How to Lower Your Cholesterol with Plant Sterols

Cardiovascular Disease and Cholesterol

Cardiovascular disease (CVD) encompasses any disease or injury of the heart or blood vessels supplying to the heart, body and brain. This includes coronary heart disease (CHD), a condition in partial or complete blockage in/ to the heart, while a stroke, occurs due to disruption of blood flow in the brain.

A leading cause of CHD is atherosclerosis, defined as a build up of cholesterol and plaques in the blood vessels. Atherosclerosis may also develop alongside risks such as high blood pressure, obesity, abnormal cholesterol levels and diabetes.

Saturated fatty acids and trans fatty acids have been shown to raise LDL-cholesterol and are correlated with coronary heart disease risk. Key contributing dietary sources of saturated fats in the westernised diet include fatty processed meats, fatty red meats, highly processed foods, high fat dairy like cream and butter, as well as tropical oils, such as palm and coconut oils.

Heart Disease in Australia

In Australia, CVD remains a leading cause of death, with 31% of reported deaths as result of CVD in 2011 (2).

Diet and lifestyle changes are critical in the management and treatment of cardiovascular disease including:

-          Smoking cessation,

-          150 min/week of moderate- to vigorous-intensity aerobic physical activity)

-          A diet rich in vegetables and fruit, low in salt and saturated and trans fats such as the DASH diet or Mediterranean diet* (Estruch et al., 2013)

-          Limiting alcohol intake

-          Maintain a healthy weight

-          Reduce and manage stress

-          In addition, medical therapies can assist in reducing the heart's workload and improve blood flow.

How Plant Sterols can Lower Cholesterol

Phytosterols/Plant Sterols are naturally present in dietary sources (Table 1 see below). Phytosterols are structurally similar to cholesterol and reduce intestinal cholesterol absorption by displacement of cholesterol from intestinal micelles. When phytosterol-containing foods are excluded, LDL-C levels increased, however additional research on this topic indicates that dose-related whole food adjustments have a modest cholesterol lowering effect compared to supplemental and enriched sources (H. Gylling et al. 2014).

Effects have been show to reduce LDL cholesterol by 0.3 or ~8.5% from 2-52 week period in doses from 0.3-9g/day from dietary supplements or enriched foods. (Bergamin 2019). Research completed has also suggested a continuous positive dose-dependent response up to 2–3 g/day, with no reported benefits beyond these doses (Kathy Musa-Veloso et al., 2011).

Both plant sterols and plant stanols have demonstrated similar efficacy in reducing LDL-C at recommended doses (H. Gylling et al. 2014). Term phytosterols may be referenced to describe individually or combined effect of plant sterols and plant stanols.

Other lipid profile benefits include reduction in triglyceride levels of 6-20% at doses of 1.5-2g/ day and improvements in hepatic VLDL production in individuals with metabolic syndrome and moderate hypertriglyceridemia (H. Gylling et al. 2014).

Based on current evidence, daily consumption of 2 g plant stanols/ plant sterols, are recommended to improve serum LDL levels (H. Gylling et al. 2014).

The effects of phytosterols in lowering LDL-C are also shown to be additive to pharmacological treatment (i.e. statin use) in individuals with dyslipidaemia.

Plant Sterol Enriched Products

• Blackmores Cholesterol Health recommended dose is twice daily capsules with meal, each capsule contains 1g plant sterols + 1.5mg beta-carotene.

• Margarine: Tablelands Health Smart, Woolworths Cholesterol Lowering, Nuttelex Pulse Buttery, Flora ProActive, Logicol Original (2g in 1 rounded tablespoon)

• Cereal: Carmen’s Cholesterol Lowering Oats (2g per 50g oats), Weet-bix Cholesterol Lowering 2g per 2 biscuits), Carmen's cholesterol lowering porridge sachets (2g per sachet)

• Milk: Dairy Farmers Heart Active (0.8g per 250ml cup), Australia’s Own Lowers Cholesterol (0.8g per 250ml cup)

• Note: Carmen's bar and Abbotts bread options with oats may also market as cholesterol lowering from beta-glucan rather than use of phytosterols)

Other Cholesterol Lowering Products

• Similar LDL lowering effects are shown with 3-20g per day of psyllium husk with 0.3mmol/L LDL reduction over 2-52 weeks. (Bergamin 2019)

• Berberine also demonstrated reductions in LDL from 0.3-0.45mmol/L with 600-1500mg/day over 3 months to 2 years. (Wei et al., 2016), (Jianquig 2018).

If you would like a personal nutrition plan to lower your cholesterol and manage your risk of CVD, get in touch or book in with one of our Dietitians here.

References:

1)      Kathy Musa-Veloso, Theresa H. Poon, Julie Ann Elliot, Catherine Chung, A comparison of the LDL-cholesterol lowering efficacy of plant stanols and plant sterols over a continuous dose range: Results of a meta-analysis of randomized, placebo-controlled trials, Prostaglandins, Leukotrienes and Essential Fatty Acids, Volume 85, Issue 1, 2011, Pages 9-28, ISSN 0952-3278, https://doi.org/10.1016/j.plefa.2011.02.001.

2)      Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease, Atherosclerosis, Volume 232, Issue 2, 2014, 346-360, http://dx.doi.org/10.1016/j.atherosclerosis.2013.11.043

3)      Estruch R, Ros E, Salas-Salvado J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–90.

4)      Bergamin A, Mantzioris E, Cross, G, et al. Nutraceuticals: Reviewing their Role in Chronic Disease Prevention and Management, Pharmaceutical Medicine, 2019, DOI: 10.1007/s40290-019-00289-w