How Low Should Your LDL Go?

by Carole Jackson, Bottom Line Health

“Keep your LDL cholesterol low” is practically a medical mantra now. It’s a greater struggle for some folks than for others — some people are able to achieve a desirable level with little or no effort, while others accomplish it by taking statin drugs. A new tool for lowering LDL emerged about 10 years ago when margarines with plant compounds called phytosterols — known to inhibit absorption of LDL cholesterol in the intestines — started cropping up in supermarkets. Could these be the ideal solution?

Better than Statins?

Phytosterols (as well as phytostanols, a subgroup of phytosterols) exist naturally in some vegetable oils, but in amounts too low to affect our cholesterol levels. Once extracted from these oils, however, they become a food additive or supplement that can deliver quite a cholesterol-lowering punch. Indeed, studies showed that consuming about two to three grams of phytosterols a day (you get this from about four to six tablespoons of the margarine) lowers total cholesterol by up to about 10% and LDL by up to about 14%.

Research had examined the effects of ingesting just two to three grams of phytosterols a day… but what would happen if you doubled or even tripled that intake? It’s known that statin drugs work to only a certain point — they have what’s known as a “leveling off” effect, which means that there is a diminishing effect — doubling the dose won’t double the result. Does this happen with phytosterols, too?

Recently, a Dutch scientist, Ronald Mensink, MSc, PhD, professor of molecular nutrition in the department of human biology at Maastricht University Medical Centre in The Netherlands, conducted a three-week study to answer that question, using the type of phytosterol called phytostanols.

Ninety-three people with mildly elevated LDL cholesterol were divided into four groups — consuming no stanols or three, six or nine grams daily. Results: The more stanols people ate, the lower their LDL dropped. The three-gram group had a 7.4% decrease on average… the six-gram group showed an 11.9% decrease… those consuming nine grams of stanols per day decreased LDL by an average of 17.4%. No adverse effects were found in any of the groups.

But Dr. Mensink urged caution despite the impressive findings — he said that more research is needed before advising any consumption increase, since we don’t yet have data on the long-term safety of consuming higher levels of sterols.

Dr. Rubman’s Advice

When I checked in with Daily Health News medical editor Andrew L. Rubman, ND, he agreed that phytosterols — in the form of supplements or food additives — may be helpful. Echoing Dr. Mensink’s cautionary note, he said…

  • People with high LDL (above 150 mg/dl) can benefit from phytosterol/stanol-fortified foods, whether or not they are taking a statin drug.
  • A good phytosterol supplement, such as EP Phytosterols made by Endurance Products (800-483-2532,, $20 for a bottle of 100 tablets, 450 mg each tablet) may be better yet.
  • Until we have further research, consume no more than two to three grams of phytosterols/stanols per day.
  • Don’t take phytosterol/stanol supplements or fortified foods if you already have low LDL (below 100 mg/dl). Yes, they’re natural, said Dr. Rubman, “but they still have druglike properties that actively interfere with cholesterol uptake, just as some drugs do.”

Dr. Rubman pointed out that having high LDL may not mean your body makes too much — there are other potential causes as well. It’s therefore important to work with a knowledgeable doctor who can treat the source and not just the symptom.


Ronald P. Mensink, MSc, PhD, professor of molecular nutrition, department of human biology, Maastricht University Medical Centre, The Netherlands.

Andrew L. Rubman, ND, founder and medical director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut.