Key takeaways:
Red yeast rice supplements lower cholesterol, including the kind that contributes to heart disease. Monacolin K, the active ingredient, works like statin drugs in the body.
These supplements aren’t approved or regulated by the FDA. This makes it hard to know that what you're buying is safe and effective.
Other supplements, along with dietary fiber and plant compounds, may also lower cholesterol.
If you have high cholesterol, you may be wondering about the best way to lower it. High cholesterol — particularly low-density lipoprotein (LDL) cholesterol — increases the risk of heart disease. So lowering this “bad” cholesterol level is one way to decrease this risk.
There are many things that can help keep your cholesterol in normal range, including medications, dietary changes, and exercise. Red yeast rice is an over-the-counter supplement that may help too. But it’s important to know a bit more about it before you decide if it’s a good choice for you.
What is red yeast rice?
Red yeast rice is made by fermenting a mold called Monascus purpureus on rice. Through fermentation, the mold adds metabolites called monacolins to the rice. One of these is called monacolin K.
Monacolin K is the main active ingredient in red yeast rice. It lowers cholesterol in a similar way to statin drugs. In fact, its chemical structure is identical to lovastatin (Mevacor), a prescription statin medicine that comes from the fermentation of another fungus.
Red yeast rice powder is sold in capsules as a dietary supplement. It’s also used in traditional Chinese medicine and Chinese cooking.
Are red yeast rice supplements good for cholesterol?
Research suggests that red yeast rice supplements are good for cholesterol. They lower blood cholesterol, including LDL. LDL is the “bad” type of cholesterol that can lead to heart disease. But the supplements need to contain enough monacolin K to be effective.
Like prescription statin drugs, monacolin K blocks a liver enzyme called HMG-CoA reductase. When this enzyme is blocked, the liver makes less cholesterol and takes up cholesterol from the blood. This lowers your blood cholesterol levels.
Many studies have shown that red yeast rice can lower LDL cholesterol, total cholesterol, and triglycerides. Triglycerides are another type of fat that can increase your risk for heart disease. But the studies used different amounts of red yeast rice and monacolin K, and participants took the supplements for varying lengths of time.
Because of these differences, it's difficult to determine the best type or dose of red yeast rice for lowering cholesterol.
Decoding your cholesterol tests: If you’ve recently had your cholesterol levels checked, we can walk you through how to understand your numbers.
Are vitamins good for cholesterol? Read about the vitamins and other supplements that have been shown to help with high cholesterol.
Natural ways to lower your cholesterol: Changes in your diet can help lower your cholesterol. But these changes to your daily routine can help too.
Is it safe to take red yeast rice for cholesterol?
One of the challenges with red yeast rice supplements is that they aren’t approved by the FDA. This means the FDA hasn’t guaranteed that they’re safe and effective. In fact, the FDA considers red yeast rice supplements with monacolin K to be unapproved drugs.
Most red yeast rice supplements list the amount of red yeast rice they contain, but they don’t mention the amount of monacolin K. This makes it hard to know if the product will be effective or safe.
Also, the amount of monacolin K can vary between products. And it’s unknown how supplements with little or no monacolin K affect cholesterol levels.
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There are also safety concerns about contamination with citrinin, a substance produced during fermentation. Studies in animals show citrinin can harm the kidneys, but this hasn’t been seen in humans.
For these reasons, red yeast rice supplements aren’t usually recommended for lowering cholesterol in the U.S. Prescription statin medications are preferred instead.
Does red yeast rice have other benefits?
Red yeast rice has other cardiovascular health benefits beyond cholesterol levels. Other heart-healthy benefits include:
Improvement in endothelial function: The endothelium lines your blood vessels. Problems here contribute to the development of heart disease.
Decrease in arterial stiffness: As people age, arteries become stiffer, which raises the risk of high blood pressure and heart disease.
Decrease in other heart-related blood tests: These can include high-sensitivity C-reactive protein (hs-CRP) and Apolipoprotein B (ApoB). Hs-CRP increases when there’s more inflammation in the body. And ApoB is a protein in cholesterol, including LDL. Both are linked to a higher risk of atherosclerosis, which can lead to heart attacks and strokes.
What are the side effects of red yeast rice supplements?
The side effects of red yeast rice are similar to prescription statins. This makes sense considering its most active component, monacolin K, works like lovastatin. Side effects may include interactions with other medications and muscle aches or pain. Rare side effects can include severe muscle injury (rhabdomyolysis) and serious liver damage.
Red yeast rice supplements don’t usually cause major side effects at lower doses of monacolin K. Side effects are more likely to happen at higher doses. Or when supplements are taken with other drugs that increase the activity of monacolin K in the blood.
What are the best supplements for cholesterol?
Red yeast rice supplements aren’t the only ones out there that may lower cholesterol. Other supplements include:
Omega-3 fatty acids
Niacin (vitamin B3)
Vitamin C
You can also lower cholesterol with plant-based substances like psyllium, a type of soluble fiber, and plant sterols and stanols. In fact, the National Lipid Association recommends these over other supplements for lowering cholesterol.
The above plant compounds are in foods, but they also come in supplement form. They work by reducing the cholesterol absorbed from the intestines. This causes more cholesterol to get taken up from the blood, reducing blood cholesterol levels.
The bottom line
Red yeast rice lowers low-density lipoprotein (LDL) cholesterol — a key risk factor for heart disease, including heart attacks and strokes. Despite this evidence, it’s not usually recommended in the U.S. due to concerns about quality and safety. Prescription medicines like statins are preferred.
Other supplements and foods with plant-based substances like dietary fiber also lower cholesterol. Talk to a healthcare professional about what treatments are best for you.
Why trust our experts?
References
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Cicero, A. F. G., et al. (2021). Red yeast rice for hypercholesterolemia: JACC focus seminar. Journal of the American College of Cardiology.
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