Lipid Disorders and Red Yeast Rice

Red yeast rice is a traditional Chinese substance made by fermenting a type of yeast called Monascus purpureus over rice. Various formulations of this product have been used in China since at least 800 AD as a food and also as a medicinal substance within the context of Traditional Chinese Herbal medicine.

Red yeast rice contains cholesterol-lowering chemicals that are similar to those of prescription statins, including one identical to the drug lovastatin. Like statins, red yeast rice may help reduce high cholesterol. The research on this topic is very positive.

Red yeast rice contains naturally occurring substances similar (and, in some cases, identical) to cholesterol-lowering prescription drugs in the statin family. Statins lower cholesterol and reduce inflammation.

Read more details about Red Yeast Rice.

An 8-week, double-blind, placebo-controlled trial of 83 people with high cholesterol evaluated red yeast rice.¹ At the end of the 8-week treatment period, levels of total cholesterol decreased significantly in the red yeast rice group as compared to the placebo group. Benefits were also seen in LDL (“bad”) cholesterol and triglycerides as well. No significant differences were noted in HDL (“good”) cholesterol levels from baseline or between groups.

In an 8-week study of 79 people, use of red yeast rice was noted to improve the LDL/HDL ratio, along with several other measures of cardiac risk.^9,11

In a carefully conducted review of 93 randomized trials involving almost 10,000 patients, researchers concluded that red yeast rice can significantly lower levels of total cholesterol, LDL, and triglycerides, and raise levels of HDL compared with placebo.¹³

The dosage of red yeast rice used in most studies is 1.2 to 2.4 g of red yeast rice powder daily. However, due to patent-infringement suits by the manufacturer of a statin drug that is naturally present in red yeast rice, the most studied red yeast rice product has been taken off the market, and it is not clear whether the remaining products have greater or lesser potency.

• Chinese herbalist; acupuncturist
• Integrative MD
• Naturopathic doctor

Safety Issues

In clinical trials, use of red yeast rice has not been associated with any significant side effects. However, red yeast rice contains naturally occurring statin drugs, and use of statin drugs can cause side effects ranging from minor to life-threatening. Some of the most common include muscle pain, joint pain, liver inflammation, and peripheral nerve damage; severe breakdown of muscle tissue (rhabdomyolysis) leading to kidney failure has also occurred. It is almost certain that red yeast rice can cause the same problems if it is used by enough people, and there are at least two case reports in the literature of muscle injury caused by red yeast rice; in one case, rhabdomyolosis developed. ¹ Due to the relative lack of regulation of supplement manufacture, the statin content of red yeast rice products is unpredictable, and this could increase potential risk. In addition, red yeast rice may at times contain the toxic substance citrinin. ² Based on the known effects of statins, pregnant or nursing women, women likely to become pregnant, young children, and people with liver or kidney disease should not use red yeast rice. Furthermore, red yeast rice should not be combined with fibrate drugs , cyclosporine , erythromycin-family drugs, antifungal drugs, or high-dose niacin . Finally, it would not make sense to combine red yeast rice with standard statin drugs.

Statin drugs are known to interfere with the body’s ability to produce the natural substance CoQ 10 , ^{3 4} and one animal study found the same effect with red yeast rice. ⁵ For this reason, people taking red yeast rice could conceivably benefit from CoQ 10 supplementation; however, this has not yet been proven. (See the full article on Statins for more information.)

Interactions You Should Know About

If you are taking fibrate drugs , cyclosporine , erythromycin-family drugs, antifungal drugs, or high-dose niacin , do not use red yeast rice.

If you use red yeast rice to keep your cholesterol levels down, taking the herb St. John’s wort may impair the effectiveness of red yeast rice and cause your cholesterol to rise.

1. Prasad GV, Wong T, Meliton G, et al. Rhabdomyolysis due to red yeast rice ( Monascus purpureus ) in a renal transplant recipient. Transplantation. 2002;74:1200-1201.
2. Liu BH, Wu TS, Su MC, et al. Evaluation of citrinin occurrence and cytotoxicity in Monascus fermentation products. J Agric Food Chem. 2005;53:170-175.
3. Silver MA, Langsjoen PH, Szabo S, Patil H, Zelinger A. Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction. Am J Cardiol. 94(10):1306-10.
4. Rundek T, Naini A, Sacco R, Coates K, DiMauro S. Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke. Arch Neurol. 61(6):889-92.
5. Yang HT, Lin SH, Huang SY, et al. Acute administration of red yeast rice ( Monascus purpureus ) depletes tissue coenzyme Q(10) levels in ICR mice. Br J Nutr. 2005;93:131-135.

1. Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr. 1999;69:231-236.
9. Lin CC, Li TC, Lai MM, et al. Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia. Eur J Endocrinol. 2005;153:679-686.
11. Huang CF, Li TC, Lin CC, et al. Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients. Eur J Cardiovasc Prev Rehabil. 2007;14:438-440.
13. Liu J, Zhang J, Shi Y, et al. Chinese red yeast rice ( Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials. Chin Med. 2006;1:4.