Do red yeast rice benefits outweigh the side effects?

Red yeast rice is an ancient Chinese dietary food and medicine that has been used for centuries.

It is made by using various strains of Monascus purpureus, which is a strain of yeast, to culture rice. Red yeast rice can be found in Chinese cuisine such as Peking duck, but it is also sold as a dietary supplement.

Red yeast rice benefits

In the past, red yeast rice has been used to lower cholesterol. A substance called monacolin K can be found in some forms of red yeast rice. This substance is identical to an ingredient in lovastatin, which lowers cholesterol by reducing the production of cholesterol in the liver.

Red yeast rice has visibly grown in popularity. In both 2008 and 2009, more than $20 million worth of red yeast rice supplements were sold. More people turned to red yeast rice as a form of alternative medication, especially for patients with high blood pressure who either don’t believe in statins or cannot tolerate statin therapy.

Proceed with caution

Even though it is believed that red yeast rice can help lower cholesterol, patients should use it with caution. There are different types of red yeast rice depending on the yeast strains and the culture conditions used to manufacture the product. While some red yeast rice does contain monacolin, other strains only contain a small amount of it or none at all. Reporting the amount of monacolin in the supplement is also not required, and it is generally not published on labels.

On August 9, 2007, the FDA released a statement warning consumers not to buy or eat three red yeast rice products as the products may have contained an unauthorized drug that could be harmful to patients’ health. The three products specifically mentioned had a drug that could cause severe muscle problems (i.e., rhabdomyolysis) leading to kidney impairment.¹ Other rare side effects of red yeast rice include headache, gas, heartburn, dizziness, stomachache, or muscle aches and weakness. A doctor should be consulted whenever a patient experiences any of these side effects.

What do studies show?

There have been a number of studies done on the effectiveness of red yeast rice but there have also been studies on the ingredients and regulation of the product. While many of the studies have shown positive results when it comes to using red yeast rice to lower cholesterol, the lack of regulation by the FDA raises safety concerns.

A 2009 study by University of Pennsylvania School of Medicine researchers tested the effectiveness of red yeast rice on statin-intolerant patients. In a randomized controlled trial of 62 patients, the researchers found that red yeast rice decreased cholesterol levels without increasing pain levels. They concluded that red yeast rice was a good treatment option for dyslipidemic patients.²

In 2010, the American Journal of Cardiology studied the tolerability of red yeast rice verses pravastatin in patients with statin intolerance. After testing 43 adults with dyslipidemia, the researchers found that the cholesterol levels of the red yeast group decreased by 30 percent, while the pravastatin group only decreased by 27 percent, showing that red yeast rice was effective in this case.³

Also in 2010, a study by JAMA Internal Medicine compared 12 commercial red yeast rice formulas and tested each to see the amount of monacolin present. The researchers found that every red yeast rice product tested had a different amount of monacolin.⁴

In April 2016, the Journal of Clinical Pharmacy and Therapeutics completed a systematic review of red yeast rice. The researchers compiled results of 10 randomized controlled trials and found that red yeast rice did not show a statistically significant difference in outcomes of people with high blood pressure. They also said that even though a number of small trials showed that red yeast rice was effective, larger trials with increased methodological rigor are necessary to see the full extent on the effectiveness of red yeast rice.⁵

Overall, people have mixed feelings about the benefits of red yeast rice. While it may be helpful in lowering cholesterol, researchers and the FDA suggest caution when taking the supplement. People should consult with their doctor before they start using the product.

References

1 McDermott C. FDA Warns Consumers to Avoid Red Yeast Rice Products Promoted on Internet as Treatments for High Cholesterol Products found to contain unauthorized drug. Published August 9, 2007. Accessed October 2016.

2Becker DJ, Gordon RY, Halbert SC, French B, Morris PB, Rader DJ. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. Published June 2009. Accessed October 2016.

3 Halbert SC, French B, Gordon RY, Farrar JT, Schmitz K, Morris PB, Thompson PD, Rader DJ, Becker DJ. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Published January 2010. Accessed October 2016.

4 Gordon RY, Cooperman T, Obermeyer W, Becker DJ. Marked variability of monacolin levels in commercial red yeast rice products: buyer beware! Published October 25, 2010. Accessed October 2016.

5 Ong YC, Aziz Z. Systematic review of red yeast rice compared with simvastatin in dyslipidaemia. Published April 2016. Accessed October 2016.