Republished in entirety, courtesy of The Metagenics Healthcare Institute for Clinical Nutrition

Cardiovascular disease is the leading cause of mortality in the Unites States, and accounts for approximately 50% of preventable deaths. Dyslipidemia is a strong risk factor for cardiovascular disease, and is largely modifiable with non-pharmacological intervention. Metabolic syndrome and central obesity are also intimately connected to cardiovascular disease and dyslipidemia creating a multifactorial risk picture for millions of Americans.

Evidence supports the lipid lowering ability of numerous dietary approaches, including dietary supplements. Plant sterols, also known as Phytosterols, are the fat-soluble portions of plants that chemically resemble cholesterol. Consumption of plant Phytosterols have been shown to inhibit the absorption of cholesterol, and have been shown to lower LDL cholesterol, and reduce the risk of cardiovascular disease.2,3 Dietary sources of plant sterols include unrefined vegetable oils, whole grains, nuts and legumes. Dietary supplements, foods and beverages are now commercially produced with added phytosterols making the incorporation of Phytosterols accessible to a larger population.

 

Phytosterols’ Lipid Lowering Activity

Phytosterols lower serum total cholesterol in part by displacing cholesterol from micelles thus inhibiting cholesterol absorption.4 This displacement of cholesterol has been shown to decrease cholesterol absorption by as much as 30-40% when 1.5-1.8 grams of phytosterols are consumed.5,6 Cholesterol absorption was reduced by as much as 60% when doses of 2.2 grams daily were consumed, in one small study.7 This reduction in cholesterol absorption translates to a decrease in LDL cholesterol by 9-14% when the 2-gram approximate daily dose was consumed.8,9 While many studies have been less than four weeks in duration, they have cumulatively shown a lasting cholesterol lowering effect for up to one year.3, 10, 11 This reduction of LDL cholesterol, at levels near 10%, has been shown to decrease coronary heart disease by as much as 20%.12 This significant association is represented in the fact that the USDA FDA has approved authorized health claims supporting the consumption of Phytosterols for the reduction of heart disease risk.3

Managing the absorption of cholesterol while lowering LDL is essential for the management of dyslipidemia, and reducing cardiovascular related mortality. By reducing LDL, which is oxidized in the blood vessels, the risk for atherosclerosis is concurrently reduced. Thus incorporating phytosterols as a lipid lowering tool, in conjunction with standard diet and lifestyle modification as recommended by the American Heart Association offers a promising therapeutic option for reducing overall cardiovascular related mortality, managing lipids, and reducing oxidative and inflammatory potential within the vessel walls. Proper lipid management is crucial for the reduction in metabolic related diseases also.

 

Implications for Metabolic Syndrome

The presence of comorbidities linking the cardiovascular system and metabolic disturbances further complicates the management of cardiovascular diseases, overweight and obesity, dyslipidemia and metabolic syndrome. Utilizing a non-pharmacologic, accessible and affordable diet-based intervention to triangulate the treatment of metabolic syndrome is essential. Utilizing plant phytosterols appears to be a treatment option that can combat the interconnected cardiometabolic disease picture. In one study of people with metabolic syndrome, consuming phytosterols reduced serum triglycerides by 27%, while also reducing large and medium sized LDL cholesterol.13

 

Conclusion

The lipid lowering effects of phytosterols have been well documented. Incorporating phytosterols into an individual’s diet or supplement routine provides significant risk reduction for cardiovascular related diseases, metabolic syndrome and dyslipidemia. Phytosterols offer therapeutic benefit for a wide variety of interrelated cardiometabolic conditions, and current research supports the American Heart Associations current phytosterols recommendation of 2 grams daily for the dietary management of dyslipidemia and the encouragement of a cardio protective diet.

 

References

1 Sandeep V. Screening for lipid disorders. UpToDate; 2015. Accessed November 1, 2015.
2 Jones PJ, Macdougall DE, Ntanios F, Vanstone CA. Dietary phytosterols as cholesterol-lowering agents in humans. Can J Physiol Pharmacol. 1997;75(3):217-27.
3 Linus Pauling Institute. http://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/phytosterols. Accessed November 2, 2015.
4 Nissinen M, Gylling H, Vuoristo M, Miettinen TA. Micellar distribution of cholesterol and phytosterols after duodenal plant stanol ester infusion. Am J Physiol Gastrointest Liver Physiol. 2002;282(6):G1009-15.
5 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(5):697-705.
6 Normén L, Dutta P, Lia A, Andersson H. Soy sterol esters and beta-sitostanol ester as inhibitors of cholesterol absorption in human small bowel. Am J Clin Nutr. 2000;71(4):908-13.
7 Richelle M, Enslen M, Hager C, et al. Both free and esterified plant sterols reduce cholesterol absorption and the bioavailability of beta-carotene and alpha-tocopherol in normocholesterolemic humans. Am J Clin Nutr. 2004;80(1):171-7.
8 Law MR. Plant sterol and stanol margarines and health. West J Med. 2000;173(1):43-7
9 Cofán M, Ros E. Clinical Application of Plant Sterol and Stanol Products. J AOAC Int. 2015;98(3):701-6.
10 Hendriks HF, Brink EJ, Meijer GW, Princen HM, Ntanios FY. Safety of long-term consumption of plant sterol esters-enriched spread. Eur J Clin Nutr. 2003;57(5):681-92.
11 Miettinen TA, Puska P, Gylling H, Vanhanen H, Vartiainen E. Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N Engl J Med. 1995;333(20):1308-12.
12 Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-421.

13 Damodharan K, Lee YS, Palaniyandi SA, Yang SH, Suh JW. Preliminary probiotic and technological characterization of Pediococcus pentosaceus strain KID7 and in vivo assessment of its cholesterol-lowering activity. Front Microbiol. 2015;6:768.