The scientific community has always thought high cholesterol levels in blood to be linked to increased risk of cardiovascular disease and coronary heart disease. Food and nutraceutical community regarded sterol and stanol supplementation as a solution for lowering LDL (or bad cholesterol) levels without the harmful side-effects of statins. Unfortunately cholesterol lowering products have become so lucrative that this area of knowledge is full of fallacies. Any person that has problems with her cholesterol and want to lower LDL levels effectively must understand what has been really proven in research and what is marketing before starting with a plant sterols supplement.
Lower Cholesterol Levels Don’t Decrease Cardiovascular Disease Risk
Until 2015 it was thought that saturated fats increased cardiovascular disease risk and that substituting them with polyunsaturated fats would cause cholesterol serum levels to drop thus reducing the risk of heart disease and death.
Researchers from the universities of North Carolina and Illinois in conjunction with the National Institutes of Health published in the British Medical Journal a meta-review concluding that replacing saturated with polyunsaturated fats did cause blood cholesterol levels to drop but led to no change in the risk of mortality by cardiovascular disease CVD, coronary heart disease CHD, ischemic stroke or type 2 diabetes.
In addition the review found a “moderate” correlation between total CHD, CHD mortality and increased industrial trans fat consumption causing a reduced absorption of natural or ruminant trans fats.
To understand these conclusions correctly we must understand the difference between these types of fats, how they are produced, their health effects and the differences with a plant sterols supplement.
Differences between types of fats
A fat or fatty acid contain long hydrocarbon chains that can have either one or more double bonds (unsaturated) or no double bonds (saturated) in its structure.
An example of a saturated fat is Stearic acid which is a saturated fatty acid found in animal fats and is the intended product in full hydrogenation. Stearic acid is neither cis nor trans because it has no carbon-carbon double bonds.
Only unsaturated fats can be trans or cis fat as only a double bond can be locked to two orientations therefore trans or cis refers to the type of double bond:
- Trans (Elaidic acid)
- Trans, a Latin term meaning “across”.
- A trans isomer happens when its molecular substituent groups are on opposite sides of the bond.
- A trans molecule is straighter than a cis one.
- In this particular example elaidic acid is the principal trans unsaturated fatty acid often found in partially hydrogenated vegetable oils.
- Cis (Oleic acid)
- Cis, a Latin term meaning “on this side”.
- A trans isomer happens when its molecular substituent groups are on the same side of the bond.
- A cis molecule will be bent compared to a trans molecule.
- This particular example oleic acid is a cis unsaturated fatty acid making up 55–80% of olive oil.
In nature, unsaturated fatty acids generally have a cis configuration as opposed to trans. Food manufacturers hydrogenate these cis unsaturated fats such as vegetable oils to produce saturated fats, which have better physical properties like a lower melting temperature.
The problem appears when these fats are only partially hydrogenated, these process converts some of the cis double bonds in to trans double bonds. These trans fats are the only proven fats that increase the risk of CVD, CHD, ischemic stroke and type 2 diabetes. They lower the levels of the lipoprotein HDL (good cholesterol) and raises the LDL lipoprotein levels “bad cholesterol” and increases triglycerides in blood which promote systemic inflammation and atherosclerosis in levels above 200mg/dL.
Trans fats can occur naturally in dairy products and beef, they are not as harmful as industrial trans fats because they raise both LDL and HDL. They don’t produce a significant effect because they appear only in trace amounts. Because of this we only have to be wary of processed foods and their content in trans fats. A plant sterols supplement won’t help much if we don’t stop an excessive intake of these harmful fats.
How to Reduce Trans Fat Content in The Diet
There are currently no legal requirements for food manufacturers to label the use of trans fats. So you have to deduce the use of trans fat by reading the ingredient list and the use of other types of fats like unsaturated or fully hydrogenated fats or vegetable oils. If you only see these two types all is well.
If you see the word “partially hydrogenated” fat, oil or simply “vegetable fat” that is synonym of trans fat.
Usually in the label appears “Vegetable fat (amount) – of those, saturated fats (percentage)”. The vegetable part is what you have to consider as trans, as it is better to be cautious given the state of current legislation.
The higher is on the list of ingredients the more trans fats content will contain. 
- You can use saturated fats like lard, palm oil, olive oil, fully hydrogenated fats or interesterified fats in your diet as well but the most effective measure is avoid industrial trans fat intake as it all comes from processed foods.
- NOTE: Currently there’s a disinformation campaign on TV (at least in Spain and Italy)  against palm oil implying is bad for health, in some cases, and a promoter of deforestation in Borneo and Sumatra. Palm trees have one of the highest oil yields per tree known. To produce the same amount of oil with soybeans need five times more cultivated surface. I don’t see campaigns for the ban of soy oil in food while soybean cultivation in Brazil is producing a much higher deforestation than palm trees in Borneo. The solution is to cultivate palm trees in other countries to reduce environmental impact, not banning palm oil use or use trans-free oil alternatives that don’t require arable surface.
- In respect of the health detriments of palm oil, its mesocarp oil is a 49% saturated fat and its kernel oil is a 86% saturated fat. Along with coconut it is one of the few highly saturated vegetable fats known with no trans fat content. We repeat, research proved in 2015 that saturated fats don’t increase risk of cardiovascular or coronary heart disease, ischemic stroke nor type 2 diabetes. Additionally unrefined palm oil is a significant source of carotene (some having vitamin A activity) and tocotrienol which belongs to the vitamin E family. In fact, food safety agencies of some countries have proposed palm oil as a relatively safe and affordable substitute to reduce or eliminate trans fat content in food products.
Avoid margarine. Although new generation margarine contain less than 1% of trans fats and some even are enriched with a plant sterols supplement they have ten times more omega 6 than omega 3 fatty acids due to their oil composition. Both omega fatty acids should be balanced but our western diet makes omega 6 to be almost thirty times higher than omega 3. Omega 6 has an inflammatory effect while omega 3 is anti-inflammatory.
Use butter instead, it contains butiric acid which has anti-inflammatory effects. It will still give you a lot of calories but at least it won’t imbalance your omega fatty acids or have trans fats.
Even eliminating margarine from your diet trans fats are everywhere; used baked products, like biscuits, buns… Shortenings, any type of precooked pizza, lasagna, etc. Concentrated broth tablets, peanut butter, almost every processed food contains them. It is so pervasive that the use of trans fats in food industry made the levels of heart disease to soar in the 40s. Humans have consumed fats throughout history but only with the introduction of these fats heart disease started to increase abnormally.
The solution is to buy like our grandmothers did. No processed foods, only fresh and raw food. It is more work to prepare but at the moment is the only way to avoid these type of toxic additives. In this health and nutrition article there is advice on what guidelines we can follow at the grocery store and at home to prepare healthier meals.
Scientific community thought that heating different types of oils and fats at high temperatures partially hydrogenated them thus producing trans fats. Until a study from the Dept. of Food Science and Biotechnology at the Sungkyunkwan University published by the Korean Society of Toxicology tested six different oils heating them through; stir-frying, pan-frying, baking and frying. Only stir-frying corn oil increased its trans fat content but in such small amount (0,56g/100g) that food safety agencies would declare it “zero trans fat content”. 
What Can You Expect of A Plant Sterols Supplement
Human body can metabolize many different types of fats and thus many types compete for absorption in our digestive system. The challenge for science was the different absorption rates these fats have; cholesterol (including trans fats) has a rate between 20-80%, and plant sterols have a rate between 5-15%.
Another problem is that the quantities of sterols and stanols we ingest with vegetables and seeds is not enough to be effective reducing LDL levels. Medium daily intake is between 200-400mg of sterols and 30mg of stanols while cholesterol intake is about 500mg. For sterols and stanols to produce a significant reduction in LDL levels a human needs a medium daily dose between 2000-3000mg, ten times more, as mentioned by Robert Mensink, head of human biology dpt. in Maastrich University. It is not feasible to achieve these levels through normal food, for that we need a plant sterols supplement.
The solution was to produce esters of sterol and stanol which are acid alcohol compounds. It makes them mix more easily with food fats blocking up to 14% of cholesterol absorption in the small intestine. They do this inhibiting the enzyme Acetyl-coenzyme A acetyltransferase, ACAT and stimulate the reflux of cholesterol from the epithelial small intestine cells to the intestinal lumen (the inside of the intestine). These effects reduce total levels of total cholesterol in blood up to 10% and the LDL levels up to 14% without lowering HDL levels.
There were some concern in the past that a plant sterols supplement as well as stanol supplementation could inhibit vitamin absorption, specially vitamin A, D and E but a study from the McGill University concluded that there was no deficit in vitamins after consuming these supplements compared to a healthy diet. 
Positive effects are noticeable three weeks after daily intake. 1,3g of sterols esters and 3,4 stanols esters distributed among the two most important meals of the day.
A Plant Sterols Supplement May Not Be Enough
Any supplement including plant sterols supplement, that helps to reduce or eliminate the use of statins will help your health given the serious side-effects statins produce and how is a medication that needs more safety research. 
That’s why a reduction of 14% of LDL may not be enough for people with hypercholesterolemia who want to eliminate the use of statins for their cholesterol control. In this healthy diet foods article we share more effective supplements for reducing cholesterol, triglycerides, blood glucose and for promoting weight loss which can be used in addition to a plant sterols supplement. We also warn about those supplements that science thought were effective in the past but not anymore. Those are still popular in Internet and among consumers so better save your money and put your hopes in more effective solutions. In future articles we will mention more supplements and advice for lowering your cholesterol levels.