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Complementary and Alternative Medicine - Cam

Search Health Information    Red Yeast Rice

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?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

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

Used for Why
3 Stars
High Cholesterol
1.2 to 2.4 grams (5 to 10 mg of monacolins) daily in divided amounts
One of the ingredients in red yeast rice appears to block the production of cholesterol in the liver.

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 the key enzyme in the liver (HMG-CoA reductase) that is responsible for manufacturing cholesterol.6 Monacolin K is the same compound as  lovastatin (Mevacor), a prescription drug used to treat high cholesterol. However, the amount of monacolin K in red yeast rice is small (5 mg per 2.4 grams of red yeast rice) when compared with the 20 to 40 mg of lovastatin typically used to lower cholesterol levels.7 It appears that monacolin compounds 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.

The red yeast rice used in various studies was a proprietary product called Cholestin, which contains ten different monacolins.

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.8 Despite these concerns, other red yeast rice products are being widely used and both anecdotal reports and clinical research suggest that they have a similar safety and efficacy profile as that of Cholestin.9 , 10 , 11

2 Stars
Heart Attack (Xuezhikang; for post-event treatment only, not acute attacks )
300 mg twice a day (with doctor's 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.12 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, red yeast rice extract, high in monacolins, has been found to significantly lower serum triglyceride levels.13 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. 14 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.15 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.16 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,17 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.18 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.19

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.20 , 21

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.22 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.23 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.24 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.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • 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.25 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.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • 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.26 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.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Pravastatin

    Red yeast rice (Monascus purpureas)

    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.27 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.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • 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.28 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.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • 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.29 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.
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

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.30 This product should not be used by people with liver disorders31 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.32 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.33 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.34

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.35

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. Endo A. Monacolin K, a new hypocholesterolemic agent produced by a Monascus species. J Antibiot (Tokyo) 1979;32:852–4.

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. 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.

9. Huang CF, Li TC, Lin CC, et al. Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients. Eur J Cardiovasc Prev Rehabil 2007;14:438–40.

10. Halbert SC, French B, Gordon RY, Farrar JT, Schmitz K, Morris PB, et al. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Am J Cardiol 2010;105:198–204.

11. Venero CV, Venero JV, Wortham DC, Thompson PD. Lipid-lowering efficacy of red yeast rice in a population intolerant to statins. Am J Cardiol 2010;105:664–6.

12. Lu Z, Kou W, Du B, et al. Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol 2008;101:1689–93.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639–45 [review].

26. 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.

27. Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr1999;69:231–6.

28. 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.

29. 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.

30. 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.

31. Burnham TH, Sjweain SL, Short RM (eds). Monascus. In: The Review of Natural Products. St. Louis, MO: Facts and Comparisons, 1997.

32. Smith DJ, Olive KE. Chinese red rice-induced myopathy. South Med J 2003;96:1265–7.

33. Mueller PS. Symptomatic myopathy due to red yeast rice. Ann Intern Med 2006;145:474-475.

34. 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.

35. 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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