The People's Perspective on Medicine

Is It Safe to Take Red Yeast Rice for High Cholesterol?

Most people who take red yeast rice to lower their cholesterol do well with it. But a few experience side effects such as muscle or nerve problems.
Red Yeast Rice supplements

Statisticians have shown that people with elevated levels of LDL cholesterol, are more likely to develop clogged arteries and coronary artery disease (Heart, Lung & Circulation, March 2018). If seniors also have high levels of lipoprotein a, termed Lp(a), the link is especially strong. Even individuals who have moderately raised cholesterol levels are at increased risk of heart disease compared to those whose levels are low (PLoS One, 2018). Doctors usually prescribe statins to lower cholesterol. However, some people don’t do well with them. Can they take red yeast rice instead?

Searching for Alternatives to Statins:

Q. I am a 73-year-old woman with a long history of high cholesterol. I have had a severe reaction to all statin drugs and can’t tolerate any of them.

My total cholesterol was almost 300. After taking red yeast rice twice a day along with Welchol for less than a year, my total cholesterol has come down to 184. My triglycerides are now 300, my HDL 44 and my LDL 80.

So far this has been the only thing that has worked. Even eating a healthy diet did not work. My question is: will I have side effects if I take red yeast rice long term?

A. Red yeast rice is an ancient Chinese food that was also used traditionally as a medicine. It contains compounds called monacolins. These are related to statin medications.

Many people appear to tolerate red yeast rice better than statins. That may be because the dose is generally lower.

What Are the Side Effects?

Side effects of red yeast rice are similar to those of statins (International Journal of General Medicine, April 30, 2019).  Be alert for muscle pain and weakness, elevations in blood sugar and nerve pain.

How Do Statins Compare to Red Yeast Rice?

Q. I am a woman who had a heart attack and bypass surgery two years ago. I was then prescribed three different statins, one at a time. They all caused me severe pain. Nevertheless, I had to continue.

Last summer, I noticed that I could not use my right leg to get out of the pool. When I attempted to use my right leg, holding the handrail did not help. It was impossible. I mentioned it to the cardiologist, but he did not appear concerned. I just let it go and only used my left leg to get out of the pool at the gym.

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Then last summer I fell twice with no warning. And I again fell during our summer vacation this year. I believe these falls are also related to the statin.

Finally the cardiologist agreed to place me on red yeast rice instead of a statin. So far, so good. I am regaining the strength in my right leg. I can now use it to get out of the pool.

My concern is that a friend took red yeast rice for a few months and lost the strength in his arms. He stopped it and is in recovery mode now. Is muscle weakness a side effect of red yeast rice?

Red Yeast Rice and Muscle Reactions:

A. Statin-linked muscular damage appears to be, in part, related to dose. Red yeast rice (RYR) contains lovastatin, although it is present in lower doses than those found in conventional prescription drugs. There is evidence that it can lower LDL cholesterol (Cicero et al, Nutrition & Metabolism, Sept. 25, 2017). Adding phytosterols (plant compounds such as beta-sitosterol) may increase the effectiveness of RYR.

One small trial found that many people who don’t tolerate statins do well on red yeast rice (Becker et al, Annals of Internal Medicine, June 16, 2009).  That said, some people are so sensitive to statin side effects that even RYR causes pain and muscle weakness (Philibert et al, Therapie, Oct. 27, 2016).

On the other hand, certain physicians are adamant that RYR is not an appropriate substitute for statin therapy (Dujovne, American Journal of Medicine, Oct. 2017). They may worry that such dietary supplements are not appropriately standardized or monitored for quality control (Current Atherosclerosis Reports, April 2015). 

You may find our Guide to Cholesterol Control and Heart Health useful, as it contains other non-statin strategies for controlling LDL.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
    Cholesterol Control & Heart Health

    Heart disease is still a top killer, and high cholesterol is an important risk factor. This guide will teach you about the condition, as well as many effective treatment options.

    Cholesterol Control & Heart Health
    • Simons LA et al, "LDL-cholesterol predicts a first CHD event in senior citizens, especially so in those with elevated lipoprotein (a): Dubbo study of the elderly." Heart, Lung & Circulation, March 2018. DOI: 10.1016/j.hlc.2017.04.012
    • Ueda P et al, "Long-term moderately elevated LDL-cholesterol and blood pressure and risk of coronary heart disease." PLoS One, July 30, 2018. doi: 10.1371/journal.pone.0200017
    • Farkouh A & Baumgartel C, "Mini-review: Medication safety of red yeast rice products." International Journal of General Medicine, April 30, 2019. doi: 10.2147/IJGM.S202446
    • Cicero AFG et al, "Effect of a short-term dietary supplementation with phytosterols, red yeast rice or both on lipid pattern in moderately hypercholesterolemic subjects: a three-arm, double-blind, randomized clinical trial." Nutrition & Metabolism, Sept. 25, 2017. DOI: 10.1186/s12986-017-0214-2
    • Becker DJ et al, "Red yeast rice for dyslipidemia in statin-intolerant patients: A randomized trial." Annals of Internal Medicine, June 16, 2009. DOI: 10.7326/0003-4819-150-12-200906160-00006
    • Philibert C et al, "[Red yeast-rice-induced muscular injuries: Analysis of French pharmacovigilance database and literature review]." Therapie, Oct. 27, 2016. DOI: 10.2515/therapie/2015053
    • Dujovne CA, "Red yeast rice preparations: Are they suitable substitutions for statins?" American Journal of Medicine, Oct. 2017. DOI: 10.1016/j.amjmed.2017.05.013
    • Burke FM, "Red yeast rice for the treatment of dyslipidemia." Current Atherosclerosis Reports, April 2015. DOI: 10.1007/s11883-015-0495-8
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    My doctor recommended Red Yeast Rice , took for awhile with no problem and cholesterol came down. Cannot remember numbers. Stopped taking it for some years, then began again.
    Perhaps my body chemistry changed? I thought my muscles hurt because I was overdoing yard work….then I visited a friend and my leg pain was so severe could not sleep. Since no problem previously I never thought of RYR being the problem. In the morning I tried to turn, my feet and legs didnt function, I fell flat on my face on the sidewalk. Actually broke my teeth –great horror as well as cost.
    My brother sent me an article from Indiana newspaper –headline something like this:
    ”Why Red Yeast Rice is not so nice”. The first I ever heard of the PP!
    Sure wish I had that information earlier.
    An introduction that has kept me a constant and grateful reader. Thank you.

    I usually agree with the authors of this site, but on this I have to disagree. LDL has been shown not to be as relevant as it was thought to be as a marker for heart disease and mortality. The current data suggests it is NOT correlated with any consistency. You can read the data in this article, by a reputable journalist.

    Red Yeast Rice works much like lovastatin to lower cholesterol because it contains the same key ingredient, monacolin K. However, the dose from eating some rice and repeatedly taking an extract in encapsulated form is not truly comparable. A great read for anyone who wants to go down the rabbit hole on this issue is NO more heart disease by Louis Ignarro. It speaks about his research into Nitric Oxide, for which he was a nobel prize co-recipient. Furthermore, the role of flushing niacin can not be overlooked in treating and preventing atherosclerosis.


    After menopause my LDL levels rose, but with lifelong high HDL and good triglycerides, modest family history of heart disease, various bad reactions to statins in my immediate family, and total lipid levels not horribly high, my physician did not want to prescribe statins, suggesting I could take red yeast rice if I wanted. I took one brand for several months without incident. Then I tried another, pricier brand, which apparently was more potent. Within a couple of weeks I was experiencing dizziness, strange muscle twitches that were spreading to other limbs and becoming more frequent, and a sensation of weakness in my arms. I wondered if I was getting MS or something, until I asked myself what had changed recently – the only change was brand of red yeast rice. I stopped taking it (any brand), and symptoms subsided within a week or so and have not returned in 12 years. For people with statin sensitivity, the problem with red yeast rice is that OTC supplements are not regulated/controlled for strength and do not specify statin dosage, so there can be significant dosage variation with the same number of capsules.

    I once took red yeast rice to address moderately high cholesterol. Within days I noticed a pain in my upper right abdominal quadrant. I discontinued red yeast rice and the pain in my upper right abdominal quadrant disappeared. I assume that if I took a statin drug similar complaints would occur since there are similarities between red yeast rice and statins, so I have avoided statins. I have found other ways to address my cholesterol including diet, krill oil, and a supplement from Life Extension called Chol-Support. This strategy has significantly lowered my cholesterol without abdominal pain.

    Years ago, it seemed that my cholesterol was getting higher every year, and when it finally got up to 239, my Internist decide we should do something about it….He recommended Red Yeast Rice for me to take, which I did….After a follow up Lipid blood test he was ecstatic with joy to see that it dropped a full 25%, down to 171….I’ve been taking it now for almost 18 years with no side effects…
    Of Recent my new PCP was questioning me about me taking the Red Yeast Rice…
    And after numerous questions by him, I finally asked why he seamed so inquisitive about me taking Red Yeast Rice….
    He finally stated that he was considering taking something to lower his cholesterol also…
    And wanted to know more about it…

    Red yeast rice naturally contains lovastatin and related statin (or monacolin)

    Red Yeast Rice is a STATIN

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