Red Rice – Naturally Lower Cholesterol?

Lower cholesterol with red yeast rice without side effects? Here we explain why this doesn’t make sense.

The essentials in brief:

• Red rice is rice fermented with a red mold. Red yeast rice products (dietary supplements) are often advertised as lowering cholesterol levels “all naturally” and without side effects.
• The monacolin K found in red yeast rice is identical to the prescription drug lovastatin. Both lovastatin and monacolin K can cause significant side effects.
• Interactions with a large number of medications (including anticoagulants) are possible. Blood sugar levels can also increase.
• Due to significant health safety concerns, the Federal Institute for Risk Assessment recommends not consuming dietary supplements containing red yeast rice.

What does the advertisement promise?

Dietary supplements with red mold rice (Red Rice, Red Yeast Rice, red rice) are said to lower cholesterol levels in a “natural” way thanks to the monacolin K they contain and are free of side effects.

Regulation (EU) No. 432/2012 permits the health-related advertising claim “Monacolin K from red mold rice contributes to the maintenance of normal blood cholesterol levels” for foodstuffs – provided that 10 mg of monacolin K are consumed daily with the product. But: Red Rice products from a daily dose of 5 mg Monakolin K are considered to be medicinal products that require authorization due to their significant pharmacological effect . Food supplements with monacolin K are therefore only permitted in low doses and then do not have the desired effect.

Important: The approval of an advertising claim does not take into account the risks of ingestion and is not an indication of the safety of dietary supplements containing red yeast rice. In principle, the European Food Safety Authority (EFSA) assesses the intake of monacolins in the form of dietary supplements with red yeast rice as unsafe.

Can it make sense to take it?

Cholesterol-lowering drugs (statins) have numerous undesirable effects. For many patients who cannot tolerate these medicines, taking dietary supplements with red yeast rice seems to be a purely natural alternative with few side effects. A fallacy, since Monakolin K and the well-known (prescription) drug lovastatin are the same substance.

What should I pay attention to?

• Red rice supplements may have the same effects, risks, and side effects as lovastatin medicines. These are muscle pain and cramps, headaches, nausea, diarrhea, weakness, skin rashes and disorders of kidney and liver function.
• Interactions with a large number of drugs (including anticoagulants) and harmful interactions with food, especially grapefruit, are possible.
• An increase in the blood sugar level is also conceivable.
• There is no amount that is safe for health. The safest thing is not to use such a product. Anyone who wants to try it (and suffers from high cholesterol) should definitely speak to their doctor beforehand and have their use medically monitored.

Red yeast rice does not offer any advantages over corresponding medicines:

• A safe dosing of the products is not possible. The levels of monacolin K in red mold rice products can vary due to the manufacturing process, and other monacolins are also formed during fermentation, the pharmacological effects of which are not taken into account at all. The content of monacolin K does not necessarily say anything about the cholesterol-lowering effect of the product. The potential for side effects cannot be estimated from the monacolin K content either.
• It is questionable whether taking lower amounts of monacolin K compared to the dosage of a statin is still effective in lowering cholesterol. There is therefore an additional risk of insufficient cholesterol reduction.
• Overall, the data on the safety of red yeast rice and its ingredients is insufficient. In addition, there are no standards or specifications to ensure the purity and identity of the preparations or information on the absence of toxic ingredients.
• Red yeast rice products can contain numerous other potentially hazardous substances such as the kidney-damaging mycotoxin citrinin (genotoxic and carcinogenic). Therefore, since April 1, 2020, a maximum citrinin content of 100 μg/kg in food supplements based on red yeast rice has been in force.

If you want to know more:

Statins inhibit cholesterol biosynthesis at the level of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase. In particular, the simultaneous intake of red mold rice and statins can lead to an increase in this inhibitory effect, resulting in adverse health effects.

In studies with various Red Rice products, a significant pharmacological effect was already demonstrated at dosages from 5 mg Monakolin K per day. In addition, the biological activity of the other monacolins contained in red yeast rice, such as compactin, has not yet been taken into account. They also have a cholesterol-lowering effect. When taking such products, it always remains unclear how strong the cholesterol-lowering effect is and how high the risk of side effects is. If your cholesterol level needs to be lowered with medication, you should use approved medication with safe dosages.

What is red yeast rice?

Red mold rice is a bright red fermentation product of ordinary cooked rice with certain strains of mold of the genus Monascus. The mold Monascus purpureus is often used . In addition to red, orange-red and yellow dyes, the fermentation produces various potentially effective ingredients such as e.g. the monacolins mentioned, but also a large number of other substances whose effect or risk potential has not been sufficiently clarified.

In Asia and especially in China, red mold rice has been used for centuries to colour, flavor and preserve food, in traditional Chinese medicine (TCM) also for stomach and intestinal problems. It should not be confused with types of rice that naturally have red husks, such as Carmargue rice. In the EU, red yeast rice is sold as such and also as a dietary supplement to lower cholesterol levels.