Does Zetia Block Absorption of Healthy Fats from Walnuts?
No, Zetia (ezetimibe) does not block the absorption of healthy fats from walnuts or other foods—it specifically targets only cholesterol absorption through a highly selective mechanism. 1
Mechanism of Ezetimibe's Selectivity
Ezetimibe works by targeting the Niemann-Pick C1-Like 1 (NPC1L1) protein at the brush border of the small intestine, which specifically blocks cholesterol uptake into enterocytes without affecting other nutrients. 1 This highly selective mechanism distinguishes ezetimibe from other intestinally-acting lipid-lowering agents like bile acid sequestrants, which can interfere with absorption of fat-soluble vitamins and other medications. 1
What Ezetimibe Does NOT Block
Triglycerides and dietary fats: Ezetimibe does not affect the absorption of triglycerides or dietary fats, including the healthy omega-3 fatty acids found in walnuts. 2, 3, 4
Fat-soluble vitamins: Unlike bile acid sequestrants, ezetimibe does not interfere with absorption of vitamins A, D, E, and K. 2, 4
Bile acids: The absorption of bile acids remains unaffected by ezetimibe therapy. 2, 4
Clinical Implications for Walnut Consumption
You can continue eating walnuts and other nuts while taking ezetimibe without concern about reduced absorption of their beneficial fats. 2, 4 Walnuts contain alpha-linolenic acid (a plant-based omega-3 fatty acid), which is absorbed normally during ezetimibe therapy. 5 In fact, dietary recommendations for patients on lipid-lowering therapy specifically encourage consumption of tree nuts, including walnuts, as part of a Mediterranean-style diet. 5
How Ezetimibe Actually Works
Ezetimibe inhibits approximately 54-58% of cholesterol absorption by binding to NPC1L1, keeping cholesterol in the intestinal lumen for excretion. 2 This affects only cholesterol from both dietary sources (like eggs or meat) and biliary sources (cholesterol secreted by your liver into bile), not the fatty acids or triglycerides from foods like walnuts. 2, 3