plant sterols

  • A Natural Approach to Cholesterol Reduction & Heart Health

    Heart and blood vessel (cardiovascular) disease is the number one killer of Americans, and study after study points to elevated cholesterol as a major contributor to the problem. Some authorities have indicated that for every one-percentage point that cholesterol levels are reduced, the risk for cardiovascular disease is reduced by two points. In addition, most people with diabetes have increased risk for heart disease and stroke, due in part to high cholesterol and triglyceride levels, which can result in death. In fact, more than 65 percent of people with diabetes die from heart disease or stroke. By managing diabetes, and blood lipids (cholesterol and triglycerides), however, diabetics can greatly reduce this risk.1

    The current conventional medical treatment is cholesterol- lowering prescription drugs, along with low saturated fat diets. In addition, it makes sense to work with your doctor in trying one or more of the following relatively risk-free dietary supplement approaches as part of your total program for lowering cholesterol and reducing risk of cardiovascular disease.

    Plant Sterols And Stanols
    Plant sterols are natural substances found in small quantities in many fruits, vegetables, nuts, seeds, cereals, legumes, vegetable oils, and other plant sources. Research has demonstrated that taking plant sterols orally significantly reduces total and low-density lipoprotein (LDL) cholesterol levels, but has little or no effect on high-density lipoprotein (HDL) cholesterol levels. LDL is considered to be the “bad cholesterol,” while HDL is considered to be the “good cholesterol.” The way it works is that plant sterols block cholesterol absorption in the intestines, which in turn results in lowered LDL cholesterol in the bloodstream. Plant sterols has been reported to decrease LDL cholesterol levels nine to 20 percent, and usual doses have ranged between 800 mg to six grams per day and given before meals. Plant sterols are typically given in conjunction with a low-fat diet.2,3,4,5,6,7,8,9,10,11 Orally, plant sterols are usually well tolerated. Ezetimibe (Zetia), a medication used to lower cholesterol levels, inhibits intestinal absorption of plant sterols.

    Similar to sterols, plant stanols are natural substances that occur in even smaller quantities in many of the same sources. Like sterols, stanols block the absorption of cholesterol in the intestines. Taking plant stanols orally is effective for reducing total and LDL- cholesterol in about 88 percent of adult patients when used alone or in combination with a low-fat diet or statin drug (drug that inhibits the production of cholesterol in the body).12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27 When used alone it can reduce total and LDL cholesterol levels by 10 to 15 percent. When added to statin drugs, sitostanol reduces total cholesterol and LDL cholesterol by an additional three to 11 percent and seven to 16 percent, respectively. Clinical studies have used from 800 mg to four grams per day.28 Orally, plant stanols seem to be very well tolerated. Plant stanols can reduce absorption and blood levels of beta-carotene, so it should be used at a different time if you are taking beta-carotene supplements.

    Inositol Hexanicotinate High amounts (several grams per day) of niacin lower cholesterol; an effect recognized in the approval of niacin as a prescription medication for high cholesterol.29 At such intakes, however, acute symptoms (flushing, headache, stomachache) may be severe. In an attempt to avoid the side effects of niacin, alternative health practitioners increasingly use inositol hexanicotinate (aka, “no-flush niacin”), recommending 500 to 1,000 mg, taken three times per day, instead of niacin.30,31 This special form of niacin has been reported to lower serum cholesterol but so far has not been found to cause significant toxicity.32

    Omega-3 Fatty Acids From Fish Oil Including fish as a regular part of the diet has been shown to increase HDL cholesterol33 and is linked to a reduced risk of heart disease in the majority of studies.34 One reason that it has this effect is its oils contain the omega-3 fatty acids (O3FA) which appear to protect against heart disease.35 When used supplementally, however, there is contradictory evidence about the effects of fish oil on blood fat levels. Some clinical research shows fish oil supplementation can decrease elevated triglyceride levels, and decrease LDL cholesterol and increase levels of HDL cholesterol.36,37,38 However, other clinical research did not show beneficial effects on cholesterol levels.39 Nevertheless, fish oil from supplements or from dietary sources has been shown to reduce triglyceride levels by 20 to 50 percent. This effect appears to be dose-dependent.40,41,42,43Fish oil preparations providing 465 mg of eicosapentaenoic acid (EPA) and 375 mg of docosahexaenoic acid (DHA) is particularly effective in conjunction with dietary modifications.44

    In addition, research suggests that fish oil supplementation may be superior to the cholesterol-reducing drug rosuvastatin (Crestor®) for patients with heart failure. In a study published in The Lancet,45 researchers gave 1,000 mg of omega-3 fatty acids from fish oil to about 3,500 patients with heart failure, while another 3,500 heart failure patients received a placebo. After four years researchers found that those taking the omega-3 fatty acids had a nine percent relative risk reduction of dying, and an eight percent relative risk reduction for being hospitalized. The researchers concluded their study demonstrated that long-term administration of 1,000 mg daily omega-3 fatty acids effectively reduced all-cause mortality and admissions to hospital for cardiovascular reasons.

    The same researchers conducted a parallel study, giving rosuvastatin to 2,285 heart failure patients, and placebos to 2,289 heart failure patients. After four years researchers found little difference in heart failure rates between those given omega-3 fatty acids and those given rosuvastatin. In comparing the results, the researchers concluded that the omega-3 fatty acids were slightly more effective than rosuvastatin.46

    Dietary Considerations
    I would be remiss if I did not briefly recount the incredibly important role that diet plays in cardiovascular health. Specifically, the Mediterranean diet has extensive patient-oriented outcome data showing a significant risk reduction in mortality rates and in rates of fatal and nonfatal heart attack.47 Strong evidence support Mediterranean dietary patterns, including intake of vegetables and nuts, as protective against coronary heath disease.48


    The Mediterranean Diet

    The Mediterranean diet is based upon the diets of at least 16 countries that border the Mediterranean Sea. Although there are many differences in culture, ethnic background, religion, economy and agricultural production which result in variations in food intake among the population groups, there is still a common Mediterranean dietary pattern which includes:

    • High consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
    • Olive oil is an important monounsaturated fat source
    • Dairy products, fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
    • Eggs are consumed zero to four times a week
    • Wine is consumed in low to moderate amounts

    In addition, there is strong evidence for the protective effect of monounsaturated fatty acids and prudent dietary patterns.49 Research clearly demonstrates that the people at low risk for CVD eat lots of vegetables, fruits, beans, whole grains and fish: a prudent diet.

    Those at high risk for CVD eat the typical Western pattern diet loaded with red meat, processed meat, refined grains, sweets and desserts, fried foods and high-fat dairy products.50,51 Furthermore, strong evidence has also shown a clear and harmful relationship between CVD and the intake of trans-fatty acids and foods with a high glycemic index or load.52

    In 2006 the American Heart Association released guidelines that integrate recommendations from a variety of diets into a single plan. The emphasis should be on diets that are rich in fruits, vegetables, and healthful fatty acids and that limit saturated fat intake. A stepwise individualized approach may be a practical way to help reduce your cardiovascular disease risk.53 Visit www.americanheart.org for more information.

    Conclusion
    There are many dietary supplements that may be used as part of your total program for lowering cholesterol and/or otherwise help in reducing risk of cardiovascular disease. Good choices include plant sterols/stanols, inositol hexanicotinate, and omega-3 fatty acids from fish oils. In addition, a healthy dietary program such as the Mediterranean diet should be the first line of defense for reducing the risk of cardiovascular disease.

    References:

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    8. Anon. FDA authorizes new coronary heart disease health claim for plant sterol and plant stanol esters. FDA. 2000. Available at: www. fda.gov/bbs/topics/ANSWERS/ANS01033.html.
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    10. Matvienko OA, Lewis DS, Swanson M, et al. A single daily dose of soybean phytosterols in ground beef decreases serum total cholesterol and LDL cholesterol in young, mildly hypercholesterolemic men. Am J Clin Nutr 2002;76:57–64.
    11. Neil HA, Meijer GW, Roe LS. Randomised controlled trial of use by hypercholesterolaemic patients of a vegetable oil sterol-enriched fat spread. Atherosclerosis 2001;156:329–37.
    12. Nguyen TT, Dale LC, von Bergmann K, Croghan IT. Cholesterollowering effect of stanol ester in a US population of mildly hypercholesterolemic men and women: a randomized controlled trial. Mayo Clin Proc 1999;74:1198–206.
    13. Vuorio AF, Gylling H, Turtola H, et al. Stanol ester margarine alone and with simvastatin lowers serum cholesterol in families with familial hypercholesterolemia caused by the FH-north karelia mutation. Arterioscler Thromb Vasc Biol 2000;20:500–6.
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    17. Gylling H, Radhakrishnan R, Miettinen TA. Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine: women and dietary sitostanol. Circulation 1997;96:4226–31.
    18. Gylling H, Miettinen TA. Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholesterolaemic NIDDM patients before and during sitostanol ester-margarine treatment. Diabetologia 1994;37:773–80.
    19. Gylling H, Miettinen TA. Effects of inhibiting cholesterol absorption and synthesis on cholesterol and lipoprotein metabolism in hypercholesterolemic non-insulin-dependent diabetic men. J Lipid Res 1996;37:1776–85.
    20. Gylling H, Puska P, Vartiainen E, et al. Retinol, vitamin D, carotenes and alpha-tocopherol in serum of a moderately hypercholesterolemic population consuming sitostanol ester margarine. Am J Cardiol 1999;145:279–85.
    21. Hallikainen MA, Uusitupa MI. Effects of 2 low-fat stanol estercontaining margarines on serum cholesterol concentrations as part of a low-fat diet in hypercholesterolemic subjects. Am J Clin Nutr 1999;69:403–10.
    22. 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.
    23. Gylling H, Siimes MA, Miettinen TA. Sitostanol ester margarine in dietary treatment of children with familial hypercholesterolemia. J Lipid Res 1995;36:1807–12.
    24. Miettinen TA, Puska P, Gylling H, et al. Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N Engl J Med 1995;333(20):1308-12.
    25. Vanhanen HT, Kajander J, Lehtovirta H. Serum levels, absorption efficiency, faecal elimination and synthesis of cholesterol during increasing doses of dietary sitostanol esters in hypercholesterolaemic subjects. Clin Sci (Colch) 1994;87:61-7.
    26. Plat J, van Onselen EN, van Heugten MM, Mensink RP. Effects on serum lipids, lipoproteins and fat soluble antioxidant concentrations of consumption frequency of margarines and shortenings enriched with plant stanol esters. Eur J Clin Nutr 2000;54:671–7.
    27. 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.
    28. Law M. Plant sterol and stanol margarines and health. BMJ 2000;320:861–4.
    29. Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177–84.
    30. Head KA. Inositol hexaniacinate: a safer alternative to niacin. Alt Med Rev 1996; 1:176–84.
    31. Murray M. Lipid-lowering drugs vs. Inositol hexaniacinate. Am J Natural Med 1995; 2:9 –12.
    32. Dorner Von G, Fisher FW. Zur Beinflussung der Serumlipide undlipoproteine durch den Hexanicotinsaureester des m-Inositol. Arzneimittel Forschung 1961; 11:110–3.
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    37. Chan DC, Watts GF, Barrett PH, et al. Regulatory effects of HMG CoA reductase inhibitor and fish oils on apolipoprotein B-100 kinetics in insulin-resistant obese male subjects with dyslipidemia. Diabetes 2002;51:2377–86.
    38. Friedberg CE, Janssen MJ, Heine RJ, Grobbee DE. Fish oil and glycemic control in diabetes. A meta-analysis. Diabetes Care 1998;21:494–500.
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    40. Roche HM, Gibney MJ. Effect of long-chain n-3 polyunsaturated fatty acids on fasting and postprandial triacylglycerol metabolism. Am J Clin Nutr 2000;71:232S–7S.
    41. Deslypere JP. Influence of supplementation with N-3 fatty acids on different coronary risk factors in men--a placebo controlled study. Verh K Acad Geneeskd Belg 1992;54:189–216.
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    43. Nikkila, M. Influence of fish oil on blood lipids in coronary artery disease. Eur J Clin Nutr 1991;45(4):209–13.
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    45. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebocontrolled trial. Lancet; Published online ahead or print, 31 August 2008, doi:10.1016/S0140-6736(08)61239–8.
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    49. Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169(7):659–69.
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  • Moducare: For a strong immune system

    Moducare® is a patented blend of plant sterols and sterolins, and the only sterol/sterolin product clinically proven to be effective in immune modulation. Moducare can be considered an adjunct to help shift immune responses to a more balanced state. It enhances the activity of various immune cells and increases the killing ability of specialized cells, called Natural Killer cells, responsible for immune surveillance. Moducare also has anti-inflammatory properties and helps reduce the effects of stress on the immune system by managing the release of cortisol, a stress hormone. Moducare is well-tolerated, with no known interactions with either prescribed medications or natural supplements. Plus, long-term studies have found that it has no significant negative side effects.

    Human Research Proves Plant Sterols Action
    We call sterols the forgotten nutrient because although thousands of research studies have been preformed on this nutrient, it has not been given the recognition it deserves.

    Over 4,000 published studies to date have examined phytosterols and 140 of these studies are double-blind, placebo-controlled human trials. Rheumatoid arthritis, cervical cancer, diabetes, immune function, prostate problems, HI V, herpes, hepatitis C, allergies, stress-induced immune suppression, chronic fatigue, tuberculosis, breast cancer, and high cholesterol are only some of the diseases where sterols and sterolins have been shown to be extremely effective.

    Plant sterols and sterolins are essential for modulating (balancing) the immune system, enhancing it if it is under active, and reducing it when it is over stimulated. They perform the balancing act very effectively. Patrick J.D. Bouic, Ph.D., has shown in his research that plant sterols and sterolins are effective in enhancing an under active immune system and/or decreasing an overactive one. This happens without the side effects associated with pharmaceutical substances such as interferon, prednisone or methotrexate. Sterols and sterolins have been evaluated in a 25,000-person safety study and found to have no side effects, no drug interactions, and no toxicity. It is safe for children, as well as pregnant and nursing mothers. Only those who have had an organ transplant cannot take plant sterols because they may stimulate rejection.

    Plant sterols and sterolins also increase the number and action of natural killer cells (our cancer fighters) and increase our DHE A levels naturally. They are also able to reduce the stress hormone cortisol and the proinflammatory immune factor, interleukin-6, and tumor necrosis factor alpha (TN F-a). Interleukin-6 and (TN F-a) are increased in autoimmune disorders, osteoporosis, over exercising, fibromyalgia, and osteoarthritis. Reduction of this inflammatory agent is the key to halting symptoms and pain. This is exactly what plant sterols and sterolins do.

    Sterols—Great Stress Busters
    Chronic stress is so negative that it can promote and exacerbate most disease. Numerous studies have linked our ability to deal with stress to our susceptibility to the common cold as well as more serious diseases such as cancer. Adults who have recently lost a loved one or have been divorced or separated tend to have the highest cancer rates. Unrelieved stress gradually weakens and suppresses our immune system, causing disease. Stressful situations promote the release of cortisol, the stress hormone which in turn causes the secretion of a negative immune factor interleukin-6. Abnormal levels of IL-6 are associated with osteoporosis, autoimmune disease, asthma, inflammatory diseases including arthritis, and more. We know that phytosterols are effective in reducing IL-6, cortisol and other negative immune factors. They also improve DHEA, a hormone known to help fight the effects of stress.

    An overview follows of a few of the outstanding studies published.

    Sterols Lower Cholesterol
    The rapid cholesterol-lowering effects of phytosterols have been reported in over 400 studies. Beta-sitosterol is very similar in structure to cholesterol except that it has an extra ethyl group on the side chain. Due to this similarity, it interferes with the absorption of the cholesterol found in our foods as well as the cholesterol produced by the body. By including phytosterol-rich foods or supplements containing sterols, we can normalize cholesterol much faster than with the common cholesterol-lowering drugs.

    Sterols Halt Hepatitis C
    Hepatitis C is now occurring in epidemic proportions. Over four million North Americans are infected with hepatitis C. Liver specialists are overwhelmed as they struggle to deal with the increase in the incidence of this disease. Hepatitis C is the leading cause of liver transplants in North America. Physicians using sterols and sterolins to treat hepatitis C have already shown that with 90 days of the sterols and sterolins treatment liver enzymes and viral load normalize.

    Sterols, Heart Disease and DHEA
    A team of Canadian researchers discovered that an error in the regulation of certain immune cells that fight bacterial infections may be implicated in heart attacks and strokes. In a study published in the International Journal of Immunopharmacology, plant sterols and sterolins are shown to improve the ability of the immune system to fight bacterial infections. Sterols and sterolins, not antibiotics, may be the way to treat bacterial-induced heart disease.

    Prostate Problems Eliminated
    Urologists in Germany have been using plant sterols and sterolins for over two decades for the treatment of enlarged prostate. In one double-blind, placebo-controlled study of 200 patients with an average age of 65 and with BPH, subjects were given sterols and sterolins for six months. The treatment group showed a rapid reduction of the symptoms mentioned above and an increase in peak urinary flow and a decrease in inflammation. When does a health food product become mainstream? Do 4,000 medical studies constitute good scientific evidence of a nutrient’s effectiveness? We believe plant sterols and sterolins will change the way we treat disease in the future. Instead of treating symptoms, we will get directly to the source of the symptoms and repair the cause of the disease.