The Bottom Line on Red Yeast Rice

If you remember the last Memo, I said that the active ingredient in red yeast rice (RYR) was monacolin K, which is chemically identical to a current statin medication: lovastatin. The problem with RYR in supplements is that the amounts of monacolin K varied depending on the exact type of Monascus mold used—it could be high enough to mimic the actual medication, or it could have none. You wouldn’t know because it wasn’t standardized.

As a result, the FDA declared that RYR could not be sold in the U.S. because of the lack of information on the amount of monacolin K in the supplements and because lovastatin had already been approved as a drug. Mostly the latter.

The next logical step would be to see if the FDA set a limit on the amount of monacolin K allowable in RYR products in the U.S. They have not; they consider it a drug that shouldn’t be sold in the U.S. at all. You can still find RYR as a dietary supplement, but it should not contain enough monacolin K to really do anything to lower cholesterol. On the other hand, the European equivalent of the FDA has set a limit of no more than 3 mg of monacolin K in a daily serving. You can buy it from a European company, but technically, it’s illegal in the U.S.

In this case, it makes no sense to obtain a product in the U.S. that may or may not have monacolin K in it and which could actually contain lovastatin in it as product analytics have shown. By the way, the side effects from both forms, monacolin K and lovastatin, are identical with muscle pain and the like. Doesn’t happen to most people, but it can happen. Obviously, if you’re taking a statin, don’t add RYR without your doctor’s approval.

The Bottom Line

That’s the deal with RYR in 2025. If you don’t want to take a medication, change your lifestyle to naturally lower your cholesterol. Check with your doctor to find out the limitations that he’s putting on you as it relates to exercise intensity and then get after it. Not to lose a whole bunch of weight. Not to win the next 5K. Not every day.  But to make your heart stronger and fitter. You want natural? That’s the most natural solution to high cholesterol for most people.

What are you prepared to do today?

        Dr. Chet

References:
1. Methodist Debakey Cardiovasc J. 2019 Jul-Sep;15(3):192-199.
2. NIH NCCIH 2024. Red Yeast Rice.