Get Your Personalized Supplement StackSupplement Stack Quiz

rice extract

Also known as: Red yeast rice extract, Red yeast rice (RYR) extract, Rice extract, Monascus purpureus

Overview

Red yeast rice extract (RYR) is a traditional fermented rice product derived from rice fermented with the yeast *Monascus purpureus*. It is primarily known for its lipid-lowering properties, attributed to naturally occurring compounds called monacolins, particularly monacolin K, which is chemically identical to the prescription statin drug lovastatin. RYR is widely used as a nutraceutical supplement to manage hypercholesterolemia and improve cardiovascular risk profiles. Extensive research, including multiple randomized controlled trials and meta-analyses, supports its efficacy and safety in reducing cholesterol levels. Its application is primarily focused on individuals with elevated cholesterol, offering a natural alternative or adjunct for lipid management.

Benefits

Red yeast rice extract offers significant benefits primarily in lipid management. It consistently demonstrates a statistically significant reduction in total cholesterol (mean reduction approximately 31-37 mg/dL) and LDL cholesterol (mean reduction approximately 27-36 mg/dL) in individuals with hypercholesterolemia. Some meta-analyses also report significant reductions in triglycerides (around 26 mg/dL) and modest increases in HDL cholesterol (around 7.6 mg/dL). The LDL-C reduction achieved is clinically meaningful and comparable to that of low-dose statin therapy. Beyond lipid profiles, there is potential for improved cardiovascular outcomes, particularly in post-myocardial infarction patients with borderline hypercholesterolemia, although some specific endpoints like fatal myocardial infarction have shown non-significant trends. Benefits are most pronounced in patients with hyperlipidemia, including those who have experienced a myocardial infarction or have borderline cholesterol levels. The effects typically manifest within 4 to 24 weeks of consistent use, with some cardiovascular outcome studies extending up to 4.5 years.

How it works

The primary mechanism of action for red yeast rice extract is attributed to monacolin K, its active compound. Monacolin K functions as an inhibitor of HMG-CoA reductase, which is the rate-limiting enzyme in the body's cholesterol biosynthesis pathway. By inhibiting this enzyme, RYR effectively reduces the liver's production of endogenous cholesterol. This reduction in cholesterol synthesis directly leads to decreased levels of LDL cholesterol in the bloodstream. While other bioactive compounds within RYR may contribute synergistically to its effects, their specific mechanisms are less thoroughly understood. The oral bioavailability of monacolin K is similar to that of lovastatin, with absorption potentially influenced by the specific formulation and whether it is taken with food.

Side effects

Red yeast rice extract is generally considered safe, with no significant increase in serious adverse events compared to placebo in clinical trials. Mild gastrointestinal discomfort is a rare but possible common side effect, occurring in less than 5% of users. Uncommon side effects, affecting 1-5% of users, may include muscle pain (myalgia) or elevated liver enzymes, which are similar to those associated with statin use but typically occur with lower frequency and severity. Rhabdomyolysis, a severe muscle breakdown, is a very rare side effect, occurring in less than 1% of users. Due to the presence of monacolin K, which is chemically identical to lovastatin, RYR can interact with other lipid-lowering agents, potentially increasing the risk of side effects. It can also interact with drugs metabolized by the CYP3A4 enzyme system. Contraindications for RYR use include pregnancy, breastfeeding, and individuals with pre-existing liver disease. Special populations, such as the elderly or those with multiple comorbidities, should use RYR with caution and under medical supervision, as they may be more susceptible to potential adverse effects.

Dosage

Effective daily dosages of red yeast rice extract typically range from 200 mg to 4800 mg, depending on the standardization of monacolin content. For significant lipid-lowering effects, optimal doses generally fall between 1200 mg and 2400 mg per day. It is crucial to use standardized extracts with a known monacolin K concentration to ensure consistent dosing and efficacy. The maximum safe dose has not been firmly established, but higher doses are associated with an increased risk of side effects. Taking RYR with meals may enhance absorption and help mitigate potential gastrointestinal discomfort. The timing of dosage (e.g., once daily, split doses) can vary, but consistency is key. Dosage adjustments may be necessary based on individual response, lipid levels, and the presence of any side effects. It is advisable to consult a healthcare professional to determine the appropriate dosage for specific health needs.

FAQs

Is RYR extract as effective as statins?

Red yeast rice extract can achieve similar LDL-lowering effects to low-dose statins, but generally with fewer reported side effects. Its efficacy depends on the monacolin K content.

Can it be used long-term?

Evidence supports short to medium-term use (up to 4.5 years in some studies). Longer-term safety and efficacy require further research, and ongoing medical supervision is recommended.

Is it safe to combine with statins?

Combining RYR with statins is generally not recommended due to the risk of additive effects and an increased likelihood of muscle toxicity and other side effects. Consult a doctor before combining.

How soon do effects appear?

Improvements in lipid profiles, particularly cholesterol levels, are typically observed within 4 to 12 weeks of consistent red yeast rice extract supplementation.

Research Sources

https://pubmed.ncbi.nlm.nih.gov/38794691/ – This systematic review and meta-analysis of 14 RCTs found that red yeast rice significantly reduced total cholesterol (-37.43 mg/dL) and LDL-C (-35.82 mg/dL) in hypercholesterolemic adults, with no serious side effects. The study concluded that RYR is a safe and effective option for lipid management, though it noted moderate heterogeneity and limited long-term data.
https://pubmed.ncbi.nlm.nih.gov/35111069/ – This meta-analysis of 15 RCTs involving over 1000 hyperlipidemic patients demonstrated that RYR (200-4800 mg) significantly reduced TC, LDL-C, and TG, while increasing HDL-C. The study reported no increased adverse events, supporting RYR's efficacy and safety for lipid lowering in the short to medium term, while highlighting the need for longer trials.
https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.819482/full – This article, which appears to be the full text of the Li et al. (2022) meta-analysis, provides detailed methodology and results for the finding that RYR significantly improves lipid profiles. It emphasizes the high quality of the included studies, low bias risk, and the registered protocol, reinforcing the robustness of its conclusions regarding RYR's lipid-lowering effects.
https://www.nature.com/articles/s41598-020-59796-5 – This meta-analysis of 7 studies involving 10,699 myocardial infarction patients with borderline hypercholesterolemia found that RYR improved lipid profiles and cardiovascular outcomes. While some endpoints, like fatal MI, showed non-significant trends, the study's large sample size and low bias contribute to its high quality, suggesting a potential role for RYR in secondary prevention.