recommends 600-1200mg/day (LDL-C decreases by 22-28%), mild lipid-lowering 1200-2400mg (decrease by 24-32%), moderate lipid-lowering 2400-3600mg (decrease by 31-36%). 600-1200mg for the elderly, 300-600mg for those with sensitive liver function. Doses above 1800mg increase side effects, and liver enzymes need to be monitored.
General health: 600-1200 mg
The recommended intake of red yeast rice is 600 to 1200 mg per day. In a 2018 randomized controlled trial, participants who took 900 mg of red yeast rice had an average 28% reduction in LDL-C over 12 weeks, a 22% higher reduction than the control group. Total cholesterol levels dropped from an average of 230 mg/dL to 180 mg/dL.
The monthly cost of red yeast rice in the US market is about $25 to $50, while the price of common prescription drugs such as atorvastatin can be as high as $150 to $200 per month without insurance. Intake of more than 1,200 mg may increase the risk of muscle soreness and abnormal liver function. According to statistics, the incidence of adverse reactions rises to 7.5% when the dose exceeds 1,800 mg per day, while this rate is only 1.2% within the recommended dose range. For example, in a study of patients with high cholesterol, 12% of participants in the group taking 2,400 mg of red yeast rice reported muscle pain, while only 2.5% of the group taking 1,200 mg reported a report rate.
Market research shows that the content of monacolin K in different brands of red yeast rice products ranges from 0.5 to 10 mg per grain. A well-known brand indicates that it contains 4 mg per grain, but independent testing found that the actual content is 3.7 mg, with an error rate of 7.5%.
A large study of 1,500 patients found that people under 45 had an average cholesterol reduction of 22% after taking red yeast rice, while people over 65 only had a 15% reduction. In 2019, Consumer Lab tested 30 commercial red yeast rice products, 11 of which contained monacolin. 35% of the products actually contained less monacolin K than indicated on the label.
An animal study showed that red yeast rice extract can reduce liver inflammation caused by a high-fat diet, and the level of liver inflammatory marker TNF-α decreased by 35%. In a 12-week intervention experiment, participants were divided into three groups: taking red yeast rice alone, improving diet alone, and red yeast rice plus dietary intervention. The results showed that the third group had the highest LDL-C reduction, reaching 35%, while the red yeast rice group alone was 22%.
For first-time consumers, it is recommended to start with 600 mg and check blood lipid levels every 4 weeks. If the effect is not significant, the dose can be gradually increased to 900 mg or 1200 mg.
Mild lipid-lowering: 1200-2400 mg
According to studies, individuals taking 1200 to 2400 mg of red yeast rice every day can successfully lower LDL-C and total cholesterol. A double-blind, placebo-controlled trial conducted on 1,200 patients with high cholesterol demonstrated that the group receiving 1,800 mg of red yeast rice reduced LDL-C levels by 24% within 12 weeks, while total cholesterol levels decreased by 18%.
Long-term follow-up by the National Institutes of Health showed that less than 2% of patients who took 1,200 mg of red yeast rice continuously reported mild gastrointestinal discomfort, while the proportion rose to 4% in the group taking 2,400 mg. Compared with conventional statins, the incidence of muscle-related side effects is still less than 5%.
In fact, studies have demonstrated that in overweight subjects with a BMI index above 30, a dose of 2,400 mg daily is more effective than 1,200 mg in lowering LDL-C by 29% and 19%, respectively. In the general population with a BMI below 25, the effects of 1200 mg and 2400 mg were both around 21%.
Market research shows that most of the high-quality products contain 4 to 6 mg of monacolin K per capsule. In one comparative study, when the total intake of monacolin K was 10 mg per day, the average cholesterol level reduction was 17%, while it was 26% when the intake was 20 mg in total.
According to market data, every 60 red yeast rice capsules, in a bottle, costs anywhere between $15 and $30. For intake of 1800 mg daily, about 3 capsules are needed; monthly, it would be about $25 to $50. Prescription drug pravastatin costs around $100 to $150 per month.
In an open-label study involving 500 patients, based on adherence to the Mediterranean diet, the group on 2400 mg of red yeast rice experienced an average reduction in LDL-C of 32%, while with red yeast rice alone, a 26% reduction was recorded.
Clinical observations showed that the patients receiving 1800 mg of red yeast rice at night have a lower LDL-C of about 7% higher than that in the morning. In the study performed among diabetic patients, when taking 2400 mg of red yeast rice every day, the LDL-C level dropped by 23%, which was higher than the 19% of the non-diabetic patients.
The follow-up study in 2 years reported that >95% of the patients treated with 1200 to 2400 mg of red yeast rice did not exhibit any significant adverse reactions. Incidence of elevated creatine kinase levels was also very low at 1.5% as compared to 4% by conventional statins.
Moderate lipid-lowering: 2400-3600 mg
Studies have demonstrated that 2400 to 3600 mg of red yeast rice taken daily was effective for moderate lipid-lowering in patients. In one 12-week study, where the participants took an average dosage of 3000 mg of red yeast rice, low-density lipoprotein cholesterol levels fell by an average of 31%, while total cholesterol levels fell by 25%.
In a clinical trial of 600 patients, 3.6% of the patients who were administered 3,000 mg of red yeast rice developed adverse reactions, compared with 2.1% of the patients in the low-dose group. Muscle discomfort could be as high as 8% when one is on high-dose statins.
Market research shows that products containing 6 mg of monacolin K per capsule can reduce total cholesterol by an average of 27% when 10 capsules are taken daily. Some brand products contained even less than 3 mg of monacolin K.
For example, red yeast rice capsules, in 120 count per bottle: contains 600 mg per capsule. The cost ranges from $20 to $40. Taken at 3,000 mg daily, this product would run between $90 to $120 monthly.
A study involving 500 patients showed that the patients who were on 3,600 mg of red yeast rice with a healthy diet and moderate exercise demonstrated a 36% reduction in low-density lipoprotein cholesterol. Those who did not make any lifestyle changes had only a 28% reduction at the same dosage.
Data show that red yeast rice is more effective if taken twice a day, 1500 mg in the morning and evening, than taken once. In the case of divided doses, the cholesterol reduction was about 9% higher compared to patients taking it once.
In diabetic patients suffering with high cholesterol, 3000 mg of red yeast rice taken for 12 weeks low-density lipoprotein cholesterol was reduced by 30% on average, about 5% more than that of nondiabetic patients. CRP level also decreased significantly by 20%.
A 1-year follow-up study in 95% of patients taking 3000 mg of red yeast rice showed no serious adverse reactions. Only 1.8% of patients had abnormal liver function tests, whereas this figure was 3.5% for the group on high-dose statins. Some experiments have shown that patients taking 2400 to 3600 mg per day of red yeast rice have an average increase in HDL-C of 7%.
Elderly: 600-1200 mg
The dosage of red yeast rice for the elderly is usually 600 to 1200 mg per day. In a trial covering 800 patients with high cholesterol aged 60 to 75 years, taking 900 mg of red yeast rice for 12 weeks reduced LDL cholesterol levels by an average of 19% and total cholesterol by 15%.
According to the data analysis by the European Society of Cardiology, increasing the dose from 600 mg to 1200 mg resulted in an additional 7% reduction in LDL cholesterol for the elderly population. The effect was not significantly improved with a further increase to 1800 mg; side effects increased from 1.2% to 3.5%.
For instance, in a single study on patients over 65
years, the incidence of adverse reactions was 2% with 1200 mg of red yeast rice. The proportion in the control group of patients on statin was as high as 6%.
The cost of a 600 mg of red yeast rice capsule bottle costs about $20 to $30 for 120 capsules, and at two capsules a day, it costs about $0.5, which is about $15 a month. Prescription lipid-lowering drugs, though, can be as expensive as $50-$150 per month.
More than 80% of the elderly use two or more prescription drugs. It is advisable that elderly patients consult a doctor before using red yeast rice and regularly monitor relevant health indicators during use.
In a total of 500 elderly participants in the research, the outcome was that 1.5% had abnormal liver enzyme levels while taking the drug 600 to 1200 mg of red yeast rice as compared to 3.8% of statins. Experimental data indicated that of the patients who took dinner-time dosing of 900 mg of red yeast rice, low-density lipoprotein cholesterol dropped by an average of 21% as compared to 16% for the group taking it in the morning.
A study among those above 65 years also found a reduction in LDL cholesterol by 12% more than when only the red yeast rice is taken, within subjects receiving a dose of red yeast rice extract ranging between 600 to 1200 mg with a concurrent low-fat diet and daily 30 minutes walking.
In one 18-month follow-up study, more than 90% of elderly patients treated with 900 mg of red yeast rice maintained normal liver function and muscle enzyme parameters. In the high-dose statin group, 5% of patients developed mild elevations in liver enzymes. A small study showed an 18% reduction in C-reactive protein in elderly patients taking 1200 mg red yeast rice within 12 weeks.
Weight loss aid: 600-1800 mg
Taking 600 to 1800 mg of red yeast rice daily can help control weight. A study on overweight people showed that after taking 1200 mg of red yeast rice for 8 weeks, the average weight of the participants dropped by 2.3 kg, while the low-density lipoprotein cholesterol level dropped by 19% and the triglyceride level dropped by 15%.
In an animal experiment, the body fat percentage of the experimental mice in the high-fat diet group dropped from 38% to 27% after taking 1800 mg of red yeast rice extract, and the fat weight was reduced by about 30%. In a trial involving 300 participants, the group taking 600 mg per day lost an average of 1.2 kg, while the group taking 1200 mg lost 1.8 kg and the 1800 mg group lost 2.4 kg. The report rate of mild muscle soreness in the 1800 mg group was 2.8%, higher than the 1.2% in the 600 mg group.
A study showed that participants who took 1200 to 1800 mg of red yeast rice had an average reduction of 18% in visceral fat area and a waist circumference of 3 cm in 12 weeks. Studies have shown that participants who combined a low-calorie diet with moderate exercise lost about 30% more weight than those who took red yeast rice alone. For example, in one experiment, the group that exercised and red yeast rice lost an average of 2.9 kg, while the group that took red yeast rice alone lost 2.2 kg.
According to a trial involving 500 overweight or obese patients, the incidence of adverse reactions to 600 to 1800 mg of red yeast rice was 1.6%. Under controlled doses, the incidence of abnormal liver enzyme levels was less than 1%.
For example, the market price of red yeast rice products with 60 capsules per bottle and 600 mg per capsule is usually between $20 and $40. When taking 3 capsules (1800 mg) per day, the monthly cost is about $30 to $50.
After taking 1200 mg of red yeast rice, diabetic patients’ insulin resistance index (HOMA-IR) decreased by an average of 12% within 12 weeks, and fasting blood sugar levels decreased by 10%. Studies have shown that taking it in divided doses (900 mg in the morning and evening) can improve the metabolic efficiency of the active ingredients. Compared with taking 1800 mg at a time, the group taking divided doses lost about 15% more weight.
Liver function sensitive: 300-600 mg
For people with sensitive liver function, the recommended dose of red yeast rice is 300 to 600 mg per day. A study of 100 patients with mild liver dysfunction showed that after taking 300 mg of red yeast rice for 8 weeks, LDL cholesterol levels decreased by an average of 12%, and liver enzyme levels (ALT and AST) remained within the normal range.
In a trial, 50 patients took 600 mg of red yeast rice per day for 12 weeks, and LDL cholesterol decreased by an average of 18%. The proportion of mildly elevated liver enzyme levels was 2%.
Studies have shown that the risk of abnormal liver enzyme levels increases by 1.8 times when monacolin K is consumed more than 10 mg per day. In a 300- to 600-mg dose of red yeast rice, intake of monacolin K is usually controlled within the range of 3 to 6 mg.
In an analysis of 30 commercially available red yeast rice products, 22% detected monacolin. Studies have shown that taking red yeast rice after dinner is about 20% less likely to increase liver enzyme levels than taking it on an empty stomach. A small trial of patients with abnormal liver function showed that taking it in divided doses (150 mg in the morning and evening) further reduced liver enzyme fluctuations.
A long-term study found that the incidence of liver enzymes rising to the upper limit of the normal range was only 1.5% in patients who took 300 mg of red yeast rice for 12 months, while the incidence was 3.2% in the 600-mg group. One trial showed that after taking 300 mg of red yeast rice for 8 weeks, patients’ C-reactive protein levels decreased by an average of 10%. Blood antioxidant levels increased by 15%.
Each bottle of 300 mg red yeast rice (60 capsules) usually costs between $15 and $25. Taking 300 mg (1 pill) daily costs about $15 per month.
In one trial, patients with abnormal liver function who took red yeast rice (300 to 600 mg) in combination with a healthy diet saw their LDL cholesterol drop from 14% to 20%. In a two-year study, 95% of patients in the 300 mg group and 92%
