Elevated serum cholesterol and, in particular, LDL Cholesterol (LDL-C) are important risk factors for atherosclerosis and cardiovascular disease. First-line treatment for elevated cholesterol typically involves the use of statin type medication to lower LDL cholesterol levels. Apart from medication, lifestyle changes such as smoking cessation as well as improving your diet along with regular exercise can also improve your cholesterol levels.
Functional foods have also gained attention for their potential benefits at lowering cholesterol levels. For just over the past ten years, margarine products containing phytostanols and phytosterols have been available in many countries. Essentially phytosterols are molecules that are structurally related to cholesterol and compete with cholesterol for absorption in your intestines. This leads to a higher fecal output of cholesterol.
Phytostanol Supplements and Cholesterol:
Current estimates suggest that phytosterols/stanols reduce total cholesterol and LDL-C levels by approximately 6% and 10% respectively (from randomized controlled trial data). Since statin medications can have significant side effects or patients may not tolerate increases in their dosage, one alternative to doubling statin dose is to add phytostanols/sterols to statin therapy.
A recent study published in the medical journal, Public Health Nutrition , assessed the cholesterol lowering potential of phytostanol/phytosterol based margarine products in both users and non-users of statins. The study used a retrospective cohort design and included data from 3829 men and women (31-71 years) who were examined initially then 5 years later at follow-up. Consumption of margarine (phytostanol/sterol enriched) was divided in four groups: no, low (.0 to 10 g/d), medium (10 to 20 g/d) or high (20 g/d).
Phytostanol/sterol-enriched margarine users were more likely to be highly educated and consumed more alcohol than non-users in this study.
While only 9% of the subjects in this study consumed the recommended dose of margarine, serum total cholesterol decreased significantly in those who consumed enriched-margarine with or without the use of statins:
- “Serum total cholesterol decreased by respectively -0·16 (95 % CI -0·26, -0·05) mmol/l, -1·40 (95 % CI -1·51, -1·30) mmol/l and -1·64 (95 % CI -1·91, -1·37) mmol/l in subjects who started to use phytosterols/phytostanols only, statins only or a combination of both compounds at some point in time between examination and re-examination, compared with subjects who did not start using phytosterols/phytostanols or statins.”
A dose response effect was observed in relation to the amount of margarine consumed and the cholesterol lowering effect:
- “Cholesterol-lowering effects of the phytosterols/phytostanols were similar in statin users and statin non-users and increased with increasing intake of enriched margarine (no intake, 0; low intake, -0·017 (95 % CI -0·16, 0·13) mmol/l; medium intake, -0·089 (95 % CI -0·22, 0·038) mmol/l; high intake, -0·32 (95 % CI -0·50, -0·14) mmol/l).”
From the results of this particular study, phytosterol/phytostanol enriched margarine was effective at lowering cholesterol levels in both users and non-users of statin medication. The study authors concluded:
“In the present study we found that phytosterol/-stanolenriched margarine is effective in lowering total cholesterol (TC), non-HDL-C and TC:HDL-C (ratio) under customary conditions in both statin users and statin non-users. Recommended intake levels were achieved by only 9 % of the subjects and resulted in a 4 % decline in TC levels. Phytosterol/-stanol-enriched margarine can be recommended to statin non-users with normal to moderately increased serum TC and non-HDL-C concentrations who wish to maintain their cholesterol levels at, or reduce their cholesterol levels to, healthy levels. Statin users who wish to reduce their TC and non-HDL-C levels through diet can use the phytosterol/- stanol-enriched margarines as an adjunct to their ongoing statin therapy. This might be especially beneﬁcial for those subjects who do not achieve recommended TC and nonHDL-C target levels with statin monotherapy.”
- Eussen SR, de Jong N, Rompelberg CJ, Garssen J, Verschuren WM, Klungel OH. Dose-dependent cholesterol-lowering effects of phytosterol/phytostanol-enriched margarine in statin users and statin non-users under free-living conditions. Public Health Nutr. 2011 Feb 28:1-10.