Plant Sterols, Cholesterol and Heart Disease

Cardiovascular disease remains the number one cause of death for both men and women in the United States. Elevated levels of "bad" LDL cholesterol are generally recognized as a major risk factor for heart disease. Diet and lifestyle modification are a good start, but often do not provide sufficient reductions. While a variety of medications are available to help reduce cholesterol cardiovascular disease, there are natural alternatives, such as plant sterols.

Naturally Occurring Plant Sterols

Just as the sterol cholesterol is present in all animal species, plant sterols, also termed phytosterols, are found in all plants. The best dietary sources of plant sterols are vegetables, seeds, and nuts. Plant sterols are a class of compounds with chemical structures similar to cholesterol. Clinical evidence over the past 50 years has consistently demonstrated that consumption of 1-3 grams per day of plant sterols inhibit the intestinal absorption of cholesterol and may produce decreases in LDL cholesterol of up to 8-15%. There are no reported serious side effects or adverse reactions.

Brief Review of Efficacy

Numerous regulatory authorities, cholesterol educational coalitions and independent researchers have reviewed the data of numerous clinical studies and have concluded that dietary intake of plant sterols is effective in lowering LDL cholesterol.

Upon review of existing evidence, the U.S. FDA concluded that "there is significant scientific agreement that plant sterols/stanols reduce total and LDL cholesterol levels." The FDA authorized a health claim describing the relationship between dietary intake of plant sterols and reduced risk of heart disease. That health claim states that "Foods containing at least 0.4 grams per serving of plant sterols, eaten twice a day with meals for a daily total intake of at least 0.8 grams, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease."

In December 2010, the FDA proposed changes to the claim based on a review of the current scientific research, which include increasing the minimum amount per reference amount customarily consumed (0.5 g free sterol equivalents) required for a product to bear the claim, as well as increasing the target daily intake to 2 g/day (for more information, see Resources).

Foods Enriched with Plant Sterols

Plant sterols have been added to a variety of food products worldwide including margarine, salad dressings, yogurt, and others. Most recently, an innovation by Cargill has allowed plant sterols to be added, with no adverse impact on taste or texture, in such foods as orange juice, cheese and dairy substitutes.

Foods with added plant sterols have demonstrated their efficacy in lowering cholesterol in clinical trials. For example, researchers at the University of California, Davis, gave study subjects 1 gram of plant sterol in 8 ounces of orange juice twice daily for an eight-week period. Subjects included both men and women, with normal and borderline high total cholesterol. Total cholesterol was reduced by approximately 8 percent and LDL-C fell by almost 13 percent.

Conclusions

The need for cholesterol reduction is clear and visible--an estimated 102 million American adults (nearly half the adults in the US), have been classified as having borderline-high or higher total blood cholesterol concentrations (AHA, 2011). The safety and efficacy of plant sterols have been well established. The availability of foods enriched with plant sterols proves to be an effective, safe and convenient way to improve LDL cholesterol levels and reduce the risk of heart disease.