Title: Phytosterol Testing in Maine: Uncovering Campesterol and Identifying Hyperabsorbers
Cholesterol management is a key factor in maintaining heart health and longevity -- That's why Lifestyle Medicine Maine is offering Phytosterol Testing. While saturated fat is the predominant driver of our LDL cholesterol (ApoB), dietary cholesterol can also play a role. Recent studies shed light on how dietary protein sources and cholesterol absorption influence overall health outcomes. Phytosterol testing, particularly for compounds like campesterol, can help identify whether individuals are hyperabsorbers of cholesterol—those who absorb cholesterol more readily from their diet, potentially increasing their risk for heart disease. Understanding our cholesterol absorption patterns could lead to more personalized approaches for reducing cardiovascular risk.
The Impact of Protein Sources on Mortality
Studies like those from the U.S. and Japan demonstrate a significant connection between plant and animal protein intake and mortality risks (1)(2)(3). Plant protein intake has been associated with lower all-cause mortality, while high animal protein consumption may increase the risk of specific diseases like heart disease (1)(2)(3). These findings suggest that shifting towards plant-based proteins could positively impact longevity and cardiovascular health (PMIDs: 27479196, 32658243, 31682257).
The Role of Dietary Cholesterol
Eggs and other high-cholesterol foods have long been debated in the context of heart health. Research reveals mixed results, with some individuals, like an 88-year-old man consuming 25 eggs daily, showing normal cholesterol levels, while others experience a significant rise in LDL cholesterol from increased dietary cholesterol (4)(5)(6)(7)(8). These varying responses highlight the complex nature of cholesterol homeostasis, making it crucial to tailor dietary recommendations to individual absorption patterns.
Hyperabsorption of Cholesterol and Cardiovascular Risk
The key to understanding how dietary cholesterol affects your heart health lies in cholesterol homeostasis, which refers to the body’s balance between cholesterol absorption and synthesis. Some people are hyperabsorbers, meaning they take in more cholesterol from their diet, potentially leading to higher serum cholesterol levels and greater heart disease risk (6). Phytosterols—naturally occurring compounds found in plant foods—can help block cholesterol absorption, but their effectiveness may vary based on individual cholesterol absorption rates.
Why Phytosterol Testing Matters
Phytosterol testing, specifically for compounds like campesterol, can determine how much cholesterol you absorb from your diet. This personalized insight can be crucial in optimizing dietary interventions. For those who are hyperabsorbers, increasing the intake of phytosterol-rich foods (like nuts, seeds, and whole grains) may be a helpful strategy. However, individuals who are not hyperabsorbers might not benefit as much from these interventions.
Precision and Personalized Treatment
Given the heterogeneous response to cholesterol in the diet, more precision in treatment is needed. Studies suggest the importance of early, intensive, and individualized management of cardiovascular disease risk, especially for those with higher absorption rates (7). Incorporating phytosterol testing into routine health assessments could pave the way for targeted dietary and medical interventions, leading to more effective cholesterol management and reduced heart disease risk.
How to Interpret These Tests
Each phytosterol test is interpreted by percentile. Those of us below the 20th percentile are considered to be hypo-absorbers while those of us above the 80th percentile are hyper-absorbers.
Hypo-absorbers: dietary cholesterol doesn't effect them much
Hyper-absorbers: dietary cholesterol can make a big impact
Identifying Hypo- and Hyper-Absorbers
Each phytosterol test has a different cutoff. Here at Lifestyle Medicine Maine, we use run our tests through Boston Heart. Here are the percentiles:
Desmosterol
20th percentile: less than 0.8 mg/L
80th percentile: greater than 1.5 mg/L
Lathosterol
20th percentile: less than 0.7 mg/L
80th percentile: greater than 2.7 mg/L
Beta-Sitosterol
20th percentile: less than 1.4 mg/L
80th percentile: greater than 3.2 mg/L
Campesterol
20th percentile: less than 2.0 mg/L
80th percentile: greater than 4.7 mg/L
What do I think?
Phytosterol testing is an underutilized tool that can offer invaluable insights into cholesterol absorption, particularly for hyperabsorbers. Coupled with personalized dietary adjustments, this testing can significantly improve cardiovascular health outcomes. If you are concerned about your cholesterol levels or heart disease risk, consider phytosterol testing as part of a comprehensive approach to managing your health. This is something that we are beginning to offer in the Fall of 2024. Join us for the next Live Weight Loss and Wellness Group Program as we optimize our health and wellness. See you there!
References
Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. Song, et al. JAMA Internal Medicine. (2016) https://doi.org/10.1001/jamainternmed.2016.4182
Association Between Plant and Animal Protein Intake and Overall and Cause-Specific Mortality. Huang, et al. JAMA Internal Medicine. (2020) https://doi.org/10.1001/jamainternmed.2020.2790
Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort. Budhthoki, et al. JAMA Internal Medicine. (2019) https://doi.org/10.1001/jamainternmed.2019.2806
Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You? Wang, et al. American Journal of Cardiology. (2018) https://doi.org/10.1016/j.jacc.2018.03.023
Food sources of energy and nutrients among adults in the US: NHANES 2003–2006. O'Neil, et al. Nutrients. (2012) https://doi.org/10.3390/nu4122097
Heterogeneity of cholesterol homeostasis in man. Response to changes in dietary fat quality and cholesterol quantity. McNamara, et al. Journal of Clinical Investigation. (1987) https://doi.org/10.1172/jci113013
Meta-regression analysis of the effects of dietary cholesterol intake on LDL and HDL cholesterol. Vincent, et al. American Journal of Clinical Nutrition. (2019) https://doi.org/10.1093/ajcn/nqy273
Normal plasma cholesterol in an 88-year-old man who eats 25 eggs a day. Mechanisms of adaptation. Kern. New England Journal of Medicine (1991) https://doi.org/10.1056/nejm199103283241306
There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness. Makover, et al. American Journal of Preventative Cardiology. (2022) https://doi.org/10.1016/j.ajpc.2022.100371
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