Question: Hi there, I'm a 33 y/o male working to get healthier, including an exercise program, good nutrition for foods (whole foods as much as possible), controlling my blood pressure (through garlic, cayenne, and lifestyle changes) and also vitamins/supplements such as a good multivitamin, antioxidants (both fresh and supplementary), and fish oil. I've been told my cholesterol is a bit higher than the doctor would like (though I'm still awaiting results on my most recent labworks), and I've considered adding phytosterols to my regimen as I'd like to avoid statins if possible. I currently get about 500mg through a dry eye fish oil supplement I'm taking, but could easily increase that to the 2.1g I've seen recommended through additional supplements. That said, it seems while phytosterols do seem to lower cholesterol, long-term studies have been mixed as to safety. Most of the negative studies seem to be in people who have a genetic problem regarding sterols and/or cholesterol in general, but there have been links to excess plasma phytosterols and atherosclerosis (in at least these people). However, studies in healthy people seem to indicate phytosterols can also decrease atherosclerosis and improve cardiovascular risk, so the mixed results confuse me quite a lot, and there doesn't seem to be a definitive study; just lots of contradictions. My question is: should I be supplementing with ~2g of phytosterols, or are there too many unknowns for this to be safe/recommended? I'd like to keep my heart working as efficiently as possible. Thanks!

Hi Dr. XXXXXXX Thanks for the information! I'm not scheduled to get the results of the latest tests until around the 19th of this month at a visit with my primary care physician (they did say they'd call if there was anything too alarming, so I'm taking it as a good sign that they haven't yet). I plan to discuss this with her but would be glad to have a second opinion. If you're talking about the previous results (of a test more than a year ago), I unfortunately don't have that paperwork; it was something she had in my file. Side effects aside (and the possibility of a more gradual dose), is your opinion that phytosterols are relatively safe and likely beneficial, not dangerous? I do have a related follow-up. I recently came across information that high levels of lecithin (and choline which comes from it) when converted by the gut (into TMAO) are now considered possibly detrimental in regards to heart disease risk (whereas before they were thought to be beneficial for fat loss/heart health). For a period of time (multiple years; I can't tell you exactly how many), I was taking a substantial amount of Lecithin (~6g daily including ~2.5g choline). I have since of course stopped and am living much healthier in general, but is it likely I caused any irreversible harm? Thank you much for your help!

Yes, as for the recent tests, I should know around the 19th. I will talk to my doctor about phytosterols and not worry too much about them for the moment - thank you. The lecithin (soy-based, by the way, not egg-based, if it matters) was discontinued some time ago. However, I'm still worried over my fairly heavy dose over a period of several years and whether I could have created a large amount of plaque during that time. I've read conflicting information; some seems to suggest lecithin itself does NOT convert into the damaging compound TMAO (and that other things, like fish, should actually make more, which doesn't seem to hurt heart health), but I can't seem to find clear data on the subject. I even see soy lecithin products are still advertised as being *good* for cardiovascular health. So I don't know what to believe or how much damage could have potentially been caused. Are there any tests where I can find out if I'm okay as far as plaque? In your opinion, is significant damage likely in my case? A few good things to note: I have no chest pain/angina/shortness of breath, can exercise just fine, have a good resting pulse, am bringing down my blood pressure (even though it was a little high) as well as weight, and I also don't have sexual problems (which I think might be a good sign in regards to plaque...). Thanks for helping to ease my anxiety. I'm pretty worried about all this at the moment.

Thank you very much! This eases my concern, and I'll talk to my doctor when I see her. Hopefully the potential benefits of what I was taking help cancel out any TMAO that's made, and you're right, conclusions are still inconclusive and there's nothing I can do now except live as healthily as I can. Instead of panicking, I'll talk to my primary care to sort this out. I appreciate your patience in explaining this stuff to me. =) Warmly, XXXXXXX