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Red yeast rice (Monascuspurpureus)

Synonyms/Common Names/Related Substances:

  • 3Alpha-hydroxy-3,5-dihydromonacolin L, alkaloids, angkak, anka, ankaflavin, arroz de levadura roja (Spanish), Asian traditional fermentation foodstuff, astaxanthin, beni-koju, ben-koji, Chinese red yeast rice, Cholestin®, citrinin, compactin, CRYR, dehydromonacolin K, dietary red yeast, dihydromeyinolin, dihydromonacolin K, dihydromonacolin L, DSM1379, DSM1603, ergosterol, flavonoids, GABA, gamma-aminobutyric acid, glycosides, HMG-CoA reductase inhibitors, hon-chi, hong qu, hongqu, hung-chu, hydroxymethylglutaryl coenzyme A reductase, KCCM11832, koji, linoleic acid, lovastatin, M9011, mevinolin, monacolin, monacolin hyroxyacid, monacolin J, monacolin K, monacolin K (hydroxyl acid form), monacolin L, monacolin M, monacolin X, Monascaceae (yeast family), monascopyridine A, monascopyridine B, monascopyridine C, monascopyridine D, monascorubramine, monascorubrin, Monascus, Monascusanka, Monascus purpureus, Monascus purpureus fermentate, Monascus purpureus HM105, Monascus purpureus NTU568, Monascus purpureus Went rice, Monascusruber, monascorubramine, oleic acid, orange anka pigment, palmitoleic acid, Phaffia rhodozyma, phenols, protein, red fermented rice, red koji, red leaven, red mould rice, red rice, red rice yeast, red yeast, red yeast rice extract, rice, RICE products, rubropunctamine, rubropunctatin, RYR, RYRE, saponins, statins, stearic acid, tannins, Xue Zhi Kang, Xuezhikang, yellow anka pigment, Zhi tai, Zhitai.
  • Selected brand names: Cholestene® (red yeast rice), Cholestin® (containing red yeast rice; no longer available in the United States and Canada), Cholesto-Rite® (red yeast rice, gugulipid, Aspalathus linearis), Health Direct's Red Yeast Rice Vcaps (red yeast rice), Lipolysar, Only Naturals' Red Yeast Rice Plus, Source Naturals' Red Yeast Rice capsules.
  • Note: Monacolin K, a constituent of red yeast rice, has the same chemical structure as the drugs lovastatin and mevinolin. This monograph covers Monascuspurpureus, excluding details about related species.

Clinical Bottom Line/Effectiveness

Brief Background:

  • Red yeast rice (RYR) is the product of yeast (Monascuspurpureus) grown on rice. It is a dietary staple in some Asian countries. Processed red yeast rice supplements include red yeast rice extract (RYRE), which is any extract of red yeast rice, and Xuezhikang, an alcohol extract of red yeast rice.
  • RYR contains several compounds collectively known as monacolins, substances known to inhibit cholesterol synthesis. One of these, monacolin K, has the same chemical structure as the drugs lovastatin and mevinolin, potent inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase (1). Overall, studies suggest that RYR use may lead to a 10-33% reduction in LDL-C (2;3). This is a moderate effect compared to the U.S. Food and Drug Administration (FDA)-approved "statin" drugs (4). Although side effects are rare in published clinical trials of RYR, long-term safety data are limited.
  • RYRE has been sold as a natural cholesterol-lowering agent in over-the-counter supplements, such as Cholestin® (Pharmanex, Inc.). However, the formula has been changed, and what was once seen as a trademarked product in the scientific literature (™) now appears to be exclusively marketed as a registered product (®). Cholestin® has contained many compounds in addition to monacolin K, including other monacolins, starch, fiber, protein, fatty acids, and plant polyphenols. Studies have shown this product to be effective for treatment of hyperlipidemia in both humans and animals (3;5;6;7;8;9;10). More specifically, decreases in total cholesterol (TC), LDL cholesterol (LDL-C), and triglycerides (TG) have been noted. In some studies, HDL cholesterol (HDL-C) increased with RYR use (5;9;10). Due to the multiple compounds in red yeast rice, effects attributed solely to monacolin K are lacking.
  • There has been legal and industrial dispute among Pharmanex, Inc., the FDA, and pharmaceutical producers of HMG-CoA reductase inhibitors ("statins") as to whether Cholestin® should be considered a drug or dietary supplement (11;12). The U.S. District Court in Utah ruling in March 2001 stated that RYRE contains lovastatin (monacolin K) and is an unapproved drug. Thus, the RYRE known as Cholestin® is no longer available in the United States. Other products containing RYRE alone or in combination products may still be commercially available in the United States, primarily through Internet retailers.
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Dosing/Toxicology

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Precautions/Contraindications

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Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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Mechanism of Action

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History

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Evidence Table

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Evidence Discussion

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Products Studied

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Author Information

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References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.