Red yeast rice

Overview

Red yeast rice has been used for centuries in China as both food and medicine. It is made by fermenting a type of yeast called Monascus purpureus over red rice. In Chinese medicine, red yeast rice is used to lower cholesterol, improve blood circulation, and help digestive problems.

Red yeast rice contains chemicals that are similar to prescription statin medications. One of these, called monacolin K, has the same makeup as the drug lovastatin (Mevacor). Doctors prescribe statins to lower "bad" LDL cholesterol levels and help reduce the risk of heart disease.

Researchers aren't sure if red yeast rice lowers cholesterol because of the statin-like chemical or because of other things in red yeast rice, such as unsaturated fatty acids, isoflavones, and phytosterols. But because many red yeast rice supplements did have monacolin, the Food and Drug Administration (FDA) considered them to be drugs. Manufacturers were supposed to remove any red yeast rice products with monacolin from the market. As a result, many of the red yeast rice products you can buy may not contain monacolin. There's no way to tell, because monacolin isn't listed on the label.

Therapeutic Uses

Prevention

Several studies have shown that red yeast rice lowers "bad" LDL cholesterol levels. High cholesterol levels raise the risk of heart disease. Red yeast (Monascus purpureus) stops the action of an enzyme in the body that helps make cholesterol.

Red yeast rice contains substances known as monacolins. One of these, monacolin K, has the same chemical makeup as lovastatin (Mevacor), a prescription drug that lowers cholesterol. Some researchers think that's why red yeast rice lowers cholesterol. But others point out that the amount of monacolin in red yeast rice is less than you would find in the prescription drug. They think there may be other substances in red yeast rice that help lower cholesterol. More research is needed.

Treatment

Several studies suggest that red yeast rice reduces high cholesterol. However, most of the studies have used a formulation of red yeast rice -- Cholestin -- that is no longer available in the U.S. You can still buy Cholestin, but it no longer has any red yeast rice. The FDA requires any red yeast product that has monacolin to be taken off the market.

These studies support the claim that red yeast rice lowers cholesterol:

  • A 2008 study compared people with high cholesterol who took fish oil and red yeast rice with people who took a standard dose of simvastatin (Zocor). The red yeast rice contained lovastatin (Mevacor), but at a lower dose than the prescription drug. Cholesterol levels went down in both groups.
  • One study by UCLA School of Medicine involved 83 people with high cholesterol levels. Those who took red yeast rice over a 12 week period had lower levels of total cholesterol, "bad" LDL cholesterol, and triglycerides (fats in the blood) compared to those taking placebo. "Good" HDL cholesterol levels did not change in either study group.
  • A study presented to the American Heart Association showed that red yeast rice lowered LDL cholesterol. In the study, 187 people had mild-to-moderately high levels of total cholesterol and LDL cholesterol. The study showed that taking red yeast rice reduced total cholesterol by more than 16%, LDL cholesterol by 21%, and triglycerides by 24%. HDL cholesterol also went up by 14%.
  • In another 8-week study of 446 people with high cholesterol, those who took red yeast rice had a drop in cholesterol levels compared to those who took placebo. Total cholesterol fell by 22.7%, LDL by 31%, and triglycerides by 34% in the red yeast rice group. HDL cholesterol went up by 20% in the red yeast rice group as well.

Dietary Sources

Asia and Chinese communities in North America use red yeast rice in powdered form as a food coloring for fish, alcoholic beverages, and cheese.

Dosage and Administration

Red yeast rice is an ingredient in several supplements advertised  to promote heart health. Red yeast rice is also available in commercial preparations. One of the proprietary products most often studied was Cholestin, which contained monacolin. However, that product is no longer on the market. The current ingredients in Cholestin do not include red yeast rice.

Pediatric

People younger than 20 should not use red yeast rice supplements.

Adult

In Traditional Chinese Medicine, the dosage of dietary or supplemental red yeast rice is as high as 6,000 - 9,000 mg per day. But the right dose for adults may be different, depending on the form of the supplement. Most studies have used standardized extract: 600 mg, 2 - 4 times daily.

Precautions

Researchers don't know whether it is safe to use red yeast rice for longer than 12 weeks.

People with liver disease and those at risk for liver disease should not take red yeast rice. Red yeast rice may affect the function in the same way prescription drugs to lower cholesterol can.

These people should not take red yeast rice: people with kidney disease, thyroid problems, or musculoskeletal disorders, or those at higher risk of cancer.

People who drink more than two alcoholic beverages a day, have a serious infection or physical condition, or have had an organ transplant should also avoid using red yeast rice.

Side Effects

Side effects of red yeast rice are rare but can include:

  • Headache
  • Stomach ache or bloating
  • Gas
  • Dizziness
  • Heartburn
  • Muscle aches and weakness -- this can lead to a rare but serious condition called rhabdomyolysis. Stop taking red yeast rice immediately and call your doctor

Pregnancy and Breastfeeding

Pregnant and breastfeeding women should not take red yeast rice.

Pediatric Use

People under 20 should not take red yeast rice until more research is done.

Geriatric Use

No studies have looked at the safety of red yeast rice in older adults. However, elderly people who took 1,200 mg per day of red yeast rice in an 8 week study had no major side effects.

Interactions and Depletions

Cholesterol-lowering medications -- If you take drugs to lower your cholesterol, you shouldn't take red yeast rice unless your doctor tells you to. Red yeast rice may make the effect of these drugs stronger, increasing the risk of liver damage. If you are already taking a statin or other drug to lower cholesterol, talk to your doctor before taking red yeast rice.

Anticoagulants (blood-thinners) -- Red yeast rice may increase the risk of bleeding. Blood thinners include warfarin (Coumadin), clopidogrel (Plavix), and daily aspirin.

Grapefruit juice -- If you take a statin, grapefruit and grapefruit juice can increase the amount of the drug in your blood. That can give you a greater chance of side effects and liver damage. Because red yeast rice may act like statins in the body, you should not drink grapefruit juice or eat grapefruit while taking red yeast rice.

Coenzyme Q10 -- Statins can lower the amount of coenzyme Q10 in the body. CoQ10 is very important in heart and muscle health and in energy production. Not having enough CoQ10 can cause fatigue, muscle aches and pains, and muscle damage. Red yeast rice also may lower amounts of CoQ10 in the body. Ask your doctor if you need to take CoQ10 while you are taking red yeast rice products.

Other medications -- Because it acts like a statin, red yeast rice may pose the same potential risk of liver damage that statins do, when combined with other prescription medications that also affect the liver. Some of these include:

  • Azathioprine (Imuran)
  • Cimetidine (Tagamet)
  • Clarithromycin (Biaxin)
  • Cyclosporine
  • Diclofenac (Voltaren)
  • Erythromycin
  • Gemfibrozil (Lopid)
  • Itraconazole (Sporanox)
  • Ketoconazole (Nizoral)
  • Methotrexate (Rheumatrex)
  • Rosiglitazone (Avandia)
  • Valproic acid

Supporting Research

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):830-9.

Becker DJ, Gordon RY, Morris PB, Yorko J, Gordon YJ, Li M, Iqbal N. Simvastatin vs therapeutic lifestyle changes and supplements: randomized primary prevention trial. Mayo Clin Proc. 2008 Jul;83(7):758-64.

Bonovich, K, Colfer H, Davidson M, Dujovne C, Greenspan M, Karlberg R, et al. A Multi-Center, Self-Controlled Study of Cholestin In Subjects With Elevated Cholesterol. American Hear Association. 39th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, Orlando, Fl. March 1999.

Havel R. Dietary supplement or drug? The case of cholestin. Am J Clin Nut.r 1999;69(2):175-176.

Heber D, Yip I, Ashley JM, Elashoff DA, Go VLW. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr. 1999;69:231-236.

Huang CF, Li TC, Lin CC, Liu CS, Shih HC, Lai MM. Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients. Eur J Cardiovasc Prev Rehabil. 2007 Jun;14(3):438-40.

Li C, Li Y, Hou Z. Toxicity study for Monascus purpureus (red yeast) extract. Information of the Chinese Pharmacology Society. 1995;12 (4):12 [Translation].

Li C, Zhu Y, Wang Y, Zhu J, Chang J, Kritchevsky D. Monascus Purpureus-Fermented Rice (Red Yeast Rice): A natural food product that lowers blood cholesterol in animal models of hypercholesterolemia. Nutrition Research. 1998;18(1):71-81.

Liu J, Zhang J, Shi Y, Grimsgaard S, Alraek T, Fønnebø V. Chinese red yeast rice (Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials. Chin Med. 2006 Nov 23;1:4.

Ma J, Li Y, Ye Q, Li J, Hua Y, Ju D, et al. Constituents of red yeast rice, a traditional Chinese food and medicine. J Agric Food Chem. 2000;48:5220-5225.

Mark D. All red yeast rice products are not created equal. The Am J of Cardiol. 106(3).

Mueller PS. Symptomatic myopathy due to red yeast rice. Ann Intern Med. 2006;145(6):474-5.

Ong HT, Cheah JS. Statin alternatives or just placebo: an objective review of omega-3, red yeast rice and garlic in cardiovascular therapeutics. Chin Med J (Engl). 2008 Aug 20;121(16):1588-94.

Qin S, Zhang W, Qi P, Zhao M, Dong Z, Li Y , et al. Elderly patients with primary hyperlipidemia benefited from treatment with a Monacus purpureus rice preparation: A placebo-controlled, double-blind clinical trial. American Heart Association. 39th Annual conference on Cardiovascular Disease Epidemiology and Prevention, Orlando, Fl. March 1999.

Wang J, Lu Z, Chi J, Wang W, Su M, Kou W, et al. Multicenter clinical trial of serum lipid-lowering effects of a Monascus purpureus (red yeast) rice preparation from traditional Chinese medicine. Curr Ther Res. 1997;58(12):964-978.

Venero C, Venero J, Wortham D, Thompson P. Lipid-lowering efficacy of red yeast rice in a population intolerant to statins. The Am J Cardiol. 1-5(5).

Vercelli L, Mongini T, Olivero N, Rodolico C, Musumeci O, Palmucci L. Chinese red rice depletes muscle coenzyme Q10 and maintains muscle damage after discontinuation of statin treatment. J Am Geriatr Soc. 2006;54(4):718-20.

Alternative Names

Angkak; Beni-koji; Hong qu; Hung-chu; Monascus; Red koji; Red leaven; Red rice; Xue zhi kang; Zhitai

Version Info

  • Last Reviewed on 12/28/2012
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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This page was last updated: June 24, 2013

         
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