Plant Sterols and Stanols as Part of Therapeutic Lifestyle Changes
As noted in Table 1, NCEP has recommended Therapeutic Lifestyle changes (TLC) as part of bringing LDL cholesterol to target levels:
Plant sterols and stanols lower blood LDL cholesterol by blocking the absorption of cholesterol from the intestine. Soluble fibers, such as oat bran beta-glucans lower LDL cholesterol (Theuwissen et al 2008). Beta-glucans interfere with the absorption of cholesterol and at the same time interfere with the re-absorption of bile acids (Clifton 2009). The reduction in absorption of bile acids partly shifts liver metabolism from cholesterol synthesis to bile acid synthesis. Soluble fibers are additive to plant sterols and stanols in lowering LDL cholesterol (Theuwissen et al 2007). By combining changes in the diet with weight reduction and plant sterols and stanols it is possible to reduce LDL cholesterol by 25-30%. See Table 2 which provides an estimate of LDL eduction that can be obtained with lifestyle changes.