PLANT STEROLS: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

Overview

Plant sterols are substances that are similar to cholesterol but are made in plants. They're found in the highest amounts in vegetable oils, nuts, and seeds.

Plant sterols might help reduce cholesterol levels by limiting the amount of cholesterol that is able to enter the body. Some plant sterols might also reduce how much cholesterol is made in the body.

People commonly use plant sterols for lowering cholesterol levels. Plant sterols are also used for heart disease, colon cancer, stomach cancer, obesity, heart attack, and many other conditions, but there is no good scientific evidence to support many of these other uses.

Don't confuse plant sterols with beta-sitosterol or sitostanol. These are specific types of plant sterols.

Uses & Effectiveness

Likely Effective for

Inherited tendency towards high cholesterol (familial hypercholesterolemia). When used along with a cholesterol-lowering diet, taking plant sterols by mouth reduces low-density lipoprotein (LDL or "bad") cholesterol levels in children and adults with high cholesterol levels due to familial hypercholesterolemia.
High cholesterol. Taking plant sterols by mouth lowers low-density lipoprotein (LDL or "bad") cholesterol levels in people with high cholesterol who are also following a cholesterol-lowering diet. But it doesn't seem to reduce triglyceride levels.

Possibly Effective for

Heart disease. Eating foods that contain at least 3.4 grams of plant sterols daily as part of a low-fat, low-cholesterol diet might help prevent heart disease.

There is interest in using plant sterols for a number of other purposes, but there isn't enough reliable information to say whether it might be helpful.

Side Effects

When taken by mouth: Plant sterols are likely safe for most people. They're usually well-tolerated.

Special Precautions and Warnings

When taken by mouth: Plant sterols are likely safe for most people. They're usually well-tolerated.

Pregnancy and breast-feeding: There isn't enough reliable information to know if plant sterols are safe to use when pregnant or breast-feeding. Stay on the safe side and avoid use.

Children: Plant sterols are likely safe when taken by mouth in doses of 1.6-2.3 grams daily for up to 6 months.

Sitosterolemia, a rare inherited fat storage disease: People with this condition might have a build up of plant sterols and related fats in their blood and tissues. Taking plant sterols might make this condition worse. Don't take plant sterols if you have sitosterolemia.

Short bowel syndrome, a condition related to removal of part of the gut: Plant sterols should be used cautiously in people with this condition. They might affect liver function.

Interactions

We currently have no information for PLANT STEROLS overview.

Dosing

In adults, plant sterols have most often been used in doses of 1.6-3 grams by mouth daily for up to 1 year. In children, plant sterols have most often been used in doses of 1.6-2.3 grams by mouth daily for up to 6 months. Speak with a healthcare provider to find out what dose might be best for a specific condition.

View References

REFERENCES:

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Relas, H., Gylling, H., and Miettinen, T. A. Fate of intravenously administered squalene and plant sterols in human subjects. J.Lipid Res. 2001;42(6):988-994. View abstract.

Tuomilehto, J., Tikkanen, M. J., Hogstrom, P., Keinanen-Kiukaanniemi, S., Piironen, V., Toivo, J., Salonen, J. T., Nyyssonen, K., Stenman, U. H., Alfthan, H., and Karppanen, H. Safety assessment of common foods enriched with natural nonesterified plant sterols. Eur J Clin Nutr 2009;63(5):684-691. View abstract.

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Casas-Agustench P, Serra M, Pérez-Heras A, Cofán M, Pintó X, Trautwein EA, Ros E. Effects of plant sterol esters in skimmed milk and vegetable-fat-enriched milk on serum lipids and non-cholesterol sterols in hypercholesterolaemic subjects: a randomised, placebo-controlled, crossover study. Br J Nutr. 2012 Jun;107(12):1766-75. View abstract.

Chen JT, Wesley R, Shamburek RD, et al. Meta-Analysis of natural therapies for hyperlipidemia: plant sterols and stanols versus policosanol. Pharmacotherapy 2005;25:171-83. View abstract.

Demonty I, Ras RT, van der Knaap HC, Meijer L, Zock PL, Geleijnse JM, Trautwein EA. The effect of plant sterols on serum triglyceride concentrations is dependent on baseline concentrations: a pooled analysis of 12 randomised controlled trials. Eur J Nutr. 2013 Feb;52(1):153-60. View abstract.

Doornbos AM, Meynen EM, Duchateau GS, van der Knaap HC, Trautwein EA. Intake occasion affects the serum cholesterol lowering of a plant sterol-enriched single-dose yoghurt drink in mildly hypercholesterolaemic subjects. Eur J Clin Nutr. 2006 Mar;60(3):325-33. View abstract.

Eady S, Wallace A, Willis J, Scott R, Frampton C. Consumption of a plant sterol-based spread derived from rice bran oil is effective at reducing plasma lipid levels in mildly hypercholesterolaemic individuals. Br J Nutr. 2011 Jun 28;105(12):1808-18. View abstract.

EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA), Turck D, Castenmiller J, et al. Safety of the extension of use of plant sterol esters as a novel food pursuant to Regulation (EU) 2015/2283. EFSA J. 2020;18(6):e06135. View abstract.

Electronic Code of Federal Regulations. Title 21. Part 101.83 - Health claims: plant sterol/stanol esters and risk of coronary heart disease (CHD). Available at: https://www.ecfr.gov/cgi-bin/text-idx?SID=c7e427855f12554dbc292b4c8a7545a0&mc=true&node=pt21.2.101&rgn=div5#se21.2.101_180

Gomes GB, Zazula AD, Shigueoka LS, et al. A randomized open-label trial to assess the effect of plant sterols associated with ezetimibe in low-density lipoprotein levels in patients with coronary artery disease on statin therapy. J Med Food. 2017;20(1):30-36. View abstract.

Guo P, Feng R, Li Z, Han T. Gender differences in the relationships between dietary phytosterols intake and prevalence of obesity in Chinese population. Food Sci Nutr 2022;11(1):569-577. View abstract.

Hallikainen MA, Sarkkinen ES, Gylling H, et al. Comparison of the effects of plant sterol ester and plant stanol ester-enriched margarines in lowering serum cholesterol concentrations in hypercholesterolaemic subjects on a low-fat diet. Eur J Clin Nutr 2000;54:715-25. View abstract.

Haque Hussain SS, Weir J, Roberts N. Severe dermatitis secondary to plant sterol supplements. Clin Exp Dermatol. 2009 Oct;34(7):e276-7. View abstract.

Heinemann T, Kullak-Ublick GA, Pietruck B, von Bergmann K. Mechanisms of action of plant sterols on inhibition of cholesterol absorption. Comparison of sitosterol and sitostanol. Eur J Clin Pharmacol 1991;40 Suppl 1:S59-63. View abstract.

Hongu N, Kitts DD, Zawistowski J, Dossett CM, Kopec A, Pope BT, Buchowski MS. Pigmented rice bran and plant sterol combination reduces serum lipids in overweight and obese adults. J Am Coll Nutr. 2014;33(3):231-8. View abstract.

Jiang L, Zhao X, Xu J, Li C, Yu Y, Wang W, Zhu L. The protective effect of dietary phytosterols on cancer risk: A systematic meta-analysis. J Oncol. 2019;2019:7479518. View abstract.

Jones PJ, Demonty I, Chan YM, Herzog Y, Pelled D. Fish-oil esters of plant sterols differ from vegetable-oil sterol esters in triglycerides lowering, carotenoid bioavailability and impact on plasminogen activator inhibitor-1 (PAI-1) concentrations in hypercholesterolemic subjects. Lipids Health Dis. 2007 Oct 25;6:28. View abstract.

Jones PJ, Ntanios FY, Raeini-Sarjaz M, et al. Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men. Am J Clin Nutr 1999;69:1144-50. View abstract.

Jones PJ, Raeini-Sarjaz M, Ntanios FY, et al. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. J Lipid Res 2000;41:697-705. View abstract.

Klingberg S, Ellegård L, Johansson I, Jansson JH, Hallmans G, Winkvist A. Dietary intake of naturally occurring plant sterols is related to a lower risk of a first myocardial infarction in men but not in women in northern Sweden. J Nutr. 2013 Oct;143(10):1630-5. View abstract.

Korpela R, Tuomilehto J, Högström P, Seppo L, Piironen V, Salo-Väänänen P, Toivo J, Lamberg-Allardt C, Kärkkäinen M, Outila T, Sundvall J, Vilkkilä S, Tikkanen MJ. Safety aspects and cholesterol-lowering efficacy of low fat dairy products containing plant sterols. Eur J Clin Nutr. 2006 May;60(5):633-42. View abstract.

Kwon YJ, Kwon GE, Lee HS, Choi MH, Lee JW. The Effect of Orlistat on Sterol Metabolism in Obese Patients. Front Endocrinol (Lausanne). 2022 Feb 23;13:824269. View abstract.

Law M. Plant sterol and stanol margarines and health. BMJ 2000;320:861-4. View abstract.

Lichtenstein AH, Deckelbaum RJ. Stanol/sterol ester-containing foods and blood cholesterol levels: a statement for healthcare professionals from Nutrition Committee, Council on Nutrition, Physical Activity, Metabolism of American Heart Association. Circulation 2001;103:1177-9. View abstract.

Mackay DS, Gebauer SK, Eck PK, Baer DJ, Jones PJ. Lathosterol-to-cholesterol ratio in serum predicts cholesterol-lowering response to plant sterol consumption in a dual-center, randomized, single-blind placebo-controlled trial. Am J Clin Nutr. 2015 Mar;101(3):432-9. View abstract.

Maki KC, Lawless AL, Reeves MS, Dicklin MR, Jenks BH, Shneyvas E, Brooks JR. Lipid-altering effects of a dietary supplement tablet containing free plant sterols and stanols in men and women with primary hypercholesterolaemia: a randomized, placebo-controlled crossover trial. Int J Food Sci Nutr. 2012 Jun;63(4):476-82. View abstract.

Maki KC, Lawless AL, Reeves MS, Kelley KM, Dicklin MR, Jenks BH, Shneyvas E, Brooks JR. Lipid effects of a dietary supplement softgel capsule containing plant sterols/stanols in primary hypercholesterolemia. Nutrition. 2013 Jan;29(1):96-100. View abstract.

Malhotra A, Shafiq N, Arora A, Singh M, Kumar R, Malhotra S. Dietary interventions (plant sterols, stanols, omega-3 fatty acids, soy protein and dietary fibers) for familial hypercholesterolaemia. Cochrane Database Syst Rev. 2014 Jun 10;6:CD001918. View abstract.

McKenney JM, Jenks BH, Shneyvas E, Brooks JR, Shenoy SF, Cook CM, Maki KC. A softgel dietary supplement containing esterified plant sterols and stanols improves the blood lipid profile of adults with primary hypercholesterolemia: a randomized, double-blind, placebo-controlled replication study. J Acad Nutr Diet. 2014 Feb;114(2):244-9. View abstract.

Musa-Veloso K, Poon TH, Elliot JA, Chung C. 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 Jul;85(1):9-28. View abstract.

Nguyen LB, Shefer S, Salen G, et al. Competitive inhibition of hepatic sterol 27-hydroxylase by sitosterol: decreased activity in sitosterolemia. Proc Assoc Am Physicians 1998;110:32-9. View abstract.

O'Neill FH, Sanders TA, Thompson GR. Comparison of efficacy of plant stanol ester and sterol ester: short-term and longer-term studies. Am J Cardiol. 2005 Jul 4;96(1A):29D-36D. View abstract.

Oliveira Godoy Ilha A, Sutti Nunes V, Silva Afonso M, et al. Phytosterols supplementation reduces endothelin-1 plasma concentration in moderately hypercholesterolemic individuals independently of their cholesterol-lowering properties. Nutrients. 2020;12(5):1507. View abstract.

Ooi EM, Watts GF, Barrett PH, Chan DC, Clifton PM, Ji J, Nestel PJ. Dietary plant sterols supplementation does not alter lipoprotein kinetics in men with the metabolic syndrome. Asia Pac J Clin Nutr. 2007;16(4):624-31. View abstract.

Patel SB, Honda A, Salen G. Sitosterolemia: exclusion of genes involved in reduced cholesterol biosynthesis. J Lipid Res 1998;39:1055-61. View abstract.

Raeini-Sarjaz M, Ntanios FY, Vanstone CA, Jones PJ. No changes in serum fat-soluble vitamin and carotenoid concentrations with the intake of plant sterol/stanol esters in the context of a controlled diet. Metabolism. 2002 May;51(5):652-6. View abstract.

Ras RT, Geleijnse JM, Trautwein EA. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. Br J Nutr. 2014 Jul 28;112(2):214-9. View abstract.

Ras RT, Koppenol WP, Garczarek U, et al. Increases in plasma plant sterols stabilize within four weeks of plant sterol intake and are independent of cholesterol metabolism. Nutr Metab Cardiovasc Dis. 2016;26(4):302-9. View abstract.

Richelle M, Enslen M, Hager C, et al. Both free and esterified plant sterols reduce cholesterol absorption and the bioavailability of beta-carotene and alpha-tocopherol in normocholesterolemic humans. Am J Clin Nutr 2004;80:171-7. View abstract.

Salen G, Shefer S, Nguyen L, et al. Sisterolemia. J Lipid Res 1992;33:945-55. View abstract.

Salen G, Shore V, Tint GS, et al. Increased sitosterol absorption, decreased removal, and expanded body pools compensate for reduced cholesterol synthesis in sitosterolemia with xanthomatosis. J Lipid Res 1989;30:1319-30. View abstract.

Scholle JM, Baker WL, Talati R, Coleman CI. The effect of adding plant sterols or stanols to statin therapy in hypercholesterolemic patients: systematic review and meta-analysis. J Am Coll Nutr. 2009 Oct;28(5):517-24. View abstract.

Sialvera TE, Pounis GD, Koutelidakis AE, Richter DJ, Yfanti G, Kapsokefalou M, Goumas G, Chiotinis N, Diamantopoulos E, Zampelas A. Phytosterols supplementation decreases plasma small and dense LDL levels in metabolic syndrome patients on a westernized type diet. Nutr Metab Cardiovasc Dis. 2012 Oct;22(10):843-8. View abstract.

CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

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