Plant-forward diet holds host of benefits for heart health, find researchers

A new study by Toronto researchers has reiterated the benefits of consuming a plant-based diet for cardiometabolic health.

The study — a large review of existing studies, published in Clinical Nutrition — found that consuming plant sterols and stanols leads to lower levels of total cholesterol, as well as lower amounts of low-density lipoprotein cholesterol (LDL-C), in different groups of people.

Plant sterols are naturally occurring components of plant cell walls that can block the absorption of cholesterol. They are naturally contained in vegetables, fruit, nuts, seeds and plant oils, and can also be found in supplements and fortified foods, like margarine and juice.

“This research helps people understand how they can improve their health through their diet,” says Andreea Zurbau, first author on the study and a postdoctoral fellow in the department of nutritional sciences at U of T’s Temerty Faculty of Medicine.

“More than one in four Canadians are living with high cholesterol levels, and our research highlights that plant foods and supplements can be a practical and accessible way to reduce LDL-cholesterol, the key driver of heart disease risk,” adds Zurbau, who is also a registered dietitian.

Zurbau and her colleagues looked at more than 800 publications in the course of their research, ultimately deeming 14 eligible for the study. They focused on systematic reviews and meta-analyses of randomized control trials.

The principal investigator on the study was John Sievenpiper, a professor in the departments of nutritional sciences and medicine at Temerty Medicine, who is also a staff physician and scientist at St. Michael’s Hospital, Unity Health Toronto.

“These results are particularly important for the public and clinicians, as coronary heart disease remains the leading cause of death and disability globally, and, despite numerous medications to treat high cholesterol, we are confronted with a major treatment gap,” says Sievenpiper.

As a result, Sievenpiper and Zurbau recommend dietary approaches like the Portfolio Diet, where consuming plant sterols and stanols helps people lower their cholesterol and their coronary heart disease risk.

In the study, the researchers found that people who consumed plant sterols and stanols also experienced many other benefits, such as some improvements in blood pressure, inflammatory markers and apolipoproteins such as ApoB, which measures the different kinds of cholesterol particles and is a strong predictor of whether a person will develop heart disease.  

The average person following a Western diet consumes about 300 milligrams of plant sterols per day, says Zurbau. This can increase to about 600 milligrams per day for people who follow a vegetarian or vegan diet, she adds.

“We explored the best available evidence and found that daily intakes as little as half a gram of plant sterols, achievable from ordinary foods or supplements, can lower harmful cholesterol in people of all health backgrounds, including those already on cholesterol-lowering medication,” says Zurbau.

An important takeaway from the study is that consuming 500 milligrams to 1.0 gram of plant sterols and stanols per day can lead to meaningful health improvements, through embracing what Zurbau calls plant-forward diets.

“There are many ways of consuming plant sterols, and many different people who can experience benefits as a result. We saw that whether the plant sterols were provided as part of fortified foods, or whether they were provided as food and supplements, people seemed to have clinically meaningful reductions in LDL cholesterol,” says Zurbau.

This study was funded by the Canadian Institutes of Health Research, through the Canada-wide Human Nutrition Trialists’ Network. For a full list of the researchers’ financial disclosures, see the Disclosures section at the end of the research paper.