Cardiovascular disease (CVD) continues to be a major cause of mortality worldwide, with elevated cholesterol levels identified as a key risk factor (1). Reducing cholesterol, particularly low-density lipoprotein cholesterol (LDL-C), has long been recognized as a key strategy for reducing the risk of CVD (2-5). While lifestyle and dietary adjustments are common recommendations, statin therapy has been the cornerstone of CVD prevention and treatment (6). However, there is a growing consumer interest in alternative proactive solutions, as evidenced by the increasing demand for functional health foods.

Benefits of plant sterols and stanols 

Plant sterols and stanols, collectively known as "phytosterols," are naturally occurring bioactive compounds recognized for their ability to lower LDL cholesterol levels. Over 40 distinct types of phytosterols have been identified from various plant sources, including roots, stems, leaves, fruits, and seeds. Others derive from grains, nuts and marine algae. They are most commonly found in vegetable oils, nuts, and vegetables.

Although the chemical structures of plant sterols and stanols vary slightly, their physiological effects are similar to cholesterol (7). Phytosterols help lower LDL by competing with dietary cholesterol for absorption in the intestines. Because they are absorbed less efficiently, they reduce the amount of cholesterol that enters the bloodstream (8). Consuming 2-3 grams of sterols and stanols daily can reduce LDL levels by around 10% in only 3 to 4 weeks (9).

The efficacy and safety of phytosterols in lowering cholesterol and reducing CVD risk is supported by extensive research as demonstrated by over 140 studies. Major health organizations globally recommend including them as part of a heart healthy diet.

Consuming enough plant sterols and stanols for heart health is a challenge

Despite their benefits, it can be challenging for individuals to consume sufficient amounts of phytosterols from food alone (10, 12-14). Therefore, supplementation or consumption of functional foods is needed to achieve optimal levels.

In many European countries, phytosterol fortified foods like yogurt, drinks and spreads are widely available. However, in the United States these products are less common and are mostly found in spreads. As a result, U.S. consumers are less aware of their cholesterol-lowering properties and role in CVD prevention. 

Opportunity for new plant sterols and stanols functional health products

The current lack of phytosterol-enriched products in the U.S. market offers brands a chance to expand their customer base by integrating these underutilized functional ingredients into everyday food items. These products are well-positioned to align with popular dietary trends, including plant-based and gut-friendly options, while also appealing to consumers seeking sustainable and upcycled products. Additionally, they offer an alternative to traditional supplement capsules that will appeal to pill-weary consumers.

Scientific evidence for plant sterols and stanols is strong enough that regulatory authorities worldwide have approved health claims. In the United States, the FDA has approved a health claim that permits companies marketing functional foods and dietary supplements to make claims related to CVD risk reduction and phytosterols, provided they adhere to the specified guidelines for such claims.

Incorporating plant sterols and stanols into functional health products 

Phytosterols are relatively easy to process and integrate into a variety of functional products. Being fat-soluble, they blend well with fat content and can be added to the vast array of existing animal and plant-based margarines, spreads, yogurts, kefir, and dairy beverages already on the market. 

Recent advancements in technology have also enabled the creation of water-soluble formulations, expanding the potential for phytosterols to be included in a range of functional health beverages such as plant-based drinks, juices, coconut water, and kombucha (15).

In addition to the evidence supporting heart health claims, recent studies suggest that plant sterols and stanols may provide a variety of health benefits, such as antioxidant properties and mood enhancement. It would be exciting to witness a rise in the popularity of phytosterols as a dietary resource for promoting heart health, as well as more research into additional health benefits of this important functional ingredient.