Why does the British Heart Foundation support the use of unproven cholesterol-lowering foods?

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I caught a television advert in the last week for a drink which, purportedly, has the ability to reduce cholesterol levels in the bloodstream. The advert also told us that two-thirds of UK adults have raised cholesterol. The underlying message is clear: regular imbibing of this drink will help lots of people stave off heart disease.

This particular drink is fortified with plant substances called ‘stanols’ which have a similar chemical structure to cholesterol, and help reduce the absorption of cholesterol from the gut. Other ‘functional foods’ with cholesterol-reducing claims may contain related substances called ‘sterols’. The advertisements for products containing stanols or sterols are usually slick and persuasive. I regularly meet people who ingest these products in the belief they are doing themselves good. But are they?

The supposed health benefits of these functional foods is based on the idea that cholesterol reduction is beneficial for heart health. Unfortunately, the research literature is littered with examples of drugs which have ‘improved’ cholesterol levels, but have failed to deliver on their promise in terms of improved health. It is a huge leap of faith to assume that just because something reduces cholesterol, it must have benefits for health too.

The National Institute for Health and Care Excellence (NICE) in the UK has this to say about the gaps in the research which you can read here.

Some people at increased risk of CVD[cardiovascular disease] might avoid the need to use drugs to modify their cholesterol levels if they make sufficient changes to their diet. Plant sterols and stanols have been shown to reduce cholesterol levels, but it is not known whether the consumption of plant sterols as part of a low-fat diet will provide worthwhile additional benefit and whether they reduce CVD events.

There is a need for trials to test both efficacy and effectiveness of plant sterols and stanols in people who are at high risk of a first CVD event. These trials should test whether plant sterols or stanols change lipid profiles and reduce CVD events under best possible conditions. Randomised controlled trials are needed to test the effectiveness of advising people who are at high risk of experiencing a first CVD event to include food items containing plant sterols or stanols in a low-fat diet. The trial should last for at least 2 years and should consider appropriate outcomes.

Elsewhere on NICE’s site we are told:

People should not routinely be recommended to take plant sterols and stanols for the primary prevention of [cardiovascular disease].

Not exactly a ringing endorsement for stanols and sterols, it it?

What says the British Heart Foundation, though – the ‘go-to’ body in the UK for advice about how to optimise our heart health? It’s a different story here, as the BHF seems friendly to and happy to promote these products. See here and here for examples of tacit endorsement of these products from the BHF.

So, NICE does not recommend cholesterol-lowering functional foods and points to the lack of evidence for them, yet the BHF is happy to recommend them. Might this have something to do with the fact, I wonder, that one of BHF’s ‘corporate partners’ is ‘Flora pro.activ’ (a cholesterol-reducing functional food)? [hr]

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