Cholesterol-lowering phytosterols: factors affecting their use and efficacy

Phytosterols are essential components of plant cells and therefore naturally ­present in the human diet. When used therapeutically, phytosterols can significantly lower serum cholesterol concentrations. Meta-analyses of clinical trials indicate about 10% reduction of low-density lipoprotein cholesterol when phytosterols are consumed at the recommended dose of 2 g/d. Thus, phytosterols can be an important part of an overall dietary strategy to manage cholesterol levels, particularly for patients who cannot tolerate cholesterol-lowering drugs. Although other health benefits have been attributed to phytosterols, including anti-inflammatory, anticancer, and immune regulatory effects, this review will focus on the therapeutic use of phytosterols related to serum cholesterol, their mechanisms of action, and the various types of phytosterols available to consumers.