Cholesterol-lowering foods even more cholesterol-lowering than first thought, but so what?

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Last year, I wrote a blog post about an advertorial which appeared in the Telegraph newspaper which featured the apparent effects Flora pro-activ drinks had on supposed ‘journalist’ Chris Jones’ cholesterol levels. I couldn’t trace Chris Jones, and although I was promised that her identity would be verified, this never happened. I did get an email purporting to know Chris Jones, but I’m afraid that won’t do.

But we’re getting side-tracked here, because the main issue for me is not whether Chris Jones exists or not, but the basis on which products like Flora pro-activ are marketed. In short, these and similar products (such as Benecol) contain ‘sterols’ or ‘stanols’ that block cholesterol absorption from the gut and can therefore lower blood cholesterol levels. Lowered cholesterol levels, we are led to believe, will help protect us against heart attacks and strokes. The marketing of products like Benecol and Flora pro.activ is based on these ideas.

But do these assumptions hold up to scrutiny? Do ‘beneficial’ changes in blood fat levels automatically lead to improved health? There’s plenty of evidence to suggest that the answer to this question is ‘no’. For example, here are five drugs or classes of drugs that have been found to ‘benefit’ blood fat levels, none of which have broad benefits for cardiovascular health, and some of which appear to damage health:

hormone replacement therapy

In fact, the only type of cholesterol-modifying drug that appears to improve cardiovascular outcomes are the statins. However, even these are pretty useless (see here for a recent blog post about this). Plus, questions have been raised about whether statins even exert their beneficial effects through cholesterol reduction. Statins have a number of different mechanisms of action in the body, including anti-inflammatory effects, which might account for their ability to reduce the risk of cardiovascular events. At least some supporting evidence for this idea comes in the form of studies which show that statins can reduce the risk of cardiovascular disease in people with normal or even low levels of cholesterol.

So, for me, the idea that products like Benecol and Flora pro.activ are good for the heart is not evidence-based. Oddly, even the PR representative (Clare Smith) for Flora pro.activ products seems to appreciate this when she comments after the original blog post that:

We absolutely agree that simply lowering cholesterol without making wider positive changes to one’s diet and lifestyle will not make a significant positive health impact.

The reason that I’m writing about this now is because I note that Raisio (manufacturer of Benecol range of foods) and Unilever (manufacturer of Flora pro.activ range of foods) have recently been petitioning the European Food Standards Agency (EFSA) regarding the claims that can be made over the cholesterol-lowering powers of their products. Previously, the claim was made that sterols and stanols can reduce LDL cholesterol by 7-10 per cent as part of a healthy diet. Now, EFSA is apparently happy with that claim be extended to say that these products can lower cholesterol ‘by up to 11.3 per cent’. You can read about this here.

So, these food conglomerates have managed to get the EFSA to up the stated maximum potency of these chemicals by 1.3 per cent (from 10.0 to 11.3 per cent). They’ve also managed to drop any reference to lower levels of benefit. And there’s no mention of average reductions either. Make no doubt about it, these food manufacturers here have done their level best to present their products’ effects in the best possible light.

And they’ve managed to do this by presenting the EFSA with new information, principally in the form of two ‘meta-analyses’ (grouping together of similar studies). These meta-analyses are not published, so you and I cannot read them. They have, most likely, been gathered together by employees of the food companies or ‘scientists’ in their pay. And it’s highly likely that the majority, if not all, of these studies was paid for by the food companies too. It’s well known that the source of funding can influence study design and influence results and how they are reported. Neither of these meta-analyses, by the way, will have been through the process of ‘peer review’ – the process by which researchers check studies for accuracy and veracity of their findings prior to publication.

But, all of this pales into insignificance when one considers the fact that there is simply no evidence that stanol- or sterol-enriched foods benefit health. We actually have some laboratory evidence that they may harm health. In fact, until 2010, sterol-enriched food products were banned in Canada because of concerns about their safety. So, when you see cholesterol-lowering foods being sold on the pretence of having benefits for health my advice is – don’t buy it.

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