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Plant Stanols –                                            From nature to cholesterol lowering

What are plant stanols?

Plant stanols are naturally found in small amounts in plant foods such as wholegrains, nuts, seeds, fruit, vegetables, beans, lentils and vegetable oils [1, 2]. They’re also added to some foods in larger amounts, such as yogurt drinks, yogurts, spreads. The reason they’ve gained so much interest in recent years is thanks to their ability to help people control their cholesterol. We talk more about plant stanols at Benecol, because Benecol products contain added plant stanols – they’re designed to taste delicious but also help people lower their cholesterol, as part of a balanced, healthy diet.
According to The Cholesterol Charity Heart UK – ‘Some experts believe foods with added plant stanols and sterols are the most effective single food for lowering cholesterol’.

What’s the link between plant stanols and cholesterol?

Plant stanols are known as the plant kingdom’s equivalent of cholesterol [3] because they are very similar to cholesterol in terms of the way they are made up and exert similar functions in the plant cells as cholesterol in our body. It’s this similarity in structure that’s responsible for the benefits achieved by adding plant stanols to our diet.

How does cholesterol get into our digestive system?

Cholesterol doesn’t just circulate in our blood. It’s also present in our digestive system. Some of this comes from the cholesterol contained in the food we eat. Most of cholesterol in digestive system comes from the bile solution, which is made in the liver, stored in the gallbladder and released when food leaves our stomach and enters the small intestine.
The bile solution contains bile acids, which are made from cholesterol by the liver. These bile acids are crucial in the digestion of dietary fats and oils. Bile acids, digested fat and fat-soluble components, like cholesterol are packed into small droplets called mixed micelles, which are kind of water-soluble “transport capsules”. These mixed micelles are attached to the small intestinal wall and fat and cholesterol are taken up by absorptive cells. After this, part of the bile acids is excreted in faeces, while most of it is recycled back to the liver.

The Simple Science of Plant Stanols

How do plant stanols help to lower cholesterol?

In our digestive system, small particles carry cholesterol to the wall of our intestine. Here, the cholesterol travels across the wall and is absorbed into the blood. Because plant stanols are similar in size and shape to cholesterol [4], they are able to jump in and take the place of some of the cholesterol in these small particles. This means more cholesterol stays in our digestive system rather than entering our bloodstream. Normally about 50% of cholesterol is absorbed from the digestive tract into the blood, but when plant stanols have been taken, just 20% of cholesterol is absorbed [5, 6]. Better still, it’s particularly the LDL cholesterol (the main component of non-HDL or ‘bad’ cholesterol) that’s lowered in our blood – our HDL or ‘good’ cholesterol isn’t affected. This is great news as less ‘bad’ cholesterol in our blood means less potential for clogging up our arteries, helping to keep them healthy and allowing blood to flow freely. High cholesterol is a risk factor in the development of coronary heart disease*[7]. The cholesterol that’s left behind in the digestive system is then eliminated from the body when we go to the toilet.

*Plant stanol ester has been shown to lower cholesterol. High cholesterol is a risk factor in the development of coronary heart disease (CHD). CHD has multiple risk factors, including smoking, inactivity, being overweight or obese, high blood pressure, high triglycerides, type 2 diabetes, drinking alcohol to excess and having too much stress, and it’s the sum of these parts that’s important – the more risk factors you have, the more you’ll need to improve to reduce your overall risk. But, the good news is that many of these risk factors overlap and influence each other: you can make improvements in one area, like your cholesterol levels, and you’re likely to see them benefit each other.

Is there any proof that stanols work?

Plant stanol esters have been rigorously researched and tested and there’s heaps of evidence that proves they help to lower cholesterol and keep it lower with daily use. In fact, their ability to lower cholesterol has been demonstrated in more than 80 independent clinical studies [8-15] and guidelines around the world recommend people with high blood cholesterol include plant stanols as part of an overall healthy eating plan that will help to reduce cholesterol [16-18]. Bottom line: plant stanol ester in Benecol foods are proven to be an effective part of a balanced and varied and an overall healthy diet to lower cholesterol. 80 + clinical studies have proven that plant stanols in Benecol products actively lower cholesterol.

Within the UK and EU countries, certain products such as spreads and dairy products that have plant stanol esters added to them in certain specified amounts can make the following claim: Plant stanol esters have been shown to lower/reduce blood cholesterol. High cholesterol is a risk factor in the development of coronary heart disease. [14]

Is there a minimum amount of plant stanols we should have to lower cholesterol?

Yes, there is! In people who have high blood cholesterol, a daily intake of 1.5-2.4g of plant stanols lowers LDL cholesterol (the main component of non-HDL or ‘bad’ cholesterol) by an average of 7-10% within two to three weeks. [19] You need to have these amounts every day for two to three weeks to see the benefit to cholesterol levels. Higher than 3 g/day plant stanols should not be consumed based on recommendations by authorities (ref. 22 or other)

How easy is it to get enough plant stanols in our diet?

Plant stanols occur naturally in a variety of plant foods such as wholegrains (for example wheat and rye), nuts, seeds, fruit, vegetables, beans, lentils and vegetable oils (like corn, sunflower and rapeseed oil) [1, 2]. However, they’re only found in small amounts, so even a healthy diet that includes plenty of these foods won’t provide enough stanols to actively lower cholesterol. Although vegetarian diets may contain slightly higher amounts, a normal diet has been shown to contain just 20-30 mg plant stanols each day [22, 23]. So, the only way to get enough stanols to actively reduce cholesterol is to enjoy foods that have stanols added to them in large enough amounts. Benecol products include yogurts, yogurt and soya drinks, spreads and fruit and nut/oat bars, all of which have plant stanol esters added to them to help you achieve each day the amount needed to see a reduction in cholesterol.

What are plant stanol esters?

Plant stanol ester simply combines plant stanols with specific fats found in vegetable oil – this form makes it easy to add them to foods such as yogurts.

Who should take products containing plant stanols?

Benecol products that have plant stanols added to them are a great choice for anyone who has been diagnosed with high cholesterol, including people who have been diagnosed with coronary heart disease and type 2 diabetes, who need a little helping hand to reach their cholesterol targets, or adults and children with inherited high cholesterol such as familial hypercholesterolaemia (FH) [8, 16, 17, 18]. People taking statin medication, or those who cannot tolerate them, would also benefit from eating Benecol foods with added plant stanols – with support from a doctor or a dietitian. They should be consumed as part of an overall healthy diet. This includes reducing saturated fat, and eating more fruit and vegetables, for example.

Is there anyone who should avoid products containing plant stanols?

Products such as Benecol are not suitable for children under five who do not have FH or pregnant or breastfeeding women, unless a doctor or other heath professional has advised them. This is because cholesterol is important for normal growth.

Can products containing plant stanols be used alongside cholesterol-lowering medication?

Statins are one of the most common medications prescribed by doctors to treat high cholesterol and they are very good at lowering ‘bad’ cholesterol levels. However, it’s important not to rely on them alone though to lower cholesterol. For the best cholesterol-lowering results, lifestyle changes such as giving up smoking, exercising more often and making changes to our diet should be made alongside taking medication. Enjoying foods with added plant stanols, such as Benecol products can be an effective way to boost the effects of an eating plan to help to lower cholesterol and can be used together with statins. Better still, taking products containing stanols alongside statins has been shown to add to their effectiveness – research shows the plant stanols in Benecol can provide an extra 10% reduction in cholesterol to that achieved by taking statins alone – this may be even greater than doubling a statin dose [8, 9, 11, 24, 25].

However, plant stanols are unlikely to have much effect if you are taking another type of cholesterol lowering medicine, Ezetrol (Eztemibe). This is because they both work in a similar way [4].

If you have been prescribed statins or other cholesterol-lowering medication, you shouldn’t replace it with Benecol products with added plant stanols. Instead, enjoy Benecol foods alongside these medications to get extra cholesterol lowering benefits.

How should Benecol products be consumed?

Benecol products should be consumed every day to get the best cholesterol-lowering effect and gain long term benefit. It’s important to eat the products with a meal rather than on their own. This is because eating a meal helps to set the whole digestive process in motion, ensuring that cholesterol is in the digestive system. And it doesn’t matter whether you have the recommended daily dose of plant stanols in one go or spread them out over several meals. [26]. The most important thing is to make sure you have enough and you eat them with meals. Check the packaging to find out the amount of plant stanols in individual Benecol products or go to our product pages for more info.

What happens if I stop taking plant stanols?

If you’ve been diagnosed with high cholesterol and have been taking the recommended dose of plant stanols on a daily basis for two to three weeks, you should see an improvement in your cholesterol levels. Missing the occasional dose is unlikely to have any immediate impact on your blood cholesterol, but if you stop taking plant stanols altogether, you can expect to see your cholesterol slowly return to its previous level in a few weeks [15]. So if you want the cholesterol-lowering benefits to stay, you need to keep taking the recommended dose of stanols on a daily basis.

Is it worth taking plant stanols if cholesterol is within healthy limits?

Products containing plant stanols such as Benecol are designed to help lower blood cholesterol in people who have raised levels. However, they may also be useful for helping to maintain blood cholesterol within a healthy range, as we age. In the UK and EU, products that deliver 0,8 g plant stanols per day may make the following claim on packaging: Plant stanols contribute to the maintenance of normal blood cholesterol levels [27].

Are plant stanols safe to take?

Absolutely! Plant stanols have been thoroughly researched and are completely safe, even when consumed for long periods of time (such as 12 to 18 months) [28]. Indeed, testimony to the safety and efficacy of plant stanol esters in Benecol’s cholesterol lowering products is that plant stanol ester was among the first and among the few chosen ingredients for which the strongest possible health claim for food was approved in Europe. And, of course on Benecol 25th Anniversary you cannot forget that Benecol products with added plant stanol esters have been safely eaten and enjoyed daily by millions of people all over the world.

Are there any side effects to taking plant stanols?

No side effects have been reported in the many studies that have been carried out with plant stanol esters since the early 1990s. Plant stanols aren’t absorbed into our body to any great extent [29] and instead pass through our digestive system.

One concern with plant stanols is that because they partially block cholesterol from getting into our bloodstream, they may interfere with the absorption of fat-soluble vitamins (A, D, E & K). However, while small reductions have been seen for some carotenoids including beta-carotene (which is converted into vitamin A in the body) [23], levels still remain within normal values [30]. More so, in general, any slight reductions can easily be compensated for by making sure you eat a diet that is rich in fruit and vegetables – at least your 5-A-Day – including orange and red varieties, such as carrots, pumpkin, squash, apricots, tomatoes and mango [21].

Anyhow, don’t worry about your cholesterol levels dropping too much by eating Benecol products with added plant stanol ester – it’s also not possible for cholesterol levels to fall too low, as the liver produces and controls the amount of cholesterol, so makes more if it’s needed. The only effect plant stanols have is to help lower cholesterol by stopping it from being absorbed from the gut into the blood – and this of course, is a big positive!

How do Benecol products fit into our overall diet?

Benecol products are a simple way to help lower cholesterol and an easy fit to your everyday diet. There are lots of Benecol products and flavours to choose from to get you the cholesterol lowering benefits you need every day, so making a change has never been easier. And as we know, it’s often the small changes, not the massive overhauls, which bring about the most lasting change.

Benecol products have full nutrition information and ingredients’ lists on the packaging and tell you the exact amount of plant stanols per serving. All are suitable for vegetarian diets and the soya drinks are ideal for people who follow a vegan or dairy-free diet. But perhaps best of all, they taste great and are a delicious way to help bring cholesterol levels down as part of an overall healthy, cholesterol-lowering diet and lifestyle.

How to get the right daily amount is up to you. You could enjoy a Benecol yogurt drink with your morning bowl of porridge and a serving of Benecol buttery taste spread on your lunchtime baked potato, or why not spread Benecol light lavishly on your breakfast toast or and have a Benecol yogurt as a healthy evening pud. The Benecol bars are also great for easy cholesterol lowering on the go, or whenever you feel like a tasty wholegrain snack. So mix and match and choose from any of the following options:

Plant stanol content in Benecol products

References:

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[2] Piironen V, Toivo J, Lampi A. Natural sources of dietary plant sterols. J Food Compos Anal 2000; 13 619-624.
[3] Main L, Baldeesh R. 4 steps to lower cholesterol. The practical guide to a healthy heart. Vermilion, London 2015.
[4] Six cholesterol busting foods. Heart UK Available at https://www.heartuk.org.uk/healthy-living/cholesterol-lowering-foods-1 Accesssed May 2020
[5] Gylling H, Miettinen TA. Effects of inhibiting cholesterol absorption and synthesis on cholesterol and lipoprotein metabolism in hypercholesterolaemic non-insulin dependent diabetic men. J Lipid Res 1996; 37: 1776-1785.
[6] Gylling H, Radhakrishnan R, Miettinen TA. Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine-Women and dietary sitostanol. Circulation. 1997; 96:4226–31.
[7] PHE 2019. Public Health Matters: preventing cardiovascular disease. Available at https://publichealthmatters.blog.gov.uk/2019/02/14/health-matters-preventing-cardiovascular-disease/ Accesssed May 2020.
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[12] Musa-Veloso K et al. 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;85(1):7-8.
[13] Rosin et al. Optimal use of plant stanol ester in the management of hypercholesterolaemia. Cholesterol 2015; 2015:706970.
[14] Agostoni C et al. European Food Safety Authority. Scientific opinion on the substantiation of a health claim relating to 3g /day plant stanols as plant stanol esters and lowering blood LDL-cholesterol and reduction risk of (coronary) heart disease pursuant to Article 19 of Regulation (EC) No 1924/2006. EFSA Journal 2012; 10 (5): 2693. Available at https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/j.efsa.2012.2693 Accessed May 2020.
[15] Miettinen T et al. Reduction of Serum Cholesterol with Sitostanol-Ester Margarine in a Mildly Hypercholesterolemic Population. N Engl J Med 1995; 333(20): 1308-1312.
[16] Catapano et al. ESC/EAS Guidelines for the management of dyslipidaemias. Atherosclerosis 2016; 253: 281-344.
[17] Piepoli et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016; 37: 2315-2381.
[18] Grundy et al. An international Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia. J Clin Lipidol 2014; 8(1): 29-60.
[19] Commission Regulation (EU) No 686/2014 as 20 June 2014 amending Regulations (EC) No 983/2009 and (EU) No 384/2010 as regards the conditions of use of certain health claims related to the lowering effect of plant sterols and plant stanols on blood LDL-cholesterol.
[20] Gylling H, Hallikainen M, Nissinen MJ, Miettinen TA. The effect of very high daily plant stanol ester intake on serum lipids, carotenoids and fat soluble vitamins. Clinical Nutrition 2010; 29: 112-118.
[21] BDA Stanols and Sterols: Food Fact Sheet. Available at https://www.bda.uk.com/resource/food-facts-plant-stanols-and-sterols.html Accessed May 2020.
[22] Valsta LM et al. Estimation of plant sterol and cholesterol intake in Finland: quality of new values and their effect on intake.Br J Nutr 2004 Oct;92(4):671-8.
[23] European Commission (2002). General view of the Scientific Committee on Food on the long-term effects of the intake of elevated levels of phytosterols from multiple dietary sources, with particular attention to the effects of beta-carotene. Available at https://ec.europa.eu/food/sites/food/files/safety/docs/sci-com_scf_out143_en.pdf. Accessed May 2020.
[24] Blair SN, Capuzzi DM, Gottlieb SO, et al. 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 (1): 46-52.
[25] de Jong et al. Effects of long-term plant sterol or plant stanol ester consumption on lipid and lipoprotein metabolism in subjects on statin treatment. Br J Nutr 2008; 100 (5): 937-941.
[26] Plat J, van Onselen E, van Heugten M. et al. Effects on serum lipids, lipoproteins and fat soluble antioxidant concentrations of consumption frequency of margarines and shortenings enriched with plant stanol esters. Eur J Clin Nutr 54, 671–677 (2000).
[27] COMMISSION REGULATION (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health.
OJ L 136, 25.5.2012, p. 1.
https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:136:FULL:EN:PDF
[28] Olga J. G. Schiepers, Renate H. M. de Groot, Martin P. J. van Boxtel, Jelle Jolles, Ariënne de Jong, Dieter Lütjohann, Jogchum Plat, Ronald P. Mensink. Consuming Functional Foods Enriched with Plant Sterol or Stanol Esters for 85 Weeks Does Not Affect Neurocognitive Functioning or Mood in Statin-Treated Hypercholesterolemic Individuals. The Journal of Nutrition, Volume 139, Issue 7, 2009; 1368–1373.
[29] Ostlund RE Jr, McGill JB, Zeng C-M, Covey DF, Stearns J, Stenson WF, Spilburg CA. Gastrointestinal absorption and plasma kinetics of soy Delta(5)-phytosterols and phytostanols in humans. Am J Physiol Endocrinol Metab. 2002 Apr;282(4):E911-6.
[30] Hallikainen M A, Sarkkinen ES, Uusitupa MIJ. Effects of low-fat stanol ester enriched margarines on concentrations of serum carotenoids in subjects with elevated serum cholesterol concentrations. Eur J Clin Nutr 1999; 53: 966-969.

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