The Best Source and Dose of Plant Sterols for Lowering Cholesterol

Despite the vast literature on phytosteriles lowering blood cholesterol levels, there is today no study investigating the ultimate proof of efficacy, the lowering of the incidence of coronary heart disease. This is probably the strongest argument against them. There are no studies with hard end points to confirm that the drop in LDL cholesterol from plant steriles translates to a drop in heart attacks. The reason is that even if people start out with a 10-year cardiovascular disease risk of 10%, you'd have to randomize about 30,000 people to phytosteriles for a decade to detect such an effect. And at a more reasonable 10-year risk of 5%, you might have to enroll more than 300,000. Now, one could argue that the cholesterol lowering is all we need to know since basically lowering LDL cholesterol by any means appears to lower cardiovascular risk, whether by statins, other kinds of drugs, diet, or surgery. However, there was a big trial of extended release niacin in a group of patients with LDLs starting down in the low 60s and researchers saw a further 10point drop after a few years that should have dropped their risk by at least five or 6% but failed to offer a statistically significant benefit in the end. So there's at least one example of that line of argument failing. There is that aettoide that does have a similar mechanism of action as phytosteriles that is blocking cholesterol absorption. It partially blocks the cholesterol absorption receptor. So cholesterol absorption is reduced by about 50%. When it was put to the test, it did indeed significantly improve cardiovascular outcomes. And the 13point drop in LDL achieved by blocking cholesterol absorption with the drug is almost the exact same drop in LDL we'd expect from blocking cholesterol absorption with phytosteriles based on more than 100 randomized control trials. Does blocking cholesterol absorption work even if you don't eat any cholesterol? Yes, because the bulk of the cholesterol flowing through our digestive tract is dumped there from our liver's own production. It also works for those on statin drugs. In fact, adding two grams of phytosteriles a day to your routine may be equivalent to like quadrupling your statin dose. So, if you are going to try phytosteriles to lower your LDL level, what's the best dose and what's the best source? The recommended daily dosing is between two to three grams a day based on dose response curves like this where the benefit appears to plateau at about those two or three daily grams. There's a comparable benefit curve with plant stanols which are similar molecules. Plant steriles and stanols are absorbed better if taken with meals because the maximum cholesterol load to the intestine occurs after gallbladder contraction and delivery of cholesterol-rich bile to the intestine. Indeed, the same dose of phytosteriles may have more than double the LDL lowering effect when taken with meals rather than between them on an empty stomach. The full LDL cholesterol-lowering effect can be detected after just two weeks and may last as long as you take them. But as soon as you stop, the cholesterol-lowering effect will be lost within a week or two. Phytosteriles, those kinds of doses are available in supplements and in fortified foods which lower LDL equivalently. As I talked about before, the margarine are total non-start. Are there any healthy phytosterile fortified foods? Not any that I could tell where I live. In Australia, there's a plant sterile fortified shredded wheat, but I don't know if you can get it anywhere else. That leaves us with supplements. It's always good to have third-party certification of authenticity, though I think there's only one USB certified brand at the moment, but Consumer's Lab also tested and approved three others. They're also pretty expensive, so I was excited to see that you can get it in bulk and you could presumably just sprinkle a bit on your food, but that presumption may be wrong. As a crystallin powder, the free phytosteriles are much less efficient at inhibiting cholesterol. That's why the initial studies a half century ago were using doses of like 10 to 20 grams a day. Then researchers figured out how to make them more soluble by making fatty phytosterile esters, which is what you see in the capsules. There are studies suggesting that free steriles block cholesterol absorption as much as a sterified steriles, but they included equal parts of an emulsifier to improve absorption. A study showing free steriles could lower LDL similarly relied on some proprietary means for solubilizing it. Um, just for fun, I tried taking the bulk powder for a month and indeed sadly saw zero effect

whereas I got a nice 17point drop in LDL taking the exact same dose in encapsulated esester form. Normally, I'm not a big fan of lab tests, but if you do start phytosterile supplements, I would get your cholesterol tested before and after a month or so on them. You should be able to get your cholesterol tested for free through your doctor. But these days, you can get your cholesterol tested at low cost or free even without insurance or a doctor visit. While some individuals respond immediately and get a major shift in lipid profiles, other are more resistant or even completely insensitive to plant steriles or do even worse. Just because the average response is around a 10% drop in LDL cholesterol, maybe you'll be lucky and respond even better. These are all individual patients and this first person saw a 38% drop. But it's also possible you won't respond as well or your cholesterol may actually go up. That unfortunate person at the end had a 33% increase in LDL. So even though the average effect is good, you want to make sure it's actually working for you.