What are Stanols and Sterols?

Focus on dietary stanols and sterols

Stanols and sterols are naturally-occurring components, similar in chemical structure to cholesterol, found in plant-based foods including fruits, vegetables, oils, grains, nuts and seeds. However, at the levels in which they normally occur in the diet, there is no appreciable effect on cholesterol. 

Through esterification, stanols and sterols are better absorbed by the body and, since the process makes them more fat-soluble, they can be incorporated into foods containing fat, such as dairy products and spreads.

How do they work?

Being similar in chemical structure to cholesterol, stanols and sterols have been demonstrated to lower blood cholesterol levels by reducing the absorption of cholesterol from the intestine. It has been suggested that stanols or sterols may compete with cholesterol for the limited space in the fat-transporting micelles. Another mechanism has shown that plant stanols and sterols may form crystals with cholesterol that cannot be absorbed and so are excreted. Consequently, more cholesterol is excreted via the faeces.

Cholesterol-lowering effects (a long wealth of evidence)

Over 50 published high quality clinical trials have clearly demonstrated the effects of plant stanols and sterols on cholesterol. In particular, one meta-analysis of 41 studies 6 showed that taking a 2g-per-day dosage of plant stanols and sterols reduced LDL-cholesterol by a clinically significant 10% after two to three weeks, consequently reducing cardiovascular risk for people with raised LDL-cholesterol.7,8

Similarly, a study of plant sterols showed that after 4 weeks on a statin combined with 2g plant sterol-enriched margarine the reduction in low-density lipoprotein cholesterol offered LDL cholesterol reduction equivalent to doubling the dose of statin.10

More recently, it has been demonstrated, using modelling techniques, that replacing usual margarine with one containing stanols reduced total cholesterol by 0.362mmol/l compared with 0.385mmol/l reduction when stanols were consumed alongside a statin.11 The authors recommended that plant stanol ester-containing spreads, used daily to replace regular spread, could be seen as a potentially cost-effective policy in men and older women with raised cholesterol levels.

It is important to note that the correct dose of stanols or sterols needs to be consumed, and manufacturers' guidelines should be followed.

A dose of 2-3g per day is generally recommended, as there seems to be no further significant improvement if larger quantities are consumed (the dose effect curve levels off). Furthermore, the beneficial effect is lost when patients stop using the product. A dose of 2-3g can be obtained by consuming three portions of foods enriched with plant stanols (found in the Benecol® range of foods) such as margarines and dairy products or sterols (e.g. Flora Pro.activ®, MiniCol cheese®). Alternatively 2g can be achieved by drinking one Benecol ‘one a day' yogurt drink, dairy free drink or a Benecol fruit and dairy smoothie or one Flora Pro.activ mini drink or a 250ml glass of Flora Pro.activ milk or eating a 65g portion of MiniCol® cheese.

In additional to the wealth of evidence to show that a healthy and varied diet, including functional foods containing plant stanols and sterols, can play a significant role in lowering cholesterol, healthcare professionals now have the added confidence from research trials to suggest these foods to their patients as an additional tool in the fight against CHD. However, many products are at a premium cost which should be weighed up before making recommendations to those on a low income.

A disease risk reduction claim relating to plant stanol esters and plant sterols was amongst the first claims to be authorised by the new Health Claims Regulation of the European Commission, which requires all food manufacturers to substantiate their health claims. The announcement of the disease risk reduction claim on 22 October 2009 means that consumers with raised cholesterol levels can feel secure in the knowledge that 2g of plant stanol esters or plant sterols consumed on a daily basis will lower cholesterol levels. High cholesterol is a risk factor in the development of CHD.

In light of the significant results from studies conducted to date, theNational Institute for Clinical Excellence (NICE) has also highlighted a research need to establish the effectiveness of plant stanols and sterols, recognising the potential of these products and an appropriately adapted low-fat diet, to avoid the need to use drugs to modify cholesterol levels.

Credit to: Online-only Article

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