Fecal Excretion

The only route of significant cholesterol excretion is through fecal excretion of neutral sterols. The combination of unabsorbed biliary and dietary cholesterol accounts for the total neutral sterol output and under most conditions is 750-850 mg per day. Dietary patterns or drugs that interfere with intestinal cholesterol absorption result in increased fecal neutral steroid excretion. In the colon, intestinal bacteria are able to metabolize cholesterol to a variety of neutral steroids as well as to nonsteroid end products. Some studies have suggested that the intestinal metabolism of cholesterol by bacteria, which can be altered by diet and drugs, can influence endogenous cholesterol metabolism as well as plasma cholesterol levels. What these relationships may be and the mechanisms involved have not been defined.

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