Sterols reaching the mainstream

The American medical profession teaches perhaps one class on nutrition to medical students, and once they become doctors, they are inundated with the pharmaceutical perspective. Amid this, plant sterols, at least, are one natural product to have broken through to mainstream medicine. Joe Keenan, MD explains the benefits

Health-savvy people know that heart disease is the number one killer of American men. Heart attack and stroke kill 444,000 American men every year — more than all forms of cancer combined. It?s also the top killer of women as well — 485,000 American women, even more than men.

These sobering statistics have been around for decades. Men tend to develop heart disease at an earlier age than women, often by their mid-40s. In fact, the National Cholesterol Education Program considers just being male and over 45 years old to be major risk factors for heart disease. The good news is that death in men from heart disease has been declining for the past 20 years, suggesting that treatment can make a difference.

Unfortunately, the same good news does not apply to women. At present more women die each year from heart attack and stroke than men, and the trend appears to be worsening. Women are more likely than men to have ?atypical? symptoms such as fatigue or numbness rather than the classic chest pain of a heart attack. This can lead to a delayed or even missed diagnosis.

Enter sterols
Limiting one?s intake of cholesterol-raising animal products and trans-fatty acids (vegetable oils that have been partially hydrogenated), and getting at least 30 minutes (latest recommendations are 90min/day) of aerobic exercise daily will go a long way toward maintaining healthy cholesterol levels and general cardiovascular health.

But now there?s an additional way to keep clear arteries: plant sterols. Also called phytosterols, plant sterols are found in all plants. The best dietary sources are vegetables, seeds and nuts.

Because they are structurally similar to cholesterol molecules, they are able to block the absorption of cholesterol from the gut into the blood stream. They block absorption of the cholesterol in foods and also block the re-absorption of cholesterol in the bile from the liver. That is quite significant since the cholesterol in the bile is four to five times higher than dietary cholesterol. This ends up lowering the amount of LDL cholesterol in the blood.

Cholesterol levels can be lowered 5-15 per cent in as little as two weeks with no side effects
The 50 years of scientific proof behind the benefits of plant sterols is so strong that the Food and Drug Administration allows products containing the appropriate amount of plant sterols to carry a heart healthy claim on their labels. Today this includes select functional juice, margarine, salad dressing, cheese and yoghurt. They are even endorsed by the National Cholesterol Education Program. Science suggests cholesterol levels can be lowered 5-15 per cent in as little as two weeks with no side effects whatsoever. Ergo, a cholesterol level of 225 (on the borderline where most doctors want to consider drug treatment) could be lowered to 192 in as little as two weeks.

Even though all plants contain sterols, they are not in sufficient quantity in the typical American diet to significantly influence cholesterol levels. Thus to get these benefits, it is important to supplement and look for ?plant sterols? on product packaging.

Eating two servings a day gives a total of 1.3g of plant sterols. Health claims note the concurrent dietary advice of eating a diet low in saturated fat and cholesterol.

This includes high-fibre, low-fat foods like oatmeal, fruit and vegetables, and lower amounts of animal fats, trans fats and fried foods. Fish, nuts and monounsaturated vegetable oils (olive oil, canola oil) are all sources of good heart-healthy fats.

Joe Keenan, MD, is a professor at the University of Minnesota Department of Food Sciences and Nutrition, Family Practice and Community Health, with a research speciality in nutritional intervention for preventing cardiovascular disease. Respond: [email protected]

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