Hi Susan,

I would like to get your take concerning the controversy surrounding supplementation ( or food fortification) with phytosterols, viz., the German Cardiac Society vs the European Society of Cardiology/European Atherosclerosis Society.

I am here concerned specifically about atherogenicity of xenosterols.

Please refer to the good discussion by Makhmudova et al., 2021 in Current Atherosclerosis Reports (PubMed)

Thank you Susan



  • @mike

    Thanks for sharing with me! My first disclaimer is that I'm not an expert in CVD so can't speak authoritatively on the topic. That said, I am skeptical of the link you shared simply because it's a narrative review vs. an actual meta-analysis or systematic review. Studies of the latter variety are more rigorous and considered a high level of scientific evidence.

    What we know about plant sterols is that they seem to be a critical part of the "Portfolio Eating Pattern", which is a predominantly plant-based diet emphasizing almonds/nuts, soy protein, and soluble fibre.

    Foods that contain added plant sterols include margarine, OJ, and yogurt; I take issues with the use of these foods because a) they aren't health promoting and b) they aren't all ensuring good absorption. If plant sterols are supplemented, it should be through a quality supplement vs. food product.

    I also considered the Canadian Cardiovascular Society's stance on plant sterols and they recommend it, citing "Strong Recommendation, High Quality Evidence"; this isn't a title used frivolous; it's based on a standard grading system.

    My conclusion? Based on available data, plant sterols appear safe for consumption and have shown benefit in hypercholesterolemia. However, this doesn't mean the mass population should consume them. Also, this stance can change with increasing high quality data.

    Hope this helps? ;)

    Susan Macfarlane, MScA, RD
    Registered Dietitian Nutritionist
    As always, any and all postings here are covered by our T&Cs:

  • Thank you, Susan, your input is helpful as usual.

    I am afraid I am approaching nutrition as if it were pharmacology with control group, animal lab experimentation ( about which I have hard time accepting), and chemistry. Nutrition is different.

    Just received the Linus Pauling ( Oregon State University) Newsletter and it puts everything I know about Zn and Vit D under question.....frustrating.....ready to give up

    But thank you so much for your valuable help.


  • @mike

    The most valuable course I ever took was one where we evaluated the quality of studies being produced in relatively well-respected journals. The number of useless studies that are published is maddening... What's even more frustrating is when media gets wind of these useless studies and blows them out of clinical relevance.

    My advice is to stick with what's tried and true:
    1. Minimize processed food
    2. Eat a lot of plants
    3. Avoid substances like cigarettes and alcohol
    4. Drink water
    5. Exercise
    6. Sleep

    I really do feel that healthy eating far more complicated than it needs to be. :)

    Susan Macfarlane, MScA, RD
    Registered Dietitian Nutritionist
    As always, any and all postings here are covered by our T&Cs:

  • Your best word of wisdom:

    "The number of useless studies that are published is maddening"

    Even in the so-called well known journals. You need to check the affiliations of the researchers; their choice of the sample population ( and exclusions), is the work done on human subjrcts or animals (animal stiudies are of limited , if any value) their statistical handling of the data. A one small study that I may be intrested in takes me close to one hour to go through.

    I agree with you about the invaluable rôle of proper nutrition, even though vegans need additional supp.

    All this and I said nothing about the pervasive use of nanoparticles in food, yes in food, and its serious effect on the blood brain barrier, short of growing your own!

    Susan, you're great asset to Cronomete. In giving my revew of Cronometer, I specifically mentioned the invaluable advice of its. ( Cronometer's resident nutritionist)


  • Susan, forgot to mention, is there a chance to set up a vegan forum, or subgroup within Cronometer for confirmed. and aspirant vegans? May be there something already going on about which I am ignorant? Thanks again

  • @mike

    Thanks so much for the words of support! I'm not aware of any sub forum but you could certainly set this up if you'd like!

    Kind regards,

    Susan Macfarlane, MScA, RD
    Registered Dietitian Nutritionist
    As always, any and all postings here are covered by our T&Cs:

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