Last fall, 80-year-old Joyce had her cholesterol levels checked. When her lab results came back, there was good news mixed with some bad. Her “good” cholesterol (HDL) was excellent, but her “bad” cholesterol (LDL) and her total cholesterol were both too high. Her family physician recommended she start taking a prescription medication to lower her cholesterol: statin.
Joyce told her doctor she had taken statin medicines simultaneously with an estrogen blocker drug for her breast cancer. Each time she started the statin, she experienced muscle aches, pain, and weakness, especially in her legs. All of these symptoms went away after she stopped taking the statin pills.
When her breast cancer returned earlier this year, Joyce was told she would need to take the same estrogen blocker medicine for the rest of her life. Last fall, when her doctor saw the results of her blood cholesterol, she advised starting a statin medication immediately.
Joyce made a different choice. For the past 8 months, she has stuck with a low-fat/good-fat diet and walked at least 2 miles daily. By making lifestyle changes to encourage her LDL to drop, she hoped she wouldn’t have to resort to medication to get her cholesterol under control.
When her doctor repeated Joyce’s lipid panel this fall, her LDL had dropped from 125 to 116. Joyce was thrilled, but her doctor wasn’t.
“Your LDL is still above 100, so I’ll send a prescription for a statin to your pharmacy.”
However, when the medicine arrived in the mail, Joyce avoided taking it.
Last week, her daughter suggested she try citrus bergamot. “I took it for 6 months, and now my cholesterol level is normal. My doctor is amazed. It's natural, so it should be safe.”
Unfortunately, that was not the case. One of Joyce's cancer medications can be affected by grapefruit. Grapefruit juice, fresh grapefruit, and citrus bergamot contain natural constituents that inactivate a particular enzyme called CYP3A4, which is concentrated in your liver and small intestine. CYP3A4 enzymes take apart specific types of compounds, including many prescription drugs. In the lining of your small intestine, CYP3A4 neutralizes part of each dose of medicine before it gets into your bloodstream.
When Joyce asked me if citrus bergamot was safe to take with her 2 drugs for breast cancer, I answered, “No. Grapefruit and bergamot can make your intestinal CYP3A4 enzymes stop working. Without CYP3A4, you could absorb up to 50% more of each dose of affected medicine, setting you up for an overdose.”
I suggested she try phytosterols instead. Phytosterols (PS) are plant-based cholesterol compounds that can decrease LDL cholesterol by 6-14% yet do not affect "good" cholesterol (HDL) or triglycerides. They also have anti-inflammatory and anti-carcinogenic properties.
The cholesterol in your food gets absorbed into your body by riding on carrier molecules. Each carrier molecule has places for cholesterol to attach to, called binding sites. Phytosterols cover up those binding sites, keeping cholesterol out of your body.
The best sources of PS are sunflower seeds and pistachios, followed by broccoli, Brussels sprouts, corn, and carrots. PS-rich beverages include pomegranate juice, carrot juice, and milk substitutes like almond, cashew, and oat milk. Benechol® and Take Control® spreads are examples of PS-fortified foods.
To maximize the cholesterol-lowering benefit of eating or drinking food and beverages containing phytosterols, they need to be taken with a meal containing fat. There must be enough fat to activate carrier molecules with their cholesterol-binding sites.
Here are 5 Tips to Getting the Best Cholesterol Lowering Results from Phytosterols:
1. Aim for at least 2 grams of PS daily.
A healthy diet gives you between 0.2-0.4 grams of PS daily. Adding one serving of 1.7 grams will get you to 2 grams of PS daily. If you need to lower your LDL by more than 10 points, you’ll need two 1.7gram servings of PS daily.
2. Take PS-fortified foods or supplements twice daily.
Phytosterols 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.
You need to have enough fat in your meal to activate the binding sites for cholesterol.
4. Avoid PS between meals or with a very low-fat meal.
Although drinking PS-rich pomegranate juice or almond milk is good for you, it won’t help lower your 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, PS supplements should be fully dissolved in your small intestine.
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
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