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Plant Sterols and Stanols in the
Management of Blood Cholesterol Levels
HNS 716 Nutrition Aspect of Disease
Phatcharee Lueyot and Maryna Lisai
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Hypothesis
Plant sterols and stanols lower intestinal
cholesterol absorption therefore lowering
blood cholesterol levels
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History
Since the 1950s dietary plant sterols and stanols have been
studied and showed to lower LDL-cholesterol levels
1952: Effects of soybean sterols in the diet on plasma and liver
cholesterol in chicks
1953: Absorption of cholesterol-4-C 14 in rats fed mixed soybean
sterols and sitosterol
1954: Lowering of Serum Cholesterol by the Administration of a
Plant Sterol
References;J. Nutrition 47: 57, 1952/Bio. &Med.83:498,1953/ Circulation, Volume X, August, 1954
J Lipid Res.1988;29:1589-91/ J Nutr Sci Vitaminol (Tokyo)1989;361-9
Based on their structural similarity to cholesterol- physicalInterference micellization in intestinal lumen
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Cholesterol absorption
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Structure of Cholesterol, Sterol and Stanol
4-desmethylsterols
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Effects of sterols and stanols on micellar composition
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Cholesterol-Lowering Effects
Compete with cholesterolin micellization
Regulation cholesterolsynthesis
Plan sterols
Increase bile acidsynthesis
Plant sterols and stanols
++
Cholesterol-
loweringEffect
Plant stanol-
Suppress bile acid
synthesis
Reference:Nutr Metab Cardiovas Dis (2004) 14:133-142
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FoodsThe typical daily intake of plant sterols and plant stanols is about 150-350 mg/d. However, in order to
get just 0.8 g/d (min effective dose) of plant sterols from these natural sources, you would need to
consume 22 oranges, 44 apples or 50 carrots.
Eur J Clin Nutr. 2008 Jun;62(6):695-703
Sources
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Supplements
Phytosterol supplements marketed as beta-sitosterol
are available without a prescription in the U.S.
Doses 60-130 mg/day
How to get an effective dose?
F.H. Mattson is a brilliant man who suggested esterification process of
plant sterols in 1972 to make them soluble in dietary fat.
Foods Enriched with Plant Sterols
and Plant Stanols
Just one tablespoon of Benecolspread
contains 0.850 g plant stanol esters.
Eur J Nutr 40 : 6673 (2001)
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Summarized data from 10 randomized trials where sterols
and stanols were solubilized in fat-containing food
Effective dose
It has been demonstrated that 2-3 g/d of plant sterols and stanols can
reduce total and LDL-cholesterol levels by 10-20%
Mayo Clin Proc. 2003;78:965-978
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Effect of frequency intake
- Most of the trials, the total daily intake of plant sterols and stanols was
divided into 2 or 3 portions over the day
- However, 3 studies showed that 2-3 g of plant stanols taken at lunchproduced the same LDL-lowering effects as 2-3 g divided over 3 meals.
# What the exact mechanism of action?
Responses of Subgroups
British Journal of Nutrition (2009), 101, 17971804 J Clin Endocrinol Metab. 2008 Nov;93(11):4200-9
0 5 10 15
Reduction in LDL (%)
pregnant women patients with diabetes children
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Main study 150 patients with mild hypercholesterolaemia (TC=200-250 mg/dl). Age 553 ,
BMI27 kg/m.
Study design: Prospective, randomized, placebo-controlled study.
Patients were randomly assigned to 1 of the following 3 groups:
1. Plant stanol ester spread (2 g/day) group (n=50)
2. Placebo group (n=50)
3. Mediterranean diet group (n=50)
The intervention period 16 weeks.
Placebo
Mediterraneandiet
Plant stanols
Nutrition, Metabolism & Cardiovascular Diseases (2009) xx, 1-9
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Side effects
Fat-soluble Vitamins (vitamins A, D, E and K)
-The effects on fat-soluble vitamin status have beenstudied in clinical trials.
- The majority of studies found no changes in plasma
vitamin A, E, D concentrations.
- There is little evidence that plant sterol or stanolconsumption adversely affects vitamin K status.
Carotenoids
- Dietary carotenoids are fat-soluble phytochemicals that circulate in
lipoproteins.
- A number of studies have observed about 10% reductions in plasma
carotenoids (alpha-carotene, beta-carotene).
- It was suggested that increasing the intake of carotenoid-rich vegetables and
fruits can compensate plasma carotenoid levels.
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Drugs interaction- It has been observed that No Drug Interaction.
- Patients who are takingstatinsand need additional
cholesterol lowering, it is more effective to add sterols
and stanols to their diets than to increase statin doses.
Atherosclerosis
- Using plant sterol (not plant stanol) enriched productselevates serum
plant sterol concentrations in humans.
- One of the concerns is the potential atherogenic effect of circulatingsitosterols and campsterols.
- High levels of sitosterols associated with very rare genetic disorder called
phytosterolemia. Patients with phytosterolemia has a high rate of
atherosclerosis. In addition, several epidemiological studies support this
assumption .
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Pre-SREBPSREBP2
Micelle
Cholesterol synthesis
Reference: ASEB J. 16 12481253 2002
chymlomicron LDL
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Pre-SREBP
Mixed micelle
Effects
OfSterols
And
Stanols
Cholesterol synthesis
ABCA1
Reference. Lipid Res. 2005. 46: 24682476.
SREBP2
chymlomicron LDL
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Conclusion
Recommendation: 2-3 g/day for
hypercholesterolemic people
Food enriched sterols and stanols (esterified)
Lower 10-20% LDL-Cholesterol, no effects on TG
and HDL Lower total cholesterol; preferable for the long-
term management of hypercholesterolemia
No side effect
Safety
Gene regulation of phytosterols is still unclear
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Opinions
Recommend plant stanols for hypercholesterolemicpeople (A-level evidence) ; healthy people should
manage their cholesterol level through balance diet
Regulation in genomic level is partially unclear**
Could reduce the risk for CHD up to 20%, thus,
there is a theoretical possibility. More future
research on CHDs