Sterols should be outlawed

While sterols occur naturally in small quantities in food (nuts, vegetables, oils), food manufacturers are adding them to processed foods in order to earn a "heart healthy" claim.

The FDA approved a cholesterol-reducing indication for sterols , the American Heart Association recommends 200 mg per day as part of its Therapeutic Lifestyle Change diet, and WebMD gushes about the LDL-reducing benefits of sterols added to foods.

Sterols--the same substance that, when absorbed to high levels into the blood in a genetic disorder called "sitosterolemia"--causes extravagant atherosclerosis in young people.

The case against sterols, studies documenting its coronary disease- and valve disease-promoting effects, is building:

Higher blood levels of sterols increase cardiovascular events:
Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Münster (PROCAM) study.

Sterols can be recovered from diseased aortic valves:
Accumulation of cholesterol precursors and plant sterols in human stenotic aortic valves.

Sterols are incorporated into carotid atherosclerotic plaque:
Plant sterols in serum and in atherosclerotic plaques of patients undergoing carotid endarterectomy.

Though the data are mixed:

Moderately elevated plant sterol levels are associated with reduced cardiovascular risk--the LASA study.

No association between plasma levels of plant sterols and atherosclerosis in mice and men.

The food industry has vigorously pursued the sterol-as-heart-healthy strategy, based on studies conclusively demonstrating LDL-reducing effects. But do sterols that gain entry into the blood increase atherosclerosis regardless of LDL reduction? That's the huge unanswered question.

Despite the uncertainties, the list of sterol-supplemented foods is expanding rapidly:

Each Nature Valley Healthy Heart Bar contains 400 mg sterols.

HeartWise orange juice contains 1000 mg sterols per 8 oz serving.

Promise SuperShots contains 400 mg sterols per container.

Corozonas has an entire line of chips that contain added sterols, 400 mg per 1 oz serving.

MonaVie Acai juice, "Pulse," contains 400 mg sterols per 2 oz serving.

Kardea olive oil has 500 mg sterols per 14 gram serving.

WebMD has a table that they say can help you choose "foods" that are sterol-rich.

In my view, sterols should not have been approved without more extensive safety data. Just as Vioxx's potential for increasing heart attack did not become apparent until after FDA approval and widespread use, I fear the same may be ahead for sterols: dissemination throughout the processed food supply, people using large, unnatural quantities from multiple products, eventually . . . increased heart attacks, strokes, aortic valve disease.

Until there is clarification on this issue, I would urge everyone to avoid sterol-added "heart healthy" products.

Some more info on sterols in a previous Heart Scan Blog post: Are sterols the new trans fat? .

Comments (10) -

  • TedHutchinson

    3/14/2009 3:10:00 PM |

    Margarine and Phytosterolemia

    Stephan Wholehealthfoodsource also has a recent interesting blog on this topic.

  • Anne

    3/16/2009 2:19:00 AM |

    The more I read about processed foods, the more I stick to whole foods. I was part of the trans fat experiment. I am not willing to take part in the sterol test.

  • Rick

    3/16/2009 5:43:00 AM |

    Most medical blogs, though useful, give us a "Choose your guru" kind of model. This post exemplifies an approach that can be summarised as: "Here's what I think, and why; you can follow my recommendations, or you can do your own research; and what's more I'll give you some pointers to get you started." Great stuff. Thank you.

    On the issue of plant sterols, the standard argumentation appears to be: "Cholesterol is bad. Anything that displaces cholesterol must be good. We're not interested in what the substances displacing cholesterol might be doing." Unfortunately, the argument is usually tacit; otherwise, it would be immediately obvious how misguided this line of thought is.

  • renegadediabetic

    3/16/2009 1:33:00 PM |

    Here they go again.  They try to solve a non-existant problem and just make things worse.

    There's big $$$$$$ in cholesterol and this is all about $$$$$, not health.

  • Anna

    3/17/2009 3:43:00 AM |

    I rarely shop in regular supermarkets anymore (farm subscription for veggies, meat bought in bulk for the freezer, eggs from a local individual, fish from a fish market, freshly roasted coffee from a local coffee place, etc.).  What little else I need comes from quirky Trader Joe's (dark chocolate!), the fish market, farmer's markets, a small natural foods store, or mail order.  

    When I do need to go into one of the many huge supermarkets near me, not being a regular shopper there, I never know where anything is, so I have to ramble a bit around the aisles before I find what I'm looking for (and I almost always can grab a hand basket, instead of a trolley cart).  

    It's almost like being on another planet!  There's always so many new products (most of them I hesitate to even call food).   It's really a shock to the senses now to see how much stuff supermarkets sell that I wouldn't even pick up to read the label, let alone put in a cart or want to taste.  I'm not even tempted by 99% of the tasting samples handed out by the sweet senior ladies in at Costco anymore (only thing I remember tasting at Costco in at least 6 mos was the Kerrygold  Irish cheese, because I know their cows have pasture access and it's real food).

    What's really shocking to me is how large some sections of the markets have become in recent years.  While Americans got larger, so did some sections of the supermarket (hint - good idea to limit the consumption of products from those areas).  Meat and seafood counters have shrunk, though.  Produce areas seem to be about the same size as always (but more of it is pre-prepped and RTE in packaging.

    But the chilled juice section is h-u-g-e!  And no, I don't think there is a Florida orange grove behind the cases.  Come on, how much juice do people need?  Juice glasses used to be teeny tiny, for a good reason.  To me it looks like a long wall stocked full of sugar water.  Avoiding that section will put a nice dent in the grocery expenses.

    The yogurt case is also e-n-o-r-m-o-u-s!   Your 115 yo Bulgarian "grandmother" wouldn't know what to make of all these "pseudo-yogurts"!  Chock full of every possible variety, but very little fit to eat.  The only yogurts I'll look at are made with plain whole milk, without added gums, emulsifiers, or non-fat milk solids, and live cultures (I mostly buy yogurt now and then to refresh my starter culture at home).  I can flavor them at home if needed.   The sterols are showing up in processed yogurts, too, along with patented new strains of probiotic cultures (I'll stick to my old fashioned, but time-proven homemade lacto-cultured veggies and yogurt instead).

    I found the same "cooler spread" in the butter & "spread" section.  The spread options were just grotesque sounding.  Actually, the butter options weren't much better, as many were blended with other ingredients to increase spreadability, reduce calories or cholesterol/saturated fat, etc.  A few plain butters were enhanced with "butter flavor" - say what?  And on no package could it be determined if the butter came from cows that were naturally fed on pasture or on grain in confined pens.

  • fizzog

    3/19/2009 12:31:00 PM |

    Are sterols the same as plant stanol esters, as in Benecol (

  • Anonymous

    3/21/2009 6:14:00 PM |

    Is beta-sitosterol, found in anti-BPH supplements in the amount of about 500 mg., okay?

  • Klimbsac

    4/11/2009 5:40:00 AM |

    I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.


  • Tony

    7/23/2009 9:51:32 PM |

    One of your articles cited concludes:

    "However, the role of dietary plant sterols in the development of atherosclerotic plaque is not known."

    Basically, there is no evidence that adsorption of sterols into serum did anything negative here. The presence of sterols is not a smoking gun.

    I take your warning as a caution, but I am not sure I believe you any more than the opposite side of this story, and yet I am by example proof that sterols have reduced my bad cholesterol levels.

    By the way, the Promise Active Supershots actually have 2 GRAMS of sterols, not 400 mg as you stated. Also, that product is being taken off the market at the end of August 2009 due to lack of market response (so I am told by Unilever).

  • buy jeans

    11/3/2010 3:20:34 PM |

    This study, piled on top of the worrisome literature that precede it, are enough for me: No more tin cans (which are lined with BPA), no more hard plastics labeled with recycling code #7 or #3, no more polycarbonate water bottles (the hard ones, often brightly colored). Microwaveable-safe may also mean human-unsafe, as highlighted by this damning assurance from the Tupperware people that BPA is not a health hazard.