Overview
Plant sterols are most commonly used for lowering cholesterol levels. Plant sterols are also used for other conditions, but there is no good scientific evidence to support these other uses.
In foods, plant sterols are added to some types of margarine.
Don't confuse plant sterols with beta-sitosterol. Beta-sitosterol is one type of plant sterol. However, it also has its own uses. Also don't confuse plant sterols with sitostanol. Sitostanol is a plant stanol.
How does it work ?
Uses & Effectiveness ?
Likely Effective for
- Inherited tendency towards high cholesterol (familial hypercholesterolemia). Plant sterols are effective for reducing cholesterol levels in children and adults with high cholesterol levels due to familial hypercholesterolemia. When taken in people who are also following a low-fat or cholesterol-lowering diet, plant sterols can reduce total and "bad" low-density lipoprotein (LDL) cholesterol more than the diet alone. Plant sterols don't decrease blood fats called triglycerides or increase "good" high-density lipoprotein (HDL) cholesterol levels.
- High cholesterol. Taking plant sterols lowers total and low-density lipoprotein (LDL or "bad") cholesterol levels by about 3% to 15% in people with high cholesterol who are following a cholesterol-lowering diet. When added to a cholesterol-lowering prescription medication, such as certain "statins", plant sterols reduce total cholesterol by an additional 12-22 mg/dL and LDL cholesterol by another 11-16 mg/dL.
Plant sterols can be incorporated in margarines, dairy products, and breads and cereals, or taken in pill form. Research suggests a dose of about 2-3 grams daily lowers cholesterol the most. But plant sterols may stop working as well when taken for more than 2-3 months. Plant sterols don't raise "good" high-density lipoprotein (HDL) cholesterol levels.
Possibly Effective for
- Heart disease. High cholesterol levels increase a person's risk for heart disease. Plant sterols can lower cholesterol levels. Because of this, eating foods that contain at least 3.4 grams of plant sterols per day as part of a low-fat, low-cholesterol diet may help prevent heart disease.
Insufficient Evidence for
- Colon cancer, rectal cancer. People who eat more plant sterols as part of their diet don't have a lower risk of colon cancer compared to people who eat less plant sterols. Also women who eat more plant sterols don't have a lower risk of rectal cancer compared to women who eat less plant sterols. But men who eat more plant sterols might have a lower risk of rectal cancer compared to men who eat less plant sterols.
- Stomach cancer. People who eat at least 82.5 mg of plant sterols daily as part of their diet seem to have a lower risk of gastric cancer compared to people who eat less than 45.5 mg daily.
- A grouping of symptoms that increase the risk of diabetes, heart disease, and stroke (metabolic syndrome). Metabolic syndrome is a group of conditions that increase the risk of having heart disease, stroke, and diabetes. These conditions include high cholesterol, high blood pressure, high blood sugar, and excess fat. Some research shows that taking 2 grams of plant sterols twice daily reduces cholesterol levels in people with metabolic syndrome. But other research shows that taking 2 grams of plant sterols once daily does not lower cholesterol levels in people with metabolic syndrome.
- Heart attack. Men who eat more plant sterols as part of their diet have a 29% lower risk of having a heart attack compared to men who eat less. But women who eat more plant sterols don't seem to have a lower risk of having a heart attack compared to women who eat less.
- Obesity. Early research shows that eating a snack bar containing 1.8 grams of plant sterols lowers total cholesterol levels by about 10% compared to eating the snack bar alone in people who are obese and trying to lose weight. But eating the snack bar containing plant sterols doesn't increase weight loss, reduce "bad" low-density lipoprotein (LDL) cholesterol levels, or improve blood sugar levels compared to eating a snack bar that doesn't contain plant sterols.
- Heart disease (cardiovascular disease or CVD).
- Heart disease (coronary heart disease or CHD).
- Prediabetes.
- Other conditions.
Side Effects
Special Precautions and Warnings
Children: Plant sterols are LIKELY SAFE when taken by mouth. They can cause some side effects, such as diarrhea or fat in the stool.
Sitosterolemia, a rare inherited fat storage disease: Plant sterols can build up in the blood and tissue of people with this condition. This build-up can make these people prone to early heart disease. Taking plant sterols might make this condition worse. Don't take plant sterols if you have sitosterolemia.
Short bowel syndrome, a condition related to removal of part of the gut: Worsening of liver function has been reported for a person with short bowel syndrome who was given nutrients containing plant sterols. Liver function improved when the plant sterols were removed from the nutrients. It's not clear if the plant sterols were responsible. Until more is known, don't take plant sterols if you have short bowel syndrome.
Interactions ?
We currently have no information for PLANT STEROLS overview.
Dosing
ADULTS
BY MOUTH:
- For heart disease: Foods that contain at least 3.4 grams of plant sterols daily, as part of a low-fat, low-cholesterol diet.
- For inherited tendency towards high cholesterol (familial hypercholesterolemia): 1.6-1.8 grams of plant sterols per day for 8-26 weeks have been used.
- For high cholesterol: Doses of about 2-3 grams daily seem to work the best.
BY MOUTH:
- For inherited tendency towards high cholesterol (familial hypercholesterolemia): 1.6-2.3 grams of plant sterols per day have been used in children 6-16 years-old.
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Clifton, P. M., Noakes, M., Sullivan, D., Erichsen, N., Ross, D., Annison, G., Fassoulakis, A., Cehun, M., and Nestel, P. Cholesterol-lowering effects of plant sterol esters differ in milk, yoghurt, bread and cereal. Eur.J Clin.Nutr. 2004;58(3):503-509. View abstract.
De Stefani, E., Boffetta, P., Ronco, A. L., Brennan, P., Deneo-Pellegrini, H., Carzoglio, J. C., and Mendilaharsu, M. Plant sterols and risk of stomach cancer: a case-control study in Uruguay. Nutr.Cancer 2000;37(2):140-144. View abstract.
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Fernandez, C., Suarez, Y., Ferruelo, A. J., Gomez-Coronado, D., and Lasuncion, M. A. Inhibition of cholesterol biosynthesis by Delta22-unsaturated phytosterols via competitive inhibition of sterol Delta24-reductase in mammalian cells. Biochem.J 8-15-2002;366(Pt 1):109-119. View abstract.
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Hallikainen, M., Huikko, L., Kontra, K., Nissinen, M., Piironen, V., Miettinen, T., and Gylling, H. Effect of parenteral serum plant sterols on liver enzymes and cholesterol metabolism in a patient with short bowel syndrome. Nutr Clin Pract. 2008;23(4):429-435. View abstract.
Hendriks, H. F., Brink, E. J., Meijer, G. W., Princen, H. M., and Ntanios, F. Y. Safety of long-term consumption of plant sterol esters-enriched spread. Eur.J Clin.Nutr. 2003;57(5):681-692. View abstract.
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Tuomilehto, J., Tikkanen, M. J., Hogstrom, P., Keinanen-Kiukaanniemi, S., Piironen, V., Toivo, J., Salonen, J. T., Nyyssonen, K., Stenman, U. H., Alfthan, H., and Karppanen, H. Safety assessment of common foods enriched with natural nonesterified plant sterols. Eur J Clin Nutr 2009;63(5):684-691. View abstract.
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Chen JT, Wesley R, Shamburek RD, et al. Meta-Analysis of natural therapies for hyperlipidemia: plant sterols and stanols versus policosanol. Pharmacotherapy 2005;25:171-83. View abstract.
Demonty I, Ras RT, van der Knaap HC, Meijer L, Zock PL, Geleijnse JM, Trautwein EA. The effect of plant sterols on serum triglyceride concentrations is dependent on baseline concentrations: a pooled analysis of 12 randomised controlled trials. Eur J Nutr. 2013 Feb;52(1):153-60. View abstract.
Doornbos AM, Meynen EM, Duchateau GS, van der Knaap HC, Trautwein EA. Intake occasion affects the serum cholesterol lowering of a plant sterol-enriched single-dose yoghurt drink in mildly hypercholesterolaemic subjects. Eur J Clin Nutr. 2006 Mar;60(3):325-33. View abstract.
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Hallikainen MA, Sarkkinen ES, Gylling H, et al. Comparison of the effects of plant sterol ester and plant stanol ester-enriched margarines in lowering serum cholesterol concentrations in hypercholesterolaemic subjects on a low-fat diet. Eur J Clin Nutr 2000;54:715-25. View abstract.
Haque Hussain SS, Weir J, Roberts N. Severe dermatitis secondary to plant sterol supplements. Clin Exp Dermatol. 2009 Oct;34(7):e276-7. View abstract.
Heinemann T, Kullak-Ublick GA, Pietruck B, von Bergmann K. Mechanisms of action of plant sterols on inhibition of cholesterol absorption. Comparison of sitosterol and sitostanol. Eur J Clin Pharmacol 1991;40 Suppl 1:S59-63. View abstract.
Hidaka H, Kojima H, Kawabata T, et al. Effects of an HMG-CoA reductase inhibitor, pravastatin, and bile sequestering resin, cholestyramine, on plasma plant sterol levels in hypercholesterolemic subjects. J Atheroscler Thromb 1995;2:60-5. View abstract.
Hongu N, Kitts DD, Zawistowski J, Dossett CM, Kopec A, Pope BT, Buchowski MS. Pigmented rice bran and plant sterol combination reduces serum lipids in overweight and obese adults. J Am Coll Nutr. 2014;33(3):231-8. View abstract.
Jones PJ, Demonty I, Chan YM, Herzog Y, Pelled D. Fish-oil esters of plant sterols differ from vegetable-oil sterol esters in triglycerides lowering, carotenoid bioavailability and impact on plasminogen activator inhibitor-1 (PAI-1) concentrations in hypercholesterolemic subjects. Lipids Health Dis. 2007 Oct 25;6:28. View abstract.
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Jones PJ, Raeini-Sarjaz M, Ntanios FY, et al. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. J Lipid Res 2000;41:697-705. View abstract.
Klingberg S, Ellegård L, Johansson I, Jansson JH, Hallmans G, Winkvist A. Dietary intake of naturally occurring plant sterols is related to a lower risk of a first myocardial infarction in men but not in women in northern Sweden. J Nutr. 2013 Oct;143(10):1630-5. View abstract.
Korpela R, Tuomilehto J, Högström P, Seppo L, Piironen V, Salo-Väänänen P, Toivo J, Lamberg-Allardt C, Kärkkäinen M, Outila T, Sundvall J, Vilkkilä S, Tikkanen MJ. Safety aspects and cholesterol-lowering efficacy of low fat dairy products containing plant sterols. Eur J Clin Nutr. 2006 May;60(5):633-42. View abstract.
Law M. Plant sterol and stanol margarines and health. BMJ 2000;320:861-4. View abstract.
Lichtenstein AH, Deckelbaum RJ. Stanol/sterol ester-containing foods and blood cholesterol levels: a statement for healthcare professionals from Nutrition Committee, Council on Nutrition, Physical Activity, Metabolism of American Heart Association. Circulation 2001;103:1177-9. View abstract.
Mackay DS, Gebauer SK, Eck PK, Baer DJ, Jones PJ. Lathosterol-to-cholesterol ratio in serum predicts cholesterol-lowering response to plant sterol consumption in a dual-center, randomized, single-blind placebo-controlled trial. Am J Clin Nutr. 2015 Mar;101(3):432-9. View abstract.
Maki KC, Lawless AL, Reeves MS, Dicklin MR, Jenks BH, Shneyvas E, Brooks JR. Lipid-altering effects of a dietary supplement tablet containing free plant sterols and stanols in men and women with primary hypercholesterolaemia: a randomized, placebo-controlled crossover trial. Int J Food Sci Nutr. 2012 Jun;63(4):476-82. View abstract.
Maki KC, Lawless AL, Reeves MS, Kelley KM, Dicklin MR, Jenks BH, Shneyvas E, Brooks JR. Lipid effects of a dietary supplement softgel capsule containing plant sterols/stanols in primary hypercholesterolemia. Nutrition. 2013 Jan;29(1):96-100. View abstract.
Malhotra A, Shafiq N, Arora A, Singh M, Kumar R, Malhotra S. Dietary interventions (plant sterols, stanols, omega-3 fatty acids, soy protein and dietary fibers) for familial hypercholesterolaemia. Cochrane Database Syst Rev. 2014 Jun 10;6:CD001918. View abstract.
McKenney JM, Jenks BH, Shneyvas E, Brooks JR, Shenoy SF, Cook CM, Maki KC. A softgel dietary supplement containing esterified plant sterols and stanols improves the blood lipid profile of adults with primary hypercholesterolemia: a randomized, double-blind, placebo-controlled replication study. J Acad Nutr Diet. 2014 Feb;114(2):244-9. View abstract.
Musa-Veloso K, Poon TH, Elliot JA, Chung C. A comparison of the LDL-cholesterol lowering efficacy of plant stanols and plant sterols over a continuous dose range: results of a meta-analysis of randomized, placebo-controlled trials. Prostaglandins Leukot Essent Fatty Acids. 2011 Jul;85(1):9-28. View abstract.
Nguyen LB, Shefer S, Salen G, et al. Competitive inhibition of hepatic sterol 27-hydroxylase by sitosterol: decreased activity in sitosterolemia. Proc Assoc Am Physicians 1998;110:32-9. View abstract.
O'Neill FH, Sanders TA, Thompson GR. Comparison of efficacy of plant stanol ester and sterol ester: short-term and longer-term studies. Am J Cardiol. 2005 Jul 4;96(1A):29D-36D. View abstract.
Ooi EM, Watts GF, Barrett PH, Chan DC, Clifton PM, Ji J, Nestel PJ. Dietary plant sterols supplementation does not alter lipoprotein kinetics in men with the metabolic syndrome. Asia Pac J Clin Nutr. 2007;16(4):624-31. View abstract.
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Scholle JM, Baker WL, Talati R, Coleman CI. The effect of adding plant sterols or stanols to statin therapy in hypercholesterolemic patients: systematic review and meta-analysis. J Am Coll Nutr. 2009 Oct;28(5):517-24. View abstract.
Sialvera TE, Pounis GD, Koutelidakis AE, Richter DJ, Yfanti G, Kapsokefalou M, Goumas G, Chiotinis N, Diamantopoulos E, Zampelas A. Phytosterols supplementation decreases plasma small and dense LDL levels in metabolic syndrome patients on a westernized type diet. Nutr Metab Cardiovasc Dis. 2012 Oct;22(10):843-8. View abstract.
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Weststrate JA, Meijer GW. Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects. Eur J Clin Nutr 1998;52:334-43. View abstract.
Yang W, Gage H, Jackson D, Raats M. The effectiveness and cost-effectiveness of plant sterol or stanol-enriched functional foods as a primary prevention strategy for people with cardiovascular disease risk in England: a modeling study. Eur J Health Econ 2018;19(7):909-22. doi: 10.1007/s10198-017-0934-2. View abstract.
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