Dose-dependent LDL-cholesterol lowering effect by plant stanol ester consumption: clinical evidence

Abstract

Elevated serum lipids are linked to cardiovascular diseases calling for effective therapeutic means to reduce particularly LDL-cholesterol (LDL-C) levels. Plant stanols reduce levels of LDL-C by partly blocking cholesterol absorption. Accordingly the consumption of foods with added plant stanols, typically esterified with vegetable oil fatty acids in commercial food products, are recommended for lowering serum cholesterol levels. A daily intake of 1.5 to 2.4 g of plant stanols has been scientifically evaluated to lower LDL-C by 7 to 10% in different populations, ages and with different diseases. Based on earlier studies, a general understanding is that no further reduction may be achieved in intakes in excess of approximately 2.5 g/day. Recent studies however suggest that plant stanols show a continuous dose–response effect in serum LDL-C lowering. This review discusses the evidence for a dose-effect relationship between plant stanol ester consumption and reduction of LDL-C concentrations with daily intakes of plant stanols of 4 g/day or more. We identified five such studies and the overall data demonstrate a linear dose-effect relationship with the most pertinent LDL-Cholesterol lowering outcome, 18%, achieved by a daily intake of 9 to 10 g of plant stanols. Along with reduction in LDL-C, the studies demonstrated a decrease in cholesterol absorption markers, the serum plant sterol to cholesterol ratios, by increasing the dose of plant stanol intake. None of the studies with daily intakes up to 10 g of plant stanols reported adverse clinical or biochemical effects from plant stanols. In a like manner, the magnitude of decrease in serum antioxidant vitamins was not related to the dose of plant stanols consumed and the differences between plant stanol ester consumers and controls were minor and insignificant or nonexisting. Consumption of plant stanols in high doses is feasible as a range of food products are commercially available for consumption including spreads and yoghurt type drinks. In conclusion, a dose-effect relationship of plant stanols in higher doses than currently recommended has been demonstrated by recent clinical studies and a meta-analysis. Further studies are called for to provide confirmatory evidence amenable for new health claim applications and dietary recommendations.

Long-term Effects of Plant Stanols on the Lipid Profile of Patients With Hypercholesterolemia. A Randomized Clinical Trial

“…A similar decrease has also been seen upon supplementation of other foods with stanols. 23 As in previous studies, our study failed to show changes in HLD-C and triglycerides. 12,21 Our study shows the long-term effects of stanols, whereas few previous studies exceeded 4 weeks and almost all of those studies were shorter than 2 months.…”

Triterpene alcohols and sterols from rice bran reduce postprandial hyperglycemia in rodents and humans

“… that showed SS increased glucose uptake by L6 myotube cells by stimulating AMP‐activated protein kinase activity in vitro. Although evidence suggested food supplemented with plant sterols, including SS, decreased total cholesterol and low‐density lipoprotein cholesterol in humans , the effects of SS alone on cholesterol metabolism remains to be clarified.…”

Assessment of hormone-like activities inGinkgo biloba,Elettaria cardamomumandPlantago ovataextracts usingin vitroreceptor-specific bioassays

“…In fact, clinical studies have demonstrated significant reductions in serum cholesterol concentrations after the consumption of phytosterol-enriched food (Demonty et al 2009;Laitinen & Gylling 2012). Early studies indicated that the main sterol components in ECS are 7-ergosterol, campesterol, γ-tocopherol, desmosterol and stigmasterol (Gopalakrishnan et al 1990), which are alcohols consisting of 28 or 29 carbon atoms, similar to cholesterol (Awad & Fink 2000).…”