In Australia, the prevalence of high cholesterol increases with age with a sharp increase from age 45 years. There is one in five people aged 65 years and over (21.2%) having high blood cholesterol level. High blood cholesterol is a risk factor for heart disease and it typically causes no symptoms. If left untreated, high cholesterol can cause plaque to build up in arteries and result in life-threatening complications e.g. stroke. Red yeast rice (RYR) has been used as an herbal supplement to reduce cholesterol level naturally and in the cuisine of East Asian countries for many years. Its active component, Monacolins-K can inhibit cholesterol production by inhibiting enzyme HMG-CoA reductase. However, if the process of fermenting RYR is not carefully controlled, a substance called citrinin (a type of mycotoxin produced during RYR fermentation that cause liver and kidney damage) can form.