Getting Enough Phytosterols

Although antioxidants get a lot of attention for their role in disease prevention, there's another shining-star category among plant-derived compounds: phytosterols. Similar in structure and function to cholesterol, phytosterols benefit heart and prostate health and are even linked to reduced cancer risk. These health-promoting compounds are found in all plant foods and are also available as supplements.

Lowering Cholesterol
All human and animal cells contain cholesterol, and plant cells contain phytosterol. Classified as sterols and stanols, phytosterols attach to the spaces in the digestive tract usually reserved for cholesterol. As a result, less cholesterol is absorbed into the bloodstream.

Evidence shows that daily consumption of foods (such as margarines, spreads, and juices) enriched with plant sterols or stanols lowers total and LDL (lousy) cholesterol levels. However, consuming enough fortified margarine (two to four tablespoons) every day to get enough phytosterols can be inconvenient, especially for anyone who doesn't use margarine.

"I prefer stanols and sterols in pill form," says Stephen R. Devries, MD, director of the Integrative Program for Heart Disease Prevention at the University of Illinois at Chicago. "These are easy to take and more convenient for most people." With 2 grams of stanols/sterols per day, you can expect a significant reduction in LDL levels, he adds.

Phytosterols and BPH
Mixtures of phytosterols, which appear as "beta-sitosterol" in individual supplements and combination formulas, are often included in herbal therapies for benign prostatic hyperplasia (BPH), or noncancerous enlargement of the prostate. In one six-month study of 200 men with BPH, 60 mg per day of a beta-sitosterol preparation increased peak urinary flow and decreased post-void residual urine volume compared to a placebo. Another six-month study of 177 men with BPH found that 130 mg per day of a different beta-sitosterol preparation improved the same urinary symptoms compared to a placebo.

The Cancer-Phytosterol Link
Available data is limited, but phytosterols show promise in cancer prevention. Case-controlled studies in Uruguay find that people with stomach, lung, and breast cancers have lower phytosterol intakes than cancer-free control groups.

Studies from the U.S. show similar results-women diagnosed with breast or uterine cancer had lower dietary phytosterol intakes than women who were cancer free. A recent study shows that beta-sitosterol significantly inhibits human breast cancer cell growth. Researchers conclude, "beta-sitosterol is an effective apoptosis-promoting agent," and "incorporation of more phytosterols in the diet may serve as a preventive measure for breast cancer."

Side Effects and Interactions
Phytosterols are extremely well tolerated. Side effects are rare but include gastrointestinal complaints and nausea. Since their safety during pregnancy and lactation has not been studied, it's wise to avoid supplements and foods with added phytosterols during these times. However, high dietary intakes of naturally occurring sterols and stanols appear safe.

Because of their cholesterol-lowering effects, phytosterols should be used with caution by anyone on cholesterol-lowering drugs. Clinical trials suggest that, for someone already on statin therapy, consuming just 2 to 3 grams per day of phytosterols can result in an additional 7 to 11 percent reduction in LDL cholesterol-an effect comparable to doubling the dose of statins.

"Beta-Sitosterol Activates Fas Signaling in Human Breast Cancer Cells" by A. B. Awad et al., Phytomedicine, 3/07 "Effect of Plant Stanol Tablets on Low-Density Lipoprotein Cholesterol Lowering in Patients on Statin Drugs" by A. C. Goldberg et al., Am J Cardiol, 2/06 An Evidence-Based Approach to Dietary Phytochemicals by Jane Higdon, PhD ($59.95, Thieme, 2007)

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