Red Yeast Rice: A Safe Therapy to Lower Cholesterol?by Steven Kang, M.D. Health Professional
Tea is not the only ancient remedy for lowering cholesterol that has gained popularity over the past years. Red yeast rice is a food that has been a part of Asian culture for thousands of years. Red yeast rice is simply rice that has been allowed to ferment in the red yeast Monascus purpureus. This fermentation gives the rice a reddish color and spicier flavor, which is commonly used in Asian cooking. The Chinese have known about its health benefits for over a millennium and ancient Chinese textbooks mention the use of red yeast rice for treating indigestion, diarrhea, and circulatory problems. Modern day science has now confirmed that red yeast rice does, in fact, lower cholesterol and may have benefit in reducing heart disease risk.
When rice is fermented in the red yeast, chemical compounds called monacolins are produced. Monacolins have the ability to inhibit the production of cholesterol mainly by acting on the liver. One monacolin in particular called monacolin K is known to specifically inhibit a liver enzyme called HMG-CoA reductase. This may sound familiar to some of you because statins, the most popular and effective medicine known to reduce cholesterol, do the same thing. In fact, monacolin K is the same compound as a commercially produced statin called Mevacor or lovastatin.
Red yeast rice currently comes in two basic preparations: Zhi Tai (red yeast whole rice in powder form) and Xue Zhi Kang (red yeast rice extracted with alcohol). Not too long ago, one could buy concentrated red yeast rice in the US in a pill form called Cholestin. However, the FDA ruled that it is no longer legal to sell supplements containing red yeast rice. The reason for this was twofold:
Red yeast rice contains lovastatin and this is considered to be a prescription medication. Statins can cause liver and muscle injury and so unregulated sales of concentrated red yeast rice in a supplement form may put the consumer at risk.
Red yeast rice containing supplements are considered new and unproven and so cannot be marketed to lower cholesterol. A second red yeast rice supplement is available called Hypocol, manufactured by a Singapore and Chinese company called AsiaPharm, but its sale is prohibited in the US.
Data does exist that red yeast rice is effective in lowering cholesterol levels. Mainly performed in China, several human studies have shown that red yeast rice may lower total cholesterol ~20%, LDL by ~15%, and triglycerides by ~20%. HDL may or may not be increased. A study performed in the US in the late 1990s also confirmed the cholesterol lowering ability of red yeast rice. More importantly, one Chinese study showed a reduction in cardiovascular disease with the administration of red yeast rice in diabetic patients. With regards to safety, red yeast rice has been a staple in the Asian diet for such a long period of time, and no consistent reports of adverse effects have been noted. Furthermore, multiple animal and human studies have not demonstrated a significant risk of liver or muscle injury, although reports of heartburn and indigestion were noted.
Given the above, red yeast rice appears to be effective and safe in lowering cholesterol and may offer some cardiovascular benefit. The FDA is awaiting the results of further testing before re-evaluating the production of red yeast rice supplements. In the meantime, red yeast rice can be bought in many grocery stores, especially Asian markets. A few words of caution: since red yeast rice (the food product) is not regulated, one cannot know how much beneficial monocalin K may or may not be present in any preparation. If you are eating red yeast rice regularly and are already on a statin or other medication that may be associated with liver and muscle damage, it would be best to let your physician know. Furthermore, some red yeast rice preparations may contain citrinic acid, a chemical that can be harmful if ingested in large quantities.
Finally, red yeast rice will only mildly reduce your cholesterol levels, while prescription statins which have been conclusively proven to markedly lower cholesterol and reduce the risk of a heart attack in high risk people still remains one of the cornerstones of cholesterol management and heart disease prevention.