RED YEAST RICE has been used in East Asia for centuries to make alcohol and fermented foods. Certain strains have also been used in herbal remedies. Today, it sits on American supplement shelves with a modern promise: lower your cholesterol naturally without taking a prescription statin.
For people uneasy about statins, a natural alternative might sound pretty great. Why take a prescription medication with some notoriously bad side effects when you could pop something fermented from rice instead? Online, a growing number of Reddit threads host users who say their PCPs and cardiologists have prescribed them red yeast rice extract instead of statins.
At a time when eligibility for statins has expanded to include younger and low-risk individuals, what’s going on here?
First, What’s the Deal With Statins?
TO UNDERSTAND THE debate over red yeast rice, it’s a good reminder to know what a statin does in the first place.
“Statins are prescription medications that lower low-density lipoprotein (LDL), or ‘bad’ cholesterol, by blocking an enzyme the liver uses to make cholesterol and helping the liver remove more LDL from the bloodstream,” says cardiologist and lipidologist Sirisha Vadali, MD.
Cholesterol in general isn’t harmful; the body needs it to build cells and make certain hormones. But there’s good cholesterol and bad cholesterol. The problem is having too much LDL (the “bad cholesterol”) in the bloodstream over time, which can contribute to plaque buildup in the arteries, says Dr. Vadali. By slowing cholesterol production in the liver, statins prompt the liver to pull more LDL from the blood. Depending on the drug and dose, statins can lower LDL by about 30 to 50 percent.
The payoff is more than a better cholesterol number, though. Statins also reduce inflammation in artery walls and help stabilize existing plaque, ultimately lowering the risk that it will rupture and cause a heart attack or stroke. “We’re not treating the cholesterol number for the sake of the number,” says Fadi Alameddine, MD, cardiologist at Houston Methodist Cypress Hospital. “We’re treating it because lowering LDL lowers cardiovascular risk.”
Introducing the “Natural Statin”
RED YEAST RICE is ordinary rice fermented with Monascus purpureus, a mold (not actually a yeast) that turns the grains a distinctive deep red. It has a long history in China and across East Asia, where it has been used as a food coloring, in rice wine, and in traditional medicine. In the United States, red yeast rice is mainly used as a dietary supplement for controlling cholesterol.
So does red yeast rice actually work to lower cholesterol? Yes, but there’s a huge catch.
“It’s a weak statin, just without a label telling you the dose,” says Dr. Alameddine.
During fermentation, the rice produces compounds called monacolins. The most important is monacolin K, which is chemically identical to lovastatin, a prescription statin the FDA approved in 1987. This means red yeast rice lowers cholesterol in much the same way a statin does, by blocking the same liver enzyme.
Dosing Is the Real Problem
AT ITS BEST, research shows red yeast rice may lower LDL by roughly 15 to 34 percent versus placebo, provided the product actually contains a meaningful amount of monacolin K. Doctors say it’s a noteworthy reduction, but generally less than what can be achieved with a moderate dose of a statin.
The bigger issue with red yeast rice is consistency. “With a statin prescription, I know exactly what’s in every pill, I can adjust the dose, and I have decades of trials in hundreds of thousands of people showing fewer heart attacks, strokes, and deaths,” says Dr. Alameddine. “With a supplement, neither the dose nor the purity is guaranteed.”
“With red yeast rice, the active ingredient varies more than sixtyfold between products, so the ‘dose’ is a lottery, really,” says Michael Farbaniec, MD, cardiologist for Penn State Health.
Studies have found that some red yeast rice products contain little to no monacolin K, while others contain amounts comparable to those found in prescription statins. For consumers, that means two bottles on a store shelf can look essentially identical while delivering dramatically different doses.
“This isn’t a natural alternative to statins; it’s actually a low-dose, unregulated statin wearing the clothes of a supplement label,” adds Dr. Farbaniec.
Red Yeast Rice Has Side Effects Too
DESPITE THEIR PROVEN benefits, statins are unpopular because of the muscle aches and pain people develop while on the drug. The muscular side effects are pretty controversial—Dr. Farbaniec says the frequency with which people attribute muscle pain to statins appears to be much greater than the number of people who actually experience a drug-related effect. In fact, large clinical trials have found that over 90 percent of muscle complaints among people taking statins were not caused by the medication.
Regardless, if you’re someone avoiding statins because of their side effects, do we have news for you.
Because monacolin K is essentially a statin, red yeast rice can cause some of the same side effects, says Dr. Vadali. The supplement may also carry additional risks related to how it’s produced, including potential contamination with citrinin, a mold byproduct that can damage the kidneys.
When Red Yeast Rice May Work
SINCE RED YEAST rice contains a statin-like compound in an unpredictable amount, whether it makes sense depends largely on a person’s existing heart disease risk.
“Red yeast rice can be reasonable for someone at low overall risk with mildly high LDL, no diabetes, no known plaque, and a firm, informed preference to avoid a statin,” Dr. Alameddine says. “A statin is the right call for anyone who has had a heart attack, stent, bypass, or stroke, has diabetes, or has an LDL of 190 or higher.”
For those who do choose to try red yeast rice supplements, make sure to get a supply that has third-party certification from organizations such as USP or NSF. The certification provides some additional reassurance about a product’s contents and manufacturing process. Dr. Alameddine also recommends checking your cholesterol levels before starting red yeast rice and again six to eight weeks later, since that’s the only way to know whether the supplement is actually doing anything.
So ultimately, red yeast rice isn’t a safer version of a statin—it’s a less predictable one. For those at higher cardiovascular risk, prescription statins offer proven benefits and consistent dosing. For lower-risk people who prefer a supplement, red yeast rice may be an option, but it should always be discussed with a doctor and monitored like any other cholesterol-lowering treatment.
Andi Breitowich is a freelance writer who covers health, fitness, relationships, beauty, and smart living. She is a graduate of Emory University and Northwestern University's Medill School of Journalism. Her work has appeared in Women's Health, POPSUGAR, Food & Wine, What To Expect, Cosmopolitan, Men's Health, and elsewhere. As a former collegiate pole vaulter, she loves all things fitness and has yet to meet a group workout class she doesn't like.