Campestanol

Campestanol works in the small intestine by competing with dietary and biliary cholesterol for incorporation into mixed micelles, the lipid vehicles that ferry cholesterol across the intestinal lining. Because stanols are very poorly absorbed themselves, they displace cholesterol from micelles, leaving more unabsorbed cholesterol to pass out in the stool. Reduced cholesterol absorption triggers upregulation of LDL receptors in the liver, which clear more LDL cholesterol from the bloodstream. The net effect at recommended intakes (2 to 3 g/day of plant stanols, including campestanol and sitostanol) is roughly a 6 to 12 percent reduction in LDL cholesterol, on top of dietary or statin therapy. Campestanol is rarely sold alone. It is usually part of a stanol blend dominated by sitostanol, marketed in margarines, yogurt drinks, and capsules.

Total plant stanol intake of 2 to 3 g/day from food or supplements produces meaningful LDL reduction. Higher doses (above 3 g/day) provide diminishing returns. Spread the dose across two or three meals for best effect, since cholesterol absorption occurs during eating.

Take plant stanols with meals containing fat for optimal cholesterol-binding activity. Splitting the dose across 2 to 3 meals works better than a single large dose. There is no specific time-of-day requirement, but consistent daily use is needed; benefits disappear within weeks of stopping.

Plant stanols are GRAS in the US and approved as foods for special medical purposes in the EU. Generally well tolerated. They may modestly lower fat-soluble vitamin (especially beta-carotene) absorption, which can be offset by eating colorful fruits and vegetables.

Plant stanols can lower beta-carotene absorption by up to 25 percent at recommended doses; eat at least one carotenoid-rich vegetable serving daily. No significant interactions with most medications, but they enhance LDL-lowering when combined with statins and ezetimibe.