What is red yeast rice?
Red yeast rice has been used in traditional Chinese medicine for centuries where it was used for medicinal purposes to improve circulation and digestion. It was also used to color and flavor food, including tofu, fish sauce, and pickled vegetables. It is made by fermenting rice with a type of yeast called Monascus purpureus, which gives the rice its red color. In the 1970s, scientists discovered that red yeast rice contains a chemical compound that is enhanced during the fermentation process called monacolin K. This chemical compound was used in the development of a prescription statin drug, lovastatin (Mevacor), which works to lower the amount of low-density lipoprotein (LDL) cholesterol, also known as “bad” cholesterol, in the body. LDL or “bad” cholesterol is a type of cholesterol that can build up plaques in the walls of arteries and narrow or block blood flow to the heart and other organs. This can increase the risk of heart attack, stroke, and other health problems. In recent years, red yeast rice supplements have gained popularity as a natural alternative to cholesterol-lowering medications.
Are red yeast rice supplements effective in lowering “bad” cholesterol?
Re d yeast rice contains monacolin K, the active ingredient that is identical to the statin drug lovastatin, that can lower your cholesterol. Some studies have found that the cholesterol-lowering effects of red yeast rice are similar to that of low-dose lovastatin; however, it is important to note that the amount of cholesterol lowered is not adequate for those who are recommended to be on a prescription statin, including those with prior heart attack or stroke. Also, not all supplements contain the same amount of active ingredient. Therefore, some supplements may have too little active ingredient and not provide the same lowering effect as seen in studies.
Are red yeast rice supplements effective in lowering “bad” cholesterol?
Red yeast rice contains monacolin K, the active ingredient that is identical to the statin drug lovastatin, that can lower your cholesterol. Some studies have found that the cholesterol-lowering effects of red yeast rice are similar to that of low-dose lovastatin; however, it is important to note that the amount of cholesterol lowered is not adequate for those who are recommended to be on a prescription statin, including those with prior heart attack or stroke. Also, not all supplements contain the same amount of active ingredient. Therefore, some supplements may have too little active ingredient and not provide the same lowering effect as seen in studies.
What are the safety concerns?
Red yeast rice is generally considered safe; however, it can cause similar side effects as statin drugs. The most common side effects include stomach pain, diarrhea, nausea, headache, and muscle pain. Red yeast rice can also interact with certain foods and medications, including grapefruit and grapefruit juice, cholesterol-lowering medications, and blood thinners, so it’s important to talk to your doctor or pharmacist before taking this supplement.
Another concern is the potential for red yeast rice to contain citrinin, a toxic contaminant if the product is not fermented properly. Citrinin can damage the liver and kidneys. Unlike prescription drugs, supplements are not highly regulated by the FDA so supplements may not be tested for citrinin levels.
Unlike prescription medications, which are highly regulated by the FDA with precise amounts of active ingredient, red yeast rice supplement products have variable amounts of active ingredient. In other words, some brands may have too much active ingredient and cause potential side effects, whereas other brands may have too little active ingredient than what is claimed on the label, making the product not as effective.
What’s the verdict?
Although some studies have suggested that red yeast rice supplements can lower cholesterol levels as effectively as low-dose lovastatin, there are safety concerns with taking supplements. The lack of regulation and standardization of supplements means that the quality, strength, and composition of the active ingredient, monacolin K, can vary widely. Furthermore, red yeast rice supplements do not achieve the same cholesterol-lowering goals that we aim for in those with high risk of or prior heart attack or stroke. Therefore, it should not be used as an alternative to statins. If you are considering taking red yeast rice supplements to lower your cholesterol, it is important to talk to your doctor or pharmacist first to see if red yeast rice is safe and effective for you.
Prepared by Melvina Lu, PharmD Candidate 2023
References:
- Becker DJ, Gordon RY, Halbert SC, French B, Morris PB, Rader DJ. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. Ann Intern Med. 2009;150(12):830-W149.
- Dujovne CA. Red Yeast Rice Preparations: Are They Suitable Substitutions for Statins?. Am J Med. 2017;130(10):1148-1150.
- Gold KR, Gold R, Avula B, Khan IA. The Red Yeast Rice story: How to manufacture a tall tale from nature. Eur J Prev Cardiol. 2018;25(1):73-75.
- Gregory PJ, Pettit R, Cochrane ZR, Wilson AF, Abe AM. Lovastatin Content of Commercially Available Red Yeast Rice Supplements. Journal of Evidence-Based Complementary & Alternative Medicine. 2012;17(2):104-107.
- Klimek M, Wang S, Ogunkanmi A. Safety and efficacy of red yeast rice (Monascus purpureus) as an alternative therapy for hyperlipidemia. P T. 2009;34(6):313-327.
- Venero CV, Venero JV, Wortham DC, Thompson PD. Lipid-lowering efficacy of red yeast rice in a population intolerant to statins. Am J Cardiol. 2010;105(5):664-666.