Red rice, particularly red yeast rice (Monascus purpureus fermented rice), has some scientific backing for use in the context of fatty liver disease, though evidence is limited and not conclusive. The primary bioactive component in red yeast rice is monacolin K, which is chemically identical to the statin drug lovastatin. Statins are known to lower cholesterol and are sometimes prescribed to patients with non-alcoholic fatty liver disease (NAFLD) who also have dyslipidemia. Some small clinical studies and animal research suggest that red yeast rice supplementation can improve lipid profiles and reduce liver fat accumulation, likely by inhibiting cholesterol synthesis and ameliorating inflammation and oxidative stress.

For example, a few human studies have shown reductions in liver enzymes and improvements in ultrasound features of fatty liver in patients taking red yeast rice supplements, but sample sizes are generally small and study durations short. The generalizability and long-term safety of red yeast rice use for fatty liver disease remain unclear, especially due to concerns about product standardization and potential for adverse effects similar to those seen with statins (e.g., muscle pain, liver toxicity).

In summary, while there is some scientific evidence suggesting red yeast rice may benefit fatty liver disease due to its statin-like effects, the evidence is modest (rated 2/5), and more robust clinical trials are needed before it can be broadly recommended for this indication.