The Power of Plant Sterols and Stanols

by Annie Lin, MS Candidate, Dietetic InternNutrition
A package of strawberry Benecol yogurts.

Cardiovascular disease (CVD) is the leading cause of death within the US, with approximately 919,000 deaths in 2023 being attributed to CVD [1]. One causal risk factor for CVD is dyslipidemia (abnormal levels of fats in the blood), which can be treated with a variety of pharmaceutical and/or dietary interventions, one being the use of plant sterols and plant stanols. In this article, we will discuss the difference between plant sterols and stanols, their benefits for lipid health, and any potential risks. 

What are plant sterols and plant stanols? Where are they found? 

Plant sterols and stanols are compounds with cholesterol-lowering properties. They can be found naturally in small quantities in plant foods, including [2]:

  • Fruits and vegetables
  • Nuts and seeds
  • Vegetable oils
  • Whole grains (wheat and rye are particularly high in plant stanols)

The average daily intake of sterols and stanols through plant foods is 300-600 milligrams of sterols and 17-24 milligrams of stanols [2]. However, current guidelines recommend the consumption of 2 grams of plant sterols/stanols per day for a 10% reduction in LDL cholesterol (LDL-C) levels, with a few meta-analyses suggesting that further reductions in LDL-C can be achieved at doses up to 3 grams/day [3-5]. Therefore, companies have begun fortifying foods like margarines and fat spreads (e.g. Benecol), various dairy products, and some juices with plant sterols and stanols, making it easier to consume 2-3 grams/day [6].

Plant sterols, plant stanols, and cholesterol [2]

Cholesterol is found in animal-based foods, like meat and dairy products, and your liver also produces its own cholesterol. While you need cholesterol for functions like Vitamin D synthesis and hormone production, abnormal levels (particularly high LDL-C) can lead to plaque buildup within your arteries, which reduces blood flow and increases your risk of CVD [7]. 

Structurally, plant sterols and stanols are very similar to cholesterol. They have the same ring structure, but plant sterols have an additional methyl/ethyl group in their sidechains and plant stanols are simply the saturated form of plant sterols. 

In order to be absorbed from your gut, cholesterol needs to be incorporated into micelles. Because plant sterols and stanols have a very similar structure to cholesterol, they are able to compete with cholesterol for space within the micelles, blocking some cholesterol from being absorbed. 

Health benefits of plant sterol/stanol-fortified foods

As a result of plant sterols and stanols outcompeting cholesterol for absorption, more cholesterol is excreted from the body, resulting in lower cholesterol levels. One study found that after 1 year, participants with mild hypercholesterolemia who replaced 24 grams of their daily fat intake with a sitosterol-ester margarine had a 10.2% decrease in serum cholesterol (0.1% in control group), 14.1% decrease in LDL-C (1.1% in control group), and a 36% decrease in campesterol absorption, indicating reduced cholesterol absorption [8]. Although there are currently no studies showing a direct association between plant sterols/stanols and cardiovascular outcomes, research has shown that for every 1 mg dL/1% decrease in LDL-C, there is an associated 1-2% reduction in CVD risk [3,4]! 

There are also benefits for individuals who take statins, a type of medication that lowers cholesterol levels through blocking the production of cholesterol by the liver. In comparison to other interventions (e.g. fish oil, cinnamon, garlic, turmeric, red yeast rice), statins seem to be the most effective in reducing LDL-C [3]. Still, one study showed that only 48% of patients on statins reach their LDL-C goals and even with increased doses, only an additional 14% of patients achieve their goals [9]! As mentioned previously, plant sterols and stanols lower cholesterol levels through reducing the absorption of cholesterol; however, to compensate for this, your body increases cholesterol production [11]. Pairing statins with plant sterols and stanols can target both cholesterol production and absorption, leading to even greater reductions in cholesterol levels. For example, an 8-week study involving patients on statins found that the use of a spread that provided 5.1 grams of plant stanols per day led to a 12% decrease in total cholesterol (5% in control group) and a 17% decrease in LDL-C (7% in control group) [10]. Similarly, a systematic review and meta-analysis of eight randomized controlled trials found that for mild-moderate hypercholesterolemic patients undergoing statin therapy, the addition of plant sterols/stanols led to greater reductions in LDL-C (13 mg/dL) and total cholesterol (14 mg/dL) as well [11]. This combined intervention can also be especially helpful for individuals who are high cholesterol absorbers (>60% cholesterol absorption) and have a higher risk of CVD due to increased plaque buildup [12].

Potential risks of plant sterols and stanols 

Normally, the amount of plant sterols and stanols present in your circulation is low (0.3-1 mg/dL and 0.002-0.012 mg/dL, respectively) due to low rates of absorption (0.05-0.2% and 0.04-0.2%, respectively) and increased excretion [2]. However, for individuals with sitosterolemia, there are mutations in the genes that encode the proteins responsible for transport and excretion of sterols, resulting in elevated levels of plant sterols in the blood and increased risk of premature CVD [13]. For these individuals, it is recommended to reduce plant sterol intake and consider consuming more plant stanols, as they are more poorly absorbed than sterols [6,11,13]. Other groups who should take caution are pregnant or breastfeeding women, as well as children under the age of 5, as there is limited data on the safety of plant sterol/stanol consumption within these groups [6]. 

Additionally, plant sterol and stanol consumption has been associated with a slight reduction in carotenoids, which have antioxidant properties and can reduce CVD risk; however, this reduction does not seem to be significant [6,11]. 

Conclusion

For individuals with dyslipidemia and/or at high risk of CVD, 2-3 grams of plant sterols or stanols per day can help with lowering cholesterol levels and improving overall cardiovascular health, particularly when paired with statins. That being said, caution should be taken for individuals with sitosterolemia, pregnant or breastfeeding women, and children under 5 years of age. 

References

  1. Centers for Disease Control and Prevention. (2024). Heart Disease Facts. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html 
  2. Barkas, F., Bathrellou, E., Nomikos, T., Panagiotakos, D., Liberopoulos, E., & Kontogianni, M. D. (2023). Plant Sterols and Plant Stanols in Cholesterol Management and Cardiovascular Prevention. Nutrients, 15(13), 2845. https://doi.org/10.3390/nu15132845
  3. Mach, F., Koskinas, K. C., Roeters van Lennep, J. E., Tokgözoğlu, L., Badimon, L., Baigent, C., Benn, M., Binder, C. J., Catapano, A. L., De Backer, G. G., Delgado, V., Fabin, N., Ference, B. A., Graham, I. M., Landmesser, U., Laufs, U., Mihaylova, B., Nordestgaard, B. G., Richter, D. J., Sabatine, M. S., … ESC/EAS Scientific Document Group (2025). 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. European heart journal, 46(42), 4359–4378. https://doi.org/10.1093/eurheartj/ehaf190 
  4. Musa-Veloso, K., Poon, T. H., Elliot, J. A., & Chung, C. (2011). A comparison of the LDL-cholesterol lowering efficacy of plant stanols and plant sterols over a continuous dose range: results of a meta-analysis of randomized, placebo-controlled trials. Prostaglandins, leukotrienes, and essential fatty acids, 85(1), 9–28. https://doi.org/10.1016/j.plefa.2011.02.001
  5. Ras, R. T., Geleijnse, J. M., & Trautwein, E. A. (2014). LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. The British journal of nutrition, 112(2), 214–219. https://doi.org/10.1017/S0007114514000750
  6. HEART UK - The Cholesterol Charity. (2025). Plant Sterols and Stanol Esters. https://www.heartuk.org.uk/four-cholesterol-lowering-foods/sterols-and-stanols 
  7. Huff, T., Boyd, B., Jialal, I. (2023). Physiology, Cholesterol. In StatPearls. StatPearls Publishing. Retrieved November 12, 2025 from  https://www.ncbi.nlm.nih.gov/books/NBK470561/
  8. Miettinen, T. A., Puska, P., Gylling, H., Vanhanen, H., & Vartiainen, E. (1995). Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. The New England journal of medicine, 333(20), 1308–1312. https://doi.org/10.1056/NEJM199511163332002
  9. Foley, K. A., Simpson, R. J., Crouse, J. R., Weiss, T. W., Markson, L. E., & Alexander, C. M. (2003). Effectiveness of statin titration on low-density lipoprotein cholesterol goal attainment in patients at high risk of atherogenic events. American Journal of Cardiology, 92(1), 79-81. https://doi.org/10.1016/s0002-9149(03)00474-0 
  10. Blair, S. N., Capuzzi, D. M., Gottlieb, S. O., Nguyen, T., Morgan, J. M., & Cater, N. B. (2000). Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy. The American journal of cardiology, 86(1), 46–52. https://doi.org/10.1016/s0002-9149(00)00976-0
  11. Scholle, J. M., Baker, W. L., Talati, R., & Coleman, C. I. (2009). The effect of adding plant sterols or stanols to statin therapy in hypercholesterolemic patients: systematic review and meta-analysis. Journal of the American College of Nutrition, 28(5), 517–524. https://doi.org/10.1080/07315724.2009.10719784
  12. Simonen, P., Öörni, K., Sinisalo, J., Strandberg, T. E., Wester, I., & Gylling, H. (2023). High cholesterol absorption: A risk factor of atherosclerotic cardiovascular diseases?. Atherosclerosis, 376, 53–62. https://doi.org/10.1016/j.atherosclerosis.2023.06.003 
  13. Farzam, K., Morgan, R. T. (2023). Sitosterolemia (Phytosterolemia). In StatPearls. StatPearls Publishing. Retrieved November 12, 2025 from  https://www.ncbi.nlm.nih.gov/books/NBK572142/