Review: Plant-based sterols and stanols in health & disease

[BrianR]

A reasonably accessible open-access review paper: https://www.sciencedirect.com/science/a ... 2718300511

Plant-based sterols and stanols in health & disease: “Consequences of human development in a plant-based environment?”
Progress in Lipid Research, Volume 74, April 2019, Pages 87-102
DOI: 10.1016/j.plipres.2019.02.003

Highlights

• Dietary plant sterols and stanols lower low density lipoprotein cholesterol, a causal risk factor for cardiovascular diseases
• Although plant sterols and stanols are poorly absorbed they are taken up by various organs, which may affect health and disease.
• Plant sterols and stanols may play a crucial role in functioning of immune cells and have beneficial effects beyond lowering low density lipoprotein cholesterol
• Effects of plant sterols on liver health depend on the route of administration as observed during parenteral nutrition regimens
  Intracellular oxidation of plant sterols might be a protective response avoiding accumulation of plant sterols within the cell.

Abstract
Dietary plant sterols and stanols as present in our diet and in functional foods are well-known for their inhibitory effects on intestinal cholesterol absorption, which translates into lower low-density lipoprotein cholesterol concentrations. However, emerging evidence suggests that plant sterols and stanols have numerous additional health effects, which are largely unnoticed in the current scientific literature. Therefore, in this review we pose the intriguing question “What would have occurred if plant sterols and stanols had been discovered and embraced by disciplines such as immunology, hepatology, pulmonology or gastroenterology before being positioned as cholesterol-lowering molecules?” What would then have been the main benefits and fields of application of plant sterols and stanols today? We here discuss potential effects ranging from its presence and function intrauterine and in breast milk towards a potential role in the development of non-alcoholic steatohepatitis (NASH), cardiovascular disease (CVD), inflammatory bowel diseases (IBD) and allergic asthma. Interestingly, effects clearly depend on the route of entrance as observed in intestinal-failure associated liver disease (IFALD) during parenteral nutrition regimens. It is only until recently that effects beyond lowering of cholesterol concentrations are being explored systematically. Thus, there is a clear need to understand the full health effects of plant sterols and stanols.

[chrissyr]

Thank you for posting this! I read mostly the CVD part, and got pretty bogged down. This part jumped out to me/interesting although it is not proven:

The current understanding is not that elevated plasma plant sterol concentrations per se increase the risk for CVD, but that individuals characterized by high plant sterol concentrations can actually be classified as subjects with higher cholesterol absorption, which might increase their risk for CVD [113] or stroke [114]. Based on observational findings, the result of the discussion around the ‘plant sterol-atherogenicity’ hypothesis is the following; CVD risk and its severity are associated with higher cholesterol absorption and reciprocally with lower cholesterol synthesis rates as measured by high levels of surrogate markers for cholesterol absorption (plasma/serum sitosterol, campesterol or cholestanol) and low levels of surrogate markers for synthesis (lathosterol or desmosterol) [113,[115], [116], [117], [118], [119], [120], [121], [122]]. Interestingly, the latest insights suggest that it seems especially the low cholesterol synthesis that is actually driving the elevated CVD risk, an intriguing hypothesis that has not been proven yet. Possibly, certain cholesterol precursors such as desmosterol and mevalonate, which are low in cholesterol-absorbers, are important for maintaining health. For example, as discussed in the previous section, desmosterol was identified as a strong regulator of anti-inflammation in macrophages [65] and mevalonate as a strong inducer of trained immunity in monocytes [64]. Interestingly, cholesterol-lowering effects of plant sterols on lowering LDL-cholesterol were most pronounced in the so-called cholesterol absorbers, who have a low endogenous cholesterol synthesis [105]. As consumption of both plant sterol and stanol esters modestly elevates endogenous cholesterol synthesis [67], their cardio-protective effects may be even further increased by elevation of cholesterol synthesis markers like desmosterol. Unfortunately, there is as yet no human trial with clinical endpoints that has evaluated the health effects of plant sterols or stanols.

-I feel better about chugging the olive oil and other plant sterols foods.
-Also, one of the links discussed true Sitosterolemia--- extremely rare, like 100 world-wide, and plasma levels of sterols 30 -100 fold higher.
-And desmosterol was mentioned somewhere else on this forum and by Tom Dayspring as potentially protective. I guess at this point if it came down to it, I'd be asking for Ezetemibe to start with instead of a statin. Ezetemibe is mentioned later in the article. Along with a whole bunch of things I don't understand, but will keep reading!