February: It's the month of love (hello, Valentine's Day!), but it's also recognized as American Heart Month. While you can learn a lot this month about how to better support the health of your ticker, you don't have to reserve heart-healthy habits to this time of year alone. There are plenty of simple ways to nurture your heart that are fairly easy to add into your everyday routine. One of those ways? Eating more plant sterols for your cholesterol. But...what are they?
Experts in This Article
sports cardiologist with McGovern Medical School at UTHealth
preventive cardiology dietitian and owner of Entirely Nourished
Plant sterols and stanols—also known as phytosterols—are naturally occurring compounds found in certain plants. Structurally, they are very similar to cholesterol found in your body, and are considered an essential component of plant cell membranes, to help them grow and thrive. Recently, this vital substance has gained attention for its ability to lower human cholesterol levels, and has been added to many foods—such as margarine, orange juice, and yogurt—as a fortifying ingredient. So, what exactly makes plant sterols so effective for your heart health?
We spoke with two cardiologists to learn more about plant sterols and their effect on cholesterol and overall heart health, plus how they can specifically help women's hearts. Read on to learn more.
How do plant sterols benefit heart health?
Before diving into the specific benefits of plant sterols on heart health, it’s important to understand how they work in the body. Plant sterols have a chemical structure similar to cholesterol, a waxy substance made by your liver and obtained through the diet from foods like meat, dairy, and eggs. Because of this similarity, plant sterols can compete with cholesterol for absorption in the digestive system.
How exactly does that work? Well, when you eat foods containing plant sterols, they enter the small intestine, where both dietary cholesterol (from foods you eat) and bile cholesterol (produced by the liver) hang out. Normally, cholesterol would be absorbed into the bloodstream through the walls of the small intestine. However, when plant sterols are present, they block a significant portion of cholesterol from being absorbed. Pretty cool, right?
And that’s not all: Because plant sterols reduce the amount of cholesterol absorbed by the small intestine, any cholesterol left behind in the gut is eventually removed from the body as waste (aka poop). Plus, when plant sterols lower absorbed cholesterol, your liver turns to pulling cholesterol from your blood instead to help produce bile acids, which reduces the amount of LDL or "bad" cholesterol in the blood. This is key to plant sterols' heart health benefits.
Here's a closer look at how plant sterols can help your heart specifically:
1. It can lower LDL cholesterol
John Higgins, MD, a sports cardiologist at UTHealth Houston in Texas, says consuming 2 grams of plant sterols daily is associated with up to a 10 percent reduction in LDL or "bad" cholesterol. As mentioned above, this is because sterols compete with cholesterol for absorption in the gut, which causes excess cholesterol to be removed from the body as waste and the liver to pull cholesterol from the blood instead. Getting 2 grams per day will look like eating plenty of beans, nuts, and fortified foods, like yogurt, or taking supplements. (More on this in a bit.)
2. It may help lower blood pressure
Dr. Higgins also notes that plant sterols may lower blood pressure. Research so far has shown a drop of about 2 mmHg in systolic blood pressure (the top number) and 1 mmHg in diastolic blood pressure (the bottom number) in response to consuming plant sterols. While more evidence is needed to confirm this connection, experts have reason to believe that eating plant sterols may help reduce blood pressure alongside other traditional treatments, which may lower your overall heart disease risk.
3. It may help lower triglycerides
While more research is needed to determine this connection, the Atherosclerosis study cited above also suggests that eating 1.5 to 2 grams of plant sterols per day may be associated with a 6 to 20 percent reduction in triglycerides (another type of fat in the blood). If your triglycerides are high, working on lowering them can also lower your risk of heart attack.
What foods naturally contain plant sterols?
Thankfully, a few different foods contain plant sterols naturally. Here are some top picks to add to your diet, according to Michelle Routhenstein, MS, RD, CDCES, a preventive cardiology nutritionist and owner of Entirely Nourished:
- Soybeans
- Peas
- Sesame oil
- Kidney beans
- Lentils
- Pistachios
Routhenstein also notes that certain fortified foods also have plant sterols in them, including margarine (a replacement spread for butter) and certain types of orange juice, chocolate, and yogurt. If you're ever unsure which foods are fortified, ask your healthcare provider for guidance on how to search for these foods at your local supermarket.
Looking for ways to include these foods? “Begin by incorporating a food you like that contains plant sterols into your daily routine. For example, pistachios or sesame seeds can be added to your morning oatmeal or yogurt, while kidney beans or soybeans could be included in a lunchtime salad or a dinner rice dish,” she suggests. Alternatively, consider replacing some of the oil in your favorite stir-fry with sesame oil—a rich source of plant sterols.
What about plant sterol or stanol supplements?
Routhenstein says that while plenty of legume and nut varieties contain some level of plant sterols and stanols, most people don't often get enough of the ingredient from diet alone—especially if they're hoping for it to improve their cholesterol. This is where supplements may come in handy, as they can help you reach an effective dose that benefits your heart and overall health. There are a few varieties of plant sterol supplements on the market, most of which include subtypes called beta-sitosterol, campesterol, and stigmasterol.
Just keep in mind that before trying any new supplement, it's important to check in with your healthcare provider first. You'll want to make sure that the product you choose does not negatively interact with any prescription medications you take, or worsen any underlying health conditions you may have.
Dosage tips for plant sterol supplements
Research shows that the average daily intake of plant sterols and stanols from a standard diet is about 200 to 400 milligrams, but the amount needed for LDL-cholesterol-lowering effects is around 2 to 3 grams per day. Eating foods fortified with phytosterols, such as margarine, orange juice, or yogurt, can help you get there, but supplements might also help.
Most plant sterol supplements contain about 900 to 1,000 milligrams per capsule, which equals about 1 gram. This means, you may have to take two or more capsules per day to reach an effective limit. Both Dr. Higgins and Routhenstein recommend around 2 grams per day to lower LDL cholesterol, but ask your healthcare provider about what dosage would be right for you and your needs.
Side effects and risks of plant sterols
Large amounts of plant sterols from food or supplements are not recommended for everyone. For example, Routhenstein says people with sitosterolemia—a rare genetic disorder that leads to cholesterol and plant sterol buildup in the body—should avoid the ingredient to lower their risk of overdose. “High levels of plant sterols may also increase the risk of early atherosclerosis (narrowing and hardening of arteries due to plaque buildup) in these individuals,” she adds.
Routhenstein also recommends that anyone with an underlying heart condition consult with their healthcare team—which may include a registered dietitian who specializes in heart disease—before trying plant sterols for their heart issues.
Lastly, there are some side effects to consider, whether you have a heart condition or not. Dr. Higgins notes that some people may experience gut side effects like diarrhea or fatty stools when increasing plant sterol intake, especially since some of the foods with naturally high plant sterols (i.e., beans and legumes) tend to cause gas and bloating.
When to see a healthcare provider about your heart
While adding plant sterols to your diet is generally a good heart-healthy habit (especially if your recent blood tests show you have high cholesterol) certain symptoms should never be ignored. Dr. Higgins recommends reaching out to a healthcare provider about your heart if you experience any of the following symptoms, as they could point to a more serious condition that requires medication or other forms of treatment:
- Chest pain
- Getting out of breath more easily than you used to
- Bad headaches
- High blood pressure
- Weight gain
- Dizziness
- Fatigue
- Fluid buildup in the arms or legs
- Fainting or passing out
Additionally, if you or a loved one has severe, persistent chest pain, shortness of breath, or loss of consciousness, call 911 and go to your nearest emergency room for immediate medical care.
The bottom line
Overall, incorporating plant sterols into your diet may be an effective strategy for reducing your risk of heart disease. These natural compounds, found in a variety of plants and fortified foods, offer a way to naturally reduce LDL cholesterol, support healthy blood pressure, and may even reduce triglycerides.
However, it’s important to note that plant sterols are just one part of the picture. Simply increasing your plant sterol intake without making other heart-healthy lifestyle choices probably won’t be the cure-all you’re hoping for. Instead, Dr. Higgins suggests adding the following to your routine:
- Eating a variety of heart-healthy foods like fruits, vegetables, nuts, seeds, legumes, whole grains, salmon, and yogurt
- Managing your stress
- Getting 7 to 9 hours of sleep per night
- Getting daily exercise
- Visiting with your healthcare provider regularly for blood work and other screenings
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