Red yeast rice has been used for more than 1,000 years in China as both a food and a medicinal product.
It was first documented in the Tang Dynasty (A.D. 618-917), and a detailed description of its manufacturing process is found in an ancient Chinese pharmacopoeia published during the Ming Dynasty (1368-1644). At that time, it was used to treat indigestion and diarrhea, improve blood circulation, and promote spleen and stomach health.
Today red yeast rice is best known as a nutrient that has been shown in clinical trials to support lower LDL (“bad”) cholesterol and triglyceride levels and higher HDL (“good”) cholesterol levels.
Red yeast rice is produced by fermenting the yeast strain Monascus purpureus on saturated (moist) rice. When fully cultured, each grain of rice is reddish purple on the outside with a bright red core. In addition to being ground or turned into a wet paste, once the red yeast rice has been dried, it can also be prepared and eaten just like white rice – a common practice in Asia.
Because of its rich red color, red yeast rice is also a popular food coloring agent in Asian cuisine. It is traditionally used as a component of food products like Peking Duck, red rice vinegar, pickled tofu, Japanese sake and several types of Chinese and Korean rice wines.
High Cholesterol Is a World-Wide Problem
According to the Centers for Disease Control and Prevention (CDC), high cholesterol affects about 20 percent of adults in the United States; and the World Health Organization (WHO) estimates that, worldwide, high cholesterol is a contributing factor in 56 percent of cases of coronary heart disease.
The most common Western medical treatment for high cholesterol and high triglycerides (also called hyperlipidemia) is prescription drugs called statins (such as Lipitor® and Zocor®). The problem with these medications is that their potential side effects are significant and can in some cases be extremely dangerous.
High Cholesterol and Lyme Disease
High cholesterol may have particular significance for people with Lyme disease. A 2015 study found that mice with high cholesterol, who were infected with the Borrelia burgorferi spirochete associated with Lyme disease, had had an increased number of spirochetes in the joints and inflamed ankles. The study authors concluded that high cholesterol could be a risk factor for increased severity in Lyme disease.(1)
Studies Confirm Red Yeast Rice May Support Cholesterol Lowering
The fact that red yeast rice is a source of naturally-occurring statins may explain why studies over the past 40 years have reported that consumption of red yeast rice can support lower blood levels of total cholesterol, LDL cholesterol, and triglycerides.
“The collective research suggests that red yeast rice is effective and safe in improving the lipid profile among patients with hyperlipidemia. Some research even has suggested that red yeast rice, along with other nonprescription treatment, may be as or more effective than a statin.”
This statement was made by Charles P. Vega, MD, Associate Professor and Residency Director in the Department of Family Medicine at the University of California-Irvine, in a Medscape “Best Evidence Reference” article.(2)
Two different studies of red yeast rice for the treatment of high cholesterol and triglycerides were presented at the 1999 American Heart Association's 39th Annual Conference on Cardiovascular Disease Epidemiology and Prevention. Their results are consistent with numerous other studies linking supplementation with red yeast rice to significantly lowered total cholesterol, LDL cholesterol and triglyceride levels.
The chart below summarizes the studies' results.(3)(4)
An Added Benefit of Red Yeast Rice
No. of Participants
Because of the potential side effects of statin drugs, many patients are afraid to take them – or have tried but were unable to continue owing to the negative side effects. People with fibromyalgia, ME/CFS, Lyme disease or other chronic pain illnesses may be particularly wary of statins, since muscle pain is one of the more common side effects.
Concern for their patients led two cardiologists to undertake a study evaluating whether red yeast rice might be an effective alternative for high-cholesterol patients who could not take prescription statins because of muscle pain.
Sixty-two patients with high cholesterol and a history of statin-associated muscle pain were enrolled. Half were given 1800 mg of red yeast rice twice daily and the other half were given a placebo. All of the patients were also enrolled in a 12-week therapeutic lifestyle change program. After 12 weeks:
• Those taking the red yeast rice saw a 27 percent drop in their LDL ("bad") cholesterol levels, while those taking the placebo only experienced a 6 percent drop.
• Total cholesterol levels also improved more in the group taking red yeast rice.
• Levels of HDL ("good") cholesterol, triglycerides and liver enzymes did not change significantly for either group.
The study also found that red yeast rice did not significantly affect blood levels of liver enzymes or creatinine phosphokinase (CPK). This is important because one of the more serious side effects of statin drugs experienced by some people is elevated liver enzymes; and also because statin drug therapy is associated with two rare but serious complications - myositis (muscle inflammation) and rhabdomyolysis (life-threatening, severe muscle breakdown) - both of which are indicated by high levels of CPK.
The study concluded that red yeast rice may be a treatment option for high cholesterol patients who cannot tolerate statin therapy.(5)
FDA Controversy Over Certain Red Yeast Rice Products
In August 2007 the FDA issued a warning to consumers not to purchase three particular red yeast rice products sold by Swanson Healthcare Products and Sunburst Biorganics.(6) They also sent warning letters to the two companies advising them to stop promoting and selling the products.(7)(8) The problem was that FDA testing had revealed the products contained lovastatin, the active pharmaceutical ingredient in Mevacor®, a prescription drug approved for marketing in the United States as a treatment for high cholesterol.
The fact is that a total of 14 monacolins – compounds known to inhibit cholesterol synthesis - have been identified in red yeast rice.(9) One of those, monacolin K, is the natural version and has the same chemical makeup as the prescription drug lovastatin. According to the FDA, “traditional red yeast rice does not contain more than trace amounts of lovastatin, if any.” Apparently the products being sold by these two companies contained “red yeast rice with enhanced or added lovastatin...” As a result of the FDA's action, the products in question have been removed from the market.
What You Need to Know Before Taking Red Yeast Rice
A few important facts you should know before taking red yeast rice:
• Both red yeast rice and prescription statin drugs inhibit the synthesis of coenzyme Q10 in the body. CoQ10 is essential for heart and muscle health and energy production. Therefore, it is recommended that anyone who takes either statins or red yeast rice should also take CoQ10 every day. Recommended CoQ10 amounts when taken with red yeast rice vary from 90 to 200 mg per day.
• Who should not take red yeast rice: Persons with liver disease, women who are pregnant or nursing, and children under 18.
• Dosing: In Traditional Chinese Medicine, doses as high as 6,000 to 9,000 mg per day may be given. However, Western healthcare professionals usually recommend 1,200 to 2,400 mg per day.
• Side effects from red yeast rice are rare but can include: headache, stomach ache, bloating, gas, dizziness, heartburn, muscle aches and weakness.
• Possible interactions: Red yeast rice should not be taken with cholesterol-lowering drugs or anticoagulants. Grapefruit and grapefruit juice should be avoided.
The collective research strongly suggests that supplemental red rice yeast may be considered part of an effective and safe approach to cholesterol management for those seeking an alternative to use of prescription statin drugs.
* Karen Lee Richards is the Lead Expert specializing in Fibromyalgia and ME/CFS, for HealthCentral's ChronicPainComnection (www.chronicpainconnection.com). Karen is co-founder of the National Fibromyalgia Association (NFA) and was Executive Editor of Fibromyalgia AWARE magazine for four years.
1. Toledo A., et al. “Hypercholesterolemia and ApoE deficiency result in severe infection with Lyme disease and relapsing-fever Borrelia.” Proc Natl Acad Sci U S A. 4/28/2015.
2. Vega, C.P. (2009, October 28). “Red yeast rice and hyperlipidemia: How strong is the evidence?” Medscape Family Medicine.
3. Qin S, 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. (Cited in the University of Maryland Medical Center article on “Red Yeast Rice.”)
4. Bonovich K, et al. “A Multi-Center, Self-Controlled Study of Cholestin In Subjects With Elevated Cholesterol. American Heart Association.” 39 Annual Conference on Cardiovascular Disease Epidemiology and Prevention, Orlando, Fl. March 1999. (Cited in the University of Maryland Medical Center article “Red Yeast Rice.”)
5. Becker DJ, et al. “Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial.” Ann Intern Med. 2009 Jun 16;150(12):830-9, W147-9.
6. U.S. Food and Drug Administration. “FDA Warns Consumers to Avoid Red Yeast Rice Products Promoted on Internet as Treatments for High Cholesterol Products found to contain unauthorized drug.” 8/9/2007.
7. U.S. Food and Drug Administration. “Warning letter to Swanson Health Products, Inc.” 8/8/2007.
8. U.S. Food and Drug Administration. "Warning letter to Sunburst Biorganics.” 8/7/2007.
9. Li YG, et al. “Identification and chemical profiling of monacolins in red yeast rice using high-performance liquid chromatography with photodiode array detector and mass spectrometry.” J Pharm Biomed Anal. 2004 Sep 3;35(5):1101-12.
Note: This information has not been evaluated by the FDA. It is general information and is not meant to prevent, diagnose, treat or cure any condition, illness, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.