Do "Heart Healthy" sterols cause heart disease?

The sterol question continues to pop up.

Sterols are an ingredient widely added by food manufacturers that allows a "heart healthy" claim, since sterols have been shown to reduce LDL cholesterol (at least transiently). HOWEVER, sterols have also been implicated in possibly increasing risk for heart disease. After all, people with the genetic condition called sitosterolemia absorb sterols into the blood and develop coronary heart disease in their teens and twenties. Those of us without sitosterolemia who increase sterol intake with sterol-enriched foods increase blood levels of sterols several-fold. Is this healthy, or does it contribute to coronary plaque as it does in people with sitosterolemia?

Below, I've reprinted a previous Heart Scan Blog post on sterols.

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 (19) -

  • steve

    9/9/2009 1:58:35 PM |

    Dr Davis:  Does this include Benecol and Take Control?

  • Kathy Hall

    9/9/2009 2:04:42 PM |

    Dr. Davis:

    The prostate supplement I give my husband has what is called Phytosterol Complex consisting of 400 mg free sterols and 180 mg of beta-sitosterol.

    I was under the impression for years that beta-sitosterol was good for the prostate.  

    Are these prostate supplements dangerous?

  • Dr. William Davis

    9/9/2009 5:53:39 PM |

    Hi, Steve--

    Benecol is okay, since it has stanol esters which do not enter the blood.

    Take Control is a sterol ester product.


    Yes, these would fall under sterols.

  • Anonymous

    9/9/2009 6:50:51 PM |

    What I find baffling about sterols, and some cholesterol drugs too, is the fact the FDA approves them (or their labeling) on the basis they supposedly reduce heart disease, without... well, ever checking if they do in fact reduce heart disease. Zetia would be one example in the drug world.

    Wouldn't it be much nicer if they tested plaque reduction (calcium scoring or even carotid artery ultrasounds), instead of relying on a number that may not matter (cholesterol)?

  • Ross

    9/9/2009 7:11:45 PM |

    This would seem to be yet another case of franken-foods gone wrong.

    Ross's rule of thumb: if a product's packaging argues that it's an especially healthy food, it's probably not food at all.

  • Anonymous

    9/10/2009 7:10:56 AM |

    Web_MD ought to be renamed into Web-Quack. Hardly ever have I seen a site that is so full of crap...

  • Anonymous

    9/10/2009 11:14:54 PM |

    A bit on the side, but related to wheat, and might be of interest:

    Celiac Disease Associated with Dilated Cardiomyopathy.

    South Med J. 2009 Sep 4;
    Authors: Lodha A, Haran M, Hollander G, Frankel R, Shani J

    Celiac disease is an intestinal disorder caused by an immunologic response to gluten, which results in diffuse damage to the proximal small intestinal mucosa with malabsorption of nutrients. An association between celiac disease and nonischemic dilated cardiomyopathy has been noted. Cardiomyopathy has been shown to improve in some patients on a gluten-free diet. We report a case of progressively worsening dilated cardiomyopathy in a patient with documented celiac disease.

    PMID: 19738524 [PubMed - as supplied by publisher]

    Best wishes from Norway

  • Brate

    9/11/2009 5:22:21 AM |

    According to the American Heart Association, heart disease is the nation's single leading cause of death for both men and women. At least 58.8 million people in this country suffer from some form of heart disease.
    And on the whole, cardiovascular diseases (the combination of heart disease and stroke) kill some 950,000 Americans every year.
    Still, there are many misconceptions about heart disease: "The biggest misconception is that heart disease only happens to the elderly," said Elizabeth Schilling, CRNP with the Center for Preventive Cardiology Program at the University of Maryland Medical Center.
    In fact, according to the American Heart Association, almost 150,00 Americans killed by cardiovascular disease each year are under the age of 65. And one out of every 20 people below the age of 40 has heart disease.
    So, it is now a wise decision to keep a constant monitoring of your health. Why to take a chance if we have the option. I was in the similar misconception that heart disease are far away waiting for me to get aged. But to my surprise, I was found to be having a calcium deposit in my coronary arteries. I need to have my advance diagnostic scans due reassure whether something really deadly is waiting for me. Though it was some dreadful going on in my life, but I never felt any kind of discomfort in advanced diagnostic facility. They were having some of the latest diagnostic equipments and non invasive techniques which made me feel safe.

  • Sifter

    9/13/2009 2:03:10 AM |

    I believe performs CAT scans for the heart, as posted on their website. I also believe Dr. Davis wrote that these are very high radiation tests, equal approximately to 100 Xrays, compared to the EBT tests that equal roughly 4 Xrays. Your choice....

  • Anonymous

    9/13/2009 7:10:45 AM |

    Does one need to worry about the sterols in nuts and oils? What levels are we talking about that should be avoided?


  • Anonymous

    9/14/2009 4:15:03 PM |

    Interesting comment about nuts. They are usually considered heart-healthy, but are they really?

    They are high in Omega 6s and sterols. Just because they can influence cholesterol in a positive way, doesn't mean they are good for you. I've wondered about that too.

  • Kismet

    9/16/2009 11:25:12 PM |

    Anonymous, yeah IIRC they are. Some observational trials clearly suggested that nuts in moderation decrease CVD risk.

    again IIRC.

  • trinkwasser

    10/2/2009 3:45:57 PM |

    I suspect another U curve, or J curve: possibly the small quantities of natural sterols in nuts are beneficial, which has led to their use in overdose quantities, which isn't (unless you're a shareholder in a foodlike substance manufacturing company - if they're cheap enough to manufacture that you can displace more expensive ingredients from your product, then mark up the price with a "heart healthy" tag you're on to a winner)

  • denparser

    10/4/2009 11:54:39 AM |

    minute maid... i regularly drink that. wow, i don't even know that it has a good nutritional effect.

  • x.ds

    11/22/2009 5:43:25 AM |

    Dr. Davis:

    Vitamin D is a steroid and chemically related to phytosterols. As a result it's my feeling that prolonged supplementation with vitamin D will cause atherosclerosis and promote coronary plaques like phytosterols.

    It's an established medical fact that high dose of vitamin D causes atherosclerosis but a small intake of it for many months may have the same effect since vitamin D like phytosterols and corticosteroids bioaccumulates in the body.

    After personally taking sarsaparilla and butcher's broom root (both rich in phytosterols) for a long time I had persistent low-grade fever. After reading that squalene inhibited the action of fat-soluble cancer-causing agents I thought it may bind phytosterols too. I tested it and after 2 weeks my fever disappeared. Upon discontinuation of squalene a few weeks later fever did not return.

  • shaheel

    9/27/2010 12:57:24 PM |

    Heart  disease is one of the most  dangerous disease which takes thousands of life every years all over the world. If we know its symptoms and Treatment for heart disease. We can prevent is to large extent.

  • buy jeans

    11/3/2010 6:47:48 PM |

    HOWEVER, sterols have also been implicated in possibly increasing risk for heart disease. After all, people with the genetic condition called sitosterolemia absorb sterols into the blood and develop coronary heart disease in their teens and twenties. Those of us without sitosterolemia who increase sterol intake with sterol-enriched foods increase blood levels of sterols several-fold. Is this healthy, or does it contribute to coronary plaque as it does in people with sitosterolemia?

  • highchords

    12/16/2010 6:38:08 AM |

    Would help people for getting aware of the negative aspects of the taking eatables containing sterols. Would be helpful in preventing the heart prone diseases.

    Heart Disease

  • Anonymous

    12/25/2010 7:43:10 PM |

    absolutely wrong i think if this were the case can u beleive Dr. william Davis , that almost all Countries including the stringent Canada is allowing Foods Fortified with plant sterols to be sold in retail chains , being a Doc . u shud be careful of scaring the people and hence depleting them of a cure for a Potential Fatal Heart Condition , here are some Conclusion of a study preformed recently :  Several experimental studies in normal and apolipoprotein-E-deficient mice in the study by Weingärtner et al. (6) indicated that the increase in serum plant sterol contents with diet-enriched plant sterol ester consumption worsens arterial function. Humans consuming a diet enriched with plant sterol esters had increased contents of plant sterols in serum and in atherosclerotic aortic valves. However, it remains open whether high plant sterol levels in aortic valves cause atherosclerosis. Even though excessively increased serum plant sterols in serum of sitosterolemic patients with mutated plant sterol metabolism can result in early atheromatosis, no consistent association is available with serum plant sterols and atheromatosis under normal conditions.
    Pls reply Doc Smile