Dr Mike MacDonald

What is the most effective supplement to lower cholesterol? Red Yeast Rice.

Red Yeast Rice lowers cholesterol

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High low density lipoprotein (LDL) cholesterol is one of the main risk factors for heart disease, heart attacks and strokes. I deal with this condition daily and one of the commonest questions I get is how can I lower my cholesterol naturally?”.  

My usual answer to this is – it is difficult! In this article we will discuss the evidence behind the most effective natural supplement to lower cholesterol, red yeast rice. We will discuss when you should use it and what you need to look out for when you buy it.

What causes high low density lipoprotein (LDL) cholesterol?

LDL is a particle that carries cholesterol around the body. One common misconception is that cholesterol comes from the diet. It doesn’t! Cholesterol is an essential substance for making cell membranes and hormones and every cell in the body had the ability to make it. Cholesterol is a fat so it is not soluble in water. It gets carried around the body by lipoprotein particles. The most abundant of these is LDL. 

When people try to lower their LDL with exercise and nutrition it can be done, but only marginally. Usually in the region of 15-25% at most. The main issue is that lifestyle changes that lower cholesterol are usually not sustainable in the long term.

Why is high LDL cholesterol a problem?

Alongside blood pressure, LDL is one of the main risk factors for vascular disease (atherosclerosis)– AKA heart attacks and strokes. LDL particles end up in the wall of the artery, they get oxidized, cause an inflammatory reaction and end up causing fatty plaques. These plaques cause blockages, but can also get inflamed and rupture leading to heart attacks and strokes.

This vascular disease is a function of time of exposure of the arteries to LDL particles and the particle concentration. Therefore if you lower the concentration of LDL particles in the arteries for a long enough time period you can reduce the risk of atherosclerosis.

How do doctors lower cholesterol?

If you have a high LDL cholesterol your doctor may use medications to lower your cholesterol. The most common, and widely studied medications are statins. These drugs form the backbone of cholesterol management. Statins are HMG CoA Reductase inhibitors that prevent the production of cholesterol (largely in the liver). They lower LDL by around 40-50%. Most common and powerful statins are rosuvastatin and atorvastatin.

Are statins safe?

YES. However, they get unnecessary bad press because in a small proportion of people they may be associated with muscle aches. Interestingly, in the statin trials placebo also caused muscle aches…. But that is for another article.

For this reason and others, some people are not keen on taking medication long-term so they understandably look for natural ways to lower LDL.

What is red yeast rice?

Red Yeast Rice is the most powerful neutraceutical for lowering cholesterol. It is fermented rice (Oryza Sativa) during the process of fermentation it turns the rice red. It contains a compound called Monacolin K. Monacolin K acts on the same enzyme as statins – HMG CoA Reductsae. Hence, it is a weak , natural statin. Red yeast rice supplements usually contain around 1.9% Monacolin K but the concentration can vary.

Does red yeast rice work?

There have been many clinical trials examining its effect on cholesterol. On average it will lower LDL/Non_HDL cholesterol by around 15-25%. In addition it has modest effects on triglycerides, ApoB and HDL.

There have been some studies in Chinese populations that have previous had heart attacks that have also shown that it can modestly prevent future heart attacks. Its power may be similar to weaker statins like pravastatin and simvastatin.

Is red yeast rice safe?

It is not a regulated drug so its manufacturing process is not under the same scrutiny as pharmaceutical drugs. Therefore the supplement you buy may have a variable concentration of moncolin K, and may have more or less than the manufacturer states on the label.

More concerningly, rice fermentation can also produce a dangerous muscle toxin called citrinin. It is potentially carcinogenic and is toxic to the kidneys. Citrinin is regularly detected in supplements people can buy! In addition, monacolin K has the potential to interact with other drugs and fruits including grapefruit.

How to choose a red yeast rice brand

Buy from a reputable manufacturer. Make sure it is certified citrinin free.  Aim for moncaolin K 3-10mg per tablet. Usual dose is 600mg – 1200mg of red yeast rice per day.

Should I take it?

If your doctor has prescribed a statin, then my advice would be to go with your doctors prescription. If you are intolerant of statins then you could try red yeast rice. It does tend to be better tolerated in people that are intolerant of statins, however it is not as potent and there is not as much evidence of their effectiveness.  If you are on other medication then please chat to your doctor first to ensure there are no interactions.


Red yeast rice is moderately effective at lowering LDL. It also has some data on reducing the risk of heart attacks. If you are going to take it, make sure it is citrinin free and made by a reputable manufacturer.

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