EastWest Gal
Thinks s/he gets paid by the post
This is a long post. Cholesterol metabolism is extremely complicated. Lipidology is a subspecialty. My knowledge, even as a general physician, is a bit limited. I'm going to create an analogy to help clarify my concerns.
Plant sterols, such as Cholestoff, do lower cholesterol levels. But they are likely not the answer. There may be harm. We don't know.
Lowering cholesterol is not the goal. The goal is to prevent and/or delay atherosclerosis, which leads to cardiovascular disease, as well as Alzheimer's disease and other forms of dementia. High LDL cholesterol, in particular found in small LDL particles, is associated with an increased risk of cardiovascular disease. Low HDL cholesterol is actually more strongly associated with increased risk of cardiovascular disease. Cholesterol is an essential component of every cell membrane in our bodies. We need cholesterol to live. We make the vast majority of our own cholesterol; relatively little comes from our diet.
There is little known about the effect of plant sterols on cardiovascular disease and Alzheimer's disease. Studies are ongoing, but are largely done with mouse models. Human studies are big and expensive, and are not controlled trials. Some mouse studies suggest that elevated plant sterols may be associated with an increased risk of atherogenesis. Additionally, in one mouse study, accumulation of plant sterols in the brain is strongly associated with neurodegeneration.
My analogy: Our LDL and HDL particles are different types of transport "busses" for cholesterol, the "passengers".
The HDL apolipoprotein is called apoA (think of it like the HDL bus driver). The HDL bus picks up excess cholesterol from the tissues and moves it out, by carrying the cholesterol to the liver, where it is used to make bile salts, which are dumped into the intestine by way of the gall bladder. HDL particles also take cholesterol to the sex organs and adrenal glands to be used to make various hormones. So the HDL bus is a waste management system, with a small amount of recycling to a couple of organs for good measure.
The LDL bus is more like a city bus, moving cholesterol around the body to the rest of the cells, except the brain, which makes all of its own cholesterol. Amongst the cholesterol the "passengers" on the bus) are a very small number of plant sterol molecules, we'll call them "aliens". The vast majority of ingested plant sterol molecules are not allowed into the body, and do not board the bus at all.
The LDL bus driver is a protein called apoB. If we have many busses, not filled with passengers, these are small LDL particles, and are much more closely associated with cardiovascular disease than the larger LDL particles. More apoB, more LDL particles, more buses with few passengers. LDL particle number is one of the most important things to measure, and most physicians don't measure it. They just measure the total LDL-C, or the number of passengers on all of the LDL buses.
The analogy would be a traffic jam of many mostly-empty buses (small LDL particles) vs a smaller number of full buses taking passengers where they need to go. The many emptier buses do much more harm to the environment than a few full buses.
What about the "alien" plant sterols? A large supplement of plant sterols will overwhelm the body's efforts to prevent them from entering the body and getting on the bus. The "alien" plant sterols will displace cholesterol "passengers" on your LDL buses, along with interfering with absorption of dietary cholesterol. Since more aliens have displaced the passengers, the LDL cholesterol number will be lower. You still don’t know the important particle count, the number of LDL buses, because you aren’t measuring it.
Plant sterols lower measurable LDL cholesterol. So what? That isn’t the desirable endpoint. Reducing cardiovascular and Alzheimer’s disease risks are what we want. We don't know if plant sterols have any effect on these endpoints. We don’t know if the aliens on the LDL buses are good or bad. We know that our bodies try to keep them out and get rid of them promptly. This suggests that our bodies treat plant sterols as undesirable aliens. Why is that?
Statins, on the other hand, reduce cholesterol synthesis in the liver. They also increase clearance of LDL particles. Since the vast majority of our cholesterol is synthesized in the liver, a statin can have a dramatic effect on LDL cholesterol. The reduction of cardiovascular risk is also statistically significant with use of a statin.
Proceed with caution if you choose plant sterol supplementation over a statin to lower cholesterol. Remember why you are doing it.
Plant sterols, such as Cholestoff, do lower cholesterol levels. But they are likely not the answer. There may be harm. We don't know.
Lowering cholesterol is not the goal. The goal is to prevent and/or delay atherosclerosis, which leads to cardiovascular disease, as well as Alzheimer's disease and other forms of dementia. High LDL cholesterol, in particular found in small LDL particles, is associated with an increased risk of cardiovascular disease. Low HDL cholesterol is actually more strongly associated with increased risk of cardiovascular disease. Cholesterol is an essential component of every cell membrane in our bodies. We need cholesterol to live. We make the vast majority of our own cholesterol; relatively little comes from our diet.
There is little known about the effect of plant sterols on cardiovascular disease and Alzheimer's disease. Studies are ongoing, but are largely done with mouse models. Human studies are big and expensive, and are not controlled trials. Some mouse studies suggest that elevated plant sterols may be associated with an increased risk of atherogenesis. Additionally, in one mouse study, accumulation of plant sterols in the brain is strongly associated with neurodegeneration.
My analogy: Our LDL and HDL particles are different types of transport "busses" for cholesterol, the "passengers".
The HDL apolipoprotein is called apoA (think of it like the HDL bus driver). The HDL bus picks up excess cholesterol from the tissues and moves it out, by carrying the cholesterol to the liver, where it is used to make bile salts, which are dumped into the intestine by way of the gall bladder. HDL particles also take cholesterol to the sex organs and adrenal glands to be used to make various hormones. So the HDL bus is a waste management system, with a small amount of recycling to a couple of organs for good measure.
The LDL bus is more like a city bus, moving cholesterol around the body to the rest of the cells, except the brain, which makes all of its own cholesterol. Amongst the cholesterol the "passengers" on the bus) are a very small number of plant sterol molecules, we'll call them "aliens". The vast majority of ingested plant sterol molecules are not allowed into the body, and do not board the bus at all.
The LDL bus driver is a protein called apoB. If we have many busses, not filled with passengers, these are small LDL particles, and are much more closely associated with cardiovascular disease than the larger LDL particles. More apoB, more LDL particles, more buses with few passengers. LDL particle number is one of the most important things to measure, and most physicians don't measure it. They just measure the total LDL-C, or the number of passengers on all of the LDL buses.
The analogy would be a traffic jam of many mostly-empty buses (small LDL particles) vs a smaller number of full buses taking passengers where they need to go. The many emptier buses do much more harm to the environment than a few full buses.
What about the "alien" plant sterols? A large supplement of plant sterols will overwhelm the body's efforts to prevent them from entering the body and getting on the bus. The "alien" plant sterols will displace cholesterol "passengers" on your LDL buses, along with interfering with absorption of dietary cholesterol. Since more aliens have displaced the passengers, the LDL cholesterol number will be lower. You still don’t know the important particle count, the number of LDL buses, because you aren’t measuring it.
Plant sterols lower measurable LDL cholesterol. So what? That isn’t the desirable endpoint. Reducing cardiovascular and Alzheimer’s disease risks are what we want. We don't know if plant sterols have any effect on these endpoints. We don’t know if the aliens on the LDL buses are good or bad. We know that our bodies try to keep them out and get rid of them promptly. This suggests that our bodies treat plant sterols as undesirable aliens. Why is that?
Statins, on the other hand, reduce cholesterol synthesis in the liver. They also increase clearance of LDL particles. Since the vast majority of our cholesterol is synthesized in the liver, a statin can have a dramatic effect on LDL cholesterol. The reduction of cardiovascular risk is also statistically significant with use of a statin.
Proceed with caution if you choose plant sterol supplementation over a statin to lower cholesterol. Remember why you are doing it.
