Disclaimer: This blog post is sponsored by the International Plant Sterols and Stanols Association (IPSSA). All opinions and thoughts expressed in this article are my own. I only promote products and services I believe will benefit my readers.
As a cardiovascular dietitian, I am always looking for simple ways to improve my client’s heart health. I take an additive approach to nutrition. When I work with clients, rather than giving you a list of foods you can’t eat, I prefer to start by discussing the foods and nutrients you should add to your diet to protect your heart.
Plant sterols and stanols, collectively known as phytosterols, are a simple addition to any heart-healthy lifestyle. In case you haven’t heard of them, sterols and stanols are bioactive compounds found in plants that when taken at certain doses, can help significantly lower LDL “bad” cholesterol in just a few weeks.
However, many of us in the United States have not heard about these powerful compounds for lowering cholesterol. Where can you find plant sterols and how can you use them to improve your cholesterol?
What are plant sterols and stanols?
Plant sterols and stanols are substances naturally found in plants, vegetable oils, roots, and seeds, that have a similar structure to cholesterol. Over 40 different types of sterols and stanols have been identified in a variety of plant-based foods.
While there are different theories as to exactly how sterols work, the cholesterol-lowering benefits are likely due to their chemical structure. When these compounds enter the digestive system, they compete with dietary cholesterol for absorption. This means the body not only absorbs less cholesterol from your diet, it is also forced to excrete existing cholesterol, decreasing the amount of total cholesterol in your body.
Plant sterols and stanols, in addition to other beneficial nutrients in plants, are one of the reasons why plant-based foods are consistently at the top of the list of a heart-healthy diet.
Plant sterols for cholesterol
Research has found that for every 1% reduction in LDL cholesterol, there is a 1% reduction in the risk of cardiovascular disease (CVD). Therefore if you are concerned about your CVD risk, lowering LDL should be a main priority.
The effectiveness of plant sterols and stanols for lowering LDL cholesterol is supported by over 200 clinical studies, meaning they have been extensively evaluated for their benefits for heart health. One meta-analysis of over 41 studies demonstrated that 2 grams/day of plant sterols and stanols decreased cholesterol by 10%.
Other research has found a cumulative effect of sterols and stanols when combined with other lifestyle strategies. In this study when sterols were combined with fiber, soy protein, and nuts this resulted in a 10-30% reduction in LDL cholesterol. It is estimated that lowering cholesterol by this much would result in a 21% decreased risk of CVD, a powerful effect.
Sterols and stanols can also be used alongside other treatments for high cholesterol. Pairing sterols and statin therapy may provide additional benefits. A 2017 study found that combining 2 grams of sterols with statins decreased LDL cholesterol by 10% more than just one therapy alone.
Emerging research has found additional benefits for sterols and diabetes, obesity, chronic kidney disease, and high blood pressure, although these have not been as extensively evaluated as cholesterol management.
Plant sterols and stanols have a strong safety record with one notable exception. There is a rare genetic condition called phytosterolemia, also known as sitosterolemia, where the body absorbs too many sterols, increasing the risk of CVD. Generally, people with this genetic condition already follow a modified diet, therefore it is unlikely they would be exposed to too many sterols.
Based on the available research, plant sterols are a simple addition to any cholesterol-lowering strategy. But, where can you find them and how much do you need?
Foods with plant sterols and stanols
As I mentioned, plant-based foods, particularly oils and nuts, are a natural source of sterols and stanols. A few foods that are good sources include:
- Pumpkin seeds (3.5 oz): 94-265 mg
- Sesame seeds (3.5 oz): 400 mg
- Sunflower seeds (3.5 oz): 176-322 mg
- Pistachios (3.5 oz): 279-297 mg
- Sesame oil (1 tsp): 118 mg
- Sunflower oil (1 tsp): 60 mg
- Olive oil (1 tsp): 30 mg
The average daily intake of sterols and stanols from food for most people is estimated to be 100-400 mg/day. Those who follow a plant-based diet may consume slightly more, but not enough to reach a therapeutic dose to lower cholesterol.
The recommended therapeutic dose of sterols and stanols as recommended by the American Heart Association is 2 grams per day. There is no additional benefit to taking more than 3 grams per day. Unfortunately, while eating sterol-rich foods is beneficial, it is difficult to get enough to lower cholesterol from food alone.
Therefore in many countries across the world, plant sterols and stanols are widely used in fortified foods or as dietary supplements. They are frequently added to dairy products, drinkable yogurts, and spreadable margarine.
Bottom Line
High LDL cholesterol remains a major risk factor for heart disease. That’s why lowering LDL levels is a big focus in my practice as a cardiovascular dietitian. I want to offer simple, yet effective solutions for lowering your LDL and improving your health. A diet rich in fruits and veggies is a great way to start, which naturally provides sterols and stanols.
The evidence to support the use of sterols and stanols is so strong that numerous global regulatory bodies have allowed them as ingredients added to foods and dietary supplements, with claims about their cholesterol-lowering efficacy.
To learn more about the benefits of sterols and stanols for lowering cholesterol, visit the International Plant Sterols and Stanols Association’s website. This organization is made up of leading international companies, working together to educate the public about the benefits of integrating plant sterols and stanols into their daily diet to help reduce blood LDL cholesterol.
References:
- Gylling H, Plat J, Turley S, et al. Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Atherosclerosis. 2014;232(2):346-360.
- Nissinen M, Gylling H, Vuoristo M, Miettinen TA. Micellar distribution of cholesterol and phytosterols after duodenal plant stanol ester infusion. Am J Physiol Gastrointest Liver Physiol. 2002;282(6):G1009-15.
- Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: Executive summary: A report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;73(24):3168-3209.
- Abumweis SS, Barake R, Jones PJH. Plant sterols/stanols as cholesterol lowering agents: A meta-analysis of randomized controlled trials. Food Nutr Res. 2008;52. doi:10.3402/fnr.v52i0.1811
- Katan MB, Grundy SM, Jones P, et al. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc. 2003;78(8):965-978.
- Jenkins DJA, Kendall CWC, Faulkner DA, et al. Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. Am J Clin Nutr. 2006;83(3):582-591.
- Gomes GB, Zazula AD, Shigueoka LS, et al. A randomized open-label trial to assess the effect of plant sterols associated with ezetimibe in low-density lipoprotein levels in patients with coronary artery disease on statin therapy. J Med Food. 2017;20(1):30-36.
- Wojda A, Janczy A, Małgorzewicz S. Mediterranean, vegetarian and vegan diets as practical outtakes of EAS and ACC/AHA recommendations for lowering lipid profile. Acta Biochim Pol. 2021;68(1):41-48.
- Helgadottir A, Thorleifsson G, Alexandersson KF, et al. Genetic variability in the absorption of dietary sterols affects the risk of coronary artery disease. Eur Heart J. 2020;41(28):2618-2628.
- Frasinariu O, Serban R, Trandafir LM, et al. The role of phytosterols in nonalcoholic fatty liver disease. Nutrients. 2022;14(11):2187.
- Martins CM, Fonseca FA, Ballus CA, et al. Common sources and composition of phytosterols and their estimated intake by the population in the city of São Paulo, Brazil. Nutrition. 2013;29(6):865-871.
- Jacobson TA, Maki KC, Orringer CE, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 2. J Clin Lipidol. 2015;9(6 Suppl):S1-122.e1.
- Amir Shaghaghi M, Abumweis SS, Jones PJH. Cholesterol-lowering efficacy of plant sterols/stanols provided in capsule and tablet formats: results of a systematic review and meta-analysis. J Acad Nutr Diet. 2013;113(11):1494-1503.