As we grow older, having high cholesterol becomes more prominent and common among our friends and family. But what’s cholesterol and how can we manage it? 

What is cholesterol and why does it affect us? 

Too much of everything is bad, and that includes cholesterol. Cholesterol is a waxy substance found in our body cells that is useful to our body, but in the right amounts. There are two different types of cholesterol: 

Low-density lipoprotein (LDL): The bad cholesterol 

LDL cholesterol is the “bad” cholesterol as it contributes to fatty buildups in arteries. They also plague our arteries, which could harden them and increase the risk of heart diseases. Lowering LDL level is key to managing our cholesterol levels. 

High-density lipoprotein (HDL): The good cholesterol  

HDL is the “good” cholesterol that absorbs bad cholesterol from the bloodstream and carries it back to the liver. The liver then flushes and removes the bad cholesterol from the body. Simple ways to increase HDL level include exercising regularly, quitting smoking and eating a heart-healthy diet.  

When the “bad” cholesterol level gets too high or “good” cholesterol level gets too low, it could increase the risk of heart attack and coronary heart diseases. That’s when taking medication and supplements can help to manage and improve our cholesterol levels.  

Apart from the common cholesterol-lowering medication – statins, supplements that contain red yeast rice can be a great alternative to managing cholesterol levels. We answer some of the most commonly asked questions on this ingredient. Keep scrolling to learn all about it. 

What is red yeast rice? ^{1 2}

Red yeast rice is a traditional Chinese medicine that is known for its cholesterol-lowering properties. It is also known as “hong qu” in Chinese and is made by fermenting a type of yeast called monascus purpureus over rice. Red yeast rice is recognised to have a ‘warming’ nature and helps to improve blood circulation.  

Benefits of red yeast rice 

Since ancient times, red yeast rice has gained attention as a natural supplement that helps to lower cholesterol levels.  

The substance in red yeast rice that’s responsible for its cholesterol-lowering effect is monacolin K. This bioactive substance is formed during the fermentation process of red yeast rice and is chemically identical to lovastatins. 

Besides cholesterol-managing benefits, red yeast rice also helps to promote circulatory health and strengthen our stomach and spleen for better digestion. ^{3 4}

Why should I choose red yeast rice to manage my cholesterol?  

1. It is a gentler alternative to help with cholesterol management ^{5 6}

Did you know? Up to 60% of statin users who discontinued statins stated the reason as muscle pain. Studies have shown that red yeast rice induced less muscle fatigue symptoms and still provided comparable cholesterol-lowering effects as statins.  

2. It contains other potential cholesterol-lowering components ⁷

Besides the key active substance monacolin K, red yeast rice also consists of beneficial plant compounds such as sterols, isoflavones, unsaturated fatty acids and monacolins. All of these compounds work together to reduce cholesterol levels more effectively.  

Is red yeast rice seen as a safe alternative?

 

The benefits and use of red yeast rice in Chinese medicine have been well-documented since hundreds of years ago. While there have been safety concerns about the substance, it depends on a few factors: 

1. Dosage 

The primary active ingredient in red yeast rice, monacolin K has been the main subject of the safety concerns. A high dosage of monacolin K can potentially have the same side effects as statins, such as headache and digestive issues.  

However, studies have shown that a well-controlled monacolin K dosage still effectively helps to lower cholesterol with no serious adverse effects reported. ⁸

2. Presence of citrinin ⁹

Citrinin is an unwanted by-product of the red yeast rice fermentation and could be harmful to our kidneys if present in high levels. 

One way to address this is to ensure that the manufacturing process of red yeast rice supplements uphold high quality standards and good manufacturing practices. This will help to ensure safe and carefully controlled levels of citrinin in red yeast rice.  

What should I take note of when taking red yeast rice supplements? 

The most important thing to note when taking red yeast rice supplements is to follow the dose strictly – do not exceed the recommended dosage! Dosage recommendations for red yeast rice are determined to ensure that you’re consuming a safe amount.  

When taking red yeast rice supplements, we also recommend avoiding grapefruit juice. Yes, you read that right. Enzymes in grapefruit juice can boost the body’s absorption of many different drugs, including statins.¹⁰ This can cause blood levels of lovastatin to increase up to 15-fold. It’s best to err on the side of caution and avoid consuming any red yeast rice supplements with grapefruit juice.  

Red yeast rice may also interact with the same drugs that statins can interact with.¹¹ Do take note to avoid them as you would when taking statins.  

These groups of people should also avoid taking red yeast rice supplements: 

1. Those with medical conditions 

Do consult your doctor before use, especially for those with liver or kidney conditions. 

2. Pregnant or lactating women 

Red yeast rice supplements are not recommended for pregnant or lactating women as it may place the foetus at unnecessary risk of central nervous system defects during the first trimester.  

*If you are taking any medications, especially cholesterol-lowering medicines, or have a medical condition, consult your doctor before using red yeast rice supplements.  

References: 

1. Zhu, B., Qi, F., Wu, J., Yin, G., Hua, J., Zhang, Q., & Qin, L. (2019). Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine. Frontiers in pharmacology, 10, 1449  ↩︎
2. Klimek, M., Wang, S., & Ogunkanmi, A. (2009). Safety and efficacy of red yeast rice (Monascus purpureus) as an alternative therapy for hyperlipidemia. P & T: a peer-reviewed journal for formulary management, 34(6), 313–327  ↩︎
3. Hu, J., Wang, J., Gan, Q. X., Ran, Q., Lou, G. H., Xiong, H. J., Peng, C. Y., Sun, J. L., Yao, R. C., & Huang, Q. W. (2020). Impact of Red Yeast Rice on Metabolic Diseases: A Review of Possible Mechanisms of Action. Journal of agricultural and food chemistry, 68(39), 10441–10455   ↩︎
4. Edward. R. Red Mold Rice. Handbook of Fermented Functional Foods, Second Edition. 452  ↩︎
5. Pergolizzi, J. V., Jr, Coluzzi, F., Colucci, R. D., Olsson, H., LeQuang, J. A., Al-Saadi, J., & Magnusson, P. (2020). Statins and muscle pain. Expert review of clinical pharmacology, 13(3), 299–310  ↩︎
6. Xue, Y. et al. (2017). Red yeast rice induces less muscle fatigue symptom than simvastatin in dyslipidemic patients: a single center randomized pilot trial. BMC cardiovascular disorders, 17(1), 127  ↩︎
7. Cicero, A. F., Morbini, M., Parini, A., Urso, R., Rosticci, M., Grandi, E., & Borghi, C. (2016). Effect of red yeast rice combined with antioxidants on lipid pattern, hs-CRP level, and endothelial function in moderately hypercholesterolemic subjects. Therapeutics and clinical risk management, 12, 281–286  ↩︎
8. Minamizuka, T., Koshizaka, M., Shoji, M., Yamaga, M., Hayashi, A., Ide, K., Ide, S., Kitamoto, T., Sakamoto, K., Hattori, A., Ishikawa, T., Kobayashi, J., Maezawa, Y., Kobayashi, K., Takemoto, M., Inagaki, M., Endo, A., & Yokote, K. (2021). Low dose red yeast rice with monacolin K lowers LDL cholesterol and blood pressure in Japanese with mild dyslipidemia: A multicenter, randomized trial. Asia Pacific journal of clinical nutrition, 30(3), 424–435  ↩︎
9. Nguyen, T., Karl, M., & Santini, A. (2017). Red Yeast Rice. Foods (Basel, Switzerland), 6(3), 19  ↩︎
10. Kantola, T., Kivistö, K. T., & Neuvonen, P. J. (1998). Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid. Clinical pharmacology and therapeutics, 63(4), 397–402   ↩︎
11. National Center for Complementary and Integrative Health. (2022). Red Yeast Rice: What You Need To Know. Last Updated on November 2022. Retrieved from: https://www.nccih.nih.gov/health/red-yeast-rice     ↩︎