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0242-supports-cholesterol-balance
Disclaimer: This post is for informational purposes only. Please discuss your medications with
your doctor.
Scientific studies reveal that there are two main categories of people: those who produce
too much cholesterol, and those who absorb more than they need in the gut. Finding out
which one you are can make a world of a difference when it comes to treatment (R).
According to one study, people with high cholesterol absorption are more likely to have heart
disease despite similar HDL and LDL cholesterol levels (R).
A lipid panel doesn’t tell you your absorption status. However, there is a simple blood test that
can tell your doctor which group you belong to: the sterols test (R).
The typical diet contains similar amounts of cholesterol from animal foods and plant sterols from
vegetables and fruits. Yet, the human body values cholesterol more, while mostly discarding
plant sterols. When you eat an omnivorous meal, cells in your gut will absorb about 50%
of cholesterol and only 5% of plant sterols (R).
Cholesterol has a bad reputation, but it’s essential to health. Our body uses it to build all cells in
the body, tissues, sex hormones, vitamin D, and bile (R).
On the other hand, the body has no use for plant sterols. Moreover, plant sterols appear to be
toxic at lower levels than cholesterol, according to some studies (R, R, R). That’s why nobody
had paid much attention to them, until recently. That is, until researchers realized that sterols
are key blood markers of cholesterol absorption!
Bear with the science: after a meal, cells in your gut take in plant sterols and cholesterol at the
same time. Since cholesterol can be stored or used, as well as produced in the liver, we can’t
know how much was absorbed from the gut based on its blood levels. However, all absorbed
plant sterols are left to float in the bloodstream (R).
Therefore, the amount of plant sterols you have in your blood directly reflects how much
cholesterol you absorb (R).
Are You a Cholesterol Hyperabsorber?
Sterols Testing
Sterols testing measures the following markers that will tell you how much cholesterol you
absorb on a daily basis:
● Campesterol
● Sitosterol
● Cholestanol
If your levels of these markers are high, you are a hyperabsorber. About 25% of people fall
into this category. They usually absorb lots of cholesterol and produce little, don’t respond to
standard statins drug therapy, and are at the highest risk of heart disease complications (R).
Whereas most people absorb 50% of cholesterol, hyperabsorbers take up 60-80% and
hypoabsorbers only about 20-30% (R).
In addition, sterols testing may measure the following compounds, which tell you how much
cholesterol you are producing (R, R):
● Desmosterol
● Lathosterol
Plus, cells have a way of transforming sterols to make them easier to move into the blood
(called esterification) , sort of like a VIP pass. Intestinal cells that give away this pass use an
enzyme called ACAT (acyl-cholesterol acyltransferase) (R).
Microbiome’s L. Reuteri strain works, in part, by taking this VIP pass away from
cholesterol-carrying bile (via activating an enzyme called bile salt hydrolase). In turn, more bile
packed with cholesterol, sterols, and other fats is removed from the body (R, R, R).
The amount of sterols that will reach the blood depend on all these factors, which often have a
genetic basis. For example, you may have a more active sterols host (NPC1L1) or a lazy
bouncer (ABCG5 and ABCG8). The latter has been linked with high cholesterol absorption and
heart disease. Other genetic factors, like your APOE genotype, can also play in (R, R, R, R, R).
Additionally, being older can make you more likely to be a hyperabsorber, especially if you are a
woman past menopause (R, R).
Where Can You Do the Test?
Although scientists have demonstrated that sterols testing can go a long way in individualizing
therapy, it’s still not commonly ordered. Only a few labs run this test, like Boston Heart’s
Cholesterol Balance Test and Mayo Clinic Laboratories. In turn, many people may be
prescribed drugs that work against their physiology: statins (R, R).
The answer ties into how statins work. Statins block an enzyme (called HMG-CoA reductase)
responsible for producing cholesterol (R).
If the reason why your cholesterol is high is that you are absorbing too much and producing too
little, then it becomes obvious that prescribing statins is a bad idea. To make matters worse, the
body tries to compensate by increasing cholesterol absorption, which accomplishes the exact
opposite of what hyperabsobers need (R).
In a subgroup of 868 patients included in a larger clinical trial, a statin called simvastatin
increased heart disease complications in hyperabsorbers. The more cholesterol patients
absorbed and the less cholesterol they produced, the more complications they suffered.
Meanwhile, hypoabsorbers—aka low absorbers— responded well to statins and experienced
fewer complications (R, R).
Adding Zetia to statin therapy helped lower the plant sterol sitosterol and LDL cholesterol in one
trial of 197 heart disease patients after 12 weeks. However, hyperabsorbers (with high sitosterol
levels) were still described as poor responders to aggressive cholesterol-lowering drug
therapies in this study (R).
Some studies also suggest that Microbiome’s strain of Lactobacillus Reuteri (NCIMB
30242) may be a good supplement choice for supporting cholesterol balance in
hyperabsorbers (R).
In a placebo-controlled clinical trial of 127 people, L. Reuteri NCIMB 30242 capsules taken over
9 weeks decreased three plant sterols in the blood that act as absorption markers (R):
● Campesterol by 41.5%
● Sitosterol by 34.2%, and
● Stigmasterol by 40.7%
Nonetheless, existing studies are promising. Importantly, L. Reuteri is a natural compound and
one of the few probiotics designated GRAS (Generally Recognized as Safe) status by the FDA.
It also has other health benefits (like supporting gut health, vitamin D levels, immune balance,
and good digestion).
Given its good safety profile and promising effects on supporting cholesterol balance,
some physicians are now trialing L. Reuteri for their patients who are hyperabsorbers.
This approach rests on clinical judgment and experience.
Takeaway
Every fourth person has high cholesterol due to increased absorption in the gut as is classified
as a hyperabsorber.
The health of hyperabsorbers can worsen on typical cholesterol-lowering drugs like statins. The
sterols test can help your doctor determine if you are a hyperabsorber, so you can get adequate
diagnosis and treatment.
These statements have not been evaluated by the Food and Drug Administration. This product
is not intended to diagnose, treat, cure, or prevent any disease.
na Aleksic, MScPharm
By A
Ana is an integrative pharmacist and scientist with many years of medical writing, clinical
research, and health advising experience. She loves communicating science and empowering
people to achieve their optimal health. Ana has edited 800+ and written 150+ posts, some of
which reached over 1 million people. Her specialties are women’s health and mental health. She
is also a birth doula and a strong advocate of bridging scientific knowledge with holistic
medicine.