Red yeast rice

Lore & Background

Red yeast rice is produced by cultivating the mold *Monascus purpureus* on rice for 3–6 days at room temperature, turning the grains bright red at the core and reddish purple on the outside. The fully cultured rice is sold as dried grain, wet paste, or fine powder. China is the world's largest producer, though European companies have entered the market. The term 'koji' in Japanese refers to 'grain or bean overgrown with a mold culture,' a tradition dating back to around 300 BCE.

Culinarily, red yeast rice is used to color fermented tofu, red rice vinegar, char siu, Peking duck, and Chinese pastries. It is also used in Chinese *huangjiu* (Shaoxing jiu) and Japanese sake (*akaisake*). The lees from wine production, called *hóngzāo*, are used in Fujian cuisine for dishes like red wine chicken. In the Philippines, it is used to color and preserve fermented shrimp (*bagoóng alamáng*), *burong isdâ*, and *balao-balao*.

In traditional Chinese medicine, red yeast rice is described in the pharmacopoeia *Ben Cao Gang Mu* by Li Shizhen, with recommendations to invigorate the body, aid digestion, and revitalize the blood. Medicinal use may date to the Tang dynasty around 800 CE.

Reader's Guide

Red yeast rice's significance stems from its dual identity as a traditional food ingredient and a source of monacolin K, which is chemically identical to the prescription drug lovastatin (marketed as Mevacor). In the late 1970s, researchers in the United States and Japan isolated lovastatin from *Aspergillus* and monacolins from *Monascus*, the same fungus used to make red yeast rice. Chemical analysis showed lovastatin and monacolin K are identical. This led to red yeast rice becoming a non-prescription dietary supplement in the United States and other countries.

The U.S. Food and Drug Administration (FDA) has taken action against red yeast rice products containing monacolin K, arguing they are identical to a prescription drug and subject to regulation as a drug. In 1998, the FDA initiated action to ban a product (Cholestin), which was initially allowed by a U.S. District Court but reversed on appeal in 2001. In 2007, the FDA sent warning letters to two companies, and both products were withdrawn. The FDA warned consumers not to buy or eat red yeast rice products that may contain an unauthorized drug, citing potential harm because consumers might not understand the dangers are the same as prescription statins.

Clinical evidence shows that red yeast rice can lower LDL-cholesterol. A meta-analysis reported a reduction of 1.02 mmol/L (39.4 mg/dL) compared to placebo, with adverse effects ranging from 0% to 5%. The largest trial, conducted in China with nearly 5,000 post-heart attack patients over 4.5 years, found that the treated group had a 45% reduction in subsequent heart attacks, 31% reduction in cardiovascular deaths, and 33% reduction in all-cause deaths. However, the safety of red yeast rice products has not been established, and some supplements have been found to contain high levels of citrinin, which can be toxic.

Did You Know?

• Monacolin K, found in red yeast rice, is chemically identical to the prescription drug lovastatin (Mevacor).
• The largest clinical trial of red yeast rice involved nearly 5,000 post-heart attack patients in China over an average of 4.5 years.