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Red Yeast Rice

Uses

Botanical names:
Monascus purpureus

Parts Used & 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.

What Are Star Ratings?

This supplement has been used in connection with the following health conditions:

Used for Why
3 Stars
High Cholesterol
600 to 1,200 mg with 2.5 to 5 mg of monacolin K twice daily
Red yeast rice contains a compound that is well known to inhibit production of cholesterol in the liver.

contains a compound called monacolin K (also known as lovastatin) that reduces production of cholesterol by inhibiting HMG-CoA reductase, a key enzyme in cholesterol synthesis. Multiple clinical trials have shown red yeast rice can effectively lower high total, LDL-, and non-HDL-cholesterol levels. In fact, six to eight weeks of treatment with red yeast rice extract has been found to reduce LDL-cholesterol levels by 15–25%.

Lovastatin (Mevacor)and several of its analogs, collectively called statins, are used as prescription drugs used to treat high cholesterol. However, a typical daily dose of red yeast rice extract provides 10 mg or less monacolin K, while a common dose of lovastatin is 20 to 40 mg per day. It has been suggested that other compounds, including other monacolins, present in red yeast rice work together with monacolin K to produce a greater cholesterol-lowering effect than would be expected from the small amount of monacolin K alone. Nevertheless, monacolins in red yeast rice products vary widely and are often not accurately quantified on labels, and red yeast rice has demonstrated a similar adverse side effect profile to lovastatin. Because HMG-CoA reductase also plays a role in synthesis of coenzyme Q10, an antioxidant needed for mitochondrial energy production, a small amount of coenzyme Q10 is sometimes included in red yeast rice supplements.

A randomized controlled trial comparing a monacolin K-containing red yeast rice product and a monacolin K-free red yeast rice product to placebo found only the monacolin K-containing supplement lowered cholesterol levels. An uncontrolled clinical trial in 25 subjects with low to moderate cardiovascular risk found supplementing with red yeast rice providing 3 mg monacolin K plus 30 mg of coenzyme Q10 daily for one year reduced total, LDL-, and non-HDL-cholesterol, as well as triglyceride and high-sensitivity C-reactive protein (hs-CRP, a marker of vascular inflammation) levels. In addition, vascular characteristics had improved at the end of the trial. In a controlled trial that included 104 participants with high cholesterol levels enrolled in a diet and lifestyle program, those additionally treated with a red yeast rice supplement providing 10 mg monacolin K and 30 mg coenzyme Q10 per day had greater reductions in total and LDL-cholesterol levels, as well as blood pressure, than those receiving no supplements.

2 Stars
Heart Attack (Xuezhikang; for post-event treatment only, not acute attacks )
300 mg twice a day (with doctor supervision)
In one trial that included patients with a previous history of a heart attack, supplementing with a particular brand of Chinese red yeast rice that contained 6 mg per day of lovastatin (a statin drug) reduced risk of death from heart disease. 
In a double-blind trial that included patients with a previous history of a heart attack, supplementation with a particular brand of Chinese red yeast rice (Xuezhikang) in the amount of 300 mg twice a day for an average of 4.5 years reduced the death rate from heart disease by about one-third, compared with a placebo. Xuezhikang is grown by a method that increases its content of lovastatin (a statin drug), and patients in this study received about 6 mg per day of lovastatin from taking Xuezhikang. It is not known whether other red yeast rice products would produce similar benefits.
2 Stars
High Triglycerides
13.5 mg total monacolins daily
Although primarily used to lower high serum cholesterol, red yeast rice extract, high in monacolins, has been found to significantly lower serum triglyceride levels.

Although primarily used to lower high serum cholesterol, extract, high in monacolins, has been found to significantly lower serum triglyceride levels. People in the trial took 1.2 grams (approximately 13.5 mg total monacolins) of a concentrated red yeast rice extract per day for two months. The sale of 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 10 monacolin compounds that are present in Cholestin, and some contain a potentially toxic fermentation product called citrinin. Until further information is available, red yeast rice products other than Cholestin cannot be recommended.

Traditional Use (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

How It Works

Botanical names:
Monascus purpureus

How It Works

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

How to Use It

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.

Interactions

Botanical names:
Monascus purpureus

Interactions with Supplements, Foods, & Other Compounds

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.

Interactions with Medicines

Certain medicines interact with this supplement.

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • none

Reduce Side Effects

  • none

Support Medicine

  • none

Reduces Effectiveness

  • none

Potential Negative Interaction

  • Atorvastatin

    A supplement containing red yeast rice (Monascus purpureas) (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated levels of these blood lipids. This extract contains small amounts of naturally occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used if you are currently taking a statin medication.

  • Fluvastatin

    A supplement containing red yeast rice (Monascus purpureas) (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated levels of these blood lipids. This extract contains small amounts of naturally occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used if you are currently taking a statin medication.

  • Gemfibrozil

    Monascus purpureus, a form of red yeast, is fermented with rice to produce a dietary supplement, Cholestin®, that contains low levels of lovastatin, a drug otherwise available only by prescription. Gemfibrozil taken with the prescription drug lovastatin has been reported to cause rhabdomyolysis, a potentially life-threatening muscle disease. People taking gemfibrozil should avoid lovastatin-containing products, including Cholestin®, until more is known. The levels of lovastatin in Cholestin® are significantly lower than those given of the drug as a single agent. Cholestin® also contains numerous other compounds that may alter the interaction of lovastatin and gemfibrozil.

  • Lovastatin

    A supplement containing red yeast rice (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated levels of these blood lipids. This extract contains small amounts of naturally occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used if you are currently taking a statin medication.

  • Pravastatin
    A supplement containing red yeast rice (Monascus purpureas) (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated levels of these blood lipids. This extract contains small amounts of naturally occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used by people who are currently taking a statin medication.
  • Rosuvastatin

    A supplement containing red yeast rice (Monascus purpureas) (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated levels of these blood lipids. This extract contains small amounts of naturally occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used if you are currently taking a statin medication.

  • Simvastatin
    A supplement containing red yeast rice (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated levels of these blood lipids. This extract contains small amounts of naturally occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used if you are currently taking a statin medication.

Explanation Required

  • none

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

Side Effects

Botanical names:
Monascus purpureus

Side Effects

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.

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 (statins). However, the frequency of side effects with red yeast rice is substantially lower than with statin drugs.18

There is one case report of hepatitis developing in a woman taking red yeast rice. She was also taking two medications that have been reported to cause hepatitis, so a cause-effect relationship with red yeast rice was not proven. However, since statin drugs have been reported to cause hepatitis, it is possible that this complication can also result from taking red yeast rice.19

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.

18. Becker DJ, Gordon RY, Halbert SC, et al. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. Ann Intern Med 2009;150:830-9, W147-9.

19. Roselle H, Ekatan A, Tzeng J, et al. Symptomatic hepatitis associated with the use of herbal red yeast rice. Ann Intern Med 2008;149:516-7.

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How It Works
 

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