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Red yeast rice

Also listed as: Angkak; Beni-koji; Hong qu; Hung-chu; Monascus; Red koji; Red leaven; Red rice; Xue zhi kang; Zhitai

Overview
Therapeutic Uses
Dietary Sources
Dosage and Administration
 
Precautions
Interactions and Depletions
Supporting Research

Overview

Red yeast rice has been used for centuries in China as both a food and a medicinal product. It is made by fermenting a type of yeast called Monascus purpureus over red rice. In Chinese medicine, red yeast rice is used to lower cholesterol, promote blood circulation, and aid digestive problems.

Research has shown that red yeast rice contains substances that are similar to prescription statin medications. One of these substances, called monacolin K, has the same makeup as the drug lovastatin. Statins are prescribed to lower "bad" LDL cholesterol levels and help reduce the risk of heart disease.

Researchers aren't sure if the cholesterol lowering effect of red yeast rice was due to the presence of monacolin or other compounds, such as unsaturated fatty acids, isoflavones, and phytosterols, in red yeast rice. But because many red yeast rice supplements did contain monacolin, the Food and Drug Administration considered them to be drugs, not supplements, and required that manufacturers remove any red yeast rice products that contained monacolin from the market. As a result, many of the red yeast rice products now on the U.S. market may not contain monacolin. Consumers cannot distinguish between red yeast products that contain monacolin from those that don't because manufacturers make no label claims for monacolin content.

Therapeutic Uses

Prevention

Red yeast rice has been shown in several studies to lower "bad" LDL cholesterol levels. High cholesterol levels increase the risk of heart disease. Research has shown that red yeast (Monascus purpureus) stops the action of an enzyme in the body called HMG-CoA reductase, which helps make cholesterol. Red yeast rice contains substances known as monacolins. One of these, monacolin K, has the same chemical makeup as lovastatin, a prescription drug that lowers cholesterol. Some researchers think that this substance is responsible for red yeast rice's cholesterol lowering properties. But others note that the amount of lovastatin in red yeast rice is below what you would find in the prescription drug, and think there may be other substances in red yeast rice that help lower cholesterol. More research is needed.

Treatment

Several studies suggest that red yeast rice significantly reduces high cholesterol. However, most of the studies have used a formulation of red yeast rice -- Cholestin -- that is no longer available in the U.S. Although a product called Cholestin is available, it no longer contains red yeast rice. The Food and Drug Administration requires any red yeast product discovered to contain monacolin to be taken off the market. It may be hard for American consumers to know what the red yeast rice product they buy contains.

These studies support the ability of red yeast rice to lower cholesterol:

  • A 2008 study compared a group of people with high cholesterol who took fish oil and red yeast rice with a group who took a standard dose of simvastatin. The red yeast rice was purchased directly from the manufacturer and contained lovastatin, but at a lower dose than what you would find in the prescription drug. Both groups saw a similar reduction in cholesterol levels.
  • One study by UCLA School of Medicine involved 83 people with high cholesterol levels. Those who received red yeast rice over a 12 week period experienced significantly lower levels of total cholesterol, "bad" LDL cholesterol, and triglycerides (fats in the blood) compared to those taking placebo. "Good" HDL cholesterol levels did not change in either study group.
  • A study presented before the American Heart Association also showed that red yeast rice lowered LDL cholesterol. In the first study, 187 people had mild-to-moderate elevations in total cholesterol and LDL cholesterol. The study showed that treatment with red yeast rice reduced total cholesterol by more than 16%, LDL cholesterol by 21%, and triglycerides by 24%. HDL cholesterol also increased by 14%.
  • In another 8-week study of 446 people with high cholesterol, those receiving red yeast rice had a significant drop in cholesterol levels compared to those who took placebo. Total cholesterol fell by 22.7%, LDL by 31%, and triglycerides by 34% in the red yeast rice group. HDL cholesterol increased by 20% in the red yeast rice group as well.

Dietary Sources

Asia and Chinese communities in North America use red yeast rice in powdered form as a food coloring for fish, alcoholic beverages, and cheese.

Dosage and Administration

Red yeast rice is an ingredient in several commercially available combination supplement products that are marketed to promote heart health. Red yeast rice is also available in commercial preparations. One of the proprietary products most often studied was Cholestin, which contained monacolin. However, the Food and Drug Administration required the manufacturer to remove that product from the market. The current formulation of Cholestin does not contain red yeast rice.

Pediatric

People younger than 20 years should not use red yeast rice supplements.

Adult

In Traditional Chinese Medicine, the dosage of dietary or supplemental red yeast rice is as high as 6,000 - 9,000 mg per day. But the appropriate dosage for adults may vary, depending on the form of the supplement. Most studies have used standardized extract: use 600 mg (oral doses), 2 - 4 times daily.

Precautions

It's not clear whether it is safe to use red yeast rice for longer than 12 weeks.

People with liver disease and those at risk for liver disease should not take red yeast rice. Red yeast rice may affect liver function in the same way prescription cholesterol lowering medications can.

The following people should not take red yeast rice: people with kidney disease, people with thyroid disorders, those at higher risk of cancer, and those with musculoskeletal disorders.

People who drink more than two alcoholic beverages a day, have a serious infection or physical disorder, or have undergone an organ transplant should also avoid using red yeast rice.

Side Effects

Side effects of red yeast rice are rare but can include:

  • Headache
  • Stomach ache or bloating
  • Gas
  • Dizziness
  • Heartburn
  • Muscle aches and weakness -- this can lead to a serious condition called rhabdomyolysis, and you should stop taking red yeast rice immediately and call your doctor

Pregnancy and Breastfeeding

Pregnant and breastfeeding women should not take red yeast rice.

Pediatric Use

People under 20 should not take red yeast rice until more research is done.

Geriatric Use

No studies have specifically looked at the safety of red yeast rice in older adults. However, elderly people who took 1,200 mg per day of red yeast rice in an 8 week study had no significant side effects.

Interactions and Depletions

Cholesterol-lowering medications -- Red yeast rice should not be taken with cholesterol-lowering medications unless supervised by your doctor. Red yeast rice may make the effect of these drugs stronger, increasing the risk of liver damage. If you are already taking a statin or other drug to lower cholesterol, talk to your doctor before adding red yeast rice to your regimen.

Anticoagulants (blood-thinners) -- Red yeast rice may increase the risk of bleeding.

Grapefruit juice -- If you take a statin, grapefruit and grapefruit juice can increase the amount of the drug in your blood. That can increase your risk of side effects and liver damage. Because red yeast rice may act like statins in the body, you should avoid drinking grapefruit juice or eating grapefruit while taking red yeast rice.

Coenzyme Q10 -- Statins can lower the amount of Coenzyme Q10 in the body. CoQ10 is very important in heart and muscle health and in energy production. Side effects of CoQ10 depletion include fatigue, muscle aches and pains, and muscle damage. Red yeast rice also may lower amounts of CoQ10 in the body. Ask your doctor about taking 150 - 200 mg CoQ10 at night while you are taking red yeast rice products, and for 4 weeks after you stop taking red yeast rice.

Supporting Research

Becker DJ, Gordon RY, Halbert SC, French B, Morris PB, Rader DJ. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. Ann Intern Med. 150(12):830-9.

Becker DJ, Gordon RY, Morris PB, Yorko J, Gordon YJ, Li M, Iqbal N. Simvastatin vs therapeutic lifestyle changes and supplements: randomized primary prevention trial. Mayo Clin Proc. 2008 Jul;83(7):758-64.

Bonovich, K, Colfer H, Davidson M, Dujovne C, Greenspan M, Karlberg R, et al. A Multi-Center, Self-Controlled Study of Cholestin In Subjects With Elevated Cholesterol. American Hear Association. 39th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, Orlando, Fl. March 1999.

Havel R. Dietary supplement or drug? The case of cholestin. Am J Clin Nut.r 1999;69(2):175-176.

Heber D, Yip I, Ashley JM, Elashoff DA, Go VLW. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr. 1999;69:231-236.

Huang CF, Li TC, Lin CC, Liu CS, Shih HC, Lai MM. Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients. Eur J Cardiovasc Prev Rehabil. 2007 Jun;14(3):438-40.

Li C, Li Y, Hou Z. Toxicity study for Monascus purpureus (red yeast) extract. Information of the Chinese Pharmacology Society. 1995;12 (4):12 [Translation].

Li C, Zhu Y, Wang Y, Zhu J, Chang J, Kritchevsky D. Monascus Purpureus-Fermented Rice (Red Yeast Rice): A natural food product that lowers blood cholesterol in animal models of hypercholesterolemia. Nutrition Research. 1998;18(1):71-81.

Liu J, Zhang J, Shi Y, Grimsgaard S, Alraek T, Fønnebø V. Chinese red yeast rice (Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials. Chin Med. 2006 Nov 23;1:4.

Ma J, Li Y, Ye Q, Li J, Hua Y, Ju D, et al. Constituents of red yeast rice, a traditional Chinese food and medicine. J Agric Food Chem. 2000;48:5220-5225.

Mark D. All red yeast rice products are not created equal. The Am J of Cardiol. 106(3).

Mueller PS. Symptomatic myopathy due to red yeast rice. Ann Intern Med. 2006;145(6):474-5.

Ong HT, Cheah JS. Statin alternatives or just placebo: an objective review of omega-3, red yeast rice and garlic in cardiovascular therapeutics. Chin Med J (Engl). 2008 Aug 20;121(16):1588-94.

Qin S, Zhang W, Qi P, Zhao M, Dong Z, Li Y , et al. Elderly patients with primary hyperlipidemia benefited from treatment with a Monacus purpureus rice preparation: A placebo-controlled, double-blind clinical trial. American Heart Association. 39th Annual conference on Cardiovascular Disease Epidemiology and Prevention, Orlando, Fl. March 1999.

Wang J, Lu Z, Chi J, Wang W, Su M, Kou W, et al. Multicenter clinical trial of serum lipid-lowering effects of a Monascus purpureus (red yeast) rice preparation from traditional Chinese medicine. Curr Ther Res. 1997;58(12):964-978.

Venero C, Venero J, Wortham D, Thompson P. Lipid-lowering efficacy of red yeast rice in a population intolerant to statins. The Am J Cardiol. 1-5(5).

Vercelli L, Mongini T, Olivero N, Rodolico C, Musumeci O, Palmucci L. Chinese red rice depletes muscle coenzyme Q10 and maintains muscle damage after discontinuation of statin treatment. J Am Geriatr Soc. 2006;54(4):718-20.


Review Date: 12/11/2010
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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