Optimal Use of Plant Stanol Ester in the Management of Hypercholesterolemia

Abstract

Plant stanol ester is a natural compound which is used as a cholesterol-lowering ingredient in functional foods and food supplements. The safety and efficacy of plant stanol ester have been confirmed in more than 70 published clinical studies and the ingredient is a well-established and widely recommended dietary measure to reduce serum cholesterol. Daily intake of 2 g plant stanols as plant stanol ester lowers LDL-cholesterol by 10%, on average. In Europe, foods with added plant stanol ester have been on the market for 20 years, and today such products are also available in many Asian and American countries. Despite the well-documented efficacy, the full potential in cholesterol reduction may not be reached if plant stanol ester is not used according to recommendations. This review therefore concentrates on the optimal use of plant stanol ester as part of dietary management of hypercholesterolemia. For optimal cholesterol lowering aiming at a lower risk of cardiovascular disease, plant stanol ester should be used daily, in sufficient amounts, with a meal and in combination with other recommended dietary changes.

Natural Cholesterol Busters

“…The effect of phytosterols is food dependent because the maximal bile secretion is with or directly after meals where stanols can target micelle formation to reduce the absorption of cholesterol and lipids [31][32][33][34][35]. Phytostanols esters showed greater effectiveness if taken on daily basis in sufficient amounts (0.8-2.0 g) with meals [31][32][33][34][35]. The beneficial effect of stanols over LDL reduction appears after 1-2 weeks of (2.0 g) daily consumption.…”

“…The beneficial effect of stanols over LDL reduction appears after 1-2 weeks of (2.0 g) daily consumption. Most importantly, this reduction in LDL persists as long as stanols being consumed [31][32][33][34][35].…”

“…Several mechanisms including interference with intestinal cholesterol solubility, inhibition of digestive enzymes, and decreasing cellular uptake of cholesterol have been proposed to explain the cholesterol-lowering effects of phytosterols [31][32][33][34][35]. Therefore, phytosterols reduce the absorption of both dietary and biliary cholesterol from the intestinal tract.…”

“…Therefore, phytosterols reduce the absorption of both dietary and biliary cholesterol from the intestinal tract. Moreover, phytosterols induce the expression of ATP-binding cassette transporters, thus increasing the efflux of cholesterol from the intestinal cells [31][32][33][34][35]. In addition, phytosterols suppress the activity of acyl-cholesterol acyl transferase required for sterols absorption, consequently reducing intestinal cholesterol uptake.…”

“…In addition, phytosterols suppress the activity of acyl-cholesterol acyl transferase required for sterols absorption, consequently reducing intestinal cholesterol uptake. Phytosterols are partially inhibiting dietary and biliary cholesterol absorption by 30-50% through inhibition of cholesterol emulsification through disruption of the lipid micelles, reducing its solubility and availability for intestinal absorption [31][32][33][34][35]. Phytosterols are present naturally in many plants, such as corn, soybeans, and sunflower seeds.…”