Phytosterols, Cholesterol Absorption and Healthy Diets

Abstract

The purpose of this review is to outline the emerging role of dietary phytosterols in human health. Dietary saturated fat, cholesterol and fiber are currently emphasized in the reduction of low-density lipoprotein cholesterol levels. However, other dietary components such as phytosterols may have equivalent or even larger effects on circulating cholesterol and need further study with respect to the potential for coronary heart disease risk reduction. Phytosterol effects were not considered in classic fat-exchange clinical trials and may account for some of the differences attributed to the food fats studied. Phytosterols reduce cholesterol absorption while being poorly absorbed themselves and the effects can be studied in human subjects in single-meal tests using stable isotopic tracers. Because phytosterols are insoluble and biologically inactive when purified, careful attention needs to be given to ensuring that commercial supplement products are rendered bioavailable by dissolution in fat or by emulsification. Recent work shows that phytosterols in natural food matrices are also bioactive. The retention of phytosterols during food manufacturing and the use of foods with high phytosterol content may constitute an alternative to the use of supplements.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (2001) 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 285:2486–2497

    Google Scholar 

  2. 2.

    Ostlund RE Jr (2002) Cholesterol absorption. Curr Opin Gastroenterol 18:254–258

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Ostlund RE Jr, Matthews DE (1993) [13C]cholesterol as a tracer for studies of cholesterol metabolism in humans. J Lipid Res 34:1825–1831

    PubMed  CAS  Google Scholar 

  4. 4.

    Miettinen TA, Kesaniemi YA (1989) Cholesterol absorption: regulation of cholesterol synthesis and elimination and within-population variations of serum cholesterol levels. Am J Clin Nutr 49:629–635

    PubMed  CAS  Google Scholar 

  5. 5.

    Bosner MS, Lange LG, Stenson WF, Ostlund RE Jr (1999) Percent cholesterol absorption in normal women and men quantified with dual stable isotopic tracers and negative ion mass spectrometry. J Lipid Res 40:302–308

    PubMed  CAS  Google Scholar 

  6. 6.

    Bosner MS, Ostlund RE Jr, Osofisan O, Grosklos J, Fritschle C, Lange LG (1993) Assessment of percent cholesterol absorption in humans with stable isotopes. J Lipid Res 34:1047–1053

    PubMed  CAS  Google Scholar 

  7. 7.

    Ostlund RE Jr (2004) Phytosterols and cholesterol metabolism. Curr Opin Lipidol 15:37–41

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Spady DK (1999) Reverse cholesterol transport and atherosclerosis regression. Circulation 100:576–578

    PubMed  CAS  Google Scholar 

  9. 9.

    Moreau RA, Whitaker BD, Hicks KB (2002) Phytosterols, phytostanols, and their conjugates in foods: structural diversity, quantitative analysis, and health-promoting uses. Prog Lipid Res 41:457–500

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Ostlund RE Jr (2002) Phytosterols in human nutrition. Ann Rev Nutr 22:533–549

    Article  CAS  Google Scholar 

  11. 11.

    Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R (2003) Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc 78:965–978

    PubMed  CAS  Article  Google Scholar 

  12. 12.

    Jonker D, van der Hoek GD, Glatz JFC, Homan C, Posthumus MA, Katan MB (1985) Combined determination of free, esterified and glycosilated plant sterols in foods. Nutr Rep Int 32:943–951

    CAS  Google Scholar 

  13. 13.

    Moreau RA, Hicks KB (2004) The in vitro hydrolysis of phytosterol conjugates in food matrices by mammalian digestive enzymes. Lipids 39:769–776

    PubMed  CAS  Google Scholar 

  14. 14.

    Ikeda I, Tanaka K, Sugano M, Vahouny GV, Gallo LL (1988) Inhibition of cholesterol absorption in rats by plant sterols. J Lipid Res 29:1573–1582

    PubMed  CAS  Google Scholar 

  15. 15.

    Ikeda I, Tanaka K, Sugano M, Vahouny GV, Gallo LL (1988) Discrimination between cholesterol and sitosterol for absorption in rats. J Lipid Res 29:1583–1591

    PubMed  CAS  Google Scholar 

  16. 16.

    Ikeda I, Tanabe Y, Sugano M (1989) Effects of sitosterol and sitostanol on micellar solubility of cholesterol. J Nutr Sci Vitamin 35:361–369

    CAS  Google Scholar 

  17. 17.

    Armstrong MJ, Carey MC (1987) Thermodynamic and molecular determinants of sterol solubilities in bile salt micelles. J Lipid Res 28:1144–1155

    PubMed  CAS  Google Scholar 

  18. 18.

    Nissinen M, Gylling H, Vuoristo M, Miettinen TA (2002) Micellar distribution of cholesterol and phytosterols after duodenal plant stanol ester infusion. Am J Physiol 282:G1009–G1015

    CAS  Google Scholar 

  19. 19.

    Ostlund RE Jr, McGill JB, Zeng CM, Covey DF, Stearns J, Stenson WF, Spilburg CA (2002) Gastrointestinal absorption and plasma kinetics of soy Delta(5)-phytosterols and phytostanols in humans. Am J Physiol Endocrinol Metab 282:E911–E916

    PubMed  CAS  Google Scholar 

  20. 20.

    Igel M, Giesa U, Lutjohann D, von Bergmann K (2003) Comparison of the intestinal uptake of cholesterol, plant sterols, and stanols in mice. J Lipid Res 44:533–538

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Plat J, Mensink RP (2002) Increased intestinal ABCA1 expression contributes to the decrease in cholesterol absorption after plant stanol consumption. FASEB J 16:1248–1253

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Plat J, Nichols JA, Mensink RP (2005) Plant sterols and stanols: effects on mixed micellar composition and LXR (target gene) activation. J Lipid Res 46:2468–2476

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Field FJ, Born E, Mathur SN (2004) Stanol esters decrease plasma cholesterol independently of intestinal ABC sterol transporters and Niemann-Pick C1-like 1 protein gene expression. J Lipid Res 45:2252–2259

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Ostlund RE Jr, Spilburg CA, Stenson WF (1999) Sitostanol administered in lecithin micelles potently reduces cholesterol absorption in humans. Am J Clin Nutr 70:826–831

    PubMed  CAS  Google Scholar 

  25. 25.

    Lees AM, Mok HYI, Lees RS, McCluskey MA, Grundy SM (1977) Plant sterols as cholesterol-lowering agents: clinical trials in patients with hypercholesterolemia and studies of sterol balance. Atherosclerosis 28:325–338

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Sudhop T, Lutjohann D, Kodal A, Igel M, Tribble DL, Shah S, Perevozskaya I, von Bergmann K (2002) Inhibition of intestinal cholesterol absorption by ezetimibe in humans. Circulation 106:1943–1948

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Plat J, Mensink RP (2002) Effects of plant stanol esters on LDL receptor protein expression and on LDL receptor and HMG-CoA reductase mRNA expression in mononuclear blood cells of healthy men and women. FASEB J 16:258–260

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Gylling H, Miettinen TA (1994) Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholesterolaemic NIDDM patients before and during sitostanol ester-margarine treatment. Diabetologia 37:773–780

    PubMed  CAS  Google Scholar 

  29. 29.

    Jones PJ, Ntanios FY, Vanstone CA, Feng JY, Parsons WE (2000) Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. J Lipid Res 41:697–705

    PubMed  CAS  Google Scholar 

  30. 30.

    Spilburg CA, Goldberg AC, McGill JB, Stenson WF, Racette SB, Bateman J, McPherson TB, Ostlund RE Jr (2003) Fat-free foods supplemented with soy stanol-lecithin powder reduce cholesterol absorption and LDL cholesterol. J Am Diet Assoc 103:577–581

    PubMed  Article  Google Scholar 

  31. 31.

    Shin MJ, Lee JH, Jang Y, Lee-Kim YC, Park E, Kim KM, Chung BC, Chung N (2005) Micellar phytosterols effectively reduce cholesterol absorption at low doses. Ann Nutr Metab 49:346–351

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Devaraj S, Jialal I, Vega-Lopez S (2004) Plant sterol-fortified orange juice effectively lowers cholesterol levels in mildly hypercholesterolemic healthy individuals. Arterioscler Thromb Vasc Biol 24:e25–e28

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Woollett LA, Wang Y, Buckley DD, Yao L, Chin S, Granholm N, Jones PJ, Setchell KD, Tso P, Heubi JE (2006) Micellar solubilisation of cholesterol is essential for absorption in humans. Gut 55:197–204

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Mattson FH, Grundy SM, Crouse JR Jr (1982) Optimizing the effect of plant sterols on cholesterol absorption in man. Am J Clin Nutr 35:697–700

    PubMed  CAS  Google Scholar 

  35. 35.

    McPherson TB, Ostlund RE, Goldberg AC, Bateman JH, Schimmoeller L, Spilburg CA (2005) Phytostanol tablets reduce human LDL-cholesterol. J Pharm Pharmacol 57:889–896

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Goldberg AC, Ostlund RE Jr, Bateman JH, Schimmoeller L, McPherson TB, Spilburg CA (2006) Effect of plant stanol tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs. Am J Cardiol 97:376–379

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Morton GM, Lee SM, Buss DH, Lawrance P (1995) Intakes and major dietary sources of cholesterol and phytosterols in the British diet. J Hum Nutr Diet 8:429–440

    Google Scholar 

  38. 38.

    Ahrens EH Jr, Boucher CA (1978) The composition of a simulated American diet. J Am Diet Assoc 73:613–620

    PubMed  CAS  Google Scholar 

  39. 39.

    Cerqueira MT, Fry MM, Connor WE (1979) The food and nutrient intakes of the Tarahumara Indians of Mexico. Am J Clin Nutr 32:905–915

    PubMed  CAS  Google Scholar 

  40. 40.

    Normen L, Johnsson M, Andersson H, van Gameren Y, Dutta P (1999) Plant sterols in vegetables and fruits commonly consumed in Sweden. Eur J Nutr 38:84–89

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Ostlund RE Jr, Racette SB, Okeke A, Stenson WF (2002) Phytosterols that are naturally present in commercial corn oil significantly reduce cholesterol absorption in humans. Am J Clin Nutr 75:1000–1004

    PubMed  CAS  Google Scholar 

  42. 42.

    Ostlund RE Jr, Racette SB, Stenson WF (2003) Inhibition of cholesterol absorption by phytosterol-replete wheat germ compared with phytosterol-depleted wheat germ. Am J Clin Nutr 77:1385–1389

    PubMed  CAS  Google Scholar 

  43. 43.

    Weihrauch JL, Gardner JM (1978) Sterol content of foods of plant origin. J Am Diet Assoc 73:39–47

    PubMed  CAS  Google Scholar 

  44. 44.

    Ostlund RE Jr, Racette SB, Stenson WF (2002) Effects of trace components of dietary fat on cholesterol metabolism: phytosterols, oxysterols, and squalene. Nutr Rev 60:349–359

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

This work was supported by NIH grant R01-50420. Dr. Ostlund and Washington University have an interest in Lifeline Technologies, Inc., a company providing emulsified phytosterols.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Richard E. Ostlund Jr.

About this article

Cite this article

Ostlund , R.E. Phytosterols, Cholesterol Absorption and Healthy Diets. Lipids 42, 41–45 (2007). https://doi.org/10.1007/s11745-006-3001-9

Download citation

Keywords

  • Cholesterol
  • Cholesterol Absorption
  • Phytosterol
  • Ezetimibe
  • Phytosterol Content