Plant Sterols/Stanols — Supplements
Phytosterols that competitively inhibit cholesterol absorption for LDL cholesterol management.
Overview
Plant sterols (phytosterols) and stanols are naturally occurring compounds structurally similar to cholesterol that competitively inhibit intestinal cholesterol absorption via the Niemann-Pick C1-Like 1 (NPC1L1) transporter. At doses of 2-3 g/day, they reduce LDL cholesterol by 6-12%. This effect is recognized by the FDA, AHA, and ESC/EAS guidelines, which include plant sterols/stanols as part of dietary strategies for cardiovascular risk reduction. The NCEP ATP III guidelines recommend plant sterols as a therapeutic lifestyle change.
Indications
- LDL cholesterol reduction
- Cardiovascular disease risk reduction
- Adjunctive therapy to statins for additional LDL lowering
- Dietary cholesterol management
Mechanism of Action
Plant sterols compete with cholesterol for incorporation into mixed micelles in the intestinal lumen
Dosing
| Compound | Dose | Frequency | Notes |
|---|---|---|---|
| Plant Sterols/Stanols | 2 g | Once daily with meals | Take with largest meal; can be divided across 2-3 meals |
Safety & Contraindications
- May reduce absorption of fat-soluble vitamins (A, D, E, K) and carotenoids
- Phytosterolemia (rare genetic condition) is a contraindication
- GI side effects are minimal
- Supplementing with a multivitamin containing fat-soluble vitamins is prudent