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

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)?

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

  1. TerryJ 11 July 2013 at 8:55 am #

    Typos – BNF instead of BHF

  2. Dr John Briffa 11 July 2013 at 11:10 am #

    Thanks TerryJ – corrected now.

  3. Tom 11 July 2013 at 1:34 pm #

    Unsurprising. I was listening to the consumer programme on Radio 4 at lunch time today (lunch time for most people, I fast until the afternoon!). They were talking about butter vs. low sat. fat spreads, and invited a BHF dietician to advise them about it all.

    I should probably have turned it off at that point, but I was curious… lo and behold, the sat fat-cholesterol-heart disease “fact” formed the basis of her advice. Shame, I wondered if we might actually get someone to bring things up to date a bit.

  4. PhilT 12 July 2013 at 9:55 am #

    Then you have Heart UK endorsing a 16.5% sugar solution – Welch’s grape juice.

    Hypertriglyceridemia anyone ?

  5. Vanessa 12 July 2013 at 6:58 pm #

    Do I detect a hint of cynicism? The very idea that corporate funding might bias the advice given by this national heart charity is being mooted? Surely not…….unfortunately that’s the general way of things nowadays and the public has been brainwashed into believing it all. Diabetic advice, statins, all those vaccinations that our children ‘have’ to have, fix everything with a drug – is anyone actually asking why juvenile (and adult) diabetes, autism (and milder learning disorders), dementia and chronic disease in general is escalating? Not that I can see. The doctors and other associated health care professionals just seem to throw drugs at everyone and nobody suggests that perhaps changing diet or looking for deficiencies may be helpful. It’s very disheartening…..

  6. Fiona Benson 12 July 2013 at 7:19 pm #

    As a subscriber to the BHF mailing list, I regular challenge them on many issues. One of the issues I have challenged them on in response to requests for contributions to research is: “How can they ask for public funding for research when their major sponsor is Unilever? Making the point that Unilever is one of the wealthiest global companies.” The BHF is not the only “so called charity” that is influenced by big food and/or big pharma.

    What can be done to control these “so called health charities” from inviting well meaning members of the general public to fund raise when they have such close relationships with any multi-national corporations?

    For now I see the BHF as a great marketing arm for Flora and have absolultely NO trust in them as an organisation.

    Their Heart Failure nurses team are great – how much do they sponsor that team who carry their logo on their uniforms?

  7. heather m 12 July 2013 at 7:22 pm #

    ‘Big Food’ will be the demise of us all…..

  8. Yossi 13 July 2013 at 9:30 am #

    Are you suggesting that the MMR vaccination is unnecessary? Or that there is link to autism? I took antibiotics when I had pneumonia. If I hadn’t I think I’d probably be dead. I am no supporter of statins or oversubscribing of drugs but to suggest that all prescription drugs are evil is barmy.

  9. Eddie Mitchell 13 July 2013 at 9:58 am #

    Some drugs work very well and have saved countless millions, many others do not work, from a man that knows.

    A senior executive with Britain’s biggest drugs company has admitted that most prescription medicines do not work on most people who take them. Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline (GSK), said fewer than half of the patients prescribed some of the most expensive drugs actually derived any benefit from them. It is an open secret within the drugs industry that most of its products are ineffective in most patients but this is the first time that such a senior drugs boss has gone public. His comments come days after it emerged that the NHS drugs bill has soared by nearly 50 per cent in three years, rising by £2.3bn a year to an annual cost to the taxpayer of £7.2bn. GSK announced last week that it had 20 or more new drugs under development that could each earn the company up to $1bn (£600m) a year.

    Dr Roses, an academic geneticist from Duke University in North Carolina, spoke at a recent scientific meeting in London where he cited figures on how well different classes of drugs work in real patients.

    Drugs for Alzheimer’s disease work in fewer than one in three patients, whereas those for cancer are only effective in a quarter of patients. Drugs for migraines, for osteoporosis, and arthritis work in about half the patients, Dr Roses said. Most drugs work in fewer than one in two patients mainly because the recipients carry genes that interfere in some way with the medicine, he said.”The vast majority of drugs – more than 90 per cent – only work in 30 or 50 per cent of the people,” Dr Roses said. “I wouldn’t say that most drugs don’t work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there on the market work, but they don’t work in everybody.”Some industry analysts said Dr Roses’s comments were reminiscent of the 1991 gaffe by Gerald Ratner, the jewelry boss, who famously said that his high street shops are successful because they sold “total crap”. But others believe Dr Roses deserves credit for being honest about a little-publicized fact known to the drugs industry for many years.

    Link http://www.commondreams.org/headlines03/1208-01.htm

  10. Lucy 13 July 2013 at 11:41 am #

    Yossi, no one is saying ALL prescription drugs are evil, but a heck of a lot are totally unnecessary, ineffective, harmful, and prescribed PURELY because they bring in a shedload of money. The ‘evil’ is in those who KNOW the drugs are useless or even downright dangerous, yet continue to prescribe them to people who don’t need them, and then prescribe more drugs to counter the side effects – ad nauseum. Google QOF points and you will understand why your GP is so keen to put you on statins, blood pressure medication, diabetes medicine, etc, when you don’t need it.

  11. Lew 13 July 2013 at 2:47 pm #

    Thanks, Dr Briffa. As usual, very interesting. Can I ask a question?I’m someone who, until now, was taking one of these drinks daily – do you suspect they have a harmful effect or whether it’s simply that we can’t prove that they have a beneficial effect?

  12. Moira 13 July 2013 at 4:55 pm #

    Great to read this contradiction by NICE. I shall printout copies for the Registrar and Dietition at the Diabetic Clinic.

    The dietitian recommended that I reduce the butter that I have with my one slice of Bergen toast each day! In addition I should consume one of the Plant Sterol Drinks or Soy products.

    But it’s not all bad having managed to convince the Consultant that three attempts of consuming various Statins may have slightly reduced my elevated Cholesterol levels but have caused myalgia. My levels are higher than approved but I still have good ratios for my HDL and my LDL to Total is 11% lower than the typical level.

  13. Yossi 17 July 2013 at 7:51 am #

    I know how to Google thanks. Vanessa, who hasn’t responded, seemed to suggest that all prescription drugs were unnecessary, and singled out MMR and a link to autism. I have known why some doctors are keen to prescribe statins etc for several years thanks.

  14. Karen Harrison 17 July 2013 at 8:58 am #

    To start please do not tar all health professionals with the same brush – I am a dietitian with a more than healthy dose of cynicism andnot a one-size-fits-all attitude – we are out there and I regularly read this blog!
    My father has been on statins for a number of years as he had a raised cholesterol. There is no family history of heart disease and he is a non-smoker, slightly overweight and with mildly raised blood pressure. Main family history aggressive cancers and he has had treatment for prostate cancer. After reading comments on here I encouraged him to ask about his contninued need for statins at his medication review as he has lost weight and brought his BP down. He duly asked and was told – Oh yes you need to stay on those. No explanation, no checking of current cholesterol level, no mention of successful lifestyle changes. I was gobsmacked! Needless to say I will be accomanying him to his next review.

  15. Mark Struthers 18 July 2013 at 7:30 am #


    Your reaction is both interesting and revealing: Vanessa didn’t mention the MMR, let alone link it to autism. However, is the MMR a necessary vaccine? The mumps component is not necessary, and the necessity for the measles and rubella components is certainly arguable. I recently expressed my reservations about the ‘miraculousness of vaccines’ in a response to Des Spence, a GP columnist at the BMJ.


    I referenced a pdf document by Dr Jayne Donegan, a GP in London, which provides ample food for thought on the necessity of vaccines, MMR or otherwise.


    If you can’t leap the subscription wall at the BMJ, Des Spence’s article on the uselessness of statins can be read here:


  16. Yossi 19 July 2013 at 7:14 am #

    Mark Struthers.
    Vanessa wrote; ” all those vaccinations that our children ‘have’ to have, fix everything with a drug – is anyone actually asking why juvenile (and adult) diabetes, autism (and milder learning disorders), dementia and chronic disease in general is escalating?”
    No she didn’t mention MMR specifically but I think it reasonable to assume that was her drift. She did mention autism. So my reaction may be interesting and revealing to you, but it was correct. Are you in agreement with Dr Wakefield? Would you stop giving children MMR?
    Not sure why you are trying to educate me on the uselessness of statins. As I have already indicated I have been aware of their uselessness for years.

  17. Mark Struthers 19 July 2013 at 5:33 pm #

    Vanessa asked why chronic disease in general is escalating. Any thoughts, Yossi? You seem to have ruled out vaccines, including MMR, as possibly being involved in the escalation of chronic disease. Is that correct?

  18. Yossi 20 July 2013 at 8:38 am #

    Mark Struthers.
    Why is chronic disease in general escalating? Huge question and no easy answers. I suspect that modern diet and lifestyle are big factors. Need to look at each chronic disease and examine evidence. Not a good idea to throw out all modern pharmaceuticals. Antibiotics saved my life. I have said nothing to rule out MMR, just think that there is no good evidence to link MMR with autism. Vanessa ( are you her official spokesperson?) and you seem to suggest a link. Do you have any evidence?

  19. Mark Struthers 20 July 2013 at 12:49 pm #


    I loved this little dialogue between CNN’s Sanjay Gupta and Julie Gerberding who is now president of Merck’s Vaccine division.


    “GUPTA: And one of those 4,900 cases was the case of nine-year- old Hannah Polling, which has been making a lot of news lately. Luckily, we have the director of the Centers for Disease Control and Prevention, Dr. Julie Gerberding here.

    We’re talking a lot about autism, as you know. I should remind people that the — my understanding is the federal government conceded that vaccines caused her autism like symptoms. First of all, is there a difference? I mean, does she have autism or autism like symptoms? What’s the difference?

    JULIE GERBERDING, DR., CDC DIRECTOR: Well, you know, I don’t have all the facts because I still haven’t been able to review the case files myself. But my understanding is that the child has a — what we think is a rare mitochondrial disorder. And children that have this disease, anything that stresses them creates a situation where their cells just can’t make enough energy to keep their brains functioning normally. Now, we all know that vaccines can occasionally cause fevers in kids. So if a child was immunized, got a fever, had other complications from the vaccines. And if you’re predisposed with the mitochondrial disorder, it can certainly set off some damage. Some of the symptoms can be symptoms that have characteristics of autism.

    GUPTA: Yes, I have a two-and-a-half-year-old and a one-year-old as you know. And you know, you know, you think about this all the time. Are we ready to say right now as things stand that childhood vaccines do not cause autism?

    GERBERDING: What we can say absolutely for sure is that we don’t really understand the causes of autism. We’ve got a long way to go before we get to the bottom of this. But there have been at least 15 very good scientific studies on the Institute of Medicine who have searched this out. And they have concluded that there really is no association between vaccines and autism.

    GUPTA: Are you comfortable everything that we know? So you talk about the…

    GERBERDING: Well, I’ll never be comfortable with everything we know. I mean, I think we have to have an open mind about this. We know that there’s very little chance that it’s something related to a vaccine that’s going to cause a serious problem for a child. We also know how life saving vaccines really are.”

    I don’t know whether to laugh or cry at all that. Of course, that conversation was recorded in 2008. Medical scientists still don’t understand the causes of autism, but that doesn’t stop people like Yossi knowing that autism cannot be linked to MMR, let alone any other vaccine.

  20. Mark Struthers 20 July 2013 at 1:09 pm #

    Yossi asks for evidence. There is plenty of evidence that the MMR is not safe for all children. I referenced some evidence in a couple of recent responses to the BMJ.




    There is ample evidence that the MMR causes brain damage and autistic like symptoms in some people. However, “there’s none so blind as those who will not see”.

  21. Yossi 21 July 2013 at 8:15 am #

    Mark Struthers.
    Nice anecdotes, both authored by you, but you dismiss the Cochrane evidence. You are now using a thread on the BHF support for stanols to promote your anti-MMR crusade. Time to stop I think.

  22. Mark Struthers 21 July 2013 at 9:53 am #

    Yossi can’t stand the weight of evidence against him and is ducking out. Yossi seems to have grasped the enormity of the great cholesterol scam, but is apparently unable to understand how he’s been conned by the vaccine industry over MMR. Odd! But perhaps he understands more than he’s letting on.

    The MMR has been an utter disaster, as the evidence in this link so clearly shows.


    The article was published yesterday.

    The treatment Andrew Wakefield received at the hands of both the medical establishment and the vaccine corporations was utterly obscene. I am not anti-vaccine, but I am no longer a fan of the pharmaceutical industry.

  23. SueG 21 July 2013 at 6:00 pm #

    I attended my first appointment at the Cardio clinic at Blackpool Victoria last week. Apart from the registrar or whoever he was not paying much attention to what I was trying to tell him, he looked at the latest blood test results and pronounced “Your cholesterol is very high (6.7 is very high?) and said ……….. “You should be taking statins”. No doubt the next doctor I see will be telling me to avoid saturated fats. My BP is fine, my pulse a little slow, everything else is “normal”.

    When I said I don’t think so, he never said a word. When oh when are the medical profession, paid for by us, the taxpayer, ever going to update their knowledge base? I find it especially frustrating that BVH, a specialist cardiac centre for the North West, continues to dole out out-dated advice. Heavens, if I can google for information, why don’t the people in charge of our medical care do the same occasionally, is it too much to ask that they at least look to see what the latest research suggests?

  24. Dr John Briffa 21 July 2013 at 6:09 pm #


    When oh when are the medical profession, paid for by us, the taxpayer, ever going to update their knowledge base?

    I was asked this question recently, and my reply was that the fact that the medical profession is often out-of-step with the up-to-date knowledge is mattering less and less. That’s because in the past, we had pretty much no information other than what health professionals gave us. But oh have things have changed with the advent of the internet. You are a prime example of how people are becoming increasingly informed and empowered.

    I don’t think health professionals realise how much our ‘knowledge’ and practices are being seen to be inappropriate and antiquated by our patients. Increasingly our advice is being ignored, sometimes with disdain. And we have only ourselves to blame.

  25. SueG 24 July 2013 at 10:10 am #

    “You are a prime example of how people are becoming increasingly informed and empowered.”

    Ah but I don’t feel terribly empowered! I can acquire all the up to date information I like and cart it along to a GP or Registrar or even a consultant should I be lucky enough to get to see one. What happens next? I don’t have sufficient medical knowledge to argue the toss and will be blinded with science. I can ignore his advice of course but am I then at risk of being told not to bother coming back if I am not prepared to follow his recommendations?

    My husband stopped his statins after reading many of your articles. On his next check up with the GP in the practice who specialises in Diabetes, he imparted this. GP wasn’t pleased and advised him “strongly” to restart them. So he did because he wasn’t in a position to understand or counter the arguments for not doing so. I despair.

    I wonder how GPs can refuse to update their knowledge and continue to give out of date and sometimes dangerous advice. Is there a policy that any radical change of advice needs to be approved first by the BMA before it can be dispensed? I suspect not as you seem to be able to manage it, or does that make you a rebel ;)?

  26. Eddie Mitchell 24 July 2013 at 10:57 am #

    SueG said.

    “I can ignore his advice of course but am I then at risk of being told not to
    bother coming back if I am not prepared to follow his recommendations?

    GP wasn’t pleased and advised him “strongly” to restart them. So he did”

    I have known diabetics achieve great control with a high fat low carb diet. Their healthcare advisors have read them the riot act and insisted on unnecessary meds. They fear to rock the boat, and what do they do ? They take the prescription, they get the meds, and then throw then in the rubbish bin. Welcome to the crazy world of diabetes.

    Regards Eddie

  27. SueG 24 July 2013 at 1:34 pm #

    I wish he would throw them in the bin Eddie, he takes them 🙁 I’ve yet to read anything good about them and I make sure I pass on every detrimental article to him to read yet still he takes them.

    He has had a measure of success with the no carb diet, lost weight, dropped one of his meds and doesn’t need his anti-hypertensive any more so it’s become a way of life for both of us.

  28. jim healthy 12 August 2013 at 7:56 pm #

    Hi, John … Not sure if you caught this “worrying” reaction by the National Health Service of the UK to managing Type 2 diabetes by diet alone…

    “In the United Kingdom, as many as one in three type 2 diabetics are managed by diet alone. It’s well-known that tight control of blood sugar levels is important for reducing the small blood vessel complications, such as kidney disease, retinal disease, peripheral vascular disease, and diabetic neuropathy. It has been a matter of some anxiety that diet-alone control (i.e. without the use of medication) may not control the blood sugar effectively. A study at the University of Nottingham, UK has examined this problem.” (When Diet Is not Enough for a Type 2 Diabetic)

    The news story goes on to report that…

    “Diabetic complications were found in 68% of those being treated by diet alone, and in 80% of those on medications. The fact that 60% of those treated by diet alone had vascular complications, 20% had eye disorders, 9% had neuropathy, and 9% had kidney complications was worrying.”

    This conclusion seems crazy. T2 diabetics who managed their condition by diet alone had FEWER serious, life-threatening complications than those on drugs. Yet, this is “worrying” to the UKNHS?

    I’m pretty sure someone in the UKNHS saw the meta-analysis of 13 studies (because it was reported in the British Medical Journal), which found that aggressive glucose-control (with drugs) in patients with Type 2 diabetes.

    Intensive treatment did NOT significantly affect all cause mortality or cardiovascular death, yet caused more than twofold increase in the risk of severe hypoglycemia. Furthermore, intensive treatment resulted in a 47% increase in risk of congestive heart failure. http://www.bmj.com/content/343/bmj.d4169

    Similar results were reported by Romain Neugebauer, Ph.D., of Kaiser Permanente in Oakland, Calif., who conducted a cohort study involving 58,000 adults with T2. Aggressive glucose-control strategies did NOT reduce the rate of myocardial infarction over 4 years of follow-up, according to the study published online July 22 in Diabetes Care. http://care.diabetesjournals.org/content/early/2013/07/18/dc12-2675.abstract

    Both studies confirm the findings of the 2008 ACCORD study which found that aggressive glucose-lowering (with drugs) resulted in MORE heart attacks, strokes and deaths, compared to T2 patients who allowed their A1C to hover above 7%.

    Doctors and drug companies continue to ignore and deny the evidence that diet-and-lifestyle modification is the safest, most affordable and most effective way to not only manage T2 – but also to reverse it. The reason for their stubborn position is obvious: There is no money in it for them.

    As a result, patients with Type 2 diabetes continue to receive ineffective, dangerous and inferior treatments (drugs and bariatric surgery) for their condition because of greedy self-interest.

    If you want to see an example of how Type 2 diabetes can be reversed with a few simple changes in your diet, check out this YouTube video: https://www.youtube.com/watch?feature=player_embedded&v=ZV-mZkOTkhk.

    Jim Healthy from http://www.jimhealthy.com.

  29. jim healthy 12 August 2013 at 8:09 pm #

    Speaking of “lowering cholesterol” …

    I highly recommend the newly-published book, The Cholesterol Myth by Dr. Stephen Sinatra (MD). This book pulls together the entire story of how cholesterol hysteria got started — and includes every major study which shows that total cholesterol and elevated LDL have little to nothing to do with CVD risk.

    Dr. Sinatra also explains the under-utilized lipid tests that DO predict CVD risk, as well as the foods and nutritional supplements which are proven to greatly reduce these risks. I’m buying several copies to distribute to my MD-friends who continue to preach the “lower your cholesterol” doctrine to their patients (which is doing nothing to improve their health and well-being). Jim Healthy


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