Therapeutic Uses

Prevention

Several studies have shown that red yeast rice lowers LDL ("bad") 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 is why red yeast rice lowers cholesterol. 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, which 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:

• 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, LDL cholesterol, and triglycerides (fats in the blood) compared to those taking placebo. HDL ("good") 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 (TCM), the dosage of dietary or supplemental red yeast rice can be quite high. 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 to 4 times daily.

Precautions

Researchers do not 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
• Stomachache 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 should not 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 (CoQ10): Statins can lower the amount of CoQ10 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, French B, Morris PB, Silvent E, Gordon RY. Phytosterols, red yeast rice, and lifestyle changes instead of statins; a randomized, double-blinded, placebo-controlled trial. Am Heart J . 2013;166(1):187-96.

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. 39 ^th 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 Nutr . 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.

Li Y, Jiang L, Jia Z, et al. A meta-analysis of red yeast rice: an effective and relatively safe alternative approach for dyslipidemia. PLoS One . 2014;9(6):e98611.

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. 39 ^th Annual conference on Cardiovascular Disease Epidemiology and Prevention, Orlando, Fl. March 1999.

Shamim S, Al Badarin FJ, DiNicolantonio JJ, Lavie CJ, O'Keefe JH. Red yeast rice for dysipidemia. Mo Med . 2013;110(4):349-54.

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 . 2010;105(5):664-6.

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.