Red Yeast Rice

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Related Topics

See also:

• Drug interactions

Botanical Names

Botanical name:

• Monascus purpureus

Parts used and where grown

This substance, native to China, is a fermentation by-product of cooked non-glutinous rice on which red yeast has been grown.¹ The dried, powdered red yeast rice is used medicinally.

Health Concerns

Red yeast rice has been used in connection with the following conditions (refer to the individual health concern for complete information):

Rating	Health Concerns
	High cholesterol
	High triglycerides
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

Traditional Use

Historical or traditional use (may or may not be supported by scientific studies)

Since 800 A.D., red yeast rice has been employed by the Chinese as both a food and a medicinal agent. Its therapeutic benefits as both a promoter of blood circulation and a digestive stimulant were first noted in the traditional Chinese pharmacopoeia, Ben Cao Gang Mu-Dan Shi Bu Yi, during the Ming Dynasty (1368-1644).² Practitioners of Traditional Chinese Medicine use red yeast rice to treat abdominal pain due to stagnant blood and dysentery, as well as external and internal trauma.³ In addition to its therapeutic applications, red yeast rice has been used for centuries as a flavor enhancer, a food preservative, and a base for a Taiwanese alcoholic rice-wine beverage.^{4, 5}

Active Constituents

Active constituents

In addition to rice starch, protein, fiber, sterols, and fatty acids, red yeast rice contains numerous active constituents, including monacolin K, dihydromonacolin, and monacolin I to VI.

Researchers have determined that one of the ingredients in red yeast rice, called monacolin K, inhibits the production of cholesterol by stopping the action of a key enzyme in the liver (e.g., HMG-CoA reductase) that is responsible for manufacturing cholesterol.⁶ The drug lovastatin (Mevacor®) acts in a similar fashion to this red yeast rice ingredient. However, the amount per volume of monacolin K in red yeast rice is small (0.2% per 5 mg) when compared to the 20-40 mg of lovastatin available as a prescription drug.⁷ This has prompted researchers to suggest that red yeast rice may have other ingredients, such as sterols, that might also contribute to lowering cholesterol.

Along with its evaluation in animal trials,⁸ red yeast rice has been clinically investigated as a therapy for reducing cholesterol in two human trials. In one trial, both men and women taking 1.2 grams (approximately 13.5 mg total monacolins) of a concentrated red yeast rice extract per day for two months had significant decreases in serum cholesterol levels.⁹ In addition, people taking red yeast rice had a significant increase in HDL ("good") cholesterol and a decrease in LDL ("bad") cholesterol. Elevated triglycerides were also found to be lowered.

A double-blind trial at the UCLA School of Medicine determined that red yeast rice in the amount of 2.4 grams per day (approximately 10 mg total monacolins) in capsules significantly decreased total- and LDL-cholesterol levels in a sample of people with elevated cholesterol after 12 weeks of therapy. Triglycerides were also reduced in those taking red yeast rice. However, unlike the original study, HDL values did not increase substantially.¹⁰

Dosage

How much is usually taken?

The red yeast rice used in various studies was a proprietary product called Cholestin®, which contains ten different monacolins. The amount of Cholestin used in these studies was 1.2-2.4 grams (5-10 mg of monacolins) per day in divided amounts for 8-12 weeks.^{11, 12}

Note: Cholestin has been banned in the United States, as a result of a lawsuit alleging patent infringement.

Other red yeast rice products currently on the market differ from Cholestin in their chemical makeup. None contain the full complement of ten monacolin compounds that are present in Cholestin, and some contain a potentially toxic fermentation product called citrinin.¹³ Despite these concerns, other red yeast rice products are being widely used and anecdotal reports suggest that they have a similar safety and efficacy profile as that of Cholestin.

Side Effects

Are there any side effects or interactions?

The Cholestin brand of red yeast rice has been generally well tolerated with possible temporary mild side effects such as heartburn, gas, and dizziness.¹⁴ This product should not be used by people with liver disorders¹⁵ and its safety during pregnancy has not been established. As in the case of medications that inhibit HMG-CoA, it is advisable that people using red yeast rice products also supplement 30-60 mg of coenzyme Q10 daily.

There is one case report of muscle weakness and joint pain occurring in a man who was taking red yeast rice.¹⁶ Because the man was also taking several prescription drugs, it was not clear whether the symptoms were caused by red yeast rice. In another case report, a woman developed severe muscle pain with laboratory evidence of muscle damage while taking red yeast rice. In that case, red yeast rice appeared to be the cause of the muscle damage.¹⁷ These reports should be taken seriously, because muscle problems are common side effects of prescription HMG CoA-reductase inhibitors.

Are there any drug interactions?

Certain medicines may interact with red yeast rice. Refer to drug interactions for a list of those medicines.

References

1. Burnham TH, Sjweain SL, Short RM (eds). Monascus. In: The Review of Natural Products. St. Louis, MO: Facts and Comparisons, 1997.
2. Burnham TH, Sjweain SL, Short RM (eds). Monascus. In: The Review of Natural Products. St. Louis, MO: Facts and Comparisons, 1997.
3. Hsu Hong-Yen. Oriental Materia Medica. Long Beach, CA: Oriental Healing Arts Institute, 1986, 731-2.
4. Burnham TH, Sjweain SL, Short RM (eds). Monascus. In: The Review of Natural Products. St. Louis, MO: Facts and Comparisons, 1997.
5. Hsu Hong-Yen. Oriental Materia Medica. Long Beach, CA: Oriental Healing Arts Institute, 1986, 731-2.
6. 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;69:231-6.
7. 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;69:231-6.
8. Li C, Zhu Y, Wang Y, et al. Monascus purpureus-fermented rice (red yeast rice): a natural food product that lowers blood cholesterol in animal models of hypercholesterolemia. Nutr Res 1998;18:71-81.
9. Wang J, Lu Z, Chi J, et al. Multicenter clinical trial of the serum lipid-lowering effects of a Monascus purpureus (red yeast) rice preparation from traditional Chinese medicine. Curr Ther Res 1997;58:964-77.
10. 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;69:231-6.
11. 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;69:231-6.
12. Wang J, Lu Z, Chi J, et al. Multicenter clinical trial of the serum lipid-lowering effects of a Monascus purpureus (red yeast) rice preparation from traditional Chinese medicine. Curr Ther Res 1997;58:964-77.
13. Heber D, Lembertas A, Lu QY, et al. An analysis of nine proprietary Chinese red yeast rice dietary supplements: implications of variability in chemical profile and contents. J Altern Complement Med 2001;7:133-9.
14. Wang J, Lu Z, Chi J, et al. Multicenter clinical trial of the serum lipid-lowering effects of a Monascus purpureus (red yeast) rice preparation from traditional Chinese medicine. Curr Ther Res 1997;58:964-77.
15. Burnham TH, Sjweain SL, Short RM (eds). Monascus. In: The Review of Natural Products. St. Louis, MO: Facts and Comparisons, 1997.
16. Smith DJ, Olive KE. Chinese red rice-induced myopathy. South Med J 2003;96:1265-7.
17. Mueller PS. Symptomatic myopathy due to red yeast rice. Ann Intern Med 2006;145:474-475.

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Last Review: 09-01-2007

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

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