Osumex Natural Products

A position statement from the Heart Foundation's Nutrition and Metabolism Advisory Committee - The Heart Foundation of Australia

Extracts:

Background
Studies indicate that incorporating plant sterols and stanols into the diet may be an effective method of lowering total and LDL cholesterol levels.

Plant sterols and stanols are not produced by animals or the human body. Plant sterols and stanols are natural substances found in wood pulp, leaves, nuts, vegetable oils, corn, rice, and some other plants. The major plant sterol is sitosterol (approx 80%). Others present in the diet include campesterol and stigmasterol and trace amounts of plant stanols such as sitostanol. The average Western diet contains between 160 to 360 mg/day of sitosterol and campersterol and 20 to 50 mg/day of sitostanol. Dietary intake of plant sterol in a traditional Asian diet is 350-400 mg/day and 600-800 mg/day in a strict vegetarian diet.

Plant sterols and stanols are similar in structure to cholesterol. The difference is the presence of a methyl or ethyl group in their side chains. This difference means that, in comparison to cholesterol, plant sterol and stanols are not absorbed, or are minimally absorbed.

Mechanism for lowering cholesterol levels
Cholesterol must exist in a soluble form to be absorbed. To achieve this, bile acids, lysolecithin, monoglycerides and fatty acids form mixed micelles to solubilise cholesterol and assist cholesterol transport. Plant sterols and stanols reduce cholesterol absorption by competing with cholesterol for uptake into mixed micelles. When less dietary and biliary cholesterol is absorbed, less cholesterol is returned to the liver. This stimulates LDL receptor formation which, in turn, increases the hepatic uptake of LDL and thus decreases serum LDL cholesterol levels.

At current intake levels, plant sterols and stanols have little effect on cholesterol absorption. However, for about 40 years it has been recognized that higher levels of consumption can interfere with cholesterol absorption and result in decreased serum cholesterol levels.

Evidence for cholesterol lowering
The first line of treatment for hypercholesterolaemia is dietary management, in particular, the reduction of saturated fat intake to lower LDL cholesterol concentrations. The effect of plant sterols and stanols on blood lipids has been shown to be additive to that of fatty acid manipulation.

In hypercholesterolaemic patients, Heinemann et al (1986) demonstrated that a low dose of sitostanol, 1.5g/day divided into 3 doses, lowered total and LDL cholesterol by 15%. In children with familial hypercholesterolaemia, Becker et al (1993) showed 6g/day of sitosterols lowered LDL cholesterol by 20% and by 33% with 1.5g/day of sitostanol.

In more recent times, the esterification of sterols and stanols has allowed for their incorporation into dietary fats, in particular margarine and mayonnaise. Short term studies of hypercholesterolaemic subjects found 3.4g/day of plant stanol ester enriched mayonnaise reduced total and LDL cholesterol by 7.5% and 10%, respectively (Vanhanen et al, 1994). Within 2.5 weeks, Weststrate and Meijer (1998), found 1.5-3.3g of sterol esters per day reduced total and LDL cholesterol by 8% and 13%, respectively, in normocholesterolaemic and mildly hypercholesterolaemic healthy males and females. These results confirmed the cholesterol lowering effects reported by Miettinen et al (1995) of a spread enriched with sitostanol ester. In this one year study, margarine fortified with 2.6g/day of sitostanol ester decreased total and LDL cholesterol by 10% and 14%, respectively, in subjects with mild hypercholesterolaemia (Miettinen et al, 1995).

The cholesterol lowering effect of plant sterols has also been demonstrated in people with Type II diabetes and postmenopausal women with CHD. Men with Type II diabetes consuming 24g margarine enriched with 3g of plant stanol reduced their total cholesterol by 8% and LDL cholesterol by 11%, and significantly increased HDL cholesterol levels. (Gylling and Miettinen, 1994). In a group of women with CHD not taking lipid lowering medication, 24g plant stanol ester margarine (3g/day of plant stanol) significantly lowered total and LDL cholesterol levels by 13 and 20%, respectively (Gylling, Radhakrishnan and Miettinen, 1997).

Studies also demonstrate that plant sterols are an effective adjunct to cholesterol lowering statins. Type II diabetic men on pravastatin lowered their serum total and LDL cholesterol by 32% and 42%, respectively. When the statin was combined with a plant stanol ester (3g/day stanol equivalents), LDL cholesterol was reduced a further 4% (Gylling and Miettinen, 1996). In the study of postmenopausal women with CHD, the use of simvastatin alone reduced the LDL cholesterol level by 35%, with the reduction growing to 46% following the addition of plant stanol ester margarine (Gylling, Radhakrishnan and Miettinen, 1997).

Safety aspects of plant sterols and stanols
On the basis of the limited number of studies undertaken to date, there is nothing to suggest that the consumption of either plant stanol esters or plant sterol esters is unsafe. This conclusion is based on studies in which the stanol or sterol has been consumed for up to 12 months. Studies of longer-term consumption have not been performed in significant numbers of people.

The consumption of plant stanol esters (2.6g/day) has been reported to lower serum concentrations of a-tocopherol (Gylling, Puska, Vartiainen etal , 1996; Gylling, Miettinen, 1997). Most of the tocopherols are carried in the LDLs, which are reduced by plant stanol esters. It is important to note that the ratio of a-tocopherol to cholesterol was not changed. Westrate and Meijer (1998) found that a small quantity of plant sterols (about 3g/day) impeded the absorption in the gut of the carotenoids. Hendriks et al (1999) showed both the lowest (0.83g/day) and the highest dose (3.24g/day), but not the middle dose (1.61g/day), affected plasma carotenoid concentrations to a limited extent.

Heart Foundation Position:

A daily intake of 2 to 3g of plant sterols or stanols reduces LDL cholesterol levels by 10% to 15%.
Plant sterols and stanols lower cholesterol in various groups including normo and hypercholesterolaemics, males, females, adults and children.
The intake of plant sterols and stanols is complementary to a cholesterol lowering eating pattern.
In order to minimize any decrease in plasma carotenoids associated with the consumption of plant sterols and stanols, the diet should include a daily intake of yellow and orange vegetables and fruits, although the effect of this in maintaining plasma carotenoid levels has not been subjected to scientific study.
There is no evidence, which would lead to safety concerns associated with the short term consumption of plant stanols and plant sterols, although long term safety studies have not yet been performed.

For people with an increased risk of coronary heart disease, plant sterols and stanols provide an additional option for risk reduction through lowering the level of plasma cholesterol. However, the benefits in terms of reduction of heart disease by lowering cholesterol in this way have yet to be demonstrated in long-term studies and data will continue to be monitored by the Heart Foundation.

The above information is provided for general educational purposes only. It is not intended to replace competent health care advice received from a knowledgeable healthcare professional. You are urged to seek healthcare advice for the treatment of any illness or disease.
Health Canada and the FDA (USA) have not evaluated these statements. This product is not intended to diagnose, treat, cure, or prevent any disease.

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