Phytosterols

Phytosterols/Drug Interactions:

  • AcarboseAcarbose: A controlled clinical trial that investigated the impact of starch malabsorption on colon carcinogenesis found that the alpha-glucosidase inhibitor acarbose decreased fecal concentration of beta-sitosterol by approximately 40%, indicating that absorption may be increased (21).
  • Acid-labile antibioticsAcid-labile antibiotics: In humans, beta-sitosterol may protect and improve the oral absorption of acid-labile antibiotics, particularly the potassium salts of penicillin G and penicillin V and erythromycin lactobionate (59).
  • Activated charcoalActivated charcoal: Data from clinical trials indicated that activated charcoal (8g given three times daily) may slightly decrease serum levels of beta-sitosterol (212).
  • Anti-benign prostate hyperplasia agentsAnti-benign prostate hyperplasia agents: In clinical studies, both subjective and objective symptom improvements have been inconsistently demonstrated for benign prostrate hyperplasia with plant sterols (102; 213; 214; 215; 55).
  • Antidiabetic agentsAntidiabetic agents: Human clinical trials have shown either a lowering of HbA1C or no effect in diabetic subjects who took plant sterols (83; 84). In animal research, fractions obtained from the leaves of Morus insignis demonstrated pronounced hypoglycemic effects (67). Since beta-sitosterol is a constituent of this plant, it may exhibit hypoglycemic effects and thereby have synergistic effects when used along with hypoglycemic drugs.
  • AntidiarrhealsAntidiarrheals: One patient developed diarrhea after treatment with beta-sitosterol (208); the dose of beta-sitosterol was not indicated.
  • AntiemeticsAntiemetics: One patient experienced several episodes of nausea after 11 days of 20mg of sitosterol three times daily in a study conducted in 200 patients for the treatment of benign prostatic hypertrophy (56).
  • Anti-erectile dysfunction agentsAnti-erectile dysfunction agents: One patient reported erectile dysfunction after two months of 20mg of sitosterol three times daily in a study conducted in 200 patients for the treatment of BPH (56).
  • AntilipemicsAntilipemics: Many studies in humans and animals have demonstrated that supplementation of beta-sitosterol into the diet decreased total serum cholesterol, as well as low-density lipoprotein (LDL) cholesterol (190; 43; 216; 217; 218; 219; 220; 195; 221; 44; 222; 223; 224; 225; 110; 187; 165; 45; 46; 47; 127; 226; 227; 48; 80; 228; 229; 230; 231; 181; 232; 32; 233; 49; 234; 235; 236; 208; 237; 18; 238; 50; 11; 81; 239; 183; 155; 23; 52; 240; 241; 242; 182; 243; 82; 244; 245; 246; 247; 53; 54; 248; 249). Clinical trials have shown additive effects of plant sterols or stanols and statins (179; 250).
  • AntineoplasticsAntineoplastics: Epidemiological, in vitro, and animal studies suggest that dietary phytosterols may offer protection against several types of cancer, including breast, colon, esophageal, rectal, stomach, and prostate cancer (14; 2; 3; 4; 20; 251; 252; 17; 253; 254; 255; 16; 256; 26; 31; 114; 32; 33; 35; 257; 36; 258; 259; 23; 260; 38; 121; 65).
  • Antiobesity agentsAntiobesity agents: The combination of beta-sitosterol and beta-sitosterol glucoside promoted weight gain in patients with pulmonary tuberculosis trying to regain weight (210).
  • Antiplatelet drugsAntiplatelet drugs: Certain plant species which contain beta-sitosterol exhibited antiplatelet aggregation activities in vitro (65). The contribution of beta-sitosterol constituents to this activity is not known. However, caution should be used when combining beta-sitosterol with these medications, due to the theoretical risk of increased bleeding.
  • Antituberculosis agentsAntituberculosis agents: Beta-sitosterol and beta-sitosterol glucoside have been shown in randomized controlled trials to improve weight gain and increase lymphocyte and eosinophil counts from baseline when used in combination with various antituberculosis agents (210).
  • AntiviralsAntivirals: In vitro, plant sterols increased a TH1 cellular response, which may inhibit viral replication (5).
  • CarbamazepineCarbamazepine: Carbamazepine had no effect on blood concentrations of plant sterols in healthy adults (261).
  • Chenic acidChenic acid: A combination of beta-sitosterol and chenic acid has been used for gallstone treatment (262).
  • Chenodeoxycholic acidChenodeoxycholic acid: A combination of beta-sitosterol and chenodeoxycholic acid has been used in cholesterol gallstone treatment (263).
  • CholestyramineCholestyramine: Cholestyramine doses of up to 32g daily reduced beta-sitosterol concentrations in patients with sitosterolemia (95; 200; 119).
  • ColestipolColestipol: In humans, a combination of colestipol and sitosterol resulted in a smaller decrease in cholesterol compared with colestipol alone (264).
  • C-reactive protein-reducing agentsC-reactive protein-reducing agents: Plant sterols have been shown to reduce levels of C-reactive protein in a clinical trial (150).
  • Cyclooxygenase inhibitorsCyclooxygenase inhibitors: In vitro analysis of some plant species containing beta-sitosterol suggested that components of the plants may exhibit anti-cyclooxygenase effects (61).
  • Dermatologic agentsDermatologic agents: In humans, topical application of the sterol-enriched fraction of canola oil resulted in fewer visible signs of sodium lauryl sulphate-induced irritation and lower transepidermal water loss, than water (control) (265).
  • DiosgeninDiosgenin: Data from animal studies suggest that the coadministration of beta-sitosterol and diosgenin may affect the uptake of diosgenin by the liver (266).
  • EzetimibeEzetimibe: Ezetimibe has been shown in a randomized controlled trial to decrease plasma plant sterol concentrations in individuals with sitosterolemia (267).
  • FibrateFibrate: The combination of fibrate and sterol-enriched margarine reduced total and LDL cholesterol more than sterol-enriched margarine alone, in a clinical trial (238).
  • Finasteride and alpha1-blockersFinasteride and alpha1-blockers: Clinical studies suggest that beta-sitosterol may relieve symptoms of benign prostatic hyperplasia through mechanisms similar to those of finasteride and alpha-blockers (74; 75; 214).
  • High-lipase pancreatinHigh-lipase pancreatin: In humans, high-lipase pancreatin did not alter fecal excretion of beta-sitosterol (268).
  • Hormonal agentsHormonal agents: Beta-sitosterol has demonstrated estrogenic and antiestrogenic activity in vitro and in animal studies (72; 100).
  • ImmunosuppressantsImmunosuppressants: In laboratory research, beta-sitosterol appeared to exert immune-modulating affects by targeting specific T-helper lymphocytes, the Th1 and Th2 cells, helping normalize their functioning and resulting in improved T lymphocyte and natural killer cell activity (15; 26).
  • LaxativesLaxatives: One patient reported constipation after one day of 20mg of sitosterol three times daily in a study conducted in 200 patients for the treatment of benign prostatic hypertrophy (56).
  • LifibrolLifibrol: Lifibrol, a lipid-lowering drug for the therapy of hypercholesterolemia, has been shown in clinical trials to reduce blood levels of sterols including lanosterol, lathosterol, beta-sitosterol, and campesterol (269).
  • Neurologic agentsNeurologic agents: In vitro analyses have identified sterol beta-d-glucosides as potential neurotoxins (90).
  • NMDA receptor antagonistsNMDA receptor antagonists: N-methyl-D-aspartic acid (NMDA) receptor antagonists may block the neurotoxic actions of sterol glucosides, according to in vitro bioassays, although they did not compete for binding at the NMDA receptor (90).
  • RifampinRifampin: The plant sterol-lowering effects of ezetimibe were reduced by rifampin in a clinical trial (270).
  • SecholexSecholex: Secholex has been shown in clinical trials to decrease serum cholesterol (271).
  • StatinsStatins: Simvastatin has been shown in randomized controlled trials to elevate the ratio of plant sterols to cholesterol in patients with the highest baseline campestanol levels, and to reduce plasma campesterol, while having no effect on stigmasterol or sitosterol (272; 273). Simvastatin and niacin in combination have been shown in a randomized controlled trial to elevate beta-sitosterol levels in patients with low HDL (205). Atorvastatin, simvastatin, and pravastatin have been shown to independently elevate the ratio of plant sterols to cholesterol in patients with coronary heart disease or hyperlipidemia (274; 275). Atorvastatin has been suggested to increase levels of plasma plant sterols in diabetics (276). In a clinical trial, use of margarine containing stanol and sterol esters reduced total and LDL cholesterol and allowed for reduction of statin therapy in post-cardiac transplantation patients (277). In two clinical trials, there was an additive effect of statins and plant sterols in terms of LDL cholesterol reduction (165; 151). Results from one clinical trial suggest the combination of plant sterols with cerivastatin, a statin which is no longer on the market, may have cholesterol-lowering effects equivalent to doubling the cerivastatin dose (134). In vitro studies suggest that beta-sitosterol may decrease the activities of HMG-CoA reductase (278).
  • TamoxifenTamoxifen: In women with advanced breast cancer treated with tamoxifen, plant sterols were inconsistently increased in serum (101).

    • Phytosterols/Herb/Supplement Interactions:

  • AcarboseAcarbose: A controlled clinical trial investigated the impact of starch malabsorption on colon carcinogenesis and found that the alpha-glucosidase inhibitor acarbose decreased fecal concentration of beta-sitosterol by approximately 40%, indicating that absorption may be increased (21).
  • AlmondsAlmonds: A combination of plant sterols, soy protein, viscous fiber, and almonds resulted in a decrease in LDL cholesterol in a clinical trial (279).
  • Alpha-tocopherol (vitamin E)Alpha-tocopherol (vitamin E): Clinical trials demonstrated that bioavailability of alpha-tocopherol may be decreased with concurrent administration of beta-sitosterol (240).
  • Anti-benign prostate hyperplasia herbs and supplementsAnti-benign prostate hyperplasia herbs and supplements: In clinical trials, both subjective and objective symptom improvements have been inconsistently demonstrated for benign prostrate hyperplasia with plant sterols (102; 213; 214; 215; 55).
  • AntidiarrhealsAntidiarrheals: One patient developed diarrhea after treatment with beta-sitosterol (208); the dose of beta-sitosterol was not indicated.
  • AntiemeticsAntiemetics: One patient experienced several episodes of nausea after 11 days of 20mg of sitosterol three times daily in a study conducted in 200 patients for the treatment of benign prostatic hypertrophy (BPH) (56).
  • Anti-erectile dysfunction herbs and supplementsAnti-erectile dysfunction herbs and supplements: One patient reported erectile dysfunction after two months of 20mg of sitosterol three times daily in a study conducted in 200 patients for the treatment of BPH (56).
  • AntilipemicsAntilipemics: Many studies in humans and animals have demonstrated that supplementation of beta-sitosterol into the diet decreased total serum cholesterol as well as low-density lipoprotein (LDL) cholesterol (190; 43; 216; 217; 218; 219; 220; 195; 221; 44; 222; 223; 224; 225; 110; 187; 165; 45; 46; 47; 127; 226; 227; 48; 80; 228; 229; 230; 231; 181; 232; 32; 233; 49; 234; 235; 236; 208; 237; 18; 238; 50; 11; 81; 239; 183; 155; 23; 52; 240; 241; 242; 182; 243; 82; 244; 245; 246; 247; 53; 54; 248; 249).
  • AntineoplasticsAntineoplastics: Epidemiological, in vitro, and animal studies suggest that dietary phytosterols may offer protection against several types of cancer, including breast, colon, esophageal, rectal, stomach, and prostate cancer (14; 2; 3; 4; 20; 251; 252; 17; 253; 254; 255; 16; 256; 26; 31; 114; 32; 33; 35; 257; 36; 258; 259; 23; 260; 38; 121; 65).
  • Antiobesity herbs and supplementsAntiobesity herbs and supplements: The combination of beta-sitosterol and beta-sitosterol glucoside promoted weight gain in patients with pulmonary tuberculosis trying to regain weight (210).
  • AntioxidantsAntioxidants: The addition of antioxidants (alpha-tocopherol and beta-carotene) to sterol esters resulted in improved markers for plasma lipid peroxidation in a clinical trial (280). These antioxidants have also been used, combined with plant sterols, in other clinical trials investigating the feasibility of using bakery products as carriers for these ingredients (281).
  • Antiplatelet herbs and supplementsAntiplatelet herbs and supplements: Certain plant species, which contain beta-sitosterol, exhibited antiplatelet aggregation activities in vitro (65). The contribution of beta-sitosterol constituent to this activity is not known. However, caution should be used when combining beta-sitosterol with these medications, due to the theoretical risk of increased bleeding.
  • Antituberculosis herbs and supplementsAntituberculosis herbs and supplements: Beta-sitosterol and beta-sitosterol glucoside have been shown in randomized controlled trials to improve weight gain and increase lymphocyte and eosinophil counts from baseline when used in combination with various antituberculosis agents (210).
  • AntiviralsAntivirals: In vitro, plant sterols increased a TH1 cellular response, which may inhibit viral replication (5; 5).
  • Beta-caroteneBeta-carotene: Clinical trials have demonstrated that plant sterols given in doses of up to 9g daily may reduce beta-carotene blood levels (190; 184; 44; 45; 48; 235; 183; 82; 54). This is thought to be a result of reductions in LDL, which carries beta-carotene, by beta-sitosterol (23). In a clinical trial, plant sterol consumption reduced bioavailability of beta-carotene by 50% (240). Data from randomized controlled trials indicate that the lowering of beta-carotene may be counterbalanced by consuming an additional daily serving of a high-carotenoid vegetable or fruit when consuming spreads containing sterol or stanol esters (50).
  • Beta-lactoglobulin tryptic hydrolysate (LTH)Beta-lactoglobulin tryptic hydrolysate (LTH): Beta-lactoglobulin tryptic hydrolysate (LTH) may reduce serum cholesterol and therefore have additive or synergistic effects with plant sterols, although this interaction is theoretical (237).
  • Carotenoids (other)Carotenoids (other): Clinical trials have demonstrated that plant sterols in doses of up to 1.5g daily may reduce blood levels of lutein and lycopene (190).
  • C-reactive protein reducing herbs and supplementsC-reactive protein reducing herbs and supplements: Plant sterols have been shown to reduce levels of C-reactive protein in a clinical trial (150).
  • Cyclooxygenase inhibitorsCyclooxygenase inhibitors: In vitro analysis of some plant species containing beta-sitosterol suggests that components of the plants may exhibit anti-cyclooxygenase effects (61).
  • Dermatological herbs and supplementsDermatological herbs and supplements: In humans, topical application of the sterol-enriched fraction of canola oil resulted in fewer visible signs of sodium lauryl sulphate-induced irritation and lower transepidermal water loss than water (control) (265).
  • Fat-soluble vitamins (other)Fat-soluble vitamins (other): Clinical trials demonstrated no effect of beta-sitosterol in doses of up to 9g daily on blood levels of fat-soluble vitamins (vitamins D and A [retinol]) (44; 45; 32; 51).
  • FiberFiber: A combination of plant sterols, soy protein, viscous fiber, and almonds resulted in a decrease in LDL cholesterol in a clinical trial (279).
  • Fish oilFish oil: The combination of fish oil to plant sterols, or esterification of plant sterols to fish oil omega-3 fatty acids, had no additional effect on plasma lipids in a clinical trial (282).
  • Hormonal herbs and supplementsHormonal herbs and supplements: Beta-sitosterol has demonstrated estrogenic and antiestrogenic activity in vitro and in animal studies (72; 100).
  • HypoglycemicsHypoglycemics: Human clinical trials have shown either a lowering of HbA1C or no effect in diabetic subjects who took plant sterols (83; 84). In animal research, fractions obtained from the leaves of Morus insignis demonstrated pronounced hypoglycemic effects (67). Since beta-sitosterol is a constituent of this plant, it may exhibit hypoglycemic effects and thereby have synergistic effects when used along with hypoglycemic agents.
  • Immunomodulatory herbs and supplementsImmunomodulatory herbs and supplements: In laboratory research, beta-sitosterol appeared to exert immune-modulating affects by targeting specific T-helper lymphocytes, the Th1 and Th2 cells, helping normalize their functioning and resulting in improved T lymphocyte and natural killer cell activity (15; 26).
  • Konjac (glucomannan)Konjac (glucomannan): In a clinical trial, konjac was found to reduce total and LDL cholesterol (283). In a second clinical trial, konjac plus plant sterols reduced cholesterol biosynthesis more than sterols alone (124).
  • LaxativesLaxatives: One patient reported constipation after one day of 20mg of sitosterol three times daily in a study conducted in 200 patients for the treatment of benign prostatic hypertrophy (56).
  • LecithinLecithin: In a clinical trial, lecithin-formulated soy stanols lowered serum total and LDL cholesterol (284).
  • MineralsMinerals: In clinical trials, meat products or low-fat foods enriched with plant sterols and minerals (potassium, calcium, and magnesium) resulted in reduced total and LDL cholesterol levels (73; 285).
  • Neurologic herbs and supplementsNeurologic herbs and supplements: In vitro analyses have identified sterol beta-d-glucosides as potential neurotoxins (90).
  • NMDA receptor antagonistsNMDA receptor antagonists: N-methyl-D-aspartic acid (NMDA) receptor antagonists may block the neurotoxic actions of sterol glucosides, according to in vitro bioassays, although they did not compete for binding at the NMDA receptor (90).
  • OlestraOlestra: Olestra, a nonabsorbable fat substitute comprising long-chain fatty acid esters of sucrose, has been shown in clinical trials to decrease the amount of plant sterols in stools (286).
  • SoySoy: A combination of plant sterols, soy protein, viscous fiber, and almonds resulted in a decrease in LDL cholesterol in a clinical trial (279).
  • TaurineTaurine: In patients with cystic fibrosis, taurine supplementation resulted in a decrease in total sterol secretion (287).

    • Phytosterols/Food Interactions:

  • AlmondsAlmonds: A combination of plant sterols, soy protein, viscous fiber, and almonds resulted in a decrease in LDL cholesterol in a clinical trial (279).
  • CarotenoidsCarotenoids: In clinical research, consumption of five or more servings of fruits or vegetables daily (with at least one serving of beta-carotene-rich food) was effective in maintaining plasma carotenoid concentrations during consumption of sitosterol (50).
  • FiberFiber: A combination of plant sterols, soy protein, viscous fiber, and almonds resulted in a decrease in LDL cholesterol in a clinical trial (279).
  • Low-fat, low-cholesterol dietLow-fat, low-cholesterol diet: In a clinical trial, the effect of a low-fat, low-cholesterol diet on serum levels of plant sterols was investigated; additional information is not available (288).
  • SoySoy: A combination of plant sterols, soy protein, viscous fiber, and almonds resulted in a decrease in LDL cholesterol in a clinical trial (279).
  • Vegan dietVegan diet: In patients with rheumatoid arthritis, a strict uncooked vegan diet decreased serum campesterol and increased serum sitosterol (289).

    • Plant sterols/Lab Interactions:

  • ApolipoproteinsApolipoproteins: In clinical trials, sterol consumption resulted in a decrease in apo B and had no effect on Apo A-1 (132; 168; 171).
  • Beta-acetyldigoxinBeta-acetyldigoxin: Administration of beta-sitosterol may change resorption of beta-acetyldigoxin (290).
  • Biliary cholesterolBiliary cholesterol: Biliary cholesterol saturation may decrease with increased consumption of beta-sitosterol (216; 291). In another clinical trial, cholesterol saturation was increased following sterol supplementation (123).
  • CarotenoidsCarotenoids: Clinical trials demonstrate that beta-sitosterol, when given in doses of up to 9g daily, may reduce carotenoid (beta-carotene, alpha-carotene, beta-cryptoxanthin) levels in blood (190; 184; 44; 45; 48; 235; 50; 23; 183; 51; 82; 54; 131; 135; 240; 292). This is thought to be a result of reductions in LDL by beta-sitosterol (23). Data from randomized controlled trials indicate that this effect of lowering beta-carotene by beta-sitosterol consumption may be counterbalanced by consuming an additional daily serving of a high-carotenoid vegetable or fruit when consuming spreads containing sterol or stanol esters (50). When changes in plasma carotenoids are controlled for based on changes in cholesterol levels, there is often no effect on plasma carotenoids (126; 128; 130; 139; 150; 152; 293; 51). In a clinical trial, daily use of plant sterols decreased plasma lycopene by 9.5% (126). Other clinical trials found no effect of sterol esters on lycopene, zeaxanthin, or lutein (131; 152).
  • CD3 and CD4 cellsCD3 and CD4 cells: Beta-sitosterol and beta-sitosterol glucoside may cause an increase in CD3 and CD4 cells (210).
  • Cholesterol acyltransferase (LCAT)Cholesterol acyltransferase (LCAT): In vivo data suggest that cholesterol acyltransferase (LCAT) activity may increase with supplementation of beta-sitosterol (246).
  • Cholesterol precursorsCholesterol precursors: In a clinical trial, concentrations of cholesterol precursors (delta-8-cholesterol, lathosterol, and desmosterol) increased following sitostanol supplementation (169).
  • Classical (CP) and alternative (AP) complement pathwaysClassical (CP) and alternative (AP) complement pathways: In vitro data demonstrated that beta-sitosterol may inhibit the classical (CP) and alternative (AP) activation pathways of the human complement system, possibly resulting in altered blood levels of certain complement system compounds (294).
  • CortisolCortisol: Beta-sitosterol and beta-sitosterol glucoside may decrease levels of cortisol (210).
  • Cortisol:DHEA-s ratioCortisol:DHEA-s ratio: Beta-sitosterol and beta-sitosterol glucoside may cause a slight decrease in the cortisol:DHEA-s ratio (210).
  • Fat-soluble vitaminsFat-soluble vitamins: Clinical trials demonstrated no effect of beta-sitosterol in doses of up to 9g daily on blood levels of fat-soluble vitamins (vitamins D, E, and A [retinol]) (44; 32; 127; 128; 135; 139; 148; 150; 152; 293; 51; 292). In one clinical trial, plant free sterols and sterol esters reduced the bioavailability of alpha-tocopherol by approximately 20% (240). In a clinical trial, stanol ester-enriched margarine reduced plasma levels of dietary retinyl palmitate (295).
  • HbA1cHbA1c: Two human clinical trials have shown either a lowering of HbA1C or no effect in diabetic subjects who took plant sterols (83; 84).
  • HDL cholesterolHDL cholesterol: HDL cholesterol has been shown in clinical trials to be increased by about 5% with supplementation of beta-sitosterol in the diet (45). Data from other clinical trials contradict this and suggest that beta-sitosterol does not increase HDL (46; 47; 230; 235; 18; 183; 82; 246; 54). One randomized controlled trial conducted in children with familial hypercholesterolemia reported a 15% reduction in HDL with treatment with beta-sitosterol (241).
  • IgE plasma levelsIgE plasma levels: In vivo studies have shown that beta-sitosterol and beta-sitosterol glucoside may decrease IgE plasma levels (296).
  • IL-2 and IL-6IL-2 and IL-6: Beta-sitosterol and beta-sitosterol glucoside may decrease levels of proinflammatory monokines IL-2 and IL-6 in the blood (15; 210).
  • Lactate dehydrogenase (LDH)Lactate dehydrogenase (LDH): In vitro bioassays demonstrated that sterol beta-d-glucosides may activate the release of LDH (90).
  • LDL cholesterolLDL cholesterol: Serum LDL cholesterol may be reduced by as much as 23% (43; 219; 44; 45; 46; 47; 226; 48; 80; 229; 230; 181; 32; 297; 49; 235; 18; 50; 81; 183; 52; 241; 82; 54; 249; 149; 143; 150). Plant sterols do not seem to have an effect on LDL cholesterol particle size (298).
  • ProgesteroneProgesterone: Data from some human trials suggest that beta-sitosterol may reduce progesterone levels in healthy males and females, though the extent and significance of the reduction is unclear (43; 299).
  • Red blood cell osmotic fragilityRed blood cell osmotic fragility: In a clinical trial, plant sterol or stanol supplementation had no effect on osmotic fragility of red blood cells (209).
  • SqualeneSqualene: In a clinical trial, stanol ester-enriched margarine reduced plasma levels of dietary squalene (295).
  • Total cholesterolTotal cholesterol: Studies in both humans and animals suggest that increased amounts of dietary plant sterols and stanols decreased total cholesterol in serum by as much as 10-18% (43; 216; 44; 45; 46; 47; 226; 80; 229; 230; 181; 297; 49; 10; 300; 18; 81; 52; 241; 182; 82; 246; 54; 301; 249; 165; 166; 187; 167; 130; 140; 149; 143; 150). Membrane cholesterol in cells may decrease by as much as 26% with beta-sitosterol supplementation (2). Not all clinical trials agree (282). Although some studies indicate that apo polymorphism may be involved with the extent of cholesterol lowering following plant sterol consumption, the apoE polymorphism did not affect serum cholesterol response to plant sterols in all studies (302). A randomized controlled trial demonstrated that the serum cholesterol- and triglyceride-lowering properties of phytosterols differed with the vehicle in which they were given. Dissolution of sterols in diacylglycerol (DG) showed a greater serum cholesterol-lowering effect than dissolution in triglyceride (TG) (234).
  • Ubiquinol-10Ubiquinol-10: Randomized controlled trials demonstrated that absolute plasma ubiquinol-10 concentrations can be lowered by up to 15.4% vs. control with beta-sitosterol supplementation of 2.6-3.7g daily (23). Plant stanol supplementation also lowered plasma ubiquinol-10; however, there was no significant effect on LDL cholesterol-standardized concentrations (303).
  • WBCs and neutrophilsWBCs and neutrophils: Beta-sitosterol and beta-sitosterol glucoside may increase WBC and neutrophil levels (210)