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The New Low-Cholesterol Diet: Plant Sterols and Stanols

What are sterols and stanols, and does anyone like to eat them?
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WebMD Feature

Almost everyone has eaten cholesterol-lowering foods like walnuts, salmon, and oatmeal. But what's a plant sterol or stanol? And do you really want to eat it?

Most experts say yes. "Eating sterol and stanol-containing foods is an easy way to lower your LDL cholesterol, which helps reduce the risk of heart disease," says Ruth Frechman, RD, a spokeswoman for the American Dietetic Association (ADA).

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Plant sterols and stanols are substances that occur naturally in small amounts in many grains, vegetables, fruits, legumes, nuts, and seeds. Since they have powerful cholesterol-lowering properties, manufacturers have started adding them to foods. You can now get stanols or sterols in margarine spreads, orange juice, cereals, and even granola bars.

How Do Plant Sterols and Stanols Help?

On a molecular level, sterols and stanols look a lot like cholesterol. So when they travel through your digestive tract, they get in the way. They can prevent real cholesterol from being absorbed into your bloodstream. Instead of clogging up your arteries, the cholesterol just goes out with the waste.

What's the Evidence?

"Plant stanol esters help block the absorption of cholesterol," Frechman tells WebMD. "Research shows that three servings a day can reduce cholesterol by 20 points."

Experts have been studying the effects of food fortified with plant sterols for decades. One important study of people with high cholesterol found that less than an ounce of stanol-fortified margarine a day could lower "bad" LDL cholesterol by 14%. The results were published in The New England Journal of Medicine.

A more recent study from the University of California Davis Medical Center looked at the effects of sterol-fortified orange juice. Of 72 adults, half received regular orange juice and half the fortified OJ. After just two weeks, the people who drank the stanol-fortified juice had a 12.4% drop in their LDL cholesterol levels. The results were published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.

The FDA gave these products the status of a "health claim." This means that experts widely agree on the cholesterol-lowering benefits of stanols and sterols. It also allows manufacturers to advertise the heart-healthy benefits on labels.

Getting Sterols and Stanols Into Your Diet

Frechman says it's easy to add in these foods to your diet. "When you are putting a spread on your whole-grain bread or rolls, choose one with sterols or stanols."

ADA spokeswoman Suzanne Farrell, MS, RD agrees. "If you use butter or margarine now, just switch over to one of these sterol-fortified spreads," she tells WebMD.

If you don't eat butter or margarine now, this is not an invitation to start slathering on the spread. More is not better. Extra margarine spread -- with or without stanols and sterols -- means extra calories.

You can also find plant sterols or stanols in some cooking oils, salad dressings, milk, yogurt, snack bars, and juices. Indeed, so many fortified products are headed to grocery store shelves that you'll soon have a dizzy array of choices. But check the labels carefully. While plant sterols are healthy, extra calories are not. Excess calories simply lead to excess pounds.

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Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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