yeast rice is made from fermented rice containing the mold, Monascus
purpureus and historically has been marketed in China for its
medicinal properties and as a food preservative to maintain taste and color of
meat and fish. Other marketed names or brands include Cholestin and
Xuezhikang. As it relates to its medicinal properties, the most cited
effect includes its ability to improve the lipid profile and possibly reduce
the risk for cardiovascular events.1-13 This appears to be due to red
yeast rice's ability to reduce the total cholesterol (TC), low density
lipoprotein-cholesterol (LDL-C), triglycerides (TG) and possibly increase the
high density lipoprotein cholesterol (HDL-C).1-10
there any active ingredients in red yeast contributing to this lipid lower
Yes. Depending on the conditions of fermentation, the
batches of red yeast rice produced can contain varying amounts of an active
ingredient called, monacolin K.14-17 This is relevant to understanding
its apparent mechanism of action since monacolin K is also known as mevinolin
and is structurally similar to the HMG CoA reductase inhibitor lovastatin
(Mevacor) .17-19 It has been reported that Cholestin in particular is
known to contain 0.4% HMG-CoA reductase inhibitors by weight, as well as other
isoflavones, monosaturated fatty acids, and sterols.17
the ingredients found in red yeast rice work in the same manner as the statin
medications currently on the market?
Yes, but the lipid lowering properties of red yeast rice
does appear to be multifactorial. One of the first and more obvious
mechanisms to be supported is red yeast rice's ability to inhibit the activity
of the rate limiting step of hepatic cholesterol biosynthesis in a
dose-dependent manner.19 This is due to its ability to inhibit the
activity of the enzyme, HMG CoA reductase. As a quick summary,
cholesterol is made within the liver or hepatocyte. This process is
started when an acetyl CoA and acetoacetyl CoA come together to form
3-hydroxy-3-methylglutaryl CoA (HMG CoA). The newly formed HMG CoA is
then reduced to mevalonate through the enzyme, HMG CoA reductase.20,21
The newly formed mevalonate eventually gets converted into isopentenyl
pyrophosphate, which then continues on through a number of reactions, one of
which leads to the formation of cholesterol. Therefore, an interruption
in the conversion of HMG CoA to mevalonate can disrupt the hepatic synthesis of
reduced intrahepatic cholesterol concentrations result in the upregulation or
availability of LDL-receptors in the liver.20,21 The purpose of the
upregulated or additional LDL-receptors is to pull cholesterol out of
circulation and bring it into the liver to replace what was not made. As
such, the plasma cholesterol levels will decrease through two mechanisms: 1)
through a reduction in the hepatic synthesis of cholesterol and 2) through an
increase in the removal of circulating cholesterol from the plasma for the
liver to use. Additionally, recent animal data in hamsters suggested that
red yeast rice also increases the hepatic excretion of bile acids, thereby
increasing need for the availability of intrahepatic cholesterol to be used for
the synthesis of additional bile.15 Therefore, this reduction in TC,
LDL-C, TG and possibly an increase in HDL-C can reduce the risk associated with
the formation of atherosclerotic lesions.
- Li JJ, Wang Y, Nie SP et al. Xuezhikang, an extract of cholestin,
decreases plasma inflammatory markers and endothelin-1, improve
exercise-induced ischemia and subjective feelings in patients with
cardiac syndrome X. Int J Card 2007;122:82-4.
- Hu Cl, Li YB, Tang YH et al. Effects of withdrawal of
Xuezhikang, an extract of cholestin, on lipid profile and C-reactive
protein: a short-term time course study in patients with coronary artery
disease. Cariovasc Drugs Ther 2006;20:185-191.
- Li JJ, Hu SS, Fang CH et al. Effects of xuezhikang, an extract
of cholestin, on lipid profile and C-reactive protein: a short-term
course study in patients with stable angina. Clinica Chimica Acta
- Cicero AFG, Brancaleoni M, Laghi L et al. Antihyperlipidaemic
effect of a Monascus purpureus brand dietary supplement on a large
sample of subjects at low risk for cardiovascular disease: a pilot
study. Complement Ther Med 2005;13:273-8.
- Zhao SP, Liu L, Cheng YC et al. Effects of xuezhikang, a
cholestin extract, on reflecting postprandial triglyceridemia after a
high-fat meal in patients with coronary heart disease. Atherosclerosis
- Keithley JK, Swanson B, Sha BE et al. A pilot study of the
safety and efficacy of cholestin in treating HIV-related dyslipidemia.
- Gheith O, Sheashaa H, Abdelsalam M et al. Efficacy and safety of
Monascus purpureus Went rice in subjects with secondary
hyperlipidemia. Clin Exp Nephrol 2008;12:189-194.
- Liu L, Zhao SP, Cheng YC et al. Xuezhikang decreases serum
lipoprotein(a) and C-reactive protein concentrations in patients with
coronary heart disease. Clinical Chemistry 2003;49:1347-1352.
- Lin CC, Li TC, Lai MM. Efficacy and safety of Monascus purpureus
Went rice in subjects with hyperlipidemia. Eur J Endocrinol
- Zhao SP, Lu ZL, Du BM et al. Xuezhikang, an extract of
cholestin, reduces cardiovascular events in type 2 diabetes patients
with coronary heart disease: subgroup analysis of patients with type 2
diabetes from China coronary secondary prevention study (CCSPS). J Card
- Li JJ, Lu ZL, Kou WR et al. Beneficial impact of Xuezhikang on
cardiovascular events and mortality in elderly hypertensive patients
with previous myocardial infarction from the China Coronary Secondary
Prevention Study (CCSPS). J Clin Pharmacol 2009;49:947-956.
- Lu Z, Kou W, Du B et al. Effect of Xuezhikang, an extract from
red yeast Chinese rice, on coronary events in a Chinese population with
previous myocardial infarction. Am J Cardiol 2008;101:1689-93.
- Lu ZL, Collaborative Group for China Coronary Secondary
Prevention Using Xuezhikang. China coronary secondary prevention study
(CCSPS). Zhonghua Xin Xue Guan Bing Za Zhi 2005;33:109-15.
- Li YG, Zhang F, Wang ZT et al. Identification and chemical
profiling of monacolins in red yeast rice using high-performance liquid
chromatography with photodiode array detector and mass spectrometry. J
Pharm Biomed Anal 2004;35:1101-1012.
KY, Zhang ZS, Zhao SX et al. Red yeast rice increases excretion of
bile acids in hamsters. Biomed Environ Sci 2009;22:269-77.
J, Li Y, Ye Q et al. Constituents of red yeast rice, a traditional
Chinese food and medicine. J Agric Food Chem 2000;48:5220-5.
- Heber D, Yip I, Ashley JM et al. Cholesterol-lowering effects of
a proprietary Chinese red-yeast rice dietary supplement. Am J Clin
- Havel RJ, Hunninghake DB, Illingworth DR et al. Lovastatin
(mevinolin) in the treatment of heterozygous familial
hypercholesterolemia. A multicenter study. Ann Intern Med
- Man RY, Lynn EG, Cheung F et al. Cholestin inhibits cholesterol
synthesis and secretion in hepatic cells (HepG2). Mol Cell Biochem
- Honda A, Salen G, Nguyen LB et al. Down-regulation of
cholesterol biosynthesis in sitosterolemia: diminished activities of
acetoacetyl-CoA thiolase, 3-hydroxy-3-methylglutaryl-CoA synthase,
reductase, squalene synthase, and 7-dehydrocholesterol delta7-reductase
in liver and mononuclear leukocytes. J Lipid Res 1998;39:44-50.
- Kwiterovich PO Jr. The metabolic pathways of high-density
lipoprotein, low-density lipoprotein, and triglycerides: a current
review. Am J Cardiol 2000 86(12A):5L-10L.
- Food and Drug Administration. FDA warns consumers to avoid red
yeast rice products promoted on internet as treatments for high
cholesterol products found to contain unauthorized drug. FDA News
Release. August 9, 2007.