Phytosterols lower LDL cholesterol by substituting themselves for cholesterol

Last week, 61-year-old Richard asked me, “Are there any non-drug options I can try to lower my “bad” cholesterol? My doctor wants to start me on a statin medication, but I want to try non-drug options first. In addition to eating a healthier diet and exercising more, are there any supplements I could try?”

“You can get good results with citrus bergamot, but it interacts with medicines, just like grapefruit does.”

Unfortunately, Richard was taking warfarin, a blood thinner, for a congenital blood condition that increased his risk of stroke. It was not safe for him to take citrus bergamot.

"My last blood test showed my LDL as 117, which needs to be 100 or below. Since then, I have been making much better food choices," he told me. "No more pizza, burgers, or fries. Is there anything else I could do?"

“You could try phytosterols, which are similar in shape to cholesterol but work differently in your body. Phytosterols (PS) are plant-based cholesterol compounds that can decrease your “bad” (LDL) cholesterol by 6-14%. Unlike LDL cholesterol, PS have anti-inflammatory and anti-carcinogenic properties.”

I explained, “Although phytosterols can help you drop your LDL and total cholesterol, they can be tricky; you need to take them in a specific way to get the best results.

That’s because cholesterol and phytosterols can’t get into your body by themselves. They need extra help: a particular molecule, called a carrier molecule, is necessary to move them from your intestines into your bloodstream.

It’s like taking a shuttle bus from a parked airplane to an airport terminal nearby. When an aircraft containing passengers arrives on the tarmac, the terminal sends a shuttle bus to the plane. The passengers deplane, then board the shuttle, which transports them to the airport.

Cholesterol and phytosterol act like passengers needing a shuttle bus to get to an airport terminal. Eating a meal that contains fat will signal your body to send carrier molecules into your intestine. Cholesterol attaches to specific places on the carrier molecules. Those carriers transfer the cholesterol from your intestine into your bloodstream.

Phytosterols lower LDL cholesterol by substituting themselves for cholesterol. They "kick" cholesterol off the carrier molecules/shuttle bus, taking their place. You'll have less cholesterol in your bloodstream because you absorb phytosterol instead of cholesterol.

To get the most from taking phytosterols, you MUST take them with a meal that has some fat in it. If your food doesn't contain enough fat, your body won't send any carrier molecules (the shuttle bus) to your intestine. Without carrier molecules, phytosterols cannot substitute themselves for cholesterol

.Sunflower seeds and pistachios are foods that have the most phytosterols. Other foods rich in PS include broccoli, Brussels sprouts, corn, and carrots. Beverages like pomegranate juice, carrot juice, and milk substitutes like almond, cashew, and oat milk also contain phytosterols. Benechol® and Take Control® spreads are examples of PS-fortified foods.

For best results, phytosterols need to substitute themselves in place of cholesterol. To maximize the cholesterol-lowering effects of phytosterols, whether in foods, beverages, pills, or gummies, ALWAYS take them with a meal containing some fat. Avoid taking PS alone, with non-fat or low-fat meals or snacks."

5 Tips to Getting the Best Cholesterol Lowering Results from taking Phytosterols:

1.        Aim for 2 servings of 1.7 grams of PS daily.

With a healthy diet giving him between 0.2-0.4 grams of PS daily, Richard needs to add two servings of 1.7 grams of PS for best results. That should decrease his LDL by 12-14%, getting him from an LDL of 117  to his goal of 100.

2.        Take PS-fortified foods or supplements twice daily.

Richard needs the maximum effect of taking phytosterols, which are more effective in decreasing LDL and total cholesterol if taken more than once daily.

3.        Always take PS supplements or concentrated foods with an adequate meal.

Your meal needs enough fat to activate the necessary carrier molecules to transport cholesterol and phytosterols into your bloodstream.

4.        Avoid eating or drinking PS between meals or with a very low-fat meal.

Drinking PS-rich pomegranate juice or almond milk is good for you, but it won’t help lower LDL if you drink it by itself or at a very low-fat meal.

5.        Avoid slow-dissolving or "extended-release" phytosterol supplements.

For best results, Richard should stick with phytosterol-rich foods and drinks or foods fortified with phytosterols, like Benechol® or Take Control®. Supplements that dissolve slowly may not be fully available to attach to carrier molecules until they are past where the carrier molecules work.

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and the author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com. ©2022 Louise Achey