Plant Stanol/Sterol Fortified Foods Part I:  What are they?
How effective are they in lowering LDL cholesterol levels?

What are they?

• Foods fortified with plant stanol ester (Benecol®, McNeil Consumer Nutritionals, Fort Washington, PA)
  or with plant sterol ester (Take Control^®, Lipton, Englewood, NJ)  are clinically proven, effective dietary tools for lowering LDL cholesterol levels. 
  
  
• These foods are recommended by the National Cholesterol Education Program as dietary options for enhancing the LDL cholesterol-lowering efficacy of a diet low in saturated fat and cholesterol.  The Food and Drug Administration have granted a health claim for these foods for their potential to lower risk of heart disease.

How effective are they?

• LDL cholesterol is lowered by 10% to 15% when 2 to 3 servings of these foods are incorporated into the diet, regardless of the composition of the background diet.
  
  
• LDL cholesterol is lowered by 20-25% when a patient switches from a diet high in saturated fat and cholesterol to a diet low in saturated fat and cholesterol that includes 2-3 servings daily of plant stanol/sterol fortified foods (5% to 10% from the reduction in saturated fat and cholesterol and 10-15% from the incorporation of plant stanols/sterols).
  
  
• LDL cholesterol is lowered an additional 10%-15% when plant stanols/sterols are added to the diets of patients already on statin therapy.  Addition of 2-3 servings daily of plant stanols/sterols
  to the diet results in greater LDL cholesterol reduction than doubling the dose of a statin.

Learn more on the mechanism of action and practical aspects about incorporating plant stanols/sterols into the diet in the next Nutrition Pearl.

References:

Miettinen TA, Puska P, Gylling H, Vanhanen H, Vartiaianen E.  Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N Engl J Med 1995; 333: 1308-12.

Cater NB.  Plant stanol ester: review of cholesterol-lowering efficacy and implications for coronary heart disease risk reduction.  Prev Cardiol 2000; 3: 121-130.

Grundy SM.  Stanol esters as dietary adjunct to cholesterol-lowering therapies.  Eur Heart J 1999; 1: S132-S138.

Blair SN, Capuzzi DM, Gottlieb SO, Nguyen TT, Morgan JM, Cater NB.  Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy.  Am J Cardiol 2000; 86: 46-52.

Westrate JA, Meijer GW.  Plant sterol-enriched margarines and reduction of plasma total and LDL cholesterol concentrations in normocholesterolemic and mildly hypercholesterolemic subjects.  Eur J Clin Nutr 1998; 52; 334-43.