Written by: Kelsey Schaffstall, MS, RD, LDN

The Risk of High Cholesterol

According to the CDC, approximately 38% of American adults have high cholesterol (total cholesterol > 200 mg/dL).¹ This is especially concerning because high cholesterol, or ‘hyperlipidemia’, puts a person at risk for heart disease and stroke; two of the leading causes of death in the US.¹ The good news is that although high cholesterol rarely has physical symptoms,¹ cholesterol levels can be easily measured by a simple blood draw. For adults aged 20 and older, the 2018 Cholesterol Clinical Practice Guidelines recommends that cardiovascular risk factors (including blood lipid levels) should be assessed at least every 4-6 years.² If you are interested, you can assess your cardiovascular risk using this free online calculator:

Factors Affecting Cholesterol Levels

There are a number of factors that can influence a person’s cholesterol levels. First, there are nonmodifiable factors including age, gender, and genetics. For example, some people’s genetics cause them to absorb more dietary cholesterol than average while others produce more cholesterol than average. The factors that are within a person’s control include diet and physical activity, which leave room for many effective cholesterol-lowering habits.

Effective Cholesterol-lowering Diet and Lifestyle Changes

One effective strategy developed by the National Institutes of Health to lower cholesterol and promote heart health is known as the TLC diet. TLC, standing for ‘therapeutic lifestyle changes’, offers a number of effective strategies that when practiced together has been shown to lower LDL cholesterol by 20-30%.⁴ These diet and lifestyle changes can also safely be combined with statin therapy, which at the highest intensity can lower cholesterol by at least 50%.⁴ The TLC recommendations are summarized below:

1. Limit saturated fat intake to < 7% of total calories
2. Consume < 200 mg of dietary cholesterol per day
3. Consume 10-25 g of soluble fiber daily
4. Consume at least 2 g of plant sterols or stanols daily
5. Get at least 30 min of moderate-intensity exercise per day

Why Supplement With Plant Sterols and Stanols 

All but one of the dietary recommendations above can be achieved through food alone. That’s because it would be nearly impossible to consume 2 g of plant sterols or stanols without supplementation. Also known as ‘phytosterols’, these naturally occurring plant compounds are able to mimic cholesterol due to similarities in chemical structure, therefore reducing cholesterol absorption from the gut into the bloodstream.⁵ Research has shown that phytosterol intakes of 0.6-3.3 g/day can substantially lower LDL cholesterol by 5-15%.^4,6,7 However, the average dietary phytosterol intake of an omnivorous diet is only 200-400 mg/day and that of a vegan or vegetarian diet is unlikely to exceed 600 mg/day.^5,7 For those who have high cholesterol, enriched food products, and plant sterol/stanol supplements are a convenient way to boost phytosterol intake to therapeutic levels. Although there is sufficient evidence to support the use of phytosterols to lower LDL cholesterol, it is important to note that insufficient evidence exists to support a beneficial relationship between phytosterol intake and cardiovascular disease outcomes. Despite this, supplementing phytosterols can be a safe and effective tool in your toolbox of cholesterol-lowering strategies. If you are concerned about your cholesterol levels or cardiovascular disease risk, work with your doctor and a Registered Dietitian to develop a personalized plan to reduce your risk of heart disease that fits your lifestyle and preferences.

References

1. Prevention CfDCa. Cholesterol. https://www.cdc.gov/cholesterol/index.htm. Published 2021. Accessed October 24, 2021.

2. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082-e1143.

4. U.S. Department of Health and Human Services NIoH, National Heart, Lung, and Blood Institute. Your Guide To Lowering Your Cholesterol With TLC. 2005(06-5235):1-85.

5. Dietitians BTAoU. Stanols and Sterols: Food Fact Sheet. 2018.

6. Jones PJH, Shamloo M, MacKay DS, et al. Progress and perspectives in plant sterol and plant stanol research. Nutr Rev. 2018;76(10):725-746.

7. Trautwein EA, Vermeer MA, Hiemstra H, Ras RT. LDL-Cholesterol Lowering of Plant Sterols and Stanols-Which Factors Influence Their Efficacy? Nutrients. 2018;10(9):1262.