Red Yeast Rice: What Is It, What Are The Benefits, and Should You Take it at Night?

Red yeast rice has gained popularity in recent years. The active compound monacolin K has a similar structure to the cholesterol-lowering drug lovastatin. Read more about the benefits of red yeast rice, why it’s better to take it at night, and ways to avoid potential side effects of red yeast rice.

By Nina Sabat (BSc Hons Dip NT)

As a fermented food with a history of traditional use in the East, red yeast rice is now a popular therapeutic supplement in the West. Clinical trials support the use of red yeast rice for its cholesterol-targeting actions and cardiovascular benefits. Animal models suggest red yeast rice benefits may extend to protection of liver cells and an anti-obesity effect. Red yeast rice is commonly taken at night because that’s when most cholesterol synthesis occurs.

If you’re seeking a natural alternative to statins, a high-quality red yeast rice supplement is certainly worth consideration. In this article you’ll find essential information on red yeast rice, from the active compounds and science-backed red yeast rice benefits to potential red yeast rice side effects and how to choose a safe and effective supplement to suit your needs.

What is Red Yeast Rice Extract?

Red yeast rice (RYR) is a fermented ingredient popular in China and other Asian countries. Depending on where you are, it could be called angkak or red rice koji, but its official name is Monascus purpureus. RYR is made by fermenting cooked, non-glutinous rice with a Monascaceae mould.

A Food and Medicine…

Red yeast rice is used as a food ingredient – as a colourant, flavour enhancer and preservative in meat, fish and soy products.

It also has an impressive history of use as a remedy in Traditional Chinese Medicine - as a remedy for indigestion, diarrhoea, weakness in the limbs and stagnation in the blood. [1]

A Rich Source of Active Plant Nutrients…

Red yeast rice contains a variety of metabolites produced through the fermentation process.

Monacolins

Monacolins are considered the principle active metabolites and have been shown to reduce the production of cholesterol in the liver.

Monacolin K is the star of the show and has the same chemical structure as lovastatin, which was approved in 1987 by the USA Food and Drug Administration as a drug for the treatment of hypercholesterolemia (high cholesterol). [2]

However, there’s more to red yeast rice than monacolin K!

Pigments

More than 25 pigments are produced during fermentation.

As research has focused on other RYR compounds, the benefits associated with monascin and ankaflavin – yellow constituents of the monascus pigment – have come to light. 

Other compounds

Red yeast rice also contains monounsaturated fatty acids, amino acids, sterols, flavonoids, polysaccharides and vitamins. [1]

Is it a Drug or a Supplement?

As monacolin K has a similar chemical structure to lovastatin, you might be tempted to think of RYR as a drug. However, red yeast rice is a supplement and there are some key differences between red yeast rice and Lovastatin prescribed by your GP.

• Red yeast rice extract may contain all 10 of the monacolins, unlike Lovastatin which is simply monacolin K.

• Red yeast rice extract may contain other active compounds, such as sterols, flavonoids and monounsaturated fats which also improve cholesterol levels, unlike Lovastatin which is purely monacolin K.

• Medicines contain a standardised lovastatin dose of 10, 20 or 40mg per tablet, whereas the amount of monacolin K present can vary from one supplement brand to the next.

5 Science-Backed Red Yeast Rice Benefits

Red yeast rice benefits include improved cholesterol levels and better cardiovascular health. Beyond this there is some evidence of the potential for red yeast rice extract to improve liver function, control blood sugar and even reduce appetite.

1. Improves Cholesterol and Triglyceride Levels

Red yeast rice extract supports healthy cholesterol levels.

 The hypolipidemic actions of red yeast rice – lowering LDL cholesterol (LDL-C), total cholesterol and triglycerides – are a well-documented science-backed benefit.

 Red yeast rice is comparable to statins at reducing elevated cholesterol. [3] Having appropriate amounts of healthy cholesterol, triglycerides and other fats in the blood improves long-term mortality and levels of health.

A 2014 study examined the effects of RYR extract on 116 individuals with high LDL and non-HDL cholesterol. Over 12 weeks, participants were given either placebo, 1,200mg or 2,400mg red yeast rice (2.4 or 4.8mg monacolin K). At the end of the trial, more than half the participants reduced their LDL-C levels by over 30%. In addition, both RYR groups had significant reductions in total cholesterol, triglycerides and other important blood markers. [4]

Similar outcomes were produced in a trial using a lower dose of 3mg monacolin K each day. [5]

 Red yeast rice has also been shown effective when combined with other plant nutrients.

 A mix of RYR, berberine, policosanol and coenzyme Q10 significantly lowered cholesterol in older patients unable to take statins. [6] Similarly, a significant cholesterol-lowering effect was achieved using RYR, grape seed, B3 and B9 in statin-free, newly diagnosed adults. [7]

2. Improves Cardiovascular Health

Red yeast rice has additional cardioprotective actions.

In animal models and in vitro, RYR helped reduce the build-up of plaque, stabilised plaque already present and protected the arteries from further damage. [1] In humans, hardened fatty plaques underly atherosclerotic disease.

In a recent study which used just 200mg RYR each day, not only was LDL-C reduced, but those in the treatment group also saw their blood pressure significantly fall. [8] 

3. Increases HDL-Cholesterol

Another aspect of heart health is having sufficient levels of desirable HDL-cholesterol. This is where the research highlights RYR pigments.

In one study which used a matched dose of monascin and ankaflavin pigments or monacolin K, a very interesting outcome was seen. While the results showed a significant reduction in LDL-C, total cholesterol and triglycerides, the pigments produced additional effects.

 Ankaflavin was more effective than monacolin K at protecting the liver and reducing fatty plaques in the arteries. Monascin was more effective than monacolin K at increasing levels of HDL-C. [9] 

4. May Improve Blood Sugar Control and Reduce Appetite

Red yeast rice may have an anti-obesity effect.

In one rodent study, scientists recorded a correlation between the fall in LDL-C and increases in adiponectin. The hormone adiponectin enhances how your cells respond to insulin, which influences whether dietary sugars are used for energy or stored.

Additionally, as LDL-C fell, levels of leptin, a hunger hormone that inhibits appetite and fat accumulation, also increased. [10]

5. May Support Liver Health

Red yeast rice may protect liver cells.

In mouse models where alcoholic liver disease and non-alcoholic liver disease were induced, RYR reduced transaminases and other markers of liver damage. [1] This protective quality likely stems from reductions in inflammation and lipid synthesis. [11]

There may soon be studies of RYR in human health, focusing on people with alcoholic-liver disease and non-alcoholic fatty liver disease.

Are There Any Side Effects To Watch Out For?

Red yeast rice (and Lovastatin meds) are metabolised by CYP450 liver enzymes. To reduce the risk of any red yeast rice side effects, best practice is to avoid taking your supplement with CYP450 enzyme inhibitors. This is not an exclusive list, but common enzyme inhibitors to avoid include: alcohol, grapefruit juice and medications (including omeprazole and erythromycin).

• Myopathy - muscle pain and weakness - is a potential red yeast rice side effect (and a potential side effect of prescribed Lovastatin). This is because RYR monacolins and Lovastatin act on the same enzyme pathway. They inhibit HMG-CoA reductase and slow down the conversion of HMG-CoA to mevalonate, a precursor of cholesterol. But mevalonate is also a precursor to another important molecule, co-enzyme Q10. CoQ10 helps provide energy for every living cell, so with less available highly active muscle cells, such as those found in heart and skeletal tissue, can easily become fatigued. Monacolin-free red yeast rice supplements are available which may have a lower risk.

• Rhabdomyolysis is another potentially serious side effect of red yeast rice. It results when severely damaged muscle tissue releases electrolytes and proteins into the blood, affecting kidney function and causing damage to the heart. Warning signs of rhabdomyolysis include severe cramps and pains, feeling extremely tired or fatigued and having dark coloured urine (as dark as tea or cola).

What Is The Recommended Daily Dose?

• The typical daily dose used in clinical trials ranges from 1,200 to 2,400mg, although trials of lower doses of 200mg have also achieved health benefits.

• On average, 2,400mg of red yeast rice contains approximately 4.8mg of monacolin K. It is important to note that red yeast rice supplements can vary in their monacolin content. [12]

However, check the packaging as every good supplement company will suggest how much red yeast rice to take.

Why Should I Take Red Yeast Rice at Night or in the Evening?

Although the jury’s out in regard to optimal timing, many people take their red yeast rice in the evening. This is because cholesterol synthesis mainly occurs at night, so having RYR present during this period may lead to increased enzyme regulation and less cholesterol being produced. 

If you only take it once a day, try taking your red yeast rice after your evening meal. 

Where Can I Buy Effective Red Yeast Rice Supplements?

Red yeast rice supplements come in a variety of forms. They may contain monacolin K and other monacolins. They could have additional nutrients that support cardiovascular health. Or they may be based on naturally occurring pigments in red yeast rice and be monacolin-free. 

Supplements with standardised monacolins

In some RYR tablets, the dosage will be standardised to give a precise number of monacolins per serving.

Natures Plus Extended Release Red Yeast Rice provides 10.2mg total monacolins in every 600mg tablet.

• Shop Natures Plus Extended Release Red Yeast Rice here 

Supplements with CoQ10 and other heart-healthy nutrients

Some companies offer RYR combined with other active nutrients like CoQ10 and Bergamot.

• Shop Pharma Nord StatiQinon Cholesterol Balance here
• And TerraNova Red Yeast Rice Complex with Bergamot and CoQ10 here. 

 Supplements with no monacolin K

Monacolin-free red yeast rice is a newer option in supplement ranges.

TerraNova Red Yeast Rice Complex is a patented formula that is 100% free from monacolin K. Its active ingredient is Ankascin 568-R®, a combination of ankaflavin and monascin.

• Shop TerraNova Red Yeast Rice Complex here 

Summary – What Should You Know About Red Yeast Rice?

Time for a recap on red yeast rice, including what it is, benefits of red yeast rice and why to take red yeast rice at night.

• Red yeast rice is a fermented rice product, favoured in China and other Asian countries as a food ingredient and traditional medicine.

• Red yeast rice is a source of monacolin K, a compound which has the same chemical structure as the FDA approved, cholesterol-lowering drug, lovastatin.

• Other active compounds in red yeast rice include the pigments monascin, ankaflavin along with sterols, bioflavonoids, healthy monounsaturated fats and vitamins.

• Science-backed red yeast rice benefits include lowering levels of LDL cholesterol and triglycerides, increasing levels of desirable HDL cholesterol and improved cardiovascular health. Improved blood sugar control and liver protection may be other benefits of red yeast rice.

• The amount of red yeast rice typically used in clinical trials is from 1,200 to 2,400mg each day.

• Red yeast rice supplements are often taken in the evening, as most cholesterol synthesis occurs at night. 

• You should always follow the supplement serving suggestion unless you have consulted with a healthcare professional and been advised on the recommended dose for your individual health needs.

Shop Revital’s full range of Red Yeast Rice here.

References

[1] Zhu, B. (2019) Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine

[2] Upendra, R & Khandewal, K (2021) Recent advancements in fermentation studies for lovastatin biosynthesis

[3] Roth, E. et al (2015) Red yeast rice extract shows equivalency to statins [4] Johnston, C (2012) Vitamin C.

[4] Moriarty, M. et al (2014) Effects of Xuezhikang in patients with dyslipidemia: a multicenter, randomized, placebo-controlled study

[5] Heinz, T. et al (2017) Low daily dose of 3 mg monacolin K from RYR reduces the concentration of LDL-C in a randomized, placebo-controlled intervention

[6] Marazzi, G. et al (2011) Long-term effects of nutraceuticals (berberine, red yeast rice, policosanol) in elderly hypercholesterolemic patients

[7] Kasliwal, R. et al (2016) ESSENS dyslipidemia: a placebo-controlled, randomized study of a nutritional supplement containing red yeast rice in subjects with newly diagnosed dyslipidemia

[8] Minamizuka, T. et al (2021) Low dose red yeast rice with monacolin K lowers LDL cholesterol and blood pressure in Japanese with mild dyslipidemia: a multicenter, randomized trial

[9] Lee, C. et al (2013) Monascin and ankaflavin have more anti-atherosclerosis effect and less side effect involving increasing creatinine phosphokinase activity than monacolin K under the same dosages

[10] Lee, C. et al (2013) Relationship between adiponectin and leptin, and blood lipids in hyperlipidemia patients treated with red yeast rice

[11] Zou, J. et al (2022) Red yeast rice ameliorates non-alcoholic fatty liver disease through inhibiting lipid synthesis and NF-κB/NLRP3 inflammasome-mediated hepatic inflammation in mice

[12] Klimek, M. et al (2009) Safety and Efficacy of Red Yeast Rice (Monascus purpureus) as an Alternative Therapy for Hyperlipidemia 

About Nina Sabat

Nina Sabat is a BANT-registered Nutritional Therapist who applies the principles of Functional Medicine in her practice. Living and working in London she provides supplement and lifestyle advice both instore and online for Revital. Nina received her Nutritional Therapy diploma from The Institute for Optimum Nutrition. She also uses her skills gained from studying Life Coaching and Neuroscience, at University College London, to help her clients create meaningful changes to their health.