Heart Health High Cholesterol Treatment Print Health Benefits of Phytosterol Supplements Plant-based compounds may help lower your cholesterol Medically reviewed by facebook linkedin Medically reviewed by Richard N. Fogoros, MD on July 08, 2019 Richard N. Fogoros, MD, is a retired professor of medicine and board-certified internal medicine physician and cardiologist. He is Verywell's Senior Medical Advisor. Learn about our Medical Review Board Richard N. Fogoros, MD Written by facebook Written by Jennifer Moll, PharmD Jennifer Moll, MS, PharmD, is a pharmacist actively involved in educating patients about the importance of heart disease prevention. Learn about our editorial policy Jennifer Moll, PharmD Updated on July 17, 2019 Pia_iStock89/istockphoto More in High Cholesterol Treatment Causes & Risk Factors Diagnosis Support & Coping Nutrition In This Article Table of Contents Expand Health Benefits Possible Side Effects Dosage and Preparation What to Look For Other Questions View All Back To Top Phytosterols, also known as plant sterols or stanol esters, are naturally occurring compounds found in plants that are similar in structure to cholesterol found in humans. When consumed in the foods you eat, they compete with cholesterol for absorption in the intestine. This can potentially lower the cholesterol levels in your blood, most especially the "bad" low-density lipoprotein (LDL) cholesterol that can clog your arteries. Phytosterols are found most predominately in fruits, vegetables, vegetable oils, whole grains, soybeans, mushrooms, lentils, and nuts. Some commercially prepared foods—such as juices, yogurt, breakfast bars, salad dressings, and margarine—are fortified with phytosterols during the manufacturing process. Phytosterol supplements are also widely available in many health foods stores, grocery stores, and retail pharmacies. When taken as a supplement, phytosterols may help lower your LDL and total cholesterol levels. Other popular health claims (including how phytosterols can prevent colorectal cancer or help you lose weight) are unsupported by research. 8 Common Myths About High Cholesterol Health Benefits The current body of research has consistently shown that eating 2 grams of phytosterols per day can reduce your LDL cholesterol by anywhere from 8 to 10%. Although many people can meet these goals by increasing their intake of phytosterol-rich foods, there are some who may benefit from a daily supplement. These include people with poorly controlled high cholesterol (hypercholesterolemia) and those with an inherited genetic disorder known as familial hypercholesterolemia. A typical western diet contains approximately 300 milligrams (mg) of plant sterols, while a vegetarian diet contains between 300 and 500 mg per day. This amount is considered small to achieve the desired reduction in LDL in people with hypercholesterolemia. To meet this goal, you would either need to consume phytosterol-enriched foods or take a daily supplement. A 2017 review of studies from Brazil reported that a daily 2-gram phytosterol supplement reduced LDL levels in people with hypercholesterolemia by 2.7% and in people with genetically induced hypercholesterolemia by 4.3 to 9.2%. With that being said, the evidence remains split as to whether phytosterol supplementation actually translates to a reduction in the risk of cardiovascular disease (CVD). Phytosterols and Cardiovascular Risk A 2012 review of studies from Germany, which evaluated 17 clinical trials from 1950 to 2010, could not find any association between phytosterol concentrations in the blood and the risk of CVD. As contradictory as this may seem, it is possible that phytosterol blood levels only serve as markers for cholesterol absorption. It remains unclear what impact phytosterols have on the cardiovascular system, most especially with regards to the prevention of atherosclerosis (hardening of the arteries). Although a 2013 study from Finland reported that a daily 3-gram intake of phytosterols reduced arterial stiffness, especially in men, a 2015 study from Germany showed no discernable difference in adults following the same dietary regimen. Despite the contradictory findings, most health experts agree that the reduction of LDL is beneficial no matter what the implication regarding CVD risk. What the research does definitively show is that phytosterol supplements work best when used as part of a rational treatment plan, which includes diet, exercise, and traditional cholesterol-lowering drugs. Possible Side Effects The current evidence suggests that phytosterol supplements are relatively safe and well-tolerated. Side effects, if any, tend to be mild and may include constipation, nausea, upset stomach, heartburn, flatulence, and the discoloration of stools. Many of these symptoms will resolve on their own once your body adapts to the supplement. Higher phytosterol doses are associated with an increased risk of side effects. Lowering the dose will usually resolve adverse symptoms. While phytosterol supplements are presumed to be safe over the long term, this has yet to be confirmed by research. Phytosterol supplements should not be given to people with a rare genetic disorder called phytosterolemia (also known as sitosterolemia). The inherited disease, which causes the excessive build-up of fat in blood and tissues, can be made worse by the consumption of phytosterols. Unless there is a confirmed diagnosis of familial hypercholesterolemia, phytosterol supplements should not be used in children. Even then, speak with your doctor before starting treatment. The supplement is also not advised in pregnant or breastfeeding women due to the lack of safety research. Drug Interactions Phytosterol supplements may reduce the effectiveness of the cholesterol-lowering drug Questran (cholestyramine). To avoid an interaction, take the supplement several hours before or after your Questran dose. Several studies have suggested that phytosterol supplements may reduce the absorption of beta-carotene, a precursor to vitamin A. You can usually circumvent this by taking a beta-carotene supplement or eating foods rich in beta-carotene (like root vegetables and greens). It is unknown what other drugs phytosterol may interact with. To be safe, always advise your doctor about any supplements or non-prescription drugs you are taking to avoid interactions and possible side effects. Dosage and Preparation Phytosterol supplements are generally prescribed in doses between 2 and 3 mg daily. As a rule of thumb, it is best to ask your doctor to test your baseline cholesterol levels before starting treatment. After four to six months, have your blood retested to ascertain the impact of treatment. Phytosterol supplements are available online and over the counter in capsule, tablet, and gel cap forms. They should be taken before your main meal of the day or divided into smaller doses before each meal. It is important to never self-treat a medical condition without input from a qualified health professional. Delaying or avoiding the standard care of treatment can have serious consequences. What to Look For When purchasing a dietary supplement, always choose brands that have been tested by an independent certifying body like the U.S. Pharmacopeia (USP), ConsumerLab, or NSF International. Dietary supplements are not required to undergo rigorous testing in the United States; independent certification provides you with better assurance of quality and safety. Phytosterols degrade when exposed to high temperatures or direct sunlight. To prevent this, store your supplements in their original light-resistant containers and keep them in a cool, dry room at temperatures between 59° and 86°F (15° to 30°C). Keep an eye on the use-by date, and dispose of any supplements that have expired. Other Questions Which foods are highest in phytosterols? Food should always be your first source of micronutrients, and this includes phytosterol-containing foods. These same foods tend to be high in fiber and antioxidants that protect the heart and keep your blood fats in check. High Phytosterol-Containing Foods Food Mg Per Pistachios 280 100-gram serving Macadamia nuts 198 100-gram serving Wheat germ 197 one-half cup Almonds 187 100-gram serving Pecans 150 100-gram serving Corn oil 120 one tablespoon Walnuts 113 100-gram serving Canola oil 92 one tablespoon Corn 70 100-gram serving Broccoli 49 100-gram serving Peanut butter 47 two tablespoons Lettuce 38 100-gram serving Brussels sprouts 37 100-gram serving Rye bread 33 two slices Blueberries 26.4 100-gram serving Cauliflower 25 one-half cup Red onion 19 100-gram serving Carrots 15 100-gram serving Spinach 10.2 100-gram serving Strawberries 10 100-gram serving Banana 16 100-gram serving Natural Remedies for High Cholesterol Was this page helpful? Thanks for your feedback! Looking to start a diet to better manage your cholesterol? Changing lifelong eating habits can be scary at first, but our guide will make it easier. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Abumweis SS, Marinangeli CP, Frohlich J, Jones PJ. Implementing phytosterols into medical practice as a cholesterol-lowering strategy: overview of efficacy, effectiveness and safety. Can J Cardiol. 2014;30:1225-32. doi:10.1016/j.cjca.2014.04.022 Genser B, Silbernagel G, De Backer G, et al. Plant sterols and cardiovascular disease: a systematic review and meta-analysis. Eur Heart J. 2012;33(4):444-51. doi:10.1093/eurheartj/ehr441 American Heart Association. 'Bad' Cholesterol Can Be Deadly in Otherwise Healthy People. 2018. Cabral CE, Klein MRST. Phytosterols in the Treatment of Hypercholesterolemia and Prevention of Cardiovascular Diseases. Arq Bras Cardiol. 2017;109(5):475-82. doi:10.5935/abc.20170158 National Center for Complementary and Integrative Health. High Cholesterol and Natural Products: What the Science Says. Updated February 26, 2019. Izar MC, Tegani DM, Kasmas SH, Fonsesca FA. Phytosterols and phytosterolemia: gene-diet interactions. Genes Nutr. 2011;6(1):17-26. doi:10.1007/s12263-010-0182-x Baumgartner S, Ras RT, Trautwein EA, Mensink RP, Plat J. Plasma fat-soluble vitamin and carotenoid concentrations after plant sterol and plant stanol consumption: a meta-analysis of randomized controlled trials. Eur J Nutr. 2017;56(3):909-923. doi:10.1007/s00394-016-1289-7 Additional Reading Gylling H, Halonen J, Lindholm H, et al. The effects of plant stanol ester consumption on arterial stiffness and endothelial function in adults: a randomised controlled clinical trial. BMC Cardiovasc Disord. 2013 Jul 10;13:50. doi:10.1186/1471-2261-13-50 Ras R, Fuchs D, Koppenol W. The effect of a low-fat spread with added plant sterols on vascular function markers: results of the Investigating Vascular Function Effects of Plant Sterols (INVEST) study. Am J Clin Nutr. 2015 Apr;101(4):733-41. doi:10.3945/ajcn.114.102053 Continue Reading