Stanol esters in food, plants  for cholesterol, use with statin drugs, information by Ray Sahelian, M.D.
February 24, 2016

Stanol esters are found naturally occurring in small quantities in fruits, vegetables, nuts, seeds, cereals, legumes, and vegetable oils. Stanol ester is a group of substances that lower the level of low-density lipoprotein cholesterol. The starting material for a stanols are sterols from plants. These are first hydrated to lead to a stanol which is then esterified with a mixture of fatty acids also derived from plants.
   Stanol ester is often added to rapeseed oil based margarine or other foods for its health benefits. It is thought that stanols reduce the amount of cholesterol the body absorbs from food. Stanol ester was developed by Ingvar Wester, a Finnish chemist. It is marketed by the Raisio Group with the trade name Benecol. Other chemical names used for stanol or related to it include: Beta-sitostanol, Dihydro-beta-sitosterol, Fucostanol, Phytostanol, Plant Stanol, Plant Stanol Esters, Stigmastanol.

Stanol and Cholesterol
Stanols are naturally occurring substances in fruits and vegetables that have been shown to lower elevated blood cholesterol levels. Manufacturers are now adding concentrated versions of stanols to products like margarine, yogurt, orange juice, and granola bars.
   Plant stanols have been recommended in combination with individualized dietary interventions to reduce plasma cholesterol concentrations. Dietary intervention with addition of plant stanols results in clinically relevant reduction of low-density lipoprotein cholesterol in patients optimally treated with statins, compared with similar patients on statins receiving only standard care. Natural supplements and functional foods are good options to lower cholesterol  levels. See cholesterol for a thorough discussion and consider the use of the phytosterol supplement beta sitosterol for lowering cholesterol levels.

Atherosclerosis. Feb 2014. Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Based on LDL-C lowering and the absence of adverse signals, this EAS Consensus Panel concludes that functional foods with plant sterols/stanols may be considered 1) in individuals with high cholesterol levels at intermediate or low global cardiovascular risk who do not qualify for pharmacotherapy, 2) as an adjunct to pharmacologic therapy in high and very high risk patients who fail to achieve LDL-C targets on statins or are statin- intolerant, 3) and in adults and children (>6 years) with familial hypercholesterolaemia, in line with current guidance. However, it must be acknowledged that there are no randomised, controlled clinical trial data with hard end-points to establish clinical benefit from the use of plant sterols or plant stanols.

Effects of low-fat hard cheese enriched with plant stanol esters on serum lipids and apolipoprotein B in mildly hypercholesterolaemic subjects.
Eur J Clin Nutr. 2006. Valio Ltd, Helsinki, Finland [2] 2Institute of Biomedicine, University of Helsinki, Helsinki, Finland.
To investigate the cholesterol-lowering effects of a low-fat cheese enriched with plant stanol esters in mildly hypercholesterolaemic subjects, as part of their normal diet. A randomized double-blind parallel-group study. Setting:Valio Ltd, Helsinki. Sixty-seven mildly hypercholesterolaemic volunteers (24 men, 43 women) participated in the study, which all of them completed. The subjects were randomly assigned to the plant stanol ester group or the control group. During the 5-week intervention, the subjects in the stanol group consumed a cheese enriched with 2 g of plant stanols per day, and the subjects in the control group, a control cheese with no plant stanols. In the stanol ester group, as compared to the control group, both serum total and low-density lipoprotein (LDL) cholesterol decreased significantly. There were no significant changes in high-density lipoprotein cholesterol (HDL), triglycerides or apolipoprotein B concentrations between the groups. Cheese enriched with 2 g of plant stanol in the form of fatty acid esters decreases serum total and LDL cholesterol.

Use with statin drugs
Effects of long-term plant sterol or stanol ester consumption on lipid and lipoprotein metabolism in subjects on statin treatment.
Br J Nutr. 2008; de Jong A, Plat J, Lütjohann D, Mensink RP. Department of Human Biology, Maastricht University, Maastricht, The Netherlands.
Consumption of plant sterol- or stanol-enriched margarines by statin users results in an additional LDL-cholesterol reduction of approximately 10 %, which may be larger than the average decrease of 3-7 % achieved by doubling the statin dose. However, whether this effect persists in the long term is not known. Therefore, we examined in patients already on stable statin treatment the effects of 85 weeks of plant sterol and stanol ester consumption on the serum lipoprotein profile, cholesterol metabolism, and bile acid synthesis. For this, a double-blind randomised trial was designed in which fifty-four patients consumed a control margarine with no added plant sterols or stanols for 5 weeks (run-in period). For the next 85 weeks, seventeen subjects continued with the control margarine and the other two groups with either a plant sterol or plant stanol 2.5 g/d each, ester-enriched margarine. Compared with the control group, plant sterol and stanol ester consumption reduced LDL-cholesterol by 8 % and 13 % respectively after 85 weeks. No effects were found on plasma concentrations of oxysterols or 7 alpha-hydroxy-4-cholesten-3-one, a bile acid synthesis marker. We conclude that long-term consumption of both plant sterol and stanol esters effectively lowered LDL-cholesterol concentrations in statin users.

Effect of plant stanol tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs.
Am J Cardiol. 2006. Goldberg AC, Ostlund RE Jr, Bateman JH, Schimmoeller L, McPherson TB, Spilburg CA. Department of Internal Medicine, Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri, USA.
The objective of this study was to show that plant sterols in tablet form provide additional low-density lipoprotein (LDL) cholesterol lowering for patients on statin therapy. Twenty-six patients who were following the American Heart Association Heart Healthy Diet and on long-term statin therapy were studied for 9 weeks. After 3 weeks of placebo treatment, the subjects were randomized to receive either 1.8 g of soy stanols or placebo for 6 weeks in addition to their usual statin regimen. Stanol tablets reduced LDL cholesterol by 9%. Total cholesterol was reduced by 13 mg/dl. A strong inverse correlation was found between the baseline LDL cholesterol and the percent The additional LDL cholesterol lowering with stanol / lecithin tablets provided a potential adjunctive therapy for patients who have not reached their target LDL cholesterol goal during statin therapy.