Protocol
Plant sterols or stanols 1.6 to 2 g/day
Meta-analysis A study that pools the numbers from several trials into one combined estimate. of 124 randomized studies: LDL-C Low-density lipoprotein cholesterol, the cholesterol fraction most closely tied to plaque in the arteries. falls by 6 to 12 percent across intakes of 0.6 to 3.3 g/day, dose-dependently.
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How this letter has changedLatest: October 2026 · Corrected.
The protocol was named for taking plant sterols with the largest meal. The cited meta-analysis, Ras et al. (Br J Nutr, 2014; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 24780090), pooled plant sterols and stanols and did not test meal timing; its post hoc comparison found solid foods worked better than drinks. The name now states only the dose, and the description states what the analysis found. The letter is unchanged.PMID 24780090
The record carried a not-replicated flag while its B rested on a 124-study meta-analysis of LDL lowering (Ras et al., Br J Nutr, 2014; PMID 24780090). The flag describes a single trial nobody has repeated; a meta-analysis of independent randomized trials is replication The same finding reproduced by a separate research group. A result seen once can be chance or bias; a replicated one is harder to explain away. by definition, and what caps this letter at B is the endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score., not the absence of a second trial. Flag removed, letter unchanged. Applied the written grade definition under the editor's standing instruction of October 2026 (Arnold Sandlow, D.C.).PMID 24780090
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Plant sterols and stanols are plant compounds that compete with cholesterol from food to be absorbed. A large review of 124 studies found that they lowered LDL cholesterol by about 6 to 12 percent, with more effect at higher amounts. No study measured heart attacks, strokes or deaths. Those given in solid foods lowered LDL a bit more than those given in drinks. No study compared taking them with the largest meal against other times.
Meta-analysis of 124 randomized studies: LDL-C falls by 6 to 12 percent across intakes of 0.6 to 3.3 g/day, dose-dependently. Competitive absorption with dietary cholesterol. Best combined with dietary modification. The pooled trials did not test meal timing; in a post hoc comparison, sterols and stanols given in solid foods lowered LDL cholesterol more than those given in drinks (9.2 against 6.5 percent).
Why this gradeThe reasoning, and what the grade does not cover.
Grade B on LDL cholesterol. A meta-analysis of randomized studies found plant sterols and stanols lower LDL cholesterol dose-dependently, by about 6 to 12 percent across intakes of 0.6 to 3.3 g/day (Ras et al., 2014; PMID 24780090).
WHY NOT ALDL cholesterol is a surrogate marker A lab value or measurement used in place of the outcome that matters, such as LDL cholesterol standing in for heart attacks. Moving a surrogate does not always move the outcome., and no cited trial measured heart attacks, strokes or deaths.
WHAT THIS GRADE DOES NOT COVERcardiovascular events or mortality, and the timing with the largest meal, which no cited trial compared against other timing.
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The evidence, in fullOne paper, linked to its PubMed record.
Ras et al. meta-analysis (British Journal of Nutrition, 2014; PMID 24780090): plant sterols and stanols lower LDL cholesterol dose-dependently. Capped at B because LDL is a surrogate marker.
Fasting LDL-C at baseline and 6 weeks: the documented effect is approximately 8-12% LDL reduction when consumed at 1.6-2 g/day with the largest meal. Total cholesterol and non-HDL-C are secondary endpoints An outcome a trial also measures but did not choose as its main test.. Timing with meals is critical to efficacy; a sterol supplement taken without fat will not achieve the bile acid displacement mechanism studied in the trials.
Evidence notes: meta-analysis, randomized trial
Endpoint graded: LDL cholesterol (surrogate)
Last reviewed: July 2026
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