Eating your way to lower cholesterol

Eating foods fortified with a cousin of cholesterol can lower your cholesterol. These substances, called plant sterols and stanols, are being added to foods ranging from granola bars to chocolate. Although eating extra plant sterols or stanols won't control seriously high cholesterol, it could work well for people who need a little extra help.

Plants contain a host of compounds that are chemically related to cholesterol. There are two main families: sterols and stanols. They do for plants what cholesterol does for us — they help make hormones, vitamins, and the "skin" that surrounds cells.

When eaten, plant sterols and stanols (also called phytosterols and phytostanols) gum up the body's system for absorbing cholesterol from food. Since the liver needs cholesterol to make bile acids for digestion, it grabs LDL (bad) cholesterol from the bloodstream while leaving HDL (good) cholesterol alone. The result is lower levels of total and LDL cholesterol.

Eating two grams of plant sterols or stanols a day can lower LDL cholesterol by about 10%. That may not sound like much, but it could translate into a 20% lower risk of having a heart attack or stroke on average, though effects vary widely.

The FDA has given food companies a green light to claim on packages that eating plant sterols and stanols might reduce the risk of heart disease. And federal cholesterol guidelines for Americans current in 2006 expressly mention eating plant sterols or stanols as part of the "therapeutic lifestyle changes" aimed at reducing the risk of heart disease.

More foods

The first sterol- and stanol-enriched products sold in the United States were margarines, such as Benecol and Take Control. These substances are showing up in other products. They include Minute Maid HeartWise orange juice, Nature Valley Healthy Heart granola bars, Rice Dream Heartwise rice milk, Lifetime low-fat cheese, CocoaVia chocolates, and Vivola cooking oil.

Sterols for you?

If you have high cholesterol, eating extra plant sterols or stanols could be a good addition to your portfolio of strategies for controlling it. If your cholesterol level is a tad high, this could be enough to rein it in. If it is substantially above where it should be, then a cholesterol-lowering statin, which can lower LDL as much as 50%, is a better first choice.

You need to eat about two grams worth of added sterols or stanols every day to put a dent in your cholesterol. Doing it once in a while won't work, and the cholesterol-controlling effect stops when you stop eating them.

If a food you already eat every day is being made with extra sterols or stanols, switching to the fortified version makes sense. If not, adding these foods to your diet is a high-calorie way to modestly reduce cholesterol. Two glasses of HeartWise orange juice, for example, deliver their sterols with 220 calories.

Trying to juggle a standard daily intake of sterols and stanols from several different foods could lead to getting higher-than-recommended doses. Exceeding the two-gram target doesn't do anything extra for cholesterol. What's more, no one knows the long-term effects of getting too much.

Finally, eating extra plant sterols or sterols won't work magic. They can't counteract a fatty diet, smoking, or other habits that boost cholesterol. Instead, use them as part of a package of healthy choices.

May 2006 update