Ask A Cardiothoracic Surgeon: Phytosterols Can Clog Your Arteries Just Like Cholesterol!

Added: 2026-05-28

[00:00:01]Hi everyone. I'm Dr. Michael Richmond, double board certified cardiothoracic surgeon. So today's topic I think you're going to find very interesting because it's something you probably have never heard of. And we're going to be talking about phytosteriles which are plant steriles and how they can clog your arteries just like cholesterol in certain people. So before we start, I want to give you some important facts about cardiovascular disease that I've mentioned before, but it's worth repeating. So cardiovascular disease continues to be an epidemic and is responsible for more than half of the deaths in the United States. Each day more than 2,600 Americans die from cardiovascular disease and approximately 80 million Americans are affected by cardiovascular disease. More than 150 million traditional cholesterol panels are performed annually. And despite the increase in cholesterol testing, the number of Americans affected with cardiovascular disease continues to rise. And I also discussed this. It's because we're not testing properly.

[00:01:04]Abnormal lipids, also known as dysipidemia, is a wellestablished uh strongest independent predictor of cardiovascular morbidity and mortality.

[00:01:14]And there have been multiple large outcome trials that have consistently shown that lowering your bad cholesterol or your LDL cholesterol or your lipoproteins reduces morbidity and mortality associated with coronary artery disease. And as the data continues to accumulate, the notion that lower is better has uniformly been supported. So it's with this background that I'm going to discuss today's topic.

[00:01:41]And like I said, very few people know about and understand it. And that is that non-colesterol steriles, which are known as phytosteriles, can cause atherosclerosis or block the arteries.

[00:01:54]Plant-based diets all contain high amounts of these phytosteriles. And my goal today is to make people aware that in some situations, steriles other than cholesterol can cause atherosclerosis.

[00:02:08]So let's start with some definitions first. So cholesterol is a sterile.

[00:02:14]Anything that ends in O is a sterile.

[00:02:16]The most notable sterile in humans obviously is cholesterol and it's acquired both by dietary. 20% of your diet of your cholesterol comes from your diet and 80% is made in your body endogenously. Cholesterol is essential for human life and is required for cellular membrane integrity and function as well as bile acid, steroid and vitamin D synthesis.

[00:02:42]We make far more cholesterol in our body anywhere between 800 to 1,200 milligrams daily and you ingest anywhere between 200 to 400 milligrams daily. The liver and small intestine make about 80% of the cholesterol uh in your body and every cell is capable of making its own cholesterol. The hallmark of atherosclerosis is the presence of cholesterol laden macroofagages called foam cells inside the artery wall and that's what forms a cholesterol plaque or blockage. The cholesterol as we talked about is driven into the wall by these lipoprotein particles and LDLP make up 90 to 95% of the circulating particles in the bloodstream. In contrast, there are over 40 non-colesterol steriles which are major components of plants, yeasts, fungi and shellfish present in the human diet. The most prevalent plant sterile or phytosterile something called cigtosterol. The second is campest and there's also stigmas and they're all present in the human diet in amounts equal to cholesterol and are all similarly absorbed in the small intestine. Phytosteriles are also present in nuts and seeds. So obviously vegetarians and humans who eat plant-based diets consume larger amounts of phytosteriles.

[00:04:05]Now all of these steriles with the exception of cholesterol are collectively referred to as non- cholesterol steriles or phytosteriles and unlike cholesterol none of them serve any physiologic function in human beings and phytosteriles call occur in human blood in concentrations usually less than 0.5% that of cholesterol.

[00:04:29]Cytosterol is the most ubiquitous and represents 80% of all non- cholesterol steroids in the diet and you can buy that in Amazon or in health food stores.

[00:04:38]Now, why do people do that? Well, because as far back as the 1950s, researchers noted that oral ingestion of large amounts of these plant steriles resulted in reduced cholesterol levels.

[00:04:51]And today, numerous phytosterile products are commercially available and used to lower cholesterol levels. Like I just said, you can buy them anywhere. So now you're thinking to yourself, "This sounds great. I want to take phytosteriles." Here's the problem. In 1974, first two patients were described as having nodules in their tendons called tendons and were noted to have high elevated cytool levels in their bloodstream. Now since that time several studies have shown patients having premature atherosclerosis and high cytosterol levels not cholesterol levels and this led to a new disease called phytosterolene anemia or phytosterile anemia really. So in some people high levels of plant steriles in the diet can cause high blood levels and lead to premature atherosclerosis.

[00:05:43]So, in most humans, we absorb about 50% of all steriles in the intestine. But some people are what's called hyperabsorbers and can absorb 60 to 80% of ingested steriles. And I'm not going to go through the physiology explaining exactly why they are bad um because it's too complex. But here are the takeaways from what I'm saying today. One, all steriles are artery clogging or atherogenic if they're present in high amounts in the bloodstream and they accumulate in the artery wall. Two, cholesterol is essential for human life and if present in high amounts is the main cause of atherosclerosis or blocking of the arteries. Three, the hallmark of atherosclerosis is the presence of cholesterol laden macroofagages called foam cells inside the artery wall. And four, non-colesterol steroids, which are phytosterile, serve no physiologic function in humans. Okay? And they're acquired solely from foods that we ingest. So with that, I hope you learned something today. I know it's kind of complicated, but thank you so much for listening.