Benecol - Healthcare Professionals

Dosage, Consumption Frequency and Dual Effect of Stanols

Effects of the Stanol Dosage

With esterified stanols, combining the data from the clinical studies shows that optimum LDL lowering is attained with an intake of about 2 g/d, and increasing the dose does not further reduce serum LDL levels (3). The minimum amount of stanols required to significantly lower cholesterol is about 0.8-1.0 g/d. However, most of the studies focused on higher intake levels, about 2-3 g/d of plant stanols in their esterified, fat-soluble forms.

Effects of Consumption Frequency

Most of the studies on stanol consumption assessed the effects of using stanol divided over two or more dosages. However, Plat and Mensink (4) showed that daily intake of 2.5 g for 4 weeks of esterified plant stanols once at lunch was as effective in lowering serum LDL-cholesterol concentrations as when the dose was divided over three meals.

Dual Effect of Stanols

Elevated plant sterol concentrations were implicated as an independent risk factor for coronary heart disease (CHD). In the regulation of intestinal plant sterol absorption, two ABC transporters (ABCG5 and ABCG8) play an important role by resecreting already absorbed plant sterols from the enterocytes back into the intestinal lumen. Mutations in these transporter proteins lead to the rare congenital disease sitosterolaemia, which is characterised by:

• severely elevated serum plant sterol concentrations,
• normal to moderately increased serum cholesterol concentrations, and
• a high risk of developing CHD at a very young age.

It was recently shown that polymorphisms in the ABCG5 and ABCG8 genes contribute to the variation in serum plant sterol levels in healthy, non-sitosterolaemic individuals. Furthermore, according to several epidemiological studies, the risk of developing heart disease seems to be increased even at more "normal" levels of plant sterols (8-10). Since statins were shown to increase serum plant sterol concentrations (11, 12), patients should probably not be treated with statins only but with a combination therapy focused simultaneously on improving the serum lipoprotein profile and lowering serum plant sterols.

References