Red yeast rice is a nutraceutical that results from the fermentation of common rice ( Oriza sativa ) by the yeast Monascus purpureus . A nutraceutical is a food or part of a food, of animal or plant origin, that has potential pharmacological activity. Among the compounds resulting from the fermentation of rice are: Pigments, which are responsible for the intense red color of rice; Monocholines, namely monocholine K, which chemical structure is similar to that of lovastatin. Lovastatin is one of the least potent statins and is approved by drug regulation authorities for the treatment of high cholesterol. Like statins, monocholin K inhibits the cholesterol synthesis in the liver but its action is less potent: With monocholine K, a reduction of about 15% of the values of low-density lipoprotein (LDL) cholesterol, also known as atherogenic cholesterol, is achieved. What are 'red rice pills'? 'Red rice pills' have monocholin K in their composition. They are marketed with various brands as food supplements . They are not medicines. Why do people take 'red rice pills'? The 'red rice pills' a r educe the levels of cholesterol in the blood , but with a lower efficacy than traditional medicines . It is known that about 50% of the adult population has higher than desirable LDL-cholesterol levels. It is also known that lifestyle changes, unless very restrictive, only reduce cholesterol levels by about 10%. Thus, many people clinically ineligible for statin medication resort to supplementing with red yeast rice, such as 'red rice pills', in order to control blood cholesterol levels. What problems are associated with high cholesterol in blood? Higher than normal blood cholesterol levels (hypercholesterolemia) is a cardiovascular risk factor . It promotes cardiovascular diseases occurrence, such as acute myocardial infarction, heart failure or stroke. LDL-cholesterol is directly related to the risk of cardiovascular events: The probability of cardiovascular events increases with LDL-cholesterol levels and also with the length of time the values are above the reference values. Are there scientific studies that support taking 'red rice pills'? In several observational studies, it was found that taking products prepared from the fermentation of rice was associated with a reduction in LDL-cholesterol levels and also in C-reactive protein (which is a blood marker of inflammation). Additionally, in some clinical trials an association has been demonstrated between the use of those products and the prevention of myocardial infarction and death from cardiovascular causes. However, these tests were carried out in China, a country where the diet and lifestyles of the population are very different from those of the western population . Therefore, most doctors consider that the results of these trials cannot be extrapolated to the Western world. Even so, European scientific communities, such as the European Society of Cardiology and the European Atherosclerosis Society, refer in their recommendations that there are selected groups of people eligible for supplementation with 'red rice pills'. What are the challenges of taking ‘red rice pills’? Taking 'red rice pills' for the purpose of lowering blood cholesterol levels poses 3 main challenges: Prolonged intake; Product choice; Cost. Need for daily intake over the years It is necessary to adhere to supplementation with 'red rice pills' consistently and over several years . It has no use doing it just for a few weeks or months! Choosing the right product Companies that market rice fermentation supplements do not always adopt a policy of transparency regarding the dose of monocholine K present in the tablets, which must be between 3 to 10 mg . Above this dose, toxicity may occur; Below this dose, the pills will not be effective! On the other hand, among the compounds present in the fermentation of rice, there are some with toxic action. The mycotoxin named citrinin is an important one since it can damage the kidneys and promote cancer. Thus, the product label must specify that the product is citrinin-free , which is not always the case. The cost The cost of red yeast rice supplements is not negligible! All in all, 'red rice pills' are several times more expensive than the statins usually prescribed by the doctor and partly supported by the health system. After all, should I take red rice supplements or not? If you have high cholesterol levels, supplementation with monocholine K, which is found in supplements prepared from fermented rice, can be an alternative to optimize blood cholesterol levels. However, for most people with high cholesterol, statins and other medications that have been shown to be effective in lowering cholesterol should be the first choice. What is important is that if you are considering or intending to start supplementation with 'red rice pills' you should first discuss the issue with your attending physician to make sure this is the best option for you! Author : Lígia Mendes Sources Cicero AF, Fogacci F, Zambon A. Red yeast rice for hypercholesterolemia: JACC focus seminar. J Am Coll Cardiol 2021;77:620-8. Nguyen T, Karl M, Santini A. Red yeast rice. Foods 2017;6:19. Meet the cardiology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
