Cholesterol-lowering effect of plant sterols



Plant sterols are plant components that have a chemical structure similar to cholesterol except for the addition of an extra methyl or ethyl group; however, plant sterol absorption in humans is considerably less than that of cholesterol. In fact, plant sterols reduce cholesterol absorption and thus reduce circulating levels of cholesterol. Earlier studies that have tested the efficacy of plant sterols as cholesterol-lowering agents incorporated plant sterols into fat spreads. Later on, plant sterols were added to other food matrices, including juices, nonfat beverages, milk and yogurt, cheese, meat, croissants and muffins, and cereal and chocolate bars. The beneficial physiologic effects of plant sterols could be further enhanced by combining them with other beneficial substances, such as olive and fish oils, fibers, and soy proteins, or with exercise. The addition of plant sterols to the diet is suggested by health experts as a safe and effective way to reduce the risk of coronary heart disease.

References and Recommended Reading

  1. 1.
    Piironen V, Lindsay DG, Miettinen TA, et al.: Plant sterols: biosynthesis, biological function and their importance to human nutrition. J Sci Food Agric 2000, 80:939–966.CrossRefGoogle Scholar
  2. 2.
    Berger A, Jones PJ, Abumweis SS: Plant sterols: factors affecting their efficacy and safety as functional food ingredients. Lipids Health Dis 2004, 3:5.PubMedCrossRefGoogle Scholar
  3. 3.
    Ostlund RE: Phytosterols in human nutrition. Annu Rev Nutr 2002, 22:533–549.PubMedCrossRefGoogle Scholar
  4. 4.
    Ros E: Intestinal absorption of triglyceride and cholesterol. Dietary and pharmacological inhibition to reduce cardiovascular risk. Atherosclerosis 2000, 151:357–379.PubMedCrossRefGoogle Scholar
  5. 5.
    Ostlund RE: Phytosterols and cholesterol metabolism. Curr Opin Lipidol 2004, 15:37–41.PubMedCrossRefGoogle Scholar
  6. 6.
    Hallikainen MA, Sarkkinen ES, Uusitupa MI: Effects of low-fat stanol ester enriched margarines on concentrations of serum carotenoids in subjects with elevated serum cholesterol concentrations. Eur J Clin Nutr 1999, 53:966–969.PubMedCrossRefGoogle Scholar
  7. 7.
    Jones PJ, Ntanios FY, Raeini-Sarjaz M, Vanstone CA: Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men. Am J Clin Nutr 1999, 69:1144–1150.PubMedGoogle Scholar
  8. 8.
    Miettinen TA, Puska P, Gylling H, et al.: Reduction of serum-cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N Engl J Med 1995, 333:1308–1312.PubMedCrossRefGoogle Scholar
  9. 9.
    Doornbos AM, Meynen EM, Duchateau G, et al.: Intake occasion affects the serum cholesterol lowering of a plant sterol-enriched single-dose yoghurt drink in mildly hypercholesterolaemic subjects. Eur J Clin Nutr 2006, 60:325–333.PubMedCrossRefGoogle Scholar
  10. 10.
    Quilez J, Rafecas M, Brufau G, et al.: Bakery products enriched with phytosterol esters, alpha-tocopherol and beta-carotene decrease plasma LDL-cholesterol and maintain plasma beta-carotene concentrations in normocholesterolemic men and women. J Nutr 2003, 133:3103–3109.PubMedGoogle Scholar
  11. 11.
    Devaraj S, Autret BC, Jialal I: Reduced-calorie orange juice beverage with plant sterols lowers C-reactive protein concentrations and improves the lipid profile in human volunteers. Am J Clin Nutr 2006, 84:756–761.PubMedGoogle Scholar
  12. 12.
    Yoshida M, Vanstone CA, Parsons WA, et al.: Effect of plant sterols and glucomannan on lipids in individuals with and without type II diabetes. Eur J Clin Nutr 2006, 60:529–537.PubMedCrossRefGoogle Scholar
  13. 13.
    Jones PJ, Vanstone CA, Raeini-Sarjaz M, St-Onge MP: Phytosterols in low-and nonfat beverages as part of a controlled diet fail to lower plasma lipid levels. J Lipid Res 2003, 44:1713–1719.PubMedCrossRefGoogle Scholar
  14. 14.
    Polagruto JA, Wang-Polagruto JF, Braun MM, et al.: Cocoa flavanol-enriched snack bars containing phytosterols effectively lower total and low-density lipoprotein cholesterol levels. J Am Diet Assoc 2006, 106:1804–1813.PubMedCrossRefGoogle Scholar
  15. 15.
    AbuMweis SS, Barake R, Jones PJ: Plant sterols/stanols as cholesterol lowering agents: a meta-analysis of randomized controlled trials. Food Nutr Res 2008 (in press).Google Scholar
  16. 16.
    Plat J, van Onselen EN, van Heugten MM, Mensink RP: Effects on serum lipids, lipoproteins and fat soluble antioxidant concentrations of consumption frequency of margarines and shortenings enriched with plant stanol esters. Eur J Clin Nutr 2000, 54:671–677.PubMedCrossRefGoogle Scholar
  17. 17.
    AbuMweis SS, Vanstone CA, Ebine N, et al.: Intake of a single morning dose of standard and novel plant sterol preparations for 4 weeks does not dramatically affect plasma lipid concentrations in humans. J Nutr 2006, 136:1012–1016.PubMedGoogle Scholar
  18. 18.
    Matvienko OA, Lewis DS, Swanson M, et al.: A single daily dose of soybean phytosterols in ground beef decreases serum total cholesterol and LDL cholesterol in young, mildly hypercholesterolemic men. Am J Clin Nutr 2002, 76:57–64.PubMedGoogle Scholar
  19. 19.
    AbuMweis SS, Vanstone CA, Lichtenstein AH, Jones PJ: Plant sterol consumption frequency affects plasma lipid levels and cholesterol kinetics in humans. Eur J Clin Nutr 2008 (in press).Google Scholar
  20. 20.
    Rozner S, Garti N: The activity and absorption relationship of cholesterol and phytosterols. Colloid Surf A-Physicochem Eng Asp 2006, 282:435–456.CrossRefGoogle Scholar
  21. 21.
    Beaumier-Gallon G, Dubois C, Senft M, et al.: Dietary cholesterol is secreted in intestinally derived chylomicrons during several subsequent postprandial phases in healthy humans. Am J Clin Nutr 2001, 73:870–877.PubMedGoogle Scholar
  22. 22.
    Jenkins DJ, Kendall CW, Marchie A, et al.: The effect of combining plant sterols, soy protein, viscous fibers, and almonds in treating hypercholesterolemia. Metab Clin Exp 2003, 52:1478–1483.PubMedGoogle Scholar
  23. 23.
    Shrestha S, Volek JS, Udani J, et al.: A combination therapy including psyllium and plant sterols lowers LDL cholesterol by modifying lipoprotein metabolism in hypercholesterolemic individuals. J Nutr 2006, 136:2492–2497.PubMedGoogle Scholar
  24. 24.
    Chan YM, Demonty I, Pelled D, Jones PJ: Olive oil containing olive oil fatty acid esters of plant sterols and dietary diacylglycerol reduces low-density lipoprotein cholesterol and decreases the tendency for peroxidation in hypercholesterolaemic subjects. Br J Nutr 2006, 98:563–570.CrossRefGoogle Scholar
  25. 25.
    Demonty I, Chan YM, Pelled D, Jones PJ: Fish-oil esters of plant sterols improve the lipid profile of dyslipidemic subjects more than do fish-oil or sunflower oil esters of plant sterols. Am J Clin Nutr 2006, 84:1534–1542.PubMedGoogle Scholar
  26. 26.
    Jones PJ, Demonty I, Chan YM, et al.: Fish-oil esters of plant sterols differ from vegetable-oil sterol esters in triglycerides lowering, carotenoid bioavailability and impact on plasminogen activator inhibitor-1 (PAI-1) concentrations in hypercholesterolemic subjects. Lipids Health Dis 2007, 6:28.PubMedCrossRefGoogle Scholar
  27. 27.
    Varady KA, Ebine N, Vanstone CA, et al.: Plant sterols and endurance training combine to favorably alter plasma lipid profiles in previously sedentary hypercholes terolemic adults after 8 wk. Am J Clin Nutr 2004, 80:1159–1166.PubMedGoogle Scholar
  28. 28.
    Sierksma A, Weststrate JA, Meijer GW: Spreads enriched with plant sterols, either esterified 4,4-dimethylsterols or free 4-desmethylsterols, and plasma total-and LDL-cholesterol concentrations. Br J Nutr 1999, 82:273–282.PubMedGoogle Scholar
  29. 29.
    Jakulj L, Trip MD, Sudhop T, et al.: Inhibition of cholesterol absorption by the combination of dietary plant sterols and ezetimibe: effects on plasma lipid levels. J Lipid Res 2005, 46:2692–2698.PubMedCrossRefGoogle Scholar
  30. 30.
    Thomsen AB, Hansen HB, Christiansen C, et al.: Effect of free plant sterols in low-fat milk on serum lipid profile in hypercholesterolemic subjects. Eur J Clin Nutr 2004, 58:860–870.PubMedCrossRefGoogle Scholar
  31. 31.
    Kesaniemi YA, Ehnholm C, Miettinen TA: Intestinal cholesterol absorption efficiency in man is related to apoprotein E phenotype. J Clin Invest 1987, 80:578–581.PubMedCrossRefGoogle Scholar
  32. 32.
    Vanhanen HT, Blomqvist S, Ehnholm C, et al.: Serum-cholesterol, cholesterol precursors, and plant sterols in hypercholesterolemic subjects with different Apo E phenotypes during dietary sitostanol ester treatment. J Lipid Res 1993, 34:1535–1544.PubMedGoogle Scholar
  33. 33.
    Hallikainen MA, Sarkkinen ES, Uusitupa MI: Plant stanol esters affect serum cholesterol concentrations of hypercholesterolemic men and women in a dose-dependent manner. J Nutr 2000, 130:767–776.PubMedGoogle Scholar
  34. 34.
    Plat J, Mensink RP: Vegetable oil based versus wood based stanol ester mixtures: effects on serum lipids and hemostatic factors in non-hypercholesterolemic subjects. Atherosclerosis 2000, 148:101–112.PubMedCrossRefGoogle Scholar
  35. 35.
    Plat J, Mensink RP: Relationship of genetic variation in genes encoding apolipoprotein A-IV, scavenger receptor BI, HMG-CoA reductase, CETP and apolipoprotein E with cholesterol metabolism and the response to plant stanol ester consumption. Eur J Clin Invest 2002, 32:242–250.PubMedCrossRefGoogle Scholar
  36. 36.
    Rudkowska I, AbuMweis SS, Nicolle C, Jones PJ: Association between non-responsiveness to plant sterol intervention and polymorphisms in cholesterol metabolism genes: a case-control study. Appl Physiol Nutr Metab 2008 (in press).Google Scholar
  37. 37.
    Cohen JC, Pertsemlidis A, Fahmi S, et al.: Multiple rare variants in NPC1L1 associated with reduced sterol absorption and plasma low-density lipoprotein levels. Proc Natl Acad Sci U S A 2006, 103:1810–1815.PubMedCrossRefGoogle Scholar
  38. 38.
    Berge KE, von Bergmann K, Lutjohann D et al.: Heritability of plasma noncholesterol sterols and relationship to DNA sequence polymorphism in ABCG5 and ABCG8. J Lipid Res 2002, 43:486–494.PubMedGoogle Scholar
  39. 39.
    Plat J, Bragt MC, Mensink RP: Common sequence variations in ABCG8 are related to plant sterol metabolism in healthy volunteers. J Lipid Res 2005, 46:68–75.PubMedCrossRefGoogle Scholar
  40. 40.
    Mackay J, Mensah GA: The Atlas of Heart Disease and Stroke. Geneva: World Health Organization; 2004:112.Google Scholar
  41. 41.
    Law MR, Wald NJ, Thompson SG: By how much and how quickly does reduction in serum-cholesterol concentration lower risk of ischemic-heart-disease. BMJ 1994, 308:367–373.PubMedGoogle Scholar
  42. 42.
    Vorlat A, Conraads VM, Vrints CJ: Regular use of margarine-containing stanol/sterol esters reduces total and low-density lipoprotein (LDL) cholesterol and allows reduction of statin therapy after cardiac transplantation: Preliminary observations. J Heart Lung Transplant 2003, 22:1059–1062.PubMedCrossRefGoogle Scholar
  43. 43.
    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, 78:965–978.PubMedCrossRefGoogle Scholar
  44. 44.
    Noakes M, Clifton P, Ntanios F, et al.: An increase in dietary carotenoids when consuming plant sterols or stanols is effective in maintaining plasma carotenoid concentrations. Am J Clin Nutr 2002, 75:79–86.PubMedGoogle Scholar
  45. 45.
    Tuomilehto J, Tikkanen MJ, Högström P, et al.: Safety assessment of common foods enriched with natural nonesterified plant sterols. Eur J Clin Nutr 2008 Feb 13 (Epub ahead of print).Google Scholar
  46. 46.
    Chan YM, Varady KA, Lin YG, et al.: Plasma concentrations of plant sterols: physiology and relationship with coronary heart disease. Nutr Rev 2006, 64:385–402.PubMedCrossRefGoogle Scholar
  47. 47.
    Houweling AH, Vanstone CA, Trautwein EA, et al.: Baseline plasma plant sterol concentrations do not predict changes in serum lipids, C-reactive protein (CRP) and plasma plant sterols following intake of a plant sterol-enriched food. Eur J Clin Nutr 2007 Dec 12 (Epub ahead of print).Google Scholar
  48. 48.
    Cleeman JI, Grundy SM, Becker D, et al.: Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2497.CrossRefGoogle Scholar
  49. 49.
    Lichtenstein AH, Deckelbaum RJ: Stanol/sterol ester-containing foods and blood cholesterol levels—A Statement for Healthcare Professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation 2001, 103:1177–1179.PubMedGoogle Scholar
  50. 50.
    International Atherosclerosis Society: Harmonized clinical guidelines on the prevention of atherosclerotic vascular disease. In International Atherosclerosis Society. Hamburg, Germany: 2003:1–28.Google Scholar
  51. 51.
    Poli A, Marangoni F, Paoletti R, et al.: Nonpharmacological control of plasma cholesterol levels. Nutr Metab Cardiovasc Dis 2008, 18:S1–S16.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Richardson Centre for Functional Foods and NutraceuticalsUniversity of ManitobaWinnipegCanada

Personalised recommendations