Stanol

Historically, the absorption of lipid-soluble nutrients has been considered to be carrier-independent, with solutes diffusing into enterocytes down concentration gradients. This is true for some lipid-soluble components of plants (e.g. the hydroxytyrosol in olive oil Manna et al., 2000). However, transporters have been reported for several lipid-soluble nutrients. For example, absorption of cholesterol is partly dependent on a carrier-mediated process that is inhibited by tea polyphenols (Dawson and Rudel, 1999) and other phytochemicals (Park et al., 2002). A portion of the decreased absorption caused by tea polyphenols may be due to precipitation of the cholesterol associated with micelles (Ikeda et al., 1992). Alternatively, plant stanols and other phytochemicals may compete with cholesterol for transporter sites (Plat and Mensink, 2002). It is likely that transporters for other lipid-soluble nutrients are also affected by phytochemicals, although this has not been adequately investigated. 

Therapeutic lifestyle changes should be the first approach tried in all patients (Table 9—7).3 An adequate trial of TLC should be employed in all patients, but pharmacotherapy should be instituted concurrently in higher-risk patients. This includes dietary restrictions of cholesterol and saturated fats as well as regular exercise and weight reduction. In addition, therapeutic options to enhance LDL cholesterol lowering such as consumption of plant stanols/sterols (which competitively inhibit incorporation of cholesterol into micelles) and dietary fiber should be encouraged. These therapeutic options collectively may reduce LDL cholesterol by 20% to 25%. 

Therapeutic lifestyle changes should be continued and intensified (consider adding plant sterols/stanols and increase fiber) after 6 weeks if not below LDL cholesterol target. For those patients above their LDL cholesterol target after adequate trial of TLC (12 to 18 weeks), pharmacotherapy should be strongly considered. 

Hallikainen MA, Sarkkinen ES and Uusitupa MIL 2000. Plant stanol esters affect serum cholesterol concentrations of hypercholesterolemic men and women in a dose-dependent manner. J Nutr 130 767-776. 

R.D. Bruce, B. Burruano, M.R. Hoy and N.R. Paquette, Method for producing dispersible sterol and stanol compounds, United States Patent 6,242,001, June 5, 2001. 

Fig. 6. GC-MS key ion fragmentograms of ot/z 215 and associated mass spectra (a) the stanol elution range for a feedlot dust extract, (b) the same range for the silylated extract, (c) ey i-5 3-stigmastanol, and (d) i i-5 3-stigmastanol-TMS ether. C, are the carbon skeletons of the other isomers.

Evershed RP, Bethell PH, Reynolds PJ, Welch NJ, 5P-Stigmastanol and related 5 3-stanols as bio markers of manuring Analysis of modern experimental material and assessment of the archaeological potenxi A, J Archaeological Science 24 485-495, 1997. 

Field, F.J., Bom, E., and Mathur, S.N. 2004. Stanol esters decrease plasma cholesterol independently of intestinal ABC sterol transporters and Niemann-Pick Cl-like 1 protein gene expression. J. Lipid Res. 45, 2252-2259. 

Hallikainen, M.A., Sarkkinen, E.S., Gylling, H., Erkkila, A.T., and Uusitupa, MX 2000. 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. 54, 715-725. 

Nguyen, T.T. 1999. The cholesterol-lowering action of plant stanol esters. J. Nutr. 129, 2109-2112. Ni, W., Yoshida, S., Tsuda, Y., Nagao, K., Sato, M., and Imaizumi, K. 1999. Ethanol-extracted soy protein isolate results in elevation of serum cholesterol in exogenously hypercholesterolemic rats. Lipids 34, 713-716. 

Nissinen, M., Gylling, H., Vuoristo, M., and Miettinen, T.A. 2002. Micellar distribution of cholesterol and phytosterols after duodenal plant stanol ester infusion. Am. J. Physiol. Gastrointest. Liver Physiol. 282, G1009-G1015. 

O Neill, F.H., Sanders, T. A. B., and Thompson, G.R. 2005. Comparison of efficacy of plant stanol ester and sterol ester Short-term and longer-term studies. Am. J. Cardiol. 96(Suppl.), 29D-36D. Oakenfull, D.G. 1986. Aggregation of saponins and bile acids in aqueous solution. Aust. J. Chem. 39, 1671-1683. 

Hallikainen, M.A. and Uusitupa, M.I.J. 1999. Effect of 2 low-fat stanol ester-containing margarines on serum cholesterol concentrations as part of a low-fat diet in hypercholesterolemic subjects. Am. J. Clin. Nutr. 69, 403-410. 

Table 8.6 Effects of plant sterol or stanol treatment on plasma total (TC) and LDL-cholesterol concentrations in humans results of selected randomized, double-blind studies of healthy normocholesterolemic (NC) and hypercholesterolemic (HC) males (M) and females (F).

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