The People's Perspective on Medicine

How Does Red Yeast Rice Compare to Statins?

Red yeast rice (aka RYR) is a very popular dietary supplement. How does it compare to simvastatin? What about RYR side effects? Is RYR safer than statins?

Tens of millions of people take statin-type cholesterol-lowering drugs. Many physicians believe such drugs are dramatically effective against heart disease. We will not deal with that controversial topic in this article. What a lot of readers want to know is whether red yeast rice is a viable alternative.

Many physicians believe that dietary supplements in general and red yeast rice in particular are unreliable or dangerous. They point out that the FDA doesn’t do a very good job overseeing vitamins, dietary supplements or herbal preparations. We cannot disagree. The FDA has pretty much abdicated its responsibility when it comes to nondrug alternatives. As a result, it is difficult to determine which over-the-counter supplement is trustworthy (Cohen, Avula & Khan, European Journal of Preventive Cardiology, Sep. 2017).

Research on Red Yeast Rice:

Nonetheless, a number of studies indicate that components of red yeast rice (primarily monacolin K) can indeed lower both total cholesterol and dangerous LDL cholesterol. One early study was a 24-week trial including 62 people who had reacted to statin drugs like simvastatin or atorvastatin by developing muscle pain (Becker et al, Annals of Internal Medicine, June 16, 2009). They took red yeast rice or a placebo twice daily. They were also coached on healthy lifestyle changes. The people taking red yeast rice were able to reduce cholesterol and bad LDL cholesterol levels much more than those who were on placebo. The supplement did not trigger increased muscle pain.

An Italian study compared the cholesterol-lowering effects of a Mediterranean diet alone or in combination with red yeast rice (Sartori, Evidence-Based Complementary and Alternative Medicine, Dec. 23, 2013). The six-month trial demonstrated that people who followed a Mediterranean diet lowered their cholesterol levels. Adding red yeast rice brought cholesterol down even further.

Another study examined the effects of a combination of red yeast rice with olive extract (Verhoeven et al, BMC Complementary and Alternative Medicine, March 10, 2015). In this randomized controlled trial, people taking Cholesfytol plus lowered their total cholesterol, apolipoprotein B and triglycerides significantly. One person did develop debilitating muscle pain.

Several recent reviews call for better regulation of OTC red yeast rice and further research. Most, however, consider this to be a functional food that can be a useful part of the armamentarium (Hunter & Hegele, Nature Reviews. Endocrinology, May, 2017; Nguyen, Karl & Santini, Foods, March 1, 2017Patti et al, Current Pharmaceutical Design, 2017; Johnston et al, Pharmacological Research, June 2017).

A Reader Wants to Know About Red Yeast Rice:

Q. Ten years ago, I had a heart attack. I was sent home from the hospital with eight different prescription medications.

Within two months, I felt like a 90-year-old arthritic, although I was only 55 at the time. I told my doctor about the effects of the medications. He took me off of one med each week to see if there was a change.

He determined that simvastatin was causing the problem, but he said I could not stop taking a statin for cholesterol control. I chose to switch to over-the-counter red yeast rice instead.

Within two days the side effects ceased. Within six months, my cholesterol had dropped 50 points. I also changed my diet to include lots of fruits and vegetables, stopped eating processed foods and reduced my salt intake. I started walking five days a week for at least 30 minutes per day.

I am no longer on any prescription drugs and my health is very much improved. As Hippocrates said, “Let food be thy medicine and medicine be thy food.”

A. Red yeast rice (RYR) has been used in Chinese cuisine for over 1000 years. It has also been used in Chinese medicine for indigestion and circulation.

Modern research has demonstrated that RYR contains statin-type compounds and lowers cholesterol (Atherosclerosis, June 2015).  Although it acts much like simvastatin on blood lipids, RYR is less likely to cause muscle aches and fatigue (BMC Cardiovascular Disorders, online May 18, 2017). One systematic review of 10 Chinese studies found that the cholesterol effects of red yeast rice and simvastatin were not significantly different (Ong & Aziz, Journal of Clinical Pharmacy and Therapeutics, Apr. 2016).

David Z related his experience:

“I quit taking statins and began a regime of: heaping tablespoon of Metamucil before breakfast; home-made granola with home-ground flax, barley flour, and sesame seed; 500 mg of niacin 2/day; 600 mg of red yeast rice 2/day.

“My overall cholesterol was 154 but my HDL was 24. With the new diet & combination of pills it moved to 150 overall and 39 HDL. I’m satisfied with the results.”

Side Effects from Red Yeast Rice:

Some people are so sensitive to statins, however, that they react even to RYR. Here are some stories from readers to provide some perspective on this dietary supplement:

Barry in North Carolina had liver issues:

“I used red yeast rice for about a year to help lower cholesterol. I had no muscle pain, but was turned down for insurance when a blood test found mildly elevated liver enzymes.

“After stopping the supplement the liver tests returned to normal in just a few weeks, and I was able to get the insurance I applied for. I always prefer a ‘natural’ remedy when one is available, but we all need to remember that just because a chemical occurs in nature, that doesn’t mean it will always be harmless.”

Cindy reports muscle problems on RYR:

“I used RYR for a long time after having intolerance to Lipitor, Crestor and pravastatin to name a few. I had the same side effects with red yeast rice.

I have been off it for about 3 years. I now have arthritis and my muscles have not totally recovered.”

Bonnie has a similar story:

“I used red yeast rice for about 6 months after I was taken off Lipitor and Crestor because of muscle pain in my legs. The red yeast rice kept my cholesterol levels in check, but my leg pain came back big time. It has been several months since I stopped the red yeast rice, but my legs are still not back to normal.”

When Statins and Red Yeast Rice Aren’t Tolerable:

We offer more information about this and other nondrug approaches to cholesterol control in our book, Quick & Handy Home Remedies. It is available in our bookstore.

If you like the idea that Hippocrates proposed thousands of years ago, “Let food be thy medicine and medicine be thy food,” then you will find our other books of great interest too:

Spice Up Your Health: How Everyday Kitchen Herbs & Spices Can Lengthen & Strengthen Your Life


Recipes & Remedies from The People’s Pharmacy

We discuss the pros and cons of statin-type drugs in our book:

Top Screwups

Share your own RYR or statin story below in the comment section.

Revised 3/8/18

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I work at a health food store, and have heard over and over the same complaints about red yeast rice from my customers that were the same or worse than taking prescription statins- muscle aches, elevated blood sugar, etc. Personally, I would not take either. If you feel you must though- be sure to supplement with ubiquinol (a more bio-available form of CoQ10) to protect your heart, eyes, and immune system. –Some pharmacies in Europe won’t give a prescription for statins without also selling CoQ10/ubiquinol to try to counter the harmful side effects to some extent. Women in particular have a greatly elevated risk of developing diabetes type 2 when taking statins- do your research before filling a prescription.

A nurse practitioner suggested I try red yeast rice a few years ago, and she directed me to the brands that were reliable. I did try one of the brands for a week or so and had terrible cramping in my legs when doing yoga. That was the last time I tried this supplement, and I have no plans to return to it OR take statin drugs that are just as bad if not worse. I do not believe elevated cholesterol levels are necessarily bad for everyone.

Regarding my request for info on 80 yr old man about statins: Forgot to say his cholesterol runs 30 points below normal range, LDL runs lower as well. Only triglycerides test above normal range. So you can see our dilemma.

We are in a quandary regarding the latest script for statins. Some years ago, my husband developed leg muscle weakness, pain and cramping. His MD had prescribed a statin a few weeks prior. She did some tests that were thankfully negative but took him off the statin anyway. Now living in a new state, he had a TIA a few weeks ago. All U/S, C/T, MRIs, etc., were very good with only mild arterial soft plaque deposits and no significant stenosis. He has an 18-yr history of brain aneurysm surgery repair found only by accident during an MRI for hearing loss. He has had elevated levels for both liver enzymes of 20+ points for decades. (Non alcoholic fatty liver). With so much contradictory data for an 80 year-old man who is otherwise in good health, we just don’t know what to do or who to consult. BTW, a few weeks prior to the TIA, he started taking 1000 mg of Turmeric daily. Since then, I’ve learned it possibly could be blood thinning, as Coumadin patients are warned not to take it. He does not take any blood thinners and very few NSAIDs, as the neurosurgeon cautioned him about blood thinning meds.

Does anyone know of a patient with somewhat similar data history? If so, what was the resulting outcome.

When my husband took the capsules of Red Yeast Rice, he developed yeast in his armpits, so we threw it out.

Our primary care dr. suggested I take the red yeast rice & my cholesterol counts were lower & good in his estimation. Then, for about a year I was having leg cramps in my right leg & After seeing info about how taking the RYR could be the cause of the intense pain, I stopped taking it. Also, was taking magnesium & A webinar on Lyme disease mentioned how magnesium could be the cause of leg cramps in some people. I stopped taking the magnesium & then noticed I was still having pain at times & checked out the regular vitamin pill I was consuming & sure enough it had magnesium in it: I stopped taking that pill as well & the muscle pain & cramps have gone away.

So, why would I want to consume statins if they are going to do the same thing? I told the Dr. that 15 yrs. ago & have taken pantothenic acid capsules daily which have helped reduce my cholesterol. Have to get blood tests done again after I am off the RYR for 6 mos.: so we’ll see. I refused the meds to start with when the Dr. read me all the side effects: already had most of them & didn’t feel the need of adding to what I was experiencing. Don’t we need cholesterol for healthy brains? Is this why there are so many people with Alzheimers? Whatever is wrong with butter? The Bible talks about butter & honey–natural God given things for us to consume & yet you have to have a patent to make margarine as well as these ‘sugar products’. Seems to me that something fishy is going on with all this push for statin drugs–MONEY for big pharma???!!!?

My PC doctor said that half of his heart patients have normal cholesterol levels. We heard many times that the original cholesterol study (that everyone ran with) was biased so one cannot conclude much from that data. Then the industry set TCLs at 190. Then we were told that TCL wasn’t the bad number but LDLs were. Then a combination of LDLs and HDLs. Triglycerides used to be a concern but now it isn’t (according to a well known cardio doctor). Today LDL seems to be the culprit for heart issues? None of the above relates to what my doctor has found with his heart patients.

My mom had cholesterol levels at 292. Tried statins which reduced it down to 260 but then her doctor said “You are perfectly healthy. Who am I to tell you to live your life.” Mom went off of statins (after six months at age 85) and lived to be 92 with no heart issues. Bottom line: do we really understand the cholesterol issue? While my mother is a single case my PC has many, many heart patients who, by their cholesterol numbers, don’t support the cholesterol theory.

I started RYR a yr ago. Did great for my cholesterol numbers. But decided to stop it because I was having some hair shredding which I read elsewhere could be attributed to RYR. Anyone else with this side effect?

This is to Susan in Virginia, question on hair shredding. I have never heard of hair shredding before.

Someone recommended that I take red yeast rice, not for cholesterol but for immune support. This person is not a doctor, but he strongly recommended this to help my body overcome whatever is in me that is causing an extensive skin rash. He also recommended qunol co Q 10, garlic tablets and vitamin C. Reading up on red yeast rice, I ended up here.

I saw my doctor today and asked him about RYR. He hadn’t heard of it but we talked about statins and he had been to a conference yesterday where some people were recommending that doctors take their patients off statins, don’t keep them on it indefinitely.

And then he said he had one patient who experienced hair thinning after starting statins.

So for whatever that is worth–

Is it safe? Just because it’s an herb does not mean it’s always safe. There are also issues with dosage and purity of the product. How does it affect the liver and will it interact with other medications. I would say the risks of RYR is the same as taking any other statin..for some it will work miracles; others, it can be catastrophic.

My alternative doctor suggests an herb called Guggul. Anybody have any experience?
Also what about policosinol? Have read good and bad. A friend says that 20 mg has been very effective. Should I start with 10?

For years my doctor told me my cholesterol was too high. I was put on first one med and then another. Over time I think I tried every known med for cholesterol, all with the same problems. Aches and pains in my feet, legs and hands as well as memory problems. To this day I still have some of these problems which I feel was caused by the meds that the doctor prescribed.

When I learned about Red Yeast Rice I decided to try it. Have been taking it for 10 years or so and have never had a problem with it. Had a check up in January with a new doctor I am not seeing. After doing the blood work she announced that for an 80 year of woman my cholesterol is very good.

I use a brand that is tested by Consumer lab for the manufacturer.

I suffered a small stroke last March. Even through my cholesterol levels were in the normal range the doctor prescribed a statin medicine. About 1 month later my whole body ached from my neck to my feet. My primary doctor suggested they do blood and urine tests. Everything was normal.

A friend who years earlier had been taking statins and stopped because of the body pain suggested I google the medicine I was taking. Sure enough the first thing on the list of side effects was joint and muscle pain.

I stopped taking it 4 to 6 weeks ago, but the pain lingers. I am (praying) that this will eventually clear up. I take Aleve three times a day and smoke medical pot daily just to get through the day. I’m tired of living like this!

My PCP at the time (6 yrs. ago) told me my cholesterol was a bit high and also told me to stop at the health food store on the way home to pick up some “Red Yeast Rice”. I’d never heard of it and asked her if it was something I cooked; she said “no, it’s a perfectly natural supplement that helps reduce cholesterol”. I wasn’t concerned about my cholesterol as I eat a healthy diet and workout regularly. High cholesterol runs on my mother’s side of the family, and her mother’s cholesterol went over 400 at one point. Grandma lived until 92, death not related to cholesterol, more so to an unnecessary surgery the nursing home insisted she needed (at 92???).

Back to RYR. The doctor could not suggest a brand or dosing and told me to just pick up a bottle and follow the instructions (since when do doctors have the right to prescribe herbals which are not regulated by the FDA — or anyone for that matter?). That said, I picked up a couple bottles on the way home and began my RYR consumption per label instructions, a well known brand. After a short while I started feeling weaker and weaker, and my stomach was so upset, I could hardly get food down. Then I ran to the bathroom and started vomiting…RED. At first I wondered if I had a bleeding ulcer, but then it hit me that the only thing that changed in my diet was the RED yeast rice. I grabbed a bottle, opened a capsule and poured it into a glass of water. There it was, the exact color of what I threw up (there were no clots or anything to indicate blood in the toilet, just red dye as was in the RYR (yes, some manufacturers actually add red dye for effect). I knew immediately why my health had suddenly gone downhill. Further research indicated that every brand is different and many do not have the anti-cholesterol properties. Consumer Reports repeatedly had articles about the dangers of RYR. It can destroy your liver and kidneys and has done so to numerous people. I reiterate, it is not a regulated product. PLEASE do not take it!! Oh, and the FDA considers it a statin that should be regulated and actually managed to ban its sale in the US for a year. Guess who managed to win that battle? The multi-billionaire supplement industry of course!

I will not take statins since I already have tremendous aches and pains probably caused by another heart drug I used to take. Prior to taking the heart meds did not have any pains, regularly exercised, did gardening, etc, lawn mowing. I was wondering if Sytrinol has any effect on cholesterol, either good or bad?

I took several different statins over the last 18-20 years after a few years of refusing the meds. After recently reading so much negative information on this and website and other sources about statins’ side effects (e.g., muscle pain, cognitive issues), I convinced my doctor that I wanted to try RYR. The first 3 months resulted in lower LDL (<79), higher HDL (154), but slightly higher total cholesterol. Furthermore, I have had no negative side effects. My doctor is not concerned with my higher total because my very high HDL and good ratio and triglycerides more than make up for it. I’m hoping that future blood lab results will continue to confirm that RYR works for me.

I tried RYR, and it did not work for me. I was told that it wasn’t approved by the FDA. The ratio of the ingredients vary from one manufactory to other.

My experience with red yeast rice was that it was totally ineffective. I have been taking a very mild dose of a prescription statin, for more than 15 years, which keeps my cholesterol within normal limits. I am grateful for having had no side effects and no strokes up to my age of 82, although my grandmother died at 75 of a severe stroke, my mother suffered from multiple mini-strokes and my father was diabetic.

I thought the same way. I took RYR for 3 months with no change, after playing around I figured . I would do it just like statins at bed time and added 20 mg of policosanol. That worked my chol went to 145 had never been below 190.

I’ve been taking RYR for years and it has kept my cholesterol in a normal range. No side effects, no muscle pain. I take COQ10 with it.

Red yeast rice has been excellent for me, after a stroke I was put on Crestor with terrible side effects. I simply could not walk after a week. I told my Dr. that I preferred to die than to live with those side effects. He reluctantly took me off of all statin drugs, and suggested I try RYR. After three months my total cholesterol went from 240 to 182, and stayed there. No side effects.

I tried Red Yeast Rice for a few months after disagreeing with my doctor about the need to start statins, based on my disturbing research about the side effects of statins (my good cholesterol has always really good, my combined is usually about 220, and my bad is nowhere near what is supposed to be dangerous.) I was below 200 to 190 once when I lost 40 pounds dieting. I do not take any medications, am athletic, and I eat properly at age 74, going on 50).

Real or imagined, I thought I was having some muscle issues recently, and stopped the RYR, which was a nuisance anyway taking 4 per day. I have gone to niacin, two a day, as the same doctor recommended when I mentioned it before we had the disagreement about statins. I know the doctors follow the statistics regarding statins, but I am not convinced an otherwise healthy person needs to mess up his body based on my cholesterol readings. Comments, please.

Adding to your story about Red yeast rice, consumer reports on health [July2017] has RYR under 15 supplements consumers always avoid. There is little evidence to support it’s use-or it’s safety according to the publication.

YES, you are correct! Red Yeast Rice is not FDA regulated, and there are tons of brands on the market, inconsistent with each other. I eat a low fat diet, work out regularly, but high cholesterol runs on my mother’s side of the family. I’m always told I have high cholesterol and I think, I eat a low fat, healthy diet. So, it’s genetic. But my “holier than though” female doctor told me to start taking it. I asked what it was. Answer: “A perfectly natural way to get cholesterol under control”. Asked her for a brand and dosage, she said “just follow the instructions”. PERIOD. So we stopped at a health food store and bought a bottle. Followed the instructions. Suddenly I couldn’t eat, then started vomiting RED. Researched the herbal. They are all made differently and SHE couldn’t recommend a brand or dosage! I wish I had sued her. I felt like I was on “death row.” We need some cholesterol. Yes, I started vomiting RED, and first thought I had an ulcer. Then I opened one of the capsules and put it in water. What a surprise. Same color of what I vomited into the toilet!! DON’T TAKE IT!!!!

After trying 2 different statins in 1997 with lots of intestinal issues, my doc said at least try Red Yeast Rice. So, I did, and in 2 1/2 days I was in the ER in Atlanta with rectal bleeding, had to stay overnight and the next day they wanted me to have a colonoscopy and I said good bye. I am a Nurse Case Mgr. and Medical Writer

We blindly accept the “theory” that high LDL cholesterol is bad…we now know that high cholesterol does not cause heart disease…focus on inflammation if you want to maintain your good health.


I have been taking red rice yeast for several years and I don’t think I have had any side effects. My cholesterol has gone down. However according to Consumer La b(a vitamin testing company that you pay for reports) red rice yeast varies a lot with different brands.

I just read their latest test and the brand I have been taking has increased in potency a lot. The lovastatins in the Red Rice Yeast has increased 85% since the last time they tested the brand.

Actually, it was my Internist that recommended RYR for me 15 yrs ago…
When my cholesterol reach 239 he said I should take it..
At my next checkup, my blood work showed my cholesterol had dropped to 171
He was so excited, I thought he’d wet his pants…
My cholesterol had dropped 25%…
He said he was going to tell all his proteges

pravachol caused very severe hives needing hospitalisation for my wife but stopped immeediately after switching to crestor

Cholesterol is involved in hundreds of metabolic pathways, effecting nearly every cell in the body. Inhibiting cholesterol synthesis disrupts some of them, producing the side effects.

I It is better to absorb excess cholesterol from the bloodstream, less likely to disrupt critical metabolic pathways in muscle or nervous system.

We need studies of agents like cholestyramine randomized against statins. Those are expensive and need to be long term to measure the effect on cardiovascular morbidity. Results need to be stratified. Those with very high ldl or total cholesterol may benefit more from one. In people with low, the opposite may have the lower cardiovascular mortality.

Last fall of 2016, I was presccribed Atorvastatin for high cholesterol and soon developed extreme muscle weakness over the course of a month. I stopped taking the drug and my doctor told me that not taking a statin was life threatening so I began taking Livolo and within 21 days both my hands became literally paralized with accompanyimg pain; my left arm felt as though it was broken.

I immediately stopped taking this poison and recovered in 7 days. Hopefully, I will not have permanent muscular damage which can happen with statins per my internet research which also indicates that some studies have found statins to be more harmful than beneficial and that approximately 25% of people with high cholesterol cannot take the side effects of a statin. I will never again take another statin drug; period.

Richard and others with statin side effects: at least try taking ubiquinol in 200 mg for a month or two and notice if there is any improvement. Statins seriously deplete it. Canadian doctors require taking it along with a statin drug. Why not the US?

Read the history of RYR. It contains a natural statin, lovastatin. Merck claimed that they synthesized Lovastatin . A usual Big Pharma Lie.
Merck went to court and blocked the mfg./sellers from mentioning this fact.
RYR contains a statin..The natural product from fermentation..
Look at the legal/court battle of RYR with Merck against Nuskin…
Those who take RYR take a built in Statin…
People’s Pharmacy should have divulged this…

I have oatmeal with flaxseed meal (ground every few days in a dedicated coffee grinder) a little olive oil and cinnamon for flavor. Last total cholesterol 101.

Rosuvastatin muscle pain makes me exercise less. The mood elevating effect of walking briskly on hills with my dog is important to my quality of life. Hobbling around in pain is depressing, the exact opposite of what you need.

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