Complementary Alternative Cardiovascular Medicine

84 Alternative Cardiovascular Medicine
Fig. 4. Typical fatty acid compositions. Source: Fatty acid content normalized
to 100%. USDA Nutrient Database for Standard Reference (Release 15).
trials with α-tocopherol have yielded mixed results concerning CVD
endpoints (48). As expected, studies have reported that adults (49) and
children 2 to 8 yr of age (50) who consume a low-fat diet have inadequate
vitamin E intakes.
Vegetable oils are also a source of plant sterols, commonly referred
to as phytosterols, and are structurally similar to cholesterol. The primary
plant sterols in the diet are sitosterol, stigmasterol, and campesterol.
They are not synthesized in humans, as is cholesterol, and are poorly
absorbed. Plant sterols are naturally present in vegetable oils and significantly
reduce cholesterol absorption (51). Studies show sitosterol or
mixtures of plant sterols (approx 1 g/d) reduce blood cholesterol levels
in humans by approx 10% (52,53).
Margarines that deliver plant sterol mixtures have been developed for
blood cholesterol lowering (reviewed in ref. 54). The plant sterol mixtures
are derived from different oil sources, including pine tree woodpulp
(tall oil), soybean oil, ricebran oil, and sheanut oil. Plant sterol/stanol
ester margarines have a cholesterol-lowering effect. Collectively, the
stanol/stanol ester margarine studies have fed approx 2–3 g of stanols as
either the free or the esterified form in full-fat or lower fat margarines or
mayonnaise. Two grams per day, which the ATP III recommends as part
of the Therapeutic Lifestyle Changes (TLC) diet (2), can lower LDL
cholesterol from 9% to 20% beyond that attainable by a diet low in SFA
and cholesterol and drug therapy (55). These margarines have hydroge-