Cholesterol lowering and plant sterols

A well-established and large body of scientific evidence has proven that plant sterol enriched foods significantly lower LDL-cholesterol.

Robust scientific evidence supports the cholesterol lowering efficacy of plant sterol enriched foods, with over 40 clinical trials published in peer reviewed journals. With an optimal plant sterol intake of 2-2.5g per day, significant cholesterol lowering can be achieved within 3 weeks.

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  1. Skeaff CM, Thoma C, Mann J, Chisholm A, Williams S, Richmond K. Isocaloric substitution of plant sterol- enriched fat spread for carbohydrate-rich foods in a low-fat, fibre-rich diet decreases plasma low-density lipoprotein cholesterol and increases high density lipoprotein concentrations. Nutr Metab Cardiovasc Dis 2005;15(5):337-344.   

  2. Doornbos AME, Meynen EM, Duchateau GSMJE, Knapp HCM, Trautwein EA. Intake occasion affects the serum cholesterol lowering of a plant sterol-enriched single dose yoghurt drink in mildly hypercholesterolemic subjects. European Journal of Clinical Nutrition 2006; 60: 325-333

  3. Hendriks HF, Brink EJ, Meijer GW, Princen HM, Ntanios FY. Safety of long-term consumption of plant sterol esters-enriched spread. Eur J of Clin Nutr 2003;57(5):681-692.

  4. Law M. Plant sterol and stanol margarines and health. BMJ 2000;320:861-864.

  5. Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R; Stresa Workshop Participants. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc 2003 Aug;78(8):965-978. Review. 

  6. Amundsen Å &, Ntanios F, Put Nv N, Ose L. Long-term compliance and changes in plasma lipids, plant sterols and carotenoids in children and parents with FH consuming plant sterol ester-enriched spread. Eur J Clin Nutr 2004;58(12):1612-1620.

  7. Amundsen AL, Ose L, Nenseter MS, Ntanios FY. Plant sterol ester-enriched spread lowers plasma total and LDL cholesterol in children with familial hypercholesterolemia. Am J Clin Nutr 2002;76:338-344.

  8. Cleghorn CL, Skeaff CM, Mann J, Chisholm A. Plant sterol-enriched spread enhances the cholesterol-lowering potential of a fat-reduced diet. Eur J Clin Nutr 2003;57(1):170-176.

  9. Colgan HA, Floyd S, Noone EJ, Gibney MJ, Roche HM. Increased intake of fruit and vegetables and a low-fat diet, with and without low-fat plant sterol-enriched spread consumption: effects on plasma lipoprotein and carotenoid metabolism. J Hum Nutr Diet 2004;17(6):561-569. 

  10. Davidson MH, Maki KC, Umporowicz DM, Ingram KA, Dicklin MR, Schaefer E, Lane RW, McNamara JR, Ribaya-Mercado JD, Perrone G, Robins SJ, Franke WC. Safety and tolerability of esterified phytosterols administered in reduced-fat spread and salad dressing to healthy adult men and women. J Am Coll Nutr 2001;20:307-319.

  11. Geelen A, Zock PL, de Vries JHM, Katan MB. Apolipoprotein E polymorphism and serum lipid response to plant sterols in humans. Eur J Clin Invest 2002;32:738-742.

  12. Hendriks HF, Weststrate JA, Van Vliet T, Meijer GW. Spreads enriched with three different levels of vegetable oil sterols and the degree of cholesterol lowering in normocholesterolaemic and mildly hypercholesterolaemic subjects. Eur J Clin Nutr 1999;53:319-327.

  13. Jenkins DJ, Kendall CW, Faulkner D, Vidgen E, Trautwein EA, Parker TL, Marchie A, Koumbridis G, Lapsley KG, Josse RG, Leiter LA, Connelly PW. A dietary portfolio approach to cholesterol reduction: combined effects of plant sterols, vegetable proteins, and viscous fibers in hypercholesterolemia. Metabolism 2002 Dec;51(12):1596-1604.

  14. Jenkins DJ, Kendall CW, Marchie A, Faulkner DA, Vidgen E, Lapsley KG, Trautwein EA, Josse RG, Leiter LA, Connelly PW. The effect of combining plant sterols, soy protein, viscous fibers, and almonds in treating hypercholesterolemia. Metabolism 2003;52(11):1478-1483.

  15. Jenkins DJ, Kendall CW, Marchie A, Faulkner DA, Wong JM, de Souza R, Emam A, Parker TL, Vidgen E, Lapsley KG, Trautwein EA, Josse RG, Leiter LA, Connelly PW. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003;290(4):502-510.

  16. Jenkins DJA, Kendall CWC, Marchie A, Faulkner DA, Wong JMW, de Souza R, Emam A, Parker TL, Vidgen E, Trautwein EA, Lapsley KG, Josse RG, Leiter LA, Singer W, Connelly PW. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J Clin Nutr 2005;81(2):380-387.

  17. Jones PJ, Raeini-Sarjaz M, Ntanios FY, Vanstone CA, Feng JY, Parsons WE. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. J Lipid Res 2000;41:697-705.

  18. Jongh de S, Visser MN, Rol P, Bakker HD, Kastelein JJP and Stroes ESG. Plant sterols lower LDL cholesterol without improving endothelial function in prepubertal children with familial hypercholesterolaemia. J Inherit Metab Dis 2003;26:343-351.

  19. Judd JT, Baer DJ, Chen SC, Clevidence BA, Muesing RA, Kramer M, Meijer GW. Plant sterol esters lower plasma lipids and most carotenoids in mildly hypercholesterolemic adults. Lipids 2002;37:33-42.

  20. Kwiterovich PO Jr, Chen SC, Virgil DG, Schweitzer A, Arnold DR, Kratz LE. Response of obligate heterozygotes for phytosterolemia to a low-fat diet and to a plant sterol ester dietary challenge. J Lipid Res 2003;44(6):1143-1155.

  21. Lamarche B, Desroches S, Jenkins DJ, Kendall CW, Marchie A, Faulkner D, Vidgen E, Lapsey KG, Trautwein EA, Parker TL, Josse RG, Leiter LA, Connelly PW. Combined effects of a dietary portfolio of plant sterols, vegetable protein, viscous fibre and almonds on LDL particle size. Br J Nutr 2004;92(4):657-663.

  22. Lau VW, Journoud M, Jones PJ. Plant sterols are efficacious in lowering plasma LDL and non-HDL cholesterol in hypercholesterolemic type 2 diabetic and nondiabetic persons. Am J Clin Nutr 2005;81(6):1351-1358.

  23. Lee YM, Haastert B, Scherbaum W, Hauner H. A phytosterol-enriched spread improves the lipid profile of subjects with type 2 diabetes mellitus - a randomized controlled trial under free-living conditions. Eur J Nutr 2003;42(2):111-117.

  24. Mussner MJ, Parhofer KG, Von Bergmann K, Schwandt P, Broedl U, Otto C. Effects of phytosterol ester-enriched margarine on plasma lipoproteins in mild to moderate hypercholesterolemia are related to basal cholesterol and fat intake. Metabolism 2002;51:189-194.

  25. Neil HAW, Meijer GW and Roe LS. Randomised controlled trial of use by hypercholesterolaemic patients of a vegetable oil sterol-enriched fat spread. Atherosclerosis 2001;156:329-337.

  26. Nigon F, Serfaty-Lacrosnière C, Beucler I, Chauvois D, Neveu C, Giral P, Chapman MJ, Bruckert E. Plant sterol-enriched margarine lowers plasma LDL in hyperlipidemic subjects with low cholesterol intake: Effect of fibrate treatment. Clin Chem Lab Med 2001;39:634-640.

  27. Ntanios FY, Duchateau GSMJE. A healthy diet rich in carotenoids is effective in maintaining normal blood carotenoid levels during the daily use of plant sterol-enriched spreads. Int J Vitam Nutr Res 2002;72:32-39.

  28. Ntanios FY, Homma Y, Ushiro S. A Spread Enriched with Plant Sterol-Esters Lowers Blood Cholesterol and Lipoproteins Levels without Affecting Vitamins A and E in Normal and Hypercholesterolemic Japanese Men and Women. J Nutr 2002;132:3650-3655.

  29. Patch CS, Tapsell LC, Williams PG. Plant sterol/stanol prescription is an effective treatment strategy for managing hypercholesterolemia in outpatient clinical practice. J Am Diet Assoc 2005;105(1):46-52. 

  30. Raeini-Sarjaz M, Ntanios FY, Vanstone CA, Jones PJH. No changes in serum fat-soluble vitamin and carotenoid concentrations with the intake of plant sterol/stanol esters in the context of a controlled diet. Metabolism 2002;51:652-656.

  31. Simons LA. Additive effect of plant sterol-ester margarine and cerivastatin in lowering low-density lipoprotein cholesterol in primary hypercholesterolemia. Am J Cardiol 2002;90;737-740.

  32. Stalenhoef AFH, Hectors M, Demacker PNM. Effect of plant sterol-enriched margarine on plasma lipids and sterols in subjects heterozygous for phytosterolaemia. J Intern Med 2001;249:163-166.

  33. Temme EHM, Van Hoydonck PGA, Schouten EG, Kesteloot H. Effects of a plant sterol-enriched spread on serum lipids and lipoproteins in mildly hypercholesterolaemic subjects. Acta Cardiol 2002;57:111-115.

  34. Weststrate JA, Meijer GW. Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects. Eur J Clin Nutr 1998;52:334-343.

  35. Clifton PM, Noakes M, Sullivan D, Erichsen N, Ross D, Annison G, Fassoulakis A, Cehun M & Nestel P. Cholesterol-lowering effect of plant sterol esters differ in milk, yoghurt, bread and cereal. Eur J Clin Nutr 2004;58:503-509.

  36. Mensink RP, Ebbing S, Lindhout M, Plat J, van Heugten MM. Effects of plant stanol esters supplied in low-fat yoghurt on serum lipids and lipoproteins, non-cholesterol sterols and fat soluble antioxidant concentrations Atherosclerosis 2002;160(1):205-213.

  37. Noakes M, Clifton PM, Doornbos AM, Trautwein EA. Plant sterol ester-enriched milk and yoghurt effectively reduce serum cholesterol in modestly hypercholesterolemic subjects. Eur J Nutr 2004;17: [Epub]

  38. Thomsen AB, Hansen HB, Christiansen C, Green H, Berger A. Effect of free plant sterols in low-fat milk on serum lipid profile in hypercholesterolemic subjects. Eur J Clin Nutr 2004;58(6):860-870.

  39. Volpe R, Niittynen L, Korpela R, Sirtori C, Bucci A, Fraone N, Pazzucconi F. Effects of yoghurt enriched with plant sterols on serum lipids in patients with moderate hypercholesterolaemia. Br J Nutr 2001;86(2):233-239.

  40. Beer MU, Pritchard PH, Olesen M & Black R. Free phytosterols from tall oil delivered in low fat food matrix successfully lowersplasma cholesterol. Ann Nutr Metab 2001;45S:99.

  41. Salo P, Wester I. Low-fat formunations of plant stanols and sterols. Am J Cardiol 2005;96S:51D-54D.