Red Yeast Rice: A Supplement That Combines Tradition and Science

Red yeast rice is a supplement that combines tradition and science. Used for centuries in traditional Chinese medicine as both a food and a natural remedy, today it's found in capsules and extracts for a very specific purpose: to lower cholesterol and improve cardiovascular health.

But how true are these promises? Is it safe? What do the most rigorous studies say about its effectiveness and safety? Let's analyze it in detail. To do this, we've reviewed 2 very comprehensive studies:

• Efstratios Trogkanis, Maria A Karalexi, Theodoros N Sergentanis, Eleni Kornarou, Tonia Vassilakou. Safety and Efficacy of the Consumption of the Nutraceutical "Red Yeast Rice Extract" for the Reduction of Hypercholesterolemia in Humans: A Systematic Review and Meta-Analysis. Nutrients. 2024 May 11;16(10):1453.

• Parisa Rahmani, Ebru Melekoglu, Sogand Tavakoli, Nasser Malekpour Alamdari, Pejman Rohani, Mohammad Hassan Sohouli. Impact of red yeast rice supplementation on lipid profile: a systematic review and meta-analysis of randomized-controlled trials. Expert Rev Clin Pharmacol. 2023 Jan;16(1):73-81.

What Is Red Yeast Rice?

Red yeast rice (RYR) is produced by fermenting rice with the fungus Monascus purpureus. During this process, several bioactive compounds are generated, including monacolins. The most important is monacolin K, which is chemically identical to lovastatin, a medication used to lower cholesterol.

This explains why its effect can be powerful, but also why it's not free of side effects. In a way, red yeast rice is in a "gray area": it's a natural supplement, but with the action of a real drug.

What Benefits Does It Provide? Current Scientific Evidence

A meta-analysis of 23 randomized controlled trials (Rahmani et al., 2022) analyzed more than 2,000 participants, including people with high cholesterol and the general population. The results were consistent:

• Total cholesterol: an average reduction of -33 mg/dL.

• LDL cholesterol ("bad" cholesterol): a decrease of -29 mg/dL.

• Triglycerides: a decrease of -23 mg/dL.

• HDL cholesterol ("good" cholesterol): an increase of +2.5 mg/dL.

These changes are comparable to those observed with low-intensity statins, which demonstrates the clinical impact of red yeast rice.

👉 An interesting detail: the benefits appeared even with relatively low doses (≤1200 mg/day) and in short periods (≤12 weeks).

In addition, some studies included in the review observed improvements in inflammatory and oxidative markers, suggesting that red yeast rice might have additional effects on vascular inflammation and oxidative stress, which are key factors in atherosclerosis.

Doses Used in the Studies

The dose varies widely among clinical trials, ranging from 100 mg to 2400 mg daily.

However, the most consistent effects were found between 600 and 1200 mg per day, divided into 1–2 doses.

It's important to note that what's truly relevant is not just the amount of red yeast rice, but the content of monacolins, especially monacolin K. In some supplements, the actual content of monacolin can differ drastically from what's stated on the label, which raises standardization issues.

Safety Profile: Lights and Shadows

The report from the European Food Safety Authority (EFSA, 2018) analyzed the safety data of red yeast rice in depth. Although most clinical trials report good tolerance, adverse effects similar to those of statins were also documented, such as:

• Muscle pain (myalgia).

• Liver abnormalities (increased blood enzymes).

• In rare cases, rhabdomyolysis (severe muscle damage).

Another concerning aspect is the presence of citrinin, a mycotoxin produced in some batches during fermentation, with potentially nephrotoxic effects. Some low-quality supplements have shown detectable levels of this substance.

For this reason, the EFSA concluded that the consumption of ≥10 mg/day of monacolins derived from red yeast rice might not be safe for the entire population.

Limitations and Negative Points of the Studies

Although the evidence is solid, it's not without limitations:

• Limited duration: most clinical trials lasted less than 3 months. Less is known about long-term effects.

• Product variability: different supplements have very different amounts of monacolin K, which makes it difficult to compare results.

• Heterogeneity in trial quality: not all were double-blind or multicenter.

• Geographic bias: a large part of the evidence comes from studies conducted in China, where red yeast rice has been consumed for centuries, which may limit its extrapolation to other populations.

Who Could Benefit the Most?

According to the studies, the groups that could benefit most from red yeast rice are:

• People with moderately high cholesterol who are looking for a complementary option.

• Individuals with statin intolerance, always under medical supervision.

• Adults who want to improve their lipid profile along with a healthy diet and exercise.

It is not recommended for pregnant women, breastfeeding women, minors, or in combination with statins or other hepatotoxic drugs.

Comparison with Conventional Statins

Although red yeast rice and statins share the same mechanism of action, there are important differences:

• Potency: red yeast rice typically lowers LDL by 20–30%, while high-potency statins (atorvastatin, rosuvastatin) achieve reductions of 50% or more.

• Standardization: drugs have exact, controlled doses; RYR supplements do not always.

• Accessibility: it can be purchased without a prescription, which is an advantage but also a risk, as it facilitates self-medication without supervision.

Conclusion

Red yeast rice is one of the most studied supplements for cholesterol reduction. Meta-analyses show clear reductions in total cholesterol, LDL, and triglycerides, with a slight increase in HDL.

However, it is not a harmless supplement: its effect is due to a molecule equivalent to a drug, which implies possible adverse effects. In addition, the lack of standardization in the market and the potential contamination with citrinin are important problems.

For this reason, red yeast rice can be a valuable tool in selected people, always under medical supervision and by choosing quality products.

Ultimately, red yeast rice can be considered a "bridge" between a natural supplement and pharmacology, with real benefits but also risks that should not be minimized. If you are interested, here is the link for you to discover the options available.

FAQs About Red Yeast Rice

1. How long does RYR take to work?

   Generally, reductions in LDL cholesterol are observed in 4–8 weeks.

2. Can I combine it with statins?

   Red yeast rice can be used when blood cholesterol levels are close to exceeding normal limits. If used in combination with statins, your doctor should monitor you closely to avoid the risk of side effects.

3. Is it safe long-term?

   Most studies are short-term. Safety data beyond 12 months is limited.

4. What is the most common dose used?

   Between 600 and 1200 mg per day, although the important thing is the monacolin content, which should be standardized.

5. Which supplements should I choose?

   The ideal is to opt for certified products that guarantee the absence of citrinin and state the exact monacolin content.