- 6 Benefits of Policosanol + Dosage, Side Effects & Reviews
- What is Policosanol?
- Mechanisms of Action
- 1) High Blood Pressure
- 2) Blood Clotting
- 3) Intermittent Claudication
- Insufficient Evidence:
- 4) Cholesterol Levels
- Studies Performed in Cuba
- Other Studies
- HDL Cholesterol
- 5) Triglyceride Levels
- 6) Fat Loss
- Animal and Cellular Research (Lacking Evidence)
- Blood Vessel Health
- Wound Healing
- Blood Sugar Levels
- Policosanol in Combination with Other Supplements
- Limitations and Caveats
- Policosanol Side Effects & Precautions
- The Health Benefits of Policosanol
- Policosanol benefits and side effects
- Side effects
- Recommended dosage
- Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine
- Materials and Methods
- Traditional Uses
6 Benefits of Policosanol + Dosage, Side Effects & Reviews
Policosanol is a natural supplement made from sugar cane often used to lower cholesterol levels. It may also lower blood pressure and prevent blood clotting. However, there are conflicting studies that have questioned its effectiveness. Read on to discover the potential benefits and drawbacks of policosanol, along with the optimal dosage.
What is Policosanol?
Policosanol is a term for a group of long-chain alcohols extracted from the waxy coating of sugar cane. The first policosanol supplement was isolated and produced by researchers at Dalmer Laboratories in Cuba, in the early 90s .
It is commonly used for reducing high cholesterol, including total and LDL (low-density lipoprotein) cholesterol and has become one of the fastest-growing over-the-counter supplements sold in the United States .
Most of the trials that report benefits from policosanol were conducted by a single research group in Cuba. Trials conducted by other groups have often failed to find any benefits, which is a major drawback to its use .
- May reduce blood pressure
- May improve cholesterol levels
- Protects the blood vessels
- Most benefits stem from questionable Cuban research
- There’s conflicting evidence for the effects on blood lipids
- May interact with blood thinners and statins
The components of policosanol are a mixture of high-molecular-weight alcohols, with the main ones being [3, 1]:
- Octacosanol (60 – 70%)
- Triacontanol (10 – 15%)
- Hexacosanol (4.5 – 10%)
- Dotriacontanol (3 – 8%)
Mechanisms of Action
The exact mechanisms of action of policosanol are not completely clear, however, it is thought that policosanol exerts its effects by 4]:
- Increasing the breakdown of LDL cholesterol by the liver .
- Blocking activity of HMG-CoA reductase, an enzyme involved in the production of cholesterol .
- Reducing blood clotting .
- Blocking the activity of serum cholesteryl ester transfer protein (CETP), thereby increasing HDL and lowering LDL levels .
1) High Blood Pressure
In 589 older patients being treated for both high blood pressure and high cholesterol, one year of policosanol (5 to 10 mg/day) treatment significantly lowered their blood pressure .
Policosanol supplementation for a year reduced the blood pressure of 205 patients taking blood-pressure-lowering drugs .
While the above studies were performed in Cuba, at least one study outside of Cuba has supported these findings.
A pilot study performed by a group in South Korea found that 8 weeks of policosanol supplementation reduced blood pressure in 25 volunteers .
2) Blood Clotting
Platelets are one of the main components of blood clots, and the grouping together of platelets is one of the key steps in the clotting process (platelet aggregation).
Five studies conducted by the Cuban research team found that 5-50 mg of policosanol administered daily reduced blood clotting in both healthy volunteers and patients with high cholesterol [10, 11, 12, 13, 14].
Policosanol also prevented platelet grouping in rats .
Due to questionable outcomes of other Cuban studies, we can’t make a definite conclusion in the absence of research from other authors.
3) Intermittent Claudication
Intermittent claudication is a condition that involves cramping in the legs during exercise or walking due to clogged arteries.
Policosanol (10 mg/day) improved intermittent claudication symptoms in a 20-week study of 28 patients .
In another study, policosanol for 10 weeks improved the walking distance of 39 patients with intermittent claudication .
In a study of 21 patients given 10 mg/day of policosanol for 2 years, it significantly improved walking distance and relieved the symptoms .
These results have yet to replicate by a research group outside of Cuba.
No valid clinical evidence supports the use of policosanol for any of the conditions in this section. Below is a summary of up-to-date animal studies, cell-based research, or low-quality clinical trials which should spark further investigation. However, you shouldn’t interpret them as supportive of any health benefit.
4) Cholesterol Levels
A number of earlier studies performed by the same research team in Cuba have shown that policosanol decreases LDL and total cholesterol levels. Despite these promising results, later studies performed outside of Cuba failed to show any cholesterol-lowering effects of policosanol, which casts doubt on the validity of the previous studies.
Studies Performed in Cuba
In a study of 589 elderly patients with high cholesterol, 5 mg/day of policosanol for one year reduced LDL and total cholesterol levels .
Two studies (300 postmenopausal women with high cholesterol) found that taking 5-10 mg/day of policosanol decreased LDL by as much as 27% and total cholesterol by 19.5% [19, 20].
In another study, 75 older patients with high cholesterol were given either policosanol (10 mg/day) or a statin regularly used for treating high cholesterol (atorvastatin) for 8 weeks. Policosanol lowered both LDL and total cholesterol levels but was less effective than the statin .
In a study of 120 patients, a combination of a popular statin (simvastatin) and policosanol resulted in a greater decrease in total and LDL cholesterol levels than a combination of the statin and placebo .
In three trials of nearly 400 high-cholesterol patients, policosanol (5 to 40 mg/day) significantly reduced LDL and total cholesterol levels [23, 24, 25].
However, in a study performed Mount Sinai Medical Center in Miami, FL, policosanol (20 mg/day for 12 weeks) did not reduce LDL or total cholesterol levels either alone or in combination with atorvastatin in 99 patients with high cholesterol .
Also, three smaller trials conducted by American and South African researchers (95 total patients) found that policosanol did not lower LDL or total cholesterol levels [2, 27, 28].
Many additional trials by researchers outside of Cuba (over 450 total patients) also reported no effects of policosanol on LDL or total cholesterol levels [29, 30, 31, 32, 2, 33, 34].
The research group in Cuba attributed the lack of positive results to using policosanol with a different composition of alcohols than the one used in their studies. However, other researchers have shown that the original policosanol supplement has a similar purity and composition as alternative policosanol formulations derived from non-Cuban sugarcane [1, 35, 29].
The same contradictory results seen with policosanol and LDL and total cholesterol changes are also seen with regard to HDL changes.
Several clinical studies (1,123 total patients) conducted by the same Cuban research team found that in addition to lowering LDL and total cholesterol levels, policosanol increases HDL levels [8, 23, 20, 19, 36].
However, studies performed outside of Cuba (253 total patients) by other research teams showed no change in HDL cholesterol levels [2, 33, 31].
5) Triglyceride Levels
Similar contradictory results have also been seen with regard to triglyceride levels.
A study from Cuba found that policosanol had similar effectiveness as the popular statin atorvastatin in decreasing serum triglycerides in a study of 75 older patients .
A study conducted by the same research team in Cuba showed that triglyceride levels were decreased by 11.9% in 589 elderly patients with high cholesterol after 6 weeks of taking 5-10 mg/day of policosanol for one year .
However, other studies performed outside of Cuba (459 total patients) reported no change in triglyceride levels, even in studies where LDL and total cholesterol were lowered [33, 31, 37].
6) Fat Loss
A significant decrease in visceral fat was reported in a study of 25 volunteers taking 10 mg of policosanol daily for 8 weeks. Further research is warranted .
Animal and Cellular Research (Lacking Evidence)
No clinical evidence supports the use of policosanol for any of the conditions listed in this section. Below is a summary of the existing animal and cell-based studies; they should guide further investigational efforts but should not be interpreted as supportive of any health benefit.
Blood Vessel Health
Policosanol helped prevent injury to damaged blood vessels in rabbits .
Policosanol led to faster cell renewal and improved tissue recovery in zebrafish .
Blood Sugar Levels
Policosanol decreased blood sugar levels in zebrafish .
Policosanol in Combination with Other Supplements
A combination of policosanol and red yeast rice, berberine, folic acid, coenzyme Q10, and astaxanthin in addition to low-dose statins reduced LDL-c and total cholesterol levels greater than low-dose statins alone in 100 heart disease patients .
In another study, 40 children with high cholesterol disorders were given 200 mg of red rice extract and 20 mg of policosanol or placebo for 4 weeks. Total cholesterol and LDL cholesterol and were significantly reduced compared to the placebo group .
In a study of 90 patients with high cholesterol, a combination of policosanol and omega-3 fatty acids reduced LDL cholesterol and total cholesterol, and increased HDL cholesterol levels after 8 weeks .
A combination of policosanol and omega-3 fatty acids improved mood and reaction time of 10 male athletes compared to placebo .
In one pilot study, 50 patients who suffered a stroke and were given 20 mg/day of policosanol, along with aspirin and vitamins C, E, and folic acid, and showed improved neurological outcomes .
Limitations and Caveats
Most of the studies conducted in Cuba reported benefits from policosanol on cholesterol levels, but these were not supported by most of the studies conducted outside of Cuba.
This could be due to the Cuban researchers only publishing studies that show positive results, and leaving out any studies that showed a lack of benefit (publication bias).
Another plausible explanation is diet. Many of the trials performed by the Cuban research team often had participants who were on special diets designed to lower cholesterol levels before they began supplementing with policosanol [43, 8, 46, 23, 47, 21, 36].
All three studies outside of Cuba that found benefits with policosanol used cholesterol-lowering diets before starting policosanol supplementation [48, 49].
Policosanol Side Effects & Precautions
The Health Benefits of Policosanol
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Swanson B, Keithley JK, Sha BE, et al. Policosanol for managing human immunodeficiency virus-related dyslipidemia in a medically underserved population: a randomized, controlled clinical trial. Altern Ther Health Med. 2011;17(2):30-5.
Berthold HK, Unverdorben S, Degenhardt R, Bulitta M, Gouni-berthold I. Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia: a randomized controlled trial. JAMA. 2006;295(19):2262-9. doi:10.1001/jama.295.19.2262
Lee JY, Choi HY, Kang YR, et al. Effects of long-term supplementation of policosanol on blood cholesterol/glucose levels and 3-hydroxy-3-methylglutaryl coenzyme a reductase activity in a rat model fed high cholesterol diets. Food Sci Biotechnol. 2016;25(3):899-904. doi:10.1007/s10068-016-0147-y
Gong J, Qin X, Yuan F, et al. Efficacy and safety of sugarcane policosanol on dyslipidemia: A meta-analysis of randomized controlled trials. Mol Nutr Food Res. 2018;62(1) doi:10.1002/mnfr.201700280
Castaño G, Más R, Fernández J, et al. Effects of policosanol on borderline to mildly elevated serum total cholesterol levels: a prospective, double-blind, placebo-controlled, parallel-group, comparative study. Curr Ther Res Clin Exp. 2003;64(8):522-37. doi:10.1016/j.curtheres.2003.09.002
ConsumerLab.com. Cholesterol-Lowering Supplements Review.
- Arruzazabala ML, Molina V, Mas R, Fernandez L, Carbajal D, Valdes S, Castano G. Antiplatelet Effects of Policosanol (20 and 40 Mg/Day) in Healthy Volunteers and Dyslipidaemic Patients. Clinical and Experimental Pharmacology & Physiology. 2002. 29(10):891-7.
- Berthold HK, Unverdorben S, Degenhardt R et al. Effect of Policosanol on Lipid Levels Among Patients With Hypercholesterolemia or Combined Hyperlipidemia: a Randomized Controlled Trial. JAMA. 2006. 295:2262-9.
- Castaño G, Mas R, Fernandez L, Illnait J, Gamez R, Alvarez E. Effects of Policosanol 20 Versus 40 Mg/Day in the Treatment of Patients With Type II Hypercholesterolemia: a 6-Month Double-Blind Study. International Journal of Clinical Pharmacology Research. 2001. 21(1):43-57.
- Castaño G, Mas R, Fernandez L, Illnait J, Mendoza S, Gamez R, Fernandez J, Mesa M. A Comparison of the Effects of D-003 and Policosanol (5 and 10 Mg/Day) in Patients With Type II Hypercholesterolemia: a Randomized, Double-Blinded Study. Drugs Under Experimental and Clinical Research. 2005. 31 Suppl:31-44.
- Castaño G, Mas R, Gamez R, Fernandez J, Illnait J, Fernandez L, Mendoza S, Mesa M, Gutierrez JA, Lopez E. Concomitant Use of Policosanol and Beta-Blockers in Older Patients. International Journal of Clinical Pharmacology Research. 2004. 24(2-3):65-77.
- Castaño G, Mas R, Gamez R, Fernandez L, Illnait J. Effects of Policosanol and Ticlopidine in Patients With Intermittent Claudication: a Double-Blinded Pilot Comparative Study. Angiology. 2004. 55(4):361-71.
- ConsumerLab.com. Cholesterol-Lowering Supplements Review.
- Gong Jing, et al. Efficacy and safety of sugarcane policosanol on dyslipidemia: A meta‐analysis of randomized controlled trials. Molecular Nutrition and Food Research. Volume 62, Issue 1.
- Lee Jung-Yun, et al. Effects of long-term supplementation of policosanol on blood cholesterol/glucose levels and 3-hydroxy-3-methylglutaryl coenzyme a reductase activity in a rat model fed high cholesterol diets. Food Sci Biotechnol. 2016; 25(3): 899–904.
- Lin Y, Rudrum M, van der Wielen RP, Trautwein EA, McNeill G, Sierksma A, Meijer GW. Wheat Germ Policosanol Failed to Lower Plasma Cholesterol in Subjects With Normal to Mildly Elevated Cholesterol Concentrations. Metabolism. 2004. 53(10):1309-14.
Policosanol benefits and side effects
Policosanol is a supplement made from Cuban sugar cane that is purported to have cholesterol-lowering effects. While several Cuban studies show its efficacy, other studies show little to no benefits.
Researchers are also evaluating its potential in reducing blood clots, improving blood vessel health, speeding up wound healing time and reducing blood sugar levels.
- Side effects
- Recommended dosage
In addition to being found in the seeds and the waxy coating of cane sugar, policosanol is extracted from various other sources, including wheat and wheat germ, peanuts, pomegranate seeds and grape seed oil.
Policosanol decreases LDL and total cholesterol levels — but in very limited studies. There is much debate whether or not supplementation can improve cholesterol numbers. Several studies performed by Cuban researchers tout the ability of policosanol to significantly treat LDL, a.k.a. “bad cholesterol.”
In one study of 589 men and women with high blood pressure and cholesterol (without a history of congenital heart disease or cerebrovascular disease), 5 to 10 mg per day for one year significantly lowered LDL and triglycerides and raised HDL, “good cholesterol.” 1
Multiple other trials show that supplementation with 5mg to 20 mg a day is beneficial in patients with hypercholesterolemia (2,3).
Studies performed in other countries, (including the U.S.) however, show the opposite outcomes. The results of a study published in a 2006 issue of the American Heart Journal, revealed that policosanol did not reduce LDL or total cholesterol levels either alone or in combination with atorvastatin — a lipid-lowering prescribed medication (4).
Many other trials by researchers outside of Cuba (including trials of men, postmenopausal women and HIV-positive patients) also reported no effects of policosanol on LDL or total cholesterol levels (5,6).
Questions have been raised as to why there is such a discrepancy in results. Some believe it may be due to publication bias in which positive results are represented more than negative ones.
Another explanation may be due to a difference in diet protocol; many of the studies that found supplementation to be beneficial included participants who were on special diets designed to lower cholesterol levels before they began supplementing with policosanol.
Policosanol may treat high blood pressure. A pilot study performed in South Korea showed that supplementation reduced blood pressure in 25 volunteers.
Young smokers and non-smokers along with middle-aged subjects consumed policosanol daily (10 mg/day) for 8 weeks. At the end of the study period, systolic blood pressure was significantly lowered from initial levels in the young smokers and middle-aged groups.
In addition, supplementation reduced serum triglyceride levels and elevated HDL contents (7).
In another recent study, researchers performed in vitro, in vivo and ex vivo experiments to provide more concrete data on the blood pressure-lowering effect of policosanol. Healthy Korean female volunteers (with prehypertension) took part in the study to reveal the physiological effects of policosanol consumption on blood pressure and HDL functionality.
Participants took either 10 mg of policosanol or placebo for 8 weeks.
At the end of the study, there were several notable results: total body fat mass decreased up to 12 percent in the policosanol group; visceral fat mass was reduced more than subcutaneous fat mass up to 20 percent in the policosanol group; average systolic and diastolic blood pressure levels were reduced up to 10 percent and 14 percent, respectively; and 19 percent and 14 percent reductions in total cholesterol and triglyceride levels, respectively were seen. (8)
Researchers concluded that improvement of HDL functionality was associated with lowered blood pressure and inhibition of CETP activity (elevated cholesteryl ester transfer protein) in female prehypertension subjects. CETP activity is a major determinant of atherosclerotic cardiovascular disease in South Asians (9).
Policosanol may prevent osteoporosis. To evaluate whether policosanol could prevent bone loss, researchers used a menopause rat model and published their results in Drugs under Experimental and Clinical Research.
The study concluded that policosanol prevented bone loss and decreased bone resorption, suggesting that it may be potentially useful in preventing osteoporosis in postmenopausal women (10).
Policosanol may improve athletic performance. One study of 18 karate athletes found that 21 days of supplementation with omega-3 fatty acids plus policosanol showed a reduced reaction time and improve mood. The increased mood persisted 21 days after cessation of supplementation while reaction time returned to normal (11).
Policosanol may be used for leg pain due to poor blood circulation (intermittent claudication). Intermittent claudication is pain in the calves, thighs, hips or buttocks caused by too little blood flow, typically during exercise. Atherosclerosis (the narrowing of the arteries making them stiffer and harder) is one possible cause of this condition.
There are some Cuban studies showing policosanol’s efficacy in lowering vascular risks in patients with this condition. In one study, 39 patients were randomized to receive a daily dose of 10 mg of policosanol or 100 mg of aspirin for 10 weeks. Walking distances on a treadmill were assessed before and after treatment to evaluate pain and endurance.
The group taking policosanol saw an increase in walking distances, even immediately after supplementation (12).
The results of another study of supplementation, published in an issue of Angiology, reported that long-term policosanol therapy is useful in treating patients with intermittent claudication (13). The treatment was generally well tolerated.
studies performed so far, there have been no reports of adverse reactions with use when taken short-term in the dosage range of 5-20mg. Forty milligrams for 6 months also appears to be well tolerated (14).
The standard dosage of policosanol is 5-10mg taken twice daily. However, due to conflicting results when it comes to its ability to lower cholesterol and limited human studies, researchers are not sure if it is bioactive at this dosage. More research is needed.
Policosanol is a supplement made from Cuban sugar cane that is mostly touted for its ability to lower cholesterol.
While several studies show its efficacy in lowering LDL cholesterol (bad cholesterol), triglycerides and raising HDL cholesterol (good cholesterol), many other studies performed outside Cuba show the opposite effects.
Some believe this discrepancy may be due to publication bias or the way in which the studies were performed.
As researchers perform further studies to establish whether or not supplementation can lower lipid levels, they are also focusing their attention on policosanol’s ability to treat other conditions. Early results show its ability to treat high blood pressure, prevent osteoporosis, improve athletic performance and reduce leg pain caused by intermittent claudication.
Supplementation appears to be safe when taken short-term in the dosage range of 5-20mg.
Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine
Red yeast rice (RYR) is a traditional Chinese medicine and food supplement popular in East Asian countries such as China, Japan, Korea, and Thailand (Patel, 2016).
It is produced by the fermentation of cooked rice kernels with a Monascaceae mold, Monascus purpureus, which turns rice into reddish purple kernels due to its pigmentation capability (Kalaivani et al., 2010). As part of the Asian diet, RYR is used as a food additive to enhance the color of meat, fish, and soybean products.
It is also recognized as a folk medicine for rejuvenating the body, promoting blood circulation, and restoring stomach balance (Mazzanti et al., 2017). With the increasing tendency of Western countries to use statins, a group of drugs used to treat hyperlipidemia, RYR has attracted considerable research attention (Burke, 2015).
RYR has been reported to possess numerous biological properties with hypolipidemic, anti-atherosclerotic, anti-cancer, neurocytoprotective, hepatoprotective, anti-osteoporotic, anti-fatigue, anti-diabetic, anti-obesity, immunomodulatory, anti-inflammatory, anti-hypertensive, and anti-microbial activities. RYR can also improve the quality of eggs.
Chemical analyses have revealed that RYR contains monacolins, pigments, organic acids, amino acids, sterols, decalin derivatives, flavonoids, lignans, coumarin, terpenoids, and polysaccharides. However, only a few of these compounds have been screened in bioactivity assays, and their structures have not been sufficiently characterized.
Although RYR is effective in treating various infections, the safety of its chemical constituents has not been defined. In addition, the quality control of RYR has not been investigated, and there is a lack of pharmacological information on the traditional uses of RYR.
In this article, we provide an up-to-date and comprehensive literature analysis of RYR and address its traditional uses, chemistry, pharmacological activities, possible molecular mechanisms, and safety. A critical evaluation of pharmacological studies in terms of the ethnomedical use of RYR was also performed.
This information may provide new insights on RYR or its active ingredients, and help seek effective intervention strategies for the prevention and treatment of diseases, design clinical trials of bioactive compounds in RYR in future research, and develop fungal-medicines as well as edible products containing these functional properties.
Materials and Methods
Information on studies involving RYR was gathered via the Internet using Google Scholar, Baidu Scholar, Elsevier, Web of Science, PubMed, CNKI, ScienceDirect, SciFinder, and Scopus, and a library search was performed of articles published in classic books of Chinese Herbal Medicine, local herbal encyclopedias, and Ph.D. and M.Sc.
dissertations. The key words used were RYR, red mold rice, M. purpureus, secondary metabolites, chemistry, biological activity, pharmacology, medicinal use, safety, quality control, toxicology, and other related words (Zhu et al., 2018). The MycoBank database (http://mycobank.org) was used to validate the scientific names of M.
RYR (Figures S1A, B; also known as “Hongqu” or “angkak” in China, and ‘red koji’ in Japan) is a remedy belonging to Traditional Chinese Medicine (TCM). Nowadays, it is also used as a dietary supplement in Western countries (Hong et al., 2008b; Fung et al., 2012).
It is produced by the fermentation of steamed rice with a food fungus of the Monascus genus, usually M. purpureus Went. Apart from M. purpureus, other related nonpathogenic molds of the Monascus genus, such as M. ruber, M. anka, and M.
pilosus, are also used for RYR production in Japan, Korea, India, and Thailand (Cheng et al., 2013; Hong et al., 2017). In TCM, however, M. purpureus is the only accepted medicinal fungus for RYR fermentation (Chinese Pharmacopoeia, 2015).
According to the MycoBank database (http://mycobank.org), M. purpureus (MB#235390) is the only accepted name for the fungus, and it has six synonyms, including M. albidus var. albidus, M. anka Nakaz. and K. Satô, M. araneosus K. Satô, M. major K. Satô, M.
rubiginosus K. Satô, and M. albidus var. glaber K. Satô.
M. purpureus, which was largely described by Went in 1985, belongs to family Monascaceae, class Eurotiomycetes in Ascomycota (Huang et al., 2007). It can grow rapidly at a temperature of 25°C to 30°C on Potato Dextrose Agar or Luria Bertani mediums, and it favors conditions with a humidity of 65% to 85% (Figures S1C, D) (Il Gum et al.
, 2017). M. purpureus mostly breeds in asexual generation style, with many botryoid conidium. In general, stromata are solitary to gregarious, colony margins are short pulvinate to filiform, the ascocarp wall pectizes to membrane-, ascospores are oval, the surface is smooth, and the color is red to nearly gray (Figures S1E, F) (Wei, 1979).
RYR was first recorded in the Local Chronicles of Gutian (⟪古田县志⟫), which dates back to the Tang Dynasty (A.D. 618–907) (Lin, 2017). RYR has also been recorded in many ancient texts, such as Qing Yi Lu (⟪清异录⟫) (from the Five Dynasties and North Song Dynasty, A.D. 907–1127), Hai Lu Sui Shi (⟪海录碎事⟫) (Song Dynasty, A.D.
960–1279), and Tian Gong Kai Wu (⟪天工开物⟫) (Ming Dynasty, A.D. 1368–1644), and it is widely used in the Chinese culture as a food preservative, flavor enhancer, and food-coloring agent for fish sauces, rice wines, red soybean curd, pickled vegetables, and salted meats (Burke, 2015; Lin, 2017).
In TCM, according to Materia Medica in Daily Use (⟪日用本草⟫) (Yuan Dynasty, A.D. 1271–1368) and the Compendium of Herbology (⟪本草纲目⟫) (A.D. 1552–1578), RYR is slightly mild and sweet, without significant toxicity, and it goes to the liver, spleen, and large intestines.
It has been used to treat indigestion, diarrhea, blood circulation stasis, and limb weakness for more than 700 years (Chinese Pharmacopoeia, 2015; Patel, 2016).
In some western countries, including the United States, Netherlands, and Italy, RYR has been used as an alternative to statin therapy, especially in patients who are intolerant to standardized therapy due to statin-associated myalgia or those who are opposed to taking statins (Childress et al., 2013).