Alternatives To Statins

Written by Dr. Steve Chaney on . Posted in Drugs and Health, Food and Health, Supplements and Health

How Do Stanols And Sterols Lower Cholesterol?

Author: Dr. Stephen Chaney

 

alternatives to statins%BLOG_TITLE%Are there alternatives to statins?  If you have been looking for natural approaches for lowering your cholesterol and protecting your heart, you’ve probably been hearing a lot about plant stanols and sterols lately.

What Are Stanols and Sterols & What Do They Do?

Just what are plant stanols and sterols and why does the National Institutes of Health (NIH) recommend them as a natural approach for lowering cholesterol?

Stanols and sterols are natural substances found in plants that have a structural resemblance to cholesterol. Because they look a lot like cholesterol, they compete with cholesterol for absorption from the intestine into the mucosal cells lining the intestine. However, once they get into the intestinal mucosal cells they are recognized as foreign and are immediately pumped back into the intestine so that they never get into the bloodstream.

lower cholesterolLet me give you an analogy. Let’s think of the intestinal mucosal cells as a nightclub. The doorman doesn’t check IDs. He lets everyone into the club. Pretty soon the word gets around and stanols and sterols start lining up at the door. If a cholesterol molecule comes along, he gets discouraged by the line and doesn’t even try to get in. What the stanols and sterols don’t know is that there is a bouncer inside the club who does check IDs throws everyone who doesn’t belong there out the back door.

When you think about it, this is the best of all possible worlds. Cholesterol molecules don’t get into the bloodstream and neither do the stanols and sterols.

 

Alternatives to Statins:  How Do Stanols and Sterols Lower Cholesterol?

stanols and sterols lower cholesterolAs part of their Therapeutic Lifestyle Change Program the NIH recommends that people with elevated cholesterol consume 2 grams of plant stanols and sterols a day because over 80 clinical studies have proven that they work.

Two grams a day of stanols and sterols is sufficient to lower LDL cholesterol (the bad kind) by 9 to 13%. And many other clinical studies have shown that lowering LDL cholesterol by that much will lower your risk of a heart attack by 18-26%.

No wonder the NIH is so bullish on stanols and sterols!

 

Answers To The Questions You Didn’t Think To Ask

Here are answers to some questions that you haven’t even thought of yet:

#1: If 2 grams a day is good, would more be better?

No. Studies clearly show that 2 grams/day is optimal. Higher intakes do not lead to a significantly greater reduction in LDL cholesterol.

#2: Are there any side effects from consuming plant stanols & sterols on a daily basis?

No. That’s the great thing. Plant sterols and stanols are natural substances that we consume every day – and clinical studies have shown that they have no side effects.

#3: Is there some magical stanol/sterol combination that is more effective than others (as some supplement manufacturers would have you believe)?

fruits and vegetables lower cholesterol naturallyNo. Numerous studies have shown that stanols and sterols from many different sources have exactly the same effect and that it doesn’t matter whether they are esterified or not.

#4: Can I get 2 grams a day of stanols and sterols from my diet?

It’s unlikely. Even the best natural sources (usually fruits and vegetables) only have 5 to 40 mg per serving. If you are a vegetarian you can expect to get around 700 mg from your diet. If you consume a typical American diet you get around 250 mg and if you eat a lot of fast food you are probably getting less than 100 mg.

#5: I’ve noticed that food manufactures have started fortifying foods with stanols and/or sterols. Is this a good choice for me?

Not necessarily. You need to remember that Big Food Inc is not always your friend. To get 2 grams of stanols from Benecol you would need to consume 280 calories, 4 grams of saturated fat and 1.2 grams of trans fat. Two grams of stanols from Promise activ Super-Shot only costs you 70 calories, but it comes with artificial colors and 8 grams of sugar plus sucralose.

#6: When should I consume stanols and sterols if I want to maximize my LDL cholesterol reduction?

Any time from 30 minutes prior to your meal to with your meal is ideal – but the plant sterols and stanols will exert their beneficial effects for several hours so the time that you take the stanols & sterols is not critical.

#7: Are plant sterols and stanols a source of dietary fiber?

No. Plant stanols & sterols and dietary fiber work by different mechanisms – but they do complement each other in lowering LDL cholesterol. As a matter of fact, the NIH Therapeutic Lifestyle Program recommends 10-25 grams/day of soluble fiber along with the 2 grams/day of stanols and sterols. You should consider stanols/sterols and dietary fiber as a powerful one-two punch in your battle to lower your LDL cholesterol naturally.

#8: I’m already taking a statin drug. Is it OK to take plant stanols & sterols as well?

Absolutely. The NIH recommends that people using statin drugs also follow their Therapeutic Lifestyle Change Program – which includes 2 grams of plant stanols and sterols a day. In fact, because the effects of statins and plant sterols & stanols are additive, you may be able to reduce your dosage of statins or eliminate them entirely – which means less cost and less risk of side effects to you. [Note: You should partner with your physician in determining the dosage of statins to take.]

What I do not recommend is that you go off your statin drug and switch to a supplement containing stanols and sterols without consulting your doctor. Stanols and sterols have a more modest cholesterol lowering effect (and fewer side effects) than statin drugs. So if you were to just go off your statin and switch to a stanol/sterol supplement, your cholesterol levels might actually go up.

#9: Should I ask my doctor before taking plant stanols & sterols?

I always recommend that you keep your doctor informed about what you are doing. However, because the NIH recommends plant sterols and stanols for people with elevated cholesterol, your doctor is very likely to approve.

 

The Bottom Line

 

  • Plant stanols and sterols can be an important part of a holistic approach to lowering cholesterol naturally. In fact, the NIH recommends 2 grams/day of plant stanols and sterols as part of its Therapeutic Lifestyle Change Program  for lowering cholesterol.
  • 2 grams/day of plant stanols and sterols lowers LDL cholesterol (the bad kind) by an average of 9 to 13%, which is sufficient to decrease your heart attack risk by 18-26%.
  • Here are the answers to the most common questions I receive about stanols and sterols (for the full response read the article above)
  • 2 grams of stanols & sterols a day is optimal. More is not better.
  • There are no side effects to adding stanols & sterols to your diet.
  • There is no “magical” sterol/stanol formulation. They all work about the same.
  • It is very unlikely that you can get 2 grams/day of stanols & sterols from your diet.
  • It is best to consume stanols & sterols before or with a meal, but the exact timing isn’t crucial.
  • Stanols & sterols are not the same as dietary fiber, but stanols/sterols and dietary fiber complement each other as part of a holistic approach to lower cholesterol.
  • It is OK to take stanols & sterols along with a statin drug. In fact, this is part of the approach recommended by the NIH Therapeutic Lifestyle Change Program. However, I do not recommend going off of a statin drug and substituting stanols & sterols without the permission of your doctor.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (2)

  • Don Merriman

    |

    Dr. Chaney, What are your thoughts on niacin for cholesterol control? I have a genetic problem with Lp(a) and the only thing that lowers it is niacin. The niacin also affects other blood factors for the better. I discovered niacin from a book, Cholesterol Control Without Diet – The Niacin Solution, written by Dr. William Parsons Jr. He pioneered niacin in the late 50’s at the Mayo Clinic.
    Thanks.

    Reply

    • Dr. Steve Chaney

      |

      Dear Don,

      Niacin can work, but it can also cause liver damage at the dosage required to lower cholesterol. You should take niacin only under the care of a health professional who will monitor you for possible toxicity.

      Dr. Chaney

      Reply

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Latest Article

High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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