MD Recommending Phytosterols for Elevated Cholesterol

Medical Q&A [Moderated]
1

Hello Doctors,

First, thank you for putting out useful content both in podcast and written form. Both my parents have hypercholesterolemia and I have been sensitive to reducing my risk as much as possible. Since following you and other MDs like Peter Attia, I have realized that ASCVD is an “area under the curve” issue. IE, the sooner you lower apoB, the lower you risk may be down the road.

My most recent advanced lipid panel results were as follows:
Total: 231mg/dL
HDL: 70 mg/dL
trigs: 41 mg/dL
LDL: 149 mg/dL
non HDL: 161 mg/dL
LDL particle number: 1800 nmol/L
LDL small: 319 nmol/L
LDL medium: 436 nmol/L
HDL large: 6396 nmol/L
LDL pattern A
LDL peak size: 219.3 angstrom
Apob:106 mg/dL
lpA: 181 nmol/L

I am meeting the physical activity guidelines. I resistance train 3-4x/week. My waist is 31, BF % 16-17%. 170 lb, 5’ 9". In the year prior to these most recent results, I have increased fiber intake (~20-25g), reduced saturated fat intake. My blood pressure is normal. Everything else is normal, other than elevated creatinine. I sometimes take a creatine supplement. I lost trust with this MD when she recomended I drink lots of water and reduce protein intake due to the elevated creatinine. She also recommended I start taking phytosterols to reduce my lipids. I asked if that’s a better option than a statin and she said I’m too young for a statin. I am a 31 year old male.

  1. Should I take a phytosterol supplement?
  2. How do I find a MD who is up to date with current evidence and won’t tell me to reduce protein intake to avoid “stressing my kidneys”?

Thanks in advance!

Matt

2

If your fiber intake is still only 20 grams, I would certainly work on increasing that.

Phytosterols can indeed lower blood lipid levels, and you can certainly try them - although whether that would be “enough” for you is unknown. There can also be some downsides in certain situations.

Finally, the idea that someone at high risk can be “too young for a statin” is absurd. We have 20+ year follow up data on statin use in children with genetically high cholesterol, for example. A dose as low as 2.5 mg of rosuvastatin would likely have a bigger impact here than phytosterol intake.

I do not have specific advice for you regarding finding a clinician who stays up to date with current evidence beyond word of mouth or trial and error.

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