Can Red Yeast Rice Supplements Naturally Lower My Cholesterol? (8 min.)

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Are you looking for an alternative to prescription statins to help lower cholesterol†? Many people consider red yeast rice supplements†. Individuals with high cholesterol have a build-up of cholesterol, which narrows the arteries (atherosclerosis), making it difficult for enough blood to flow through your veins and increasing the risk of heart disease, heart attack and stroke. Michael Chapman, MD, Cooper Clinic Platinum (concierge) Physician, discusses red yeast rice supplement benefits and why patients sometimes want to explore it as a statin substitute†.

High Cholesterol and Its Correlation with Health Risks

Did you know total cholesterol is made up of two lipoproteins?

1. Low-density lipoprotein (LDL) cholesterol: known as unhealthful or “bad” cholesterol
2. High-density lipoprotein (HDL) cholesterol: known as “good” cholesterol

Leading medical organizations such as the Centers for Disease Control and Prevention (CDC) and the American Heart Association warn against uncontrolled high levels of total and LDL cholesterol. They are serious risk factors for (atherosclerotic) stroke, coronary heart disease, diabetes and high blood pressure. High cholesterol and high triglycerides (a type of fat found in the blood) are also risk factors for developing metabolic syndrome, diagnosed when an individual has three or more of the following conditions listed below. Individuals with this group of conditions are at an increased risk for heart disease, stroke, type 2 diabetes and other health problems.

Risk Factors for Metabolic Syndrome 

1. High blood pressure:  130/85 mmHg or higher
2. Large waistline:  35 inches or more for women or 40 inches or more for men
3. High fasting blood sugar levels:  100 mg/dL or higher
4. Low HDL cholesterol: less than 50 mg/dL for women or less than 40 mg/dL for men
5. High triglyceride level: 150 mg/dL or higher

(Bonus: Learn about controlling cholesterol the natural way, and berberine as a supplement for cholesterol health.†)

Red Yeast Rice and The Science Behind It

Red yeast rice is a commercially available food supplement grown on white rice and fermented with a fungus, Monascus purpureus†. Some red yeast rice products contain monacolins, or natural statins, produced by the yeast. The National Center for Complementary and Integrative Health (NCCIH) cites clinical trials where some red yeast rice products containing substantial amounts of monacolin K can help lower blood cholesterol levels†. Statins lower blood cholesterol levels by reducing the production of cholesterol in the liver.

Used for centuries in China as food and for its medicinal properties, red yeast rice can help lower cholesterol†, enhance blood circulation†, improve digestion† and lower the risk of heart disease†. Data from thousands of years of traditional use combined with clinical trials indicate the many benefits of red yeast rice†. Integrative Medicine reports that “red yeast rice is the most effective over-the-counter therapy for the treatment of elevated LDL cholesterol and reduces LDL levels by 20-30%†.” Such studies have made this supplement a popular, mainstream alternative to prescription statins†.

A Naturopathic Approach to Statins

Statin drugs are typically recommended and administered to patients with cardiovascular disease and high cholesterol, given their effectiveness in reducing these events. However, some patients cannot or choose not to take statin medications because of their side effects. One review of patients who could not tolerate daily statin medication use found a decrease in total cholesterol, as well as LDL cholesterol, when taking red yeast rice†. “Some of my patients have had an increased interest in the role of nutraceuticals, such as red yeast rice, as a substitution for statins,” explains Dr. Chapman. Red yeast rice is known to reduce serum cholesterol† and has been advocated as an alternative therapy for hypercholesterolemic patients who refuse statin medication†, cannot tolerate statin side effects or prefer a “naturopathic” approach†.

In general, consuming 1000-2000 mg of red yeast rice daily can reduce total cholesterol and LDL cholesterol by 30-40 points†. Keep in mind that statin medications continue to be the primary recommendation for patients with elevated cholesterol and/or cardiovascular disease. Only 3-5% of patients have complete statin intolerance, and up to 95% of patients with statin-associated muscle symptoms can still use statin medication using the stepped approach of statin drug modification.

As a reminder, your physician understands your health profile best, so it is important to talk to them before beginning any new supplement.

Potential Risks and Dangers of Red Yeast Rice

While red yeast rice supplements are often marketed as a “natural” alternative to prescription statins, they are not without risks. Some red yeast rice products contain monacolin K, the same active compound found in the prescription statin lovastatin. As a result, these supplements may cause similar side effects and carry comparable risks. Potential side effects include:

• Muscle pain, cramps, or weakness (myopathy)
• Liver enzyme elevation or, rarely, liver damage
• Gastrointestinal issues such as an upset stomach or bloating
• Dizziness and/or headaches

In rare cases, red yeast rice has been associated with rhabdomyolysis, a serious condition that causes muscle breakdown and can lead to kidney damage. A huge concern is product variability. Since red yeast rice supplements are not regulated in the same way as prescription medications, the amount of monacolin K can vary widely between products, even between batches of the same brand. Some products may contain little to no active compound, while others may contain potentially unsafe levels.

Some red yeast rice supplements have been found to contain citrinin. Citrinin is a byproduct of the fermentation process used to make red yeast rice, and it’s toxic. It is a mycotoxin produced by certain strains of fungi, including Monascus purpureus, the same yeast used in creating red yeast rice supplements. In animal studies, citrinin has caused kidney damage, and it’s considered potentially harmful to humans, especially with long-term use. The challenge with citrinin is that its presence in red yeast rice can vary widely depending on how the product is manufactured and the specific strain of yeast used.

Because red yeast rice is a dietary supplement and not a regulated pharmaceutical, there is no standardized requirement in the U.S. to test for or limit citrinin content, making it extremely challenging for consumers to determine whether their bottle of red yeast rice contains this toxin. While some high-quality brands voluntarily test for citrinin, many do not. Your health is your responsibility. Red yeast rice is not recommended for:

• Pregnant or breastfeeding women
• Individuals with liver disease
• Individuals already taking statin medications, unless advised by their physician
• Those taking medications with known interactions with statins, including some antibiotics, antifungals, and antidepressants

Because of these risks, it’s essential to talk to your physician before beginning a red yeast rice supplement—especially if you have underlying health conditions, take prescription medications, or have a history of statin intolerance.

Side Effects of Taking Red Yeast Rice

The side effects of red yeast rice supplements may not be as adverse as those of prescription statin drugs. Statin side effects may include mild headaches, heartburn and upset stomach. Adverse side effects may include muscle pain, stomach upset, liver damage, liver inflammation, or increased blood sugar for those with type 2 diabetes. As with any statin, red yeast rice may cause muscle pain and weakness; however, research indicates that less than 10% of people experience these side effects when taking red yeast rice.

If you elect to take red yeast rice supplements, limit alcohol due to the increased risk of liver damage. Additionally, grapefruit and grapefruit juice may increase the side effects when taken with red yeast rice.

Decreasing Heart Attack and Stroke Risk with Diet and Exercise

In addition to taking a statin medication or red yeast rice, eating a heart-healthy diet, losing excess weight, exercising regularly and eliminating alcohol and smoking can help lower your cholesterol numbers and reduce the risks of heart attack and stroke†. Cooper Clinic Registered Dietitian Nutritionists say the top dietary recommendation for lowering cholesterol is to eliminate or drastically limit the foods you eat that contain saturated fats, trans fats, and dietary cholesterol. A heart-healthy diet that prioritizes fiber, whole grains, fruit, vegetables, legumes and beans and limits your intake of saturated fats from red meats, full-fat dairy, coconut, and palm oils is ideal.

Exercise and weight loss are key cholesterol game-changers. A Sports Medicine study showed that daily aerobic and resistance exercise that elevates the heart rate to 85% of its maximum could increase HDL cholesterol and decrease LDL cholesterol. A long-term weight loss study in obese men showed positive weight loss effects, such as reducing the creation of new cholesterol and increasing the absorption of cholesterol from the diet, which successfully lowered total cholesterol in the study participants. Lowering total cholesterol reduces the risk of stroke, coronary heart disease and more†.

It is best to take red yeast rice with food. Taking red yeast rice at bedtime may be more beneficial if you only take it once daily. The liver generally makes most cholesterol at night when dietary intake is the lowest. This allows more of the red yeast rice to reach the liver. Don’t take red yeast rice if you are pregnant, trying to become pregnant or breastfeeding. You should avoid taking red yeast rice with antifungal medications such as Diflucan, antibiotics and anti-depressants such as St. John’s Wort. Taken over a long period of time by healthy adults, red yeast rice supplements may help lower blood cholesterol†. Consult with your healthcare provider if you plan to take red yeast rice supplements.

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Cooper Complete June 13, 2025