Statins are widely prescribed drugs to lower LDL-cholesterol; they include Lipitor, Pravachol and Zocor. Sterols, also called phytosterols, are natural compounds derived from fruits, vegetables, nuts, seeds and legumes. They have been studied since the 1950's for their ability to reduce LDLs. Similar compounds called stanols, which come from tree bark and soybean oil, work in the same way.

Statin drugs block the body's production of cholesterol in the liver. Sterols, on the other hand, primarily prevent cholesterol absorption from food. Thus statins plus sterols are better than either one alone.

The amount of sterols you get from a typical diet is not enough for significant cholesterol-lowering. But when concentrated and added to foods and used long-term, they can reduce the risk of heart disease by 20%. Many of these foods are now available, including Promise Take Control, Promise Activ Supershots, Minute Maid Premium Heart Wise Orange Juice and Nature Valley Healthy Heart Chewy Granola Bars. Research suggests that sterol-fortified dairy products and margarine are better at lowering cholesterol than other sterol-fortified foods. Other research suggests that stanols in foods are more effective than sterols. The only major stanol-fortified foods are Benecol spread and Benecol Chews.

The FDA, the American Heart Association, and the National Heart, Lung and Blood Institute all agree that sterols can lower LDLs and reduce your risk of heart disease. But how much does it take?

A large review of the studies concluded it takes 2 to 2.4 grams a day to reduce LDLs by about 9%. More than that isn't harmful, but it isn't helpful either. Most impressive is research suggesting that adding sterol-fortified foods to a daily statin regimen may lower LDLs more than if you doubled the statin dose, which would raise the risk of side effects.

In summary, be aware that sterol-fortified foods provide calories--some more than others--so look for the "light" versions of spreads. Lastly, while sterols in supplement form are sold, and are virtually calorie-free, they are generally less well studied and less standardized than the sterols in fortified foods.

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