High cholesterol is a common problem in the US, with roughly 38% of the US adult population suffering from the condition. Healthcare providers often prescribe people the same drugs to manage their symptoms, but while these medicines can help some patients control their cholesterol levels, they don’t work for everyone, because we don’t all metabolize cholesterol in the same way.
If you are a cholesterol hyperabsorber, L. Reuteri NCIMB 30242 probiotics may help to balance your cholesterol levels – here’s how.
If you're already taking L. Reuteri NCIMB 30242 or want to start, head on over to this post:
Disclaimer: This post is for informational purposes only. Please discuss your medications with your doctor.
Why A Lipid Panel & Cholesterol Test Are Not Enough
If you have high cholesterol, your doctor will probably order the standard blood work. Most people will only be tested with a lipid panel, which measures your levels of certain fats in the blood (triglycerides and total, HDL, and LDL cholesterol) (R).
Scientific studies reveal that there are two main categories of people: those who produce too much cholesterol, and those who absorb more than they need in the gut. Finding out which one you are can make a world of a difference when it comes to treatment (R).
According to one study, people with high cholesterol absorption are more likely to have heart disease despite similar HDL and LDL cholesterol levels (R).
A lipid panel doesn’t tell you your absorption status. However, there is a simple blood test that can tell your doctor which group you belong to: the sterols test (R).
What Are Sterols?
Sterols are a family of small fatty molecules humans and plants produce. The main sterol in animals and humans is cholesterol, while plants abound in plant sterols (phytosterols) (R).
The typical diet contains similar amounts of cholesterol from animal foods and plant sterols from vegetables and fruits. Yet, the human body values cholesterol more, while mostly discarding plant sterols. When you eat an omnivorous meal, cells in your gut will absorb about 50% of cholesterol and only 5% of plant sterols (R).
Cholesterol has a bad reputation, but it’s essential to health. Our body uses it to build all cells in the body, tissues, sex hormones, vitamin D, and bile (R).
On the other hand, the body has no use for plant sterols. Moreover, plant sterols appear to be toxic at lower levels than cholesterol, according to some studies (R, R, R). That’s why nobody had paid much attention to them, until recently. That is, until researchers realized that sterols are key blood markers of cholesterol absorption!
Bear with the science: after a meal, cells in your gut take in plant sterols and cholesterol at the same time. Since cholesterol can be stored or used, as well as produced in the liver, we can’t know how much was absorbed from the gut based on its blood levels. However, all absorbed plant sterols are left to float in the bloodstream (R).
Therefore, the amount of plant sterols you have in your blood directly reflects how much cholesterol you absorb (R).
Are You a Cholesterol Hyperabsorber?
Sterols testing measures the following markers that will tell you how much cholesterol you absorb on a daily basis:
If your levels of these markers are high, you are a hyperabsorber. About 25% of people fall into this category. They usually absorb lots of cholesterol and produce little, don’t respond to standard statins drug therapy, and are at the highest risk of heart disease complications (R).
Whereas most people absorb 50% of cholesterol, hyperabsorbers take up 60-80% and hypoabsorbers only about 20-30% (R).
If your desmosterol or lathosterol are high, you are likely a hypersynthesizer.
Sterols Science, Genetics & Health Implications
Intestinal cells have transporters (labeled NPC1L1) that act as a generous host--they take sterols from food to the inside of cells. But intestinal cells also have transporters that work as bouncers, which can kick sterols--especially plant sterols--back out soon after they enter (ABCG5 and ABCG8). Liver cells have the same transporters to remove sterols from the body with bile (R).
To continue this metaphor, everyone is invited to the party, but only a select few sterols get to stay.
Plus, cells have a way of transforming sterols to make them easier to move into the blood (called esterification), sort of like a VIP pass. Intestinal cells that give away this pass use an enzyme called ACAT (acyl-cholesterol acyltransferase) (R).
Microbiome’s L. Reuteri 30242 strain works, in part, by taking this VIP pass away from cholesterol-carrying bile (via activating an enzyme called bile salt hydrolase). In turn, more bile packed with cholesterol, sterols, and other fats is removed from the body (R, R, R).
The amount of sterols that will reach the blood depend on all these factors, which often have a genetic basis. For example, you may have a more active sterols host (NPC1L1) or a lazy bouncer (ABCG5 and ABCG8). The latter has been linked with high cholesterol absorption and heart disease. Other genetic factors, like your APOE genotype, can also play in (R, R, R, R, R).
Where Can You Get Sterols Testing??
Although scientists have demonstrated that sterols testing can go a long way in individualizing therapy, it’s still not commonly ordered. Only a few labs run this test, like Boston Heart’s Cholesterol Balance Test and Mayo Clinic Laboratories. In turn, many people may be prescribed drugs that work against their physiology: statins (R, R).
Statin Dangers for Cholesterol Hyperabsorbers
Exactly why are statins alone bad for hyperabsorbers?
The answer ties into how statins work. Statins block an enzyme (called HMG-CoA reductase) responsible for producing cholesterol (R).
If the reason why your cholesterol is high is that you are absorbing too much and producing too little, then it becomes obvious that prescribing statins is a bad idea. To make matters worse, the body tries to compensate by increasing cholesterol absorption, which accomplishes the exact opposite of what hyperabsobers need (R).
In a subgroup of 868 patients included in a larger clinical trial, a statin called simvastatin increased heart disease complications in hyperabsorbers. The more cholesterol patients absorbed and the less cholesterol they produced, the more complications they suffered. Meanwhile, hypoabsorbers—aka low absorbers— responded well to statins and experienced fewer complications (R, R).
What Are The Potential Benefits Of L. Reuteri NCIMB 30242 For Cholesterol Management In Hyperabsorbers?
So, what should doctors be prescribing to hyperabsorbers? The typical answer is Zetia (ezetimibe), a pharmaceutical that lowers cholesterol absorption. People who don’t respond to high doses of statins are usually additionally put on Zetia (R).
Adding Zetia to statin therapy helped lower the plant sterol sitosterol and LDL cholesterol in one trial of 197 heart disease patients after 12 weeks. However, hyperabsorbers (with high sitosterol levels) were still described as poor responders to aggressive cholesterol-lowering drug therapies in this study (R).
Some studies also suggest that Microbiome’s strain of Lactobacillus Reuteri (NCIMB 30242) may be a good supplement choice for supporting cholesterol balance in hyperabsorbers (R). If you’re not responding to statins, you may talk to your care provider about trying Lactobacillus reuteri probiotics.
In a placebo-controlled clinical trial of 127 people, L. Reuteri NCIMB 30242 capsules taken over 9 weeks decreased three plant sterols in the blood that act as absorption markers (R):
- Campesterol by 41.5%
- Sitosterol by 34.2%, and
- Stigmasterol by 40.7%
L. Reuteri has yet to be further tested in larger clinical trials.
Nonetheless, existing studies are promising. Importantly, L. Reuteri is a natural compound and one of the few probiotics designated GRAS (Generally Recognized as Safe) status by the FDA. It also has other health benefits (like supporting gut health, vitamin D levels, immune balance, and good digestion).
Given its good safety profile and the promising possible benefits of L. Reuteri for maintaining normal cholesterol levels, physicians are now trialing L. Reuteri for their patients who are hyperabsorbers. This approach rests on clinical judgment and experience.
Every fourth person has high cholesterol due to increased absorption in the gut as is classified as a hyperabsorber.
The health of hyperabsorbers can worsen on typical cholesterol-lowering drugs like statins. Sterols testing can help your doctor determine if you are a hyperabsorber, so you can get adequate diagnosis and treatment such as L. Reuteri NCIMB 30242.
Can probiotics lower your cholesterol? Not all probiotics, but there is evidence that Lactobacillus Reuteri probiotics may help hyperabsorbers since it may support cholesterol balance,possibly by helping lower cholesterol absorption,while aiding gut health.
You can buy probiotics with L. Reuteri here.