Red Yeast Rice: The Truth Behind This Controversial Cholesterol-Lowering Supplement

The most well-known of red yeast rice benefits is by far its potential to lower cholesterol. Many people with high cholesterol turn to red yeast rice supplements to avoid the dangers of statins. These cholesterol-lowering drugs known as statins have been linked with some really concerning side effects, including memory loss, liver damage, muscle pain, high blood sugar, and even development of type 2 diabetes.

Scientific studies have demonstrated that supplementing with red yeast rice can lower overall as well as LDL cholesterol, aka “bad cholesterol.” According to Traditional Chinese Medicine, benefits of red yeast rice also include improvements in circulation and digestion.

Let’s take a look at the possible benefits of red yeast rice supplements as well as the controversy surrounding this natural over-the-counter remedy.

What Is Red Yeast Rice?

Red yeast rice is created by fermenting a type of yeast called Monascus purpureus with rice. Once the rice is combined with the fermenting yeast, the resulting red yeast rice is bright reddish purple in color. Red yeast rice extract is used to make a red yeast rice supplement.

It contains the naturally occurring chemical monacolins, which block the production of cholesterol. One of these monacolins sometimes found in red yeast rice supplements, called monacolin K, has been controversial because this chemical is said to be an active statin-like compound with the same chemical makeup as popularly prescribed statins like lovastatin and mevinolin. This is a concern because we know the potential dangers of statins include muscle pain and weakness, neuropathy, heart failure, dizziness, cognitive impairment, cancer, pancreatic rot and depression.

Experts aren’t clear on whether red yeast rice successfully lowers cholesterol because it contains monacolins or because of its naturally occurring plant compounds like phytosterols and isoflavones as well as its unsaturated fatty acid content.

In 1998, the U.S. Food and Drug Administration (FDA) began to regulate manufactures of red yeast rice supplements and said that supplements containing monacolin K are considered drugs rather than dietary supplements. Since that time, the FDA has taken legal action against companies making red yeast rice supplements with greater than trace amounts of monacolin K.

The FDA states that while red yeast rice products that have considerable amounts of monacolin K may effectively lower blood cholesterol levels, blood glucose levels and blood pressure — along with lowering the risk of heart problems and death in people with metabolic syndrome — these products are considered to be unapproved new drugs and cannot be sold legally in the U.S.

What about red yeast rice products that contain very little monacolin K? The FDA states that “it’s unknown if these products are effective in reducing cholesterol levels or improving other areas of health.”

Benefits

1. Help for High Cholesterol

When cholesterol lowering foods don’t make enough of an impact, cholesterol lowering supplements can be investigated. Red yeast rice supplements are most often taken to naturally lower hyperlipidemia or high cholesterol. The red yeast (Monascus purpureus) used to make red yeast rice has been shown to stop the action of an enzyme in the human body that helps form cholesterol. There have been many studies showing the positive effects of red yeast rice extract on cholesterol.

A 2019 study stated that “the extract of red yeast rice is the most effective cholesterol-lowering nutraceutical on the market.” The effectiveness of red yeast rice for lowering cholesterol is directly related to the amount of monacolin K with the extract (up to 10 mg/day). Consuming red yeast rice with monacolin K daily basis reduced low-density lipoprotein (LDL) or “bad” cholesterol plasma levels between 15 percent and 25 percent within 6 to 8 weeks.

Meanwhile, the same study determined that a daily consumption of between 3 and 10 mg monacolin K only had minimal associated risks, with no additional cardiovascular risk factors.

A 2010 study published in the American Journal of Cardiology examined the effects of red yeast rice supplementation on patients who could not tolerate conventional statin drugs. The results for the 25 patients treated with red yeast rice for at least four weeks or more were pretty impressive. On average, for the people taking red yeast rice who could not tolerate statins, their total cholesterol decreased by 13 percent, LDL cholesterol went down by 19 percent and the red yeast rice was generally well-tolerated.

Another study published in the European Journal of Cardiovascular Prevention and Rehabilitation evaluated the effects of red yeast rice (also called Went rice) on 79 patients with high cholesterol between 23 and 65 years of age. These patients took either 600 milligrams of red yeast rice or a placebo two times per day for a total of eight weeks. The study results revealed that the subjects who took the red yeast rice showed “significantly greater reduction” in LDL (“bad”) cholesterol levels as well as total cholesterol.

2. Fewer Muscle Fatigue Symptoms

One of the main complaints with statin users is muscle fatigue. In fact, it’s estimated that between 1o percent to 15 percent of statin users experience skeletal muscle issues. A 2017 study investigated the effects of 60 patients with abnormally high cholesterol levels and with low to moderate cardiovascular risk taking either simvastatin or red yeast rice.

After four weeks of taking either the statin or the red yeast rice, the subjects who took the simvastatin had a significantly higher muscle fatigue score compared to the red yeast rice group, who experienced no significant changes in muscle health. Even though both groups had decreases in their cholesterol, the researchers noted that the statin takers engaged in less physical activity. Overall, this study concludes that red yeast rice worked just as well for subjects as the statin but with less fatigue.

3. Possible Obesity Aid

A 2015 study published in the Journal of Medicinal Food looked at how effective red yeast rice is in the treatment of obesity and high cholesterol, which are two common health concerns that often occur together.

The researchers separated animal subjects into five groups: normal diet, high-fat diet with no treatment, and three high-fat diet groups given either one gram per kilogram a day of red yeast rice for eight weeks, one gram per kilogram a day of red yeast rice for 12 weeks or 2.5 grams per kilogram daily for eight weeks.

What did the researchers find? The supplementation with red yeast rice actually prevented weight again and also improved the atherogenic index of subjects. The atherogenic index of plasma provides information about cholesterol ratios in the body, and it is used asa marker to predict the risk of atherosclerosis and coronary heart disease. The conclusion of the study: “These findings suggest that red yeast rice has therapeutic potential in treating obesity and hyperlipidemia.”

4. Reduction in Biomarkers of Oxidative Stress

In 2017, results were published for a double-blind, placebo-controlled, randomized trial that involved 50 patients with metabolic syndrome  and the effects of a supplement containing both red yeast rice and olive extract. Metabolic syndrome is a health disorder that involves having a combination of three or more of the following health issues: abdominal obesity, hypertension, high blood sugar, elevated triglyceride levels or low HDL (“good”) cholesterol.

This trial found that supplementing with red yeast rice and olive extract greatly decreased lipoprotein-associated phospholipase A2 (Lp-PLA2) as well as oxidized low-density lipoprotein (OxLDL). This is significant since Lp-PLA2 and OxLDL are biomarkers of oxidative damage or stress, which plays a major role in disease formation. In this case, reduction of these two markers have been associated with a lower risk of heart disease in people with metabolic syndrome.

5. Improvement in Insulin Sensitivity

A study published in the World Journal of Cardiology in 2012 demonstrated that red yeast rice extract may also help with healthy maintenance of normal blood sugar levels. This study specifically looked at the effects of a supplement containing berberine, red yeast rice and policosanol compared to a placebo on insulin resistance in people with metabolic syndrome.

After 18 weeks, the group who took the supplement containing red yeast rice had a significant decrease in insulin resistance as well as both LDL and overall cholesterol.

How to Use & Dosage Recommendations

Red yeast rice supplements are extremely easy to find at your local health store or online. Any red yeast rice supplement should be taken with food. It is also best taken with coenzyme Q10 (at least 90–120 milligrams daily) to prevent deficiency in CoQ10.

What about the best red yeast rice dosage? Most studies have used a standardized extract of 600 milligrams taken two to four each day — so that can be 1,200 milligrams twice a day, which is equivalent to 600 milligrams four times per day or 2,400 milligrams per day. At least one study has shown that elderly individuals who took 1,200 milligrams (1.2 grams) of red yeast rice every day for eight weeks did not have any major side effects.

The amount of monacolins in red yeast rice supplements can differ since manufacturers can use various yeast strains and fermentation processes. Some research has shown that the amount of monacolin in red yeast rice supplements ranged more than 60-fold, from 0.09 to 5.48 mg per 1,200 mg of red yeast rice.

History

Red yeast rice is also sometimes referred to as several other names, including red yeast rice, Went rice, red fermented rice, red rice koji, akakoji, red kojic rice, red koji rice or anka.”Koji” in Japanese means “grain or bean overgrown with a mold culture.” Red yeast rice has been used in Traditional Chinese Medicine for over a thousand years to address health concerns related to poor circulation and poor digestion.

In Asia as well as Chinese communities in North America, powdered red yeast rice is used to color a variety of consumable products, including tofu, meat, fish, cheese, vinegar and pastries. Can you taste the red yeast rice? It’s said that adding red yeast rice to foods provides a subtle yet enjoyable flavor.

Red yeast rice can also be found in some alcoholic drinks, such as Korean rice wines and Japanese sakes. As you might expect, adding red yeast rice to the beverages results in a reddish tint.

In Asia, naturally occurring red yeast rice is commonly consumed on a regular basis. It is estimated that people in Asia are eating somewhere between 14 to 55 grams of red yeast rice each day.

Risks and Side Effects

Anyone under the age of 20 should not use red yeast rice supplements. You should also avoid red yeast rice if you have an allergy or sensitivity to rice, red yeast or members of the Monascaceae (yeast) family.

Research has shown that red yeast rice side effects (often mistakenly searched for as “red rice yeast side effects”) are typically mild. Side effects of red yeast rice can include headache, upset stomach, heartburn, gas or dizziness. Muscle aches and weakness are also possible, especially if the red yeast rice supplement contains high levels of monacolin, and can result in a rare yet serious condition called rhabdomyolysis. If you experience muscle aches and weakness, discontinue use of red yeast rice and contact your healthcare professional.

Red yeast rice supplements should not be taken while breastfeeding, pregnant or trying to become pregnant. It’s also recommended to avoid red yeast rice if you have kidney disease, liver disease, thyroid issues, musculoskeletal disorders or if you have a higher risk of cancer. You should also avoid red yeast rice if you have any kind of serious infection or physical condition, have had an organ transplant, or if you consume more than two alcoholic beverages per day.

It is recommended to avoid taking red yeast rice if you are already taking any of the these medications already:

• Statins or other cholesterol drugs
• Serzone (an antidepressant)
• Antifungal drugs
• Immune system suppressing drugs, such as cyclosporine
• The antibiotics erythromycin and clarithromycin (Biaxin)
• Protease inhibitors used to treat HIV

It’s a good idea to take a red yeast rice supplement under the supervision of a health care professional, especially if you are being treated for any health concerns or are currently taking any medication.

Final Thoughts

• Studies indicate that red yeast rice can benefit some major health concerns, especially high cholesterol.
• For those people taking a statin, ask your healthcare professional what they think of taking a red yeast rice supplement instead. Some physicians are known to be willing to have their patients try a scientifically researched supplement like red yeast rice.
• If you have high cholesterol, it’s also crucial to focus on your diet and exercise. If you do decide to try red yeast rice, make sure it is from a reputable source, ideally one that has strict standards for evaluating the supplements it sells to customers like you.