Red yeast rice: does it help lower cholesterol?

Red yeast rice has become popular as a supplement to lower high cholesterol levels. Works? What does science say? Find out!

Last update: 01 October, 2022

red yeast rice is a fermented product obtained from the mold known as Monascus purpureus. In East Asian countries —such as China, Japan, and Korea— it is used for culinary and medicinal purposes; in particular, it is valued for its ability to lower cholesterol and improve cardiovascular health.

And it is that, as detailed in a study shared in the magazine foods, is composed of polyketides, unsaturated fatty acids, phytosterols, pigments and monacolins. Precisely, monacolin K is identical to lovastatin, a statin used for its lipid-lowering effect. Do you want to know more about it?

What is red yeast rice?

Red yeast rice is considered a nutraceutical. It is obtained from the fermentation of white rice with yeast Monascus purpureus or other molds. At a culinary level, it has been used to flavor, color and preserve food. However, its popularity is due to its medicinal effects.

Specifically, it concentrates a substance known as monacolin K, which has a lowering effect on cholesterol levels in the blood. In addition, it is an abundant source of pigments, organic acids, sterols, flavonoids, and other bioactive compounds that are associated with positive health effects.

Thus, and according to a review published through Frontiers in Pharmacologyits properties are as follows:

  • Hypolipidemic.
  • Antiatherosclerotic.
  • Neurocytoprotective.
  • Antitumor.
  • Antiosteoporotic.
  • Energetic.
  • Antidiabetic.
  • Antihypertensive.

However, while entities such as the European Food Safety Authority recognize the potential of this supplement to reduce high cholesterol levels, other authorities, such as the United States Food and Drug Administration (FDA), disapprove of the use of monacolin K and prohibit the marketing of products that contain it.

The reason? It is feared that it may cause side effects similar to those caused by lovastatin. The FDA believes that it should be rigorously regulated as a drug and not as a dietary supplement.

Even so, red yeast rice is available in the market and there are those who swear by its cholesterol-lowering properties. Is there evidence? Let’s see.

High cholesterol is a cardiovascular risk factor. Especially when its LDL fraction is increased, associated with atherosclerosis.

Does red yeast rice help lower cholesterol levels?

The main active compound in red yeast rice, monacolin K, has exhibited positive effects in controlling high cholesterol and triglyceride levels. In a review shared via Critical Reviews in Food Science and Nutrition this product—in combination with statins—was found to be effective in lowering total and LDL cholesterol levels (bad).

Similarly, the evidence indicates that it reduces triglycerides, blood pressure and, therefore, cardiovascular risk. The most interesting thing is that it seems to cause fewer side effects than drugs used for the same purpose.

A study in BMC Cardiovascular Disorders reported that supplementation with this rice helped improve the lipid profile with fewer side effects of fatigue compared to simvastatin. Evidence suggests that monacolin K acts by inhibiting the enzyme HMG-CoA reductase and endogenous cholesterol biosynthesis.

Similarly, a review published in Methodist Debakey Cardiovascular Journal explains that monacolin K improves endothelial function and flexibility of blood vessels, which is key to reducing the risks associated with hypercholesterolemia.

Possible side effects and safety

Consumption of red yeast rice is feared to cause statin-like side effects. The Mayo Clinic notes that a high intake of monacolin K can lead to liver damage or muscle disorders (myopathy).

Regardless, the supplement is generally safe for most people. In fact, according to this same entity, it is possible that some have only small amounts of monacolin K, which tends to reduce its lipid-lowering effect.

In any case, the most common adverse reactions are the following:

  • dizziness
  • Constipation.
  • Headache.
  • Bloating and gas.
  • Abdominal pain or burning.

For safety, it should not be used on the following people:

  • Children and adolescents.
  • Pregnant and lactating.
  • Adults over 64 years.
  • People with muscular disorders.
  • Patients with kidney or liver diseases.

One concern with red yeast rice supplements is possible contamination with citrinin, a toxin produced by molds, which has been linked to kidney failure.


Like cholesterol medications, red yeast rice can cause problems when used at the same time as certain foods and drugs, such as the following:

  • Grapefruit juice. May increase the concentration of plasma levels of monacolin K.
  • hepatotoxic drugs, herbs and supplements. Increases the risk of liver damage.
  • Alcohol. Increases the risk of liver damage.
  • Other drugs to lower cholesterol.
  • antibiotics
  • Antifungals.
  • Antidepressants.
  • Antiretrovirals.
While grapefruit juice is often recommended for lowering cholesterol, it should not be combined with red yeast rice.

Dosage and recommendations for consumption

Right now, red yeast rice is distributed as a supplement in the form of capsules or tablets. Some come in combination with other substances, such as CoQ10, nattokinase, or omega-3 fatty acids.

Suggested doses range from 600 to 1,200 mg per day, divided into 2 or 3 doses. Also, it is usually recommended only when cholesterol levels are between 200 and 239 mg/dL. Ideally, consult your doctor or pharmacist before starting its consumption. In addition, it is advisable to buy it only in trusted pharmacies.

What to remember about red yeast rice?

Evidence suggests that red yeast rice has potential as an adjuvant in controlling high cholesterol levels. In fact, it has been determined that it may have fewer side effects than statins. Despite this, its consumption as a supplement should be consulted with the doctor.

It must not be overlooked that can cause side effects and drug interactions. It should not be taken simultaneously with cholesterol-lowering drugs. In addition, if it is about improving the lipid profile, it must be borne in mind that nothing replaces the effects of a good diet and physical exercise.

Before recommending these supplements or other drugs, the doctor may prescribe a special diet, as well as a change in habits. These measures are often enough to control hypercholesterolemia and its associated risks.

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