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Plant sterols and stanols (phytosterols)
Plant sterols and stanols (phytosterols) are found naturally in plants and are structurally similar to cholesterol. Their cholesterol-lowering effects have been known for some time.
How do they work?
They work by mimicking cholesterol and competing with it for absorption. The result is that less cholesterol and less bile (a cholesterol bi-product) is absorbed into the body from the gut. In order to make more bile, more cholesterol has to be removed from the circulation, so lowering blood levels of cholesterol. This reduction happens gradually and depends on the amount of plant sterol and stanol consumed.
Over 3 weeks plant sterols and stanols can reduce cholesterol levels by up to 10% when taken at optimal doses and as part of a diet low in saturated fat.
They are considered to be the most effective single food that can lower cholesterol as part of a healthy diet and lifestyle.
Are they safe for everyone to use?
Both plant sterols and stanols have been thoroughly researched and approved for use in foods.
they are targeted specifically at people who have raised cholesterol
there are no real benefits for other groups of the population.
they should be avoided by other children
they should be avoided by women who are pregnant or are breast feeding.
Do they work well with cholesterol lowering medicines?
Because they work in different ways, plant sterols can be used effectively alongside statins or fibrates and produce a significant additive benefit.
Patients taking Ezetrol (Ezetimide), a drug which inhibits cholesterol absorption in the small intestine, may receive little additional benefit however. This is because this drug has a similar mechanism of action to plant sterols and stanols.
What amounts should I take?
Scientific evidence suggests that eating between 1.5g and 2.4g of plant sterols each day can significantly reduce LDL (bad cholesterol) by up to 10%. There is no additional benefit in taking more than 3g per day.
How do I achieve the recommended amounts?
There is a range of branded (Benecol and Flora Proactive) or own label products. These are found in the chiller cabinets of most supermarkets and larger grocery stores.
CHOOSE THREE of the following plant sterol or stanol fortified foods each day:
- 250ml fortified milk
- 2 teaspoons of a fortified spread
- 1 individual fortified yoghurt
(each of these contains 0.5-0.8mg plant sterol or stanol)
- One fortified mini yoghurt drink (67.5-100ml)
(most of these contain about 2 of plant sterol or stanol)
Make sure these foods are eaten at a mealtime rather than between meals.
Plant sterols and stanols are well tolerated by most people but you may find your bowel movements are slightly looser than normal. This is usually a short term effect.
To maintain the cholesterol–lowering effect of plant sterols and stanols you need to continue to take them daily.
Plant sterol supplements
These can be purchased readily but have not undergone the same scrutiny as fortified foods and we have less evidence that they work as well. If you do decide to take a supplement instead of a fortified food, be sure to take the supplement as directed and alongside a meal.
Can stanols and sterols be used instead of statins?
Plant stanols and sterols have the ability to reduce cholesterol by up to 10%. However statins can lower cholesterol by 20-60% dependant upon the statin chosen and the dose taken. So together it is possible to achieve up to a 70% cholesterol reduction. However sterols and stanols cannot take the place of a statin. This is because statins can lower cholesterol more than a sterol or stanol. Statins also have other cardiovascular benefits. Always talk to your doctor if you are considering stopping your statin.