
• Alcohol. Increases the risk of liver damage.
• Other cholesterol-lowering drugs.
• Antibiotics.
• Antifungals.
• Antidepressants.
• Antiretrovirals.

Dosage and intake recommendations

At the moment, red yeast rice is distributed as a supplement in capsule or tablet form. Some come in combination with other substances, such as CoQ10, nattokinase, or omega-3 fatty acids.

Suggested dosages range from 600 to 1200 mg per day, divided into 2 or 3 intakes. In addition, it’s usually recommended only when cholesterol levels are between 200 and 239 mg/dL. Ideally, consult your doctor or pharmacist before starting to take it. In addition, it should be purchased only from reputable pharmacies.

What is there to remember about red yeast rice?

Evidence suggests that red yeast rice has potential as an adjuvant to control high cholesterol levels. In fact, it has been determined that it may have fewer side effects than statins. Despite this, its consumption as a supplement should be discussed with your doctor.

It shouldn’t be overlooked that it may cause side effects and drug interactions. It shouldn’t be taken simultaneously with cholesterol-lowering drugs. Furthermore, when it comes to improving the lipid profile, you should bear in mind that nothing replaces the effects of a good diet and physical exercise.

Before recommending these supplements or other drugs, the doctor may prescribe a special diet, as well as a change of habits. These measures are often sufficient to control hypercholesterolemia and the associated risks.