10 days ago I wrote a blog post focusing on an advertorial which appeared in the Daily Telegraph for Flora pro.activ drinks. The advertorial, recounted the experiences of ‘Telegraph journalist’ Chris Jones, and how the consumption of Flora pro.activ drinks had, along with other ‘healthy’ lifestyle changes, led to a lowering in Ms Jones’ cholesterol levels. I wanted to engage with Ms Jones about the purported benefits of cholesterol reduction (something I’m sceptical about). However, I was unable to trace Ms Jones, which seemed odd.
Two days after I posted this piece, I received a response from Clare Smith, who has since informed me works for Lexis – a PR company who act for Flora pro.activ products. You can read the comment here. This response justifies the advertorial format, and draws our attention to the fact that Flora pro.activ has paid to run a series of advertorials in the Daily Telegraph using ‘real-life stories’. Clare Smith reassures us that advertorials go through a ‘rigorous approval process’. We are told that Flora pro.activ has been proven to lower cholesterol levels by up to 15 per cent ‘when eaten everyday as part of a healthy diet and lifestyle’. Clare also tells us that Chris Jones is not a journalist after all, but a ‘content editor’ at the Daily Telegraph, and that I can speak to her if I like. She also appears to welcome further debate.
But perhaps the most notable statement from Clare Smith is this:
“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.”
In my response, see here, I seek further clarification. For example, I ask Clare to clarify her role, and enquire as to who it is that performs the approval process for advertorials. I also question why the cholesterol reducing properties of Flora pro-activ are qualified with ‘when taken in conjunction with a healthy diet and lifestyle’. I ask if any attempt has been made to measure the cholesterol lowering properties of Flora pro.activ in isolation. I ask what evidence there is that Flora pro.activ benefits health.
I also ask her if the photograph in the Telegraph that accompanied the piece is Chris Jones, and to email me her phone number and email so I can engage with her directly.
I also refer to this statement “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”, and ask this:
“Flora pro.activ is sold on the basis that it can reduce cholesterol levels. If cholesterol-lowering is of limited value, then this is true, surely, of any product that reduces cholesterol? Would you care to comment?”
I’m expecting a debate, but hear nothing from Clare, and end up sending her an email four days later, telling her that I’m planning a follow-up post, and want to give her right of reply. She assures me that she will be responding, and does so two days later (yesterday). You can read this response here. Clare clarifies her role and tells us that the advertorial process is overseen by Unilever (who make Flora pro.activ). She refers me to some promotional material on the subject. It appears that, in isolation, studies show that the cholesterol-reducing properties of Flora pro.activ products are modest – generally under 10 per cent. Clare Smith also writes:
“as previously mentioned Flora pro.activ is proven to help lower cholesterol by up to 10% and an additional 5% when moving to a healthier diet and lifestyle in the general population.”
Actually, not all this was previously mentioned. We now learn that, in isolation, Flora pro.activ lowers cholesterol ‘by up to 10 per cent’. I wonder what the average reduction is. Let’s call it 7 per cent. Imagine you’re running a cholesterol of 6.5. A 7 per cent reduction would bring it down to 6.0.
But none of this has any real importance, because what’s really important is not the impact the product has on cholesterol levels, but the impact it has on health. Clare Smith does not engage with this issue at all. Also, note her response to my question regarding her assertion that cholesterol reduction is unlikely to ‘make a significant health impact’.
“Lower cholesterol is not of limited value and has been recognised as a major risk factor in developing cardiovascular disease, which is well documented by the WHO and, as already mentioned, supported by the EFSA. Therefore Flora pro.activ products are not of limited value and have been clinically proven to lower cholesterol. Also these products are of even greater value when taken in conjunction with other steps to support a healthy lifestyle, such as eating a healthy diet and taking exercise.”
The first sentence doesn’t seem to make sense. But the argument, overall, appears to be that raised cholesterol is a risk factor for cardiovascular disease, and that Flora pro.activ reduces cholesterol (note the qualification about healthy lifestyle creeping in at the end, again), so the products are not of limited value. However, this stance is incompatible with Clare’s original assertion about the limited value of cholesterol reduction. It seems to me that some serious back-tracking is going on here. Plus, no evidence has been offered at all that shows Flora pro.activ to have benefits for health (as opposed to cholesterol reduction).
In answer to a commenter’s (Christopher Palmer) questions about the origin of sterols, Clare Smith tells us that “Plant sterols come from vegetable oils such as sunflower or soy, as well as tall oils.” I’d never heard of ‘tall oil’, but Wikipedia informs me that it is “is a viscous yellow-black odorous liquid obtained as a by-product of…wood pulp manufacture.” Christopher also had some questions regarding the writing of the advertorial that remain unanswered.
Clare confirms to me that the photograph is indeed of Chris Jones and that she will ‘email [me] her line manager’s details’. This seems a bit odd, to me. First of all, I was invited to speak to Ms Jones’ directly, and took her up on this offer. I asked for her contact details but actually these have not been forthcoming. Why do I need to go through a ‘line manager’? Do papers even have ‘line managers’? And also, a day later, Clare Smith has not emailed the details of said ‘line manager’ either. This morning, I called the Daily Telegraph to ask to speak to ‘Chris Jones’, and was told they have no record of someone with that name working for them.
This is a long and mucky tale, so let me summarise some of the salient points here:
- Flora pro.activ is claimed to reduce cholesterol levels by ‘up to 10 per cent’. Average reductions are likely significantly less than this. In other words, the product has, on average, very modest impact on cholesterol.
- No evidence has been offered up at all that supports the concept that Flora pro.activ has benefits for health.
- The PR represenative for Flora pro.activ admits to me that cholesterol reduction is unlikely to have significant benefits of health, and then appeared to attempt to backtrack from this comment.
- ‘Telegraph journalist’ Chris Jones turns out not to be a journalist at all. I am invited to speak with her directly. When I ask for her contact details, they are not forthcoming (a week later). Main switchboard at the Daily Telegraph tell me no one by the name of Chris Jones works there according to their records. I am, however, told I will be sent her ‘line manager’s’ contact details, but these have not been forthcoming either.
In Clare Smith’s latest response she assures us that Unilever behaves with ‘honesty, integrity and openness’. I say, let us be the judge of that.
+1. Nice work Dr B!
I complained to Advertising Standards last year after completing a short quiz on the Flora website. I was told that I was at risk from “bad” cholesterol and that I’d benefit from their products. The site was full of tosh about strokes, heart attacks and heart-friendly low fat diets. I was astonished to be told by AS that Flora was doing nothing illegal by diagnosing online and making unprovable claims about their expensive junk.
Great work Dr Briffa!
This company, Unilever, has previous form.
In the 1970s they marketed a product called Flora margarine. It was advertised as a healthy alternative to butter. It tasted absolutely disgusting but let’s put that on one side (as we are primarily concerned with health matters on this blog).
We were blinded with bogus science by Unilever about polyunsaturated fats and various half-baked health claims that, even then, did not stand up to scrutiny. The upshot was that Unilever was essentially recommending we eat a product containing trans-fat and partially hydrogenated vegetable oil – all backed up by rock-solid science, of course!
Unilever were soon caught out and forced to withdraw the product, or at least reformulate the composition, while continuing to market a new, supposedly improved, version under the same Flora brand name.
So we have seen this movie before and I think we all know the ending. Here we are in 2011 with Unilever peddling yet another formulation of Flora. The science remains as dodgy as ever. The health claims are half-baked, just like in the 1970s.
Sterols are the new snake oil!
As Dr Briffa has pointed out, sterols are probably not a good idea – at least until such time as we have some solid research as to their overall impact on health. No one should be surprised to see history repeat itself with this current edition of Flora off the market within five years.
What a tangled web we weave – notice that Clare has never answered a question directly. Also, this Chris Jones, sometime content editor or journalist; according to Clare her cholesterol was dramatically lowered, does that mean that by pure chance this ‘journalis’t conveniently was able to tell her real life story about Flora, or was the whole thing as real as Flora itself?
Well done John. In this world where everything has a price your research, your zeal and your tenacity, not to mention your low-carb knowledge, are a breath of fresh air. Congratulations and keep going with this. In Malta, 80% of the population believes it is suffering from ‘high cholesterol’ and these products are in every fridge. Nobody question anything when, years after using them, their health or ailment remains the same.
Mona Farrugia
Food Writer & Editor
http://www.planetmona.com
Hi marvelous work, thank you, wouldnt it be wonderful if the general public could be made aware of all the rubbish put out by these quasi “health consious cos.”
Awesome work Dr B! Those ads get me so agitated when I hear them cause I know they’re duping so many people.
Keep up the good work.
i always tell anybody who tries to sell me some form or other of a cure for either colesterol or overweight that for me to believe the product it has to have biiiig prints that say you can keep withyour current lifestyle and take whatever product they are trying to sell me but no one does it infact you have to read the smmmmmmmal print which says as part of a calorie controlled diet and thats the most important thing to control intake of calories or dairy products tks
‘Tall oil’ is an anglicised version of the Swedish word for pine oil, ‘tallolja’, and that made me wonder if it shared etymology with ‘tallow’. They both stem from Proto-Germanic roots but ‘tallow’s’ most common usage applies to hard animal fats. Sometimes the expression ‘plant tallow’ might be used to refer to heavy oils of plant origin.
The roots of ‘tall’ seem interesting too. We likely first think ‘tall’ refers to height but its’ own roots are more general than that. ‘Tall’ stems from a sense of ‘exaggerated’ or ‘excess’, and it associates with roots that can mean ‘plentiful’, ‘copious’ or ‘strong stream’ (of flow). ‘Tall rain’ would mean ‘heavy rain’.
Since ‘processed extract of pine oil from the wood pulp of Scandinavian pine trees’ is a bit of a mouthful and not that appealing ‘tall oil’ seems to have been adopted as a euphemism.
Now I know a bit more about ‘tall oil’ and the roots of the expression of ‘tall tale’ I’m inclined to think the advertorial is nothing more than a ‘tall tale’ intended to promote ‘tall profits’ with nothing more than a highly selective basis for the claims about efficacy and entirely cynical regard for the interests of consumers.
Something that always reminds me that our relationship with real food is highly functional is the set up for television ‘Paignton Zoo ‘ape diet’ experiment.
Cholesterol counts fell by 23% – in two weeks.
Essentially volunteers camped out in an enclosure adjacent to some captive primates and ate a diet of raw plant foods. In a loose sense it replicated attributes of a diet our distant ancestors ate way back in time even before we began to exploit larger animal carcasses as potential sources of energy and nutrients and progressed towards becoming skilled hunters and gatherers.
The ape diet is largely an exclusion diet.
Energy dense starchy foods were not suitable for inclusion because this was a raw diet and we find the most starchy foods indigestible without cooking. So this diet excludes high GL food types. Also, because cooking significantly raises GL the medium and low GL foods exhibited lower GL for being raw. A immediate reaction might be to think it was low in fat. Veggies contain a lot of water and fibre that do supply calories. Fat content can look low when listed as proportion of a foods weight, but exclude the weight of the water and the fibre, and compute % calories from fat against total calories and actually ‘low fat’ veggies reveal themselves to higher in fat that is generally perceived. Watercress supplies more than 10% of its calories from saturated fat, but you would never think that from the nutrition box.
The diet excluded a lot of common salt or sodium, while upping potential sources of potassium. The diet excluded modern cooking oils and fats of ‘vegetable origin’ – things like margarine – or sterol enriched yoghurt mini-drinks. Actually, if sterols are generally to be found in ”vegetable oils such as sunflower or soy, as well as tall oils”, then the diet, one may cursorily deduce, excluded those sources of ‘plant sterols’. It was significantly lower, probably, in polyunsaturated fatty acids compared with the volunteers usual diets.
The diet though, had its limitations, and the limitations explain in part why chimps are chimps and humans are humans. Munching through all that low energy density bulk took most of the day and some volunteers couldn’t manage their rations. There would be little time left for more enterprising behaviour. The mackerel was an addition permitted in the second week to up the energy density because people weren’t ingesting enough calories. Because we have lost the the gut morphology, certain enzymes, or the genes to make those enzymes in the course of evolution the ape diet is no longer viable for us. There was a time when we could have fermented the fibrous content and extracted some additional energy, but modern humans now only extract a portion of the calories and some simply pass out undigested.
So Ms Smith, had Ms Jones follow up tests revealed marked improvements the ape diet suggests marked improvements are entirely plausible in an very short time-frame; less grounds then to not report them. In view of the ape diet can you still justify your paymasters claiming efficacy or even ‘need’ for the product? Had you reported results for Ms Jones it would have been tantamount to fraud, because we have failed to establish that Ms Jones even exists. She seems personable from the picture and pose; how tall is she?
Yet another book on healthy eating has been published.
This concerns eating food from a region in Italy. The food are all swamped with Olive Oil of course, and much pasta and dough is included.
The same old cant about ‘healthy foods’ and transfats!
Dr. Briffa, I am convinced, but I fear the grain lobby is too powerful for any government to fight, so they will go along with the anti-fat message.
As for agriculture? I am beginning to feel that agriculture is partly responsible for famine. The unfortunates in Africa have been made dependant, on agriculture for food. As we are here in fact. However, we have the kind of climate that suits agriculture. Africa doesn’t, unless there is anever ending supply of river water, such as the Nile. So they operate a system of food production that isn’t feasible in a country that is more or less arid.
At the same time, inside an electrified fence, and fully protected, a source of food is walking around, grazing. Unfortunately for the starving people, It is against the law to hunt this wild food source; a ridiculous state of affairs.
Rant over!
John Walker
Why validate cholesterol benefits? The message to the public should be that “Inflammation” is what counts to avert heart attacks. And the public should be informed that lowering cholesterol pro se is of no value!
Plant Sterols, mainly from GMO soy and hepatotoxic canola oils were recently cited to have no cardiovascular impact especially in regard to the cholesterol myth. I’ve written extensively on this issue and the ProActiv products in my blog, Natural Health News since 2008. For the most part this product is over priced and less effective that just using plain probiotics found in natural yoghurt which you can make yourself or purchase inexpensively. And you get dairy.
On a similar or at least broadly related topic I recommend to readers of this blog a piece appearing on the editorial page of the New York Times today, written by University of Minnesota bioethicist Carl Elliot, entitled “Useless Studies, Real Harm”.
It concerns pharmaceuticals rather than food but the common thread is the ethics of marketing for profit products which may not actually improve one’s health and may even be harmful.
He argues that some of the so-called “seeding trials” are little more than marketing wheezes; are violations of research ethics; and that although not currently illegal they are inadequately controlled by oversight bodies such as the Food and Drug Administration.
If the above hyperlink does not work (or does not even appear), the full address is:
http://www.nytimes.com/2011/07/29/opinion/useless-pharmaceutical-studies-real-harm.html?nl=todaysheadlines&emc=tha212
Good to see another product debunked. Marketing has got a lot to answer for. A profession were people convince us to buy things we dont need cant afford and are shrouded in untruths that their litigator agrees with in their financial interest. Pro active my arse.
how about making a short tv documentary about this?
damn those synapses and badly behaved finger tips! the intended statement was:
Veggies contain a lot of water and fibre that do notsupply calories. (We humans find the fibre indigestible.)
The whole lot has been great reading this morning, thanks Dr B and all!
Dr Briffa,
This is very interesting and I commend your persistence and detective work.
In a related issue, can you direct me to your blogs/comments on cholesterol as an independent risk factor for cardiovascular disease?
I spend much of my time with patients (as a GP) discussing reducing risks, including optimising their lipid profile. I’d be keen to know more about your take on this.
Thanks,
Tom
Tom
Over in the right margin you’ll see ‘cholesterol and statins’ (twice) in the ‘categories’ section. There’s two of these because of a glitch I haven’t had the time to resolve yet. These pieces, collectively, give a decent overview of my take on the cholesterol debate.
In short, though, I believe that the role cholesterol plays in cardiovascular disease has been given disproportionate attention. But the real problem is that our focus, particularly as doctors, is the ‘normalisation’ of cholesterol levels. The thing is, modifying or lowering cholesterol levels should not be assumed to be good for health. Our experiences with fibrates, torcetrapid and ezetimibe (as well as dietary therapy) has made this abundantly clear, I think.
Statins, specifically, do reduce cardiovascular disease risk, but may do this through mechanisms that have nothing to do with cholesterol per se. And in primary prevention, it seems they have little or no impact on mortality, and the absolute risk reduction for CV events are very small and the NNTs very big, generally speaking. As you know, they’re not without side-effects, either.
You may gather from this that I’m a bit of a cholesterol sceptic (and you’d be right).
Please do engage further, if you’d like.
John
Dear John,
Further to our previous emails, I can confirm that I am the journalist who wrote the advertorial for Stella magazine, which was then posted on the Telegraph website. I can also confirm that I am the person in the photograph and at the time of writing the piece I was contracted to the Telegraph. My title was Content Editor because I worked on the iPad edition as well as the print editions, as previously mentioned in an email to you. I have been a journalist for more than 20 years and have not been asked for as much accreditation by anyone before.
I once again politely request that you take this post down as you seem to have ignored my previous request.
And I once took Benecol and that worked too, even though I wasn’t paid to write about it.
Sincerely,
Chris Jones.
Chris (Jones)
On 29th July (3 weeks ago) you emailed and stated that you’d be happy to verify your identity and even volunteered that you had your passport with you (so would be able to do that). Yet, since that time, you have not actually verified your identity though it’s not clear why.
The post reflects the facts and is accurate. Because of this, I will not be removing it.
Thank you for your comments about Benecol but I’m not sure I understand. There seems to be some suggestion here that being paid to write about Flora pro.activ had some potential to influence your account. Can you clarify?
Thanks for the effort put to this. Was not able to read the whole of it. Would like to post the following link. Please note this was published on 1st Nov 2011
http://www.theecologist.org/green_green_living/behind_the_label/269112/behind_the_label_flora_proactiv.html
Sam, the link is a good find, and it dates to 1st November 2006.
Gosh, I have spent a fortune on flora pro activ margarine recently and suddenly realised that hydrogenated fat is far worse for your heart than cholesterol levels back to butter !!!!!!!!!!!
I have been consuming a teaspoonful of the stuff for every piece of cheese eaten on the assumption that it would cancel the cholesterol effect of the cheese. This seemed to be a logical thing to do……………..
Hello John I am concerned that i have been conned after reading your comments and others etc regarding flora pro activ. I have been having some heated debates with my wife to buy this product because I really belived it as helped reduce my cholesterol beening a type 1 dibetic I try to eat heatlhy
I have also been duped, I have used this margarine for years and have applied it liberally to my bread frequently. I wonder what damage it has done to me?