The medical director of the British Heart Foundation does not want to engage with the troubling science on sterols

Last month, I wrote a blog post about how there was no evidence that cholesterol-lowering ‘stanols’ and ‘sterols’ (found in some margarines and other ‘functional foods’) have benefits for health. In fact, the National Institute for Health and Care Excellence explicitly states that they should not be used. Yet, the British Heart Foundation (BHF) recommends the use of stanols and sterols, though I wondered if this might have something to do with the fact that one of its corporate partners is Flora pro.activ (a brand of sterol-enriched foods made by Unilever).

On the 17th July, I emailed the BHF about this. Here’s my email to them:

The National Institute for Health and Care Excellence has this to say about dietary stanols and sterols: “People should not routinely be recommended to take plant sterols and stanols for the primary prevention of [cardiovascular disease].”

We are also advised by NICE that: “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.”

Yet, I notice that the BHF advocates stanols and sterols. Can someone explain the discrepancy, and whether the BHF believes the fact that Flora pro-avtiv is a corporate partner of represents a financial conflict of interest?

On the 30th July, I got a reply from Professor Peter Weissberg, the medical director of the BHF. Here are the highlights from his email:

  • They are not suggesting that plant sterols/stanols can prevent a heart attack
  • They do help to reduce LDL cholesterol, which is a risk factor for heart disease
  • Their information reflects this and has not been altered by their fundraising partnership with Flora pro.activ.
  • The BHF  has a very clear set of principles on the basis of which they work with commercial organisations.
  • The amount of money they take from Flora pro.activ is a tiny percentage of their overall budget.

The same day, I emailed Professor Weissberg again, this time questioning the presumed benefit of LDL-cholesterol reduction, but also to draw his attention, should he not be aware of it already, of the considerable body of evidence which suggests sterols have the potential for harm. Here’s my email:

Dear Professor Weissberg

Thank you for getting back to me.

As you allude to, sterols/stanols have never been demonstrated to have clinical benefit, and it appears your support of them rests on their ability to reduce LDL-cholesterol levels (which you say is a risk factor for heart disease). Unfortunately, as I’m sure you’ll know, reduction of LDL-cholesterol most certainly does not assure clinical benefit. Ezetimibe – which has a similar mechanism of action to sterols/stanols – is a case in point.

Also, if arsenic and cyanide were found to be effective LDL-cholesterol reducing agents, it still would not make sense to recommend them for people for the reduction of cardiovascular disease risk, right?

The reason that I use this example is because, as you may know, there is a considerable body of evidence which suggests that sterols/stanols may have adverse effects on health. These are very well summarized in a paper published in the European Heart Journal in 2009 [Weingartner O, et al Controversial role of plant sterol esters in the management of hypercholesterolaemia. Europlean Heart Journal 2009;30:404-409]. If you have not already read it, I urge you to.

In this paper, the authors cite evidence linking the presence of sterols in the blood with an increased risk of cardiovascular disease. For example:
…there is evidence that elevated levels of plant sterols are associated with an increased cardiovascular risk. Glueck et al [Relationships of serum plant sterols (phytosterols) and cholesterol in 595 hypercholesterolemic subjects, and familial aggregation of phytosterols, cholesterol, and premature coronary heart disease in hyperphytosterolemic probands and their first-degree relatives. Metabolism 1991;40:842–848] were the first to report that elevated plant sterols might be a risk factor for coronary heart disease. In a study with 595 hypercholesterolaemic patients, they found that slightly elevated plasma levels of plant sterols were a heritable marker for an increased cardiovascular risk.

Rajaratnam et al [Independent association of serum squalene and noncholesterol sterols with coronary artery disease in postmenopausal women. J Am Coll Cardiol 2000;35:1185–1191]…found that in postmenopausal women, plant sterols were independently associated with coronary heart disease in a multivariate analysis. These findings were confirmed by Sutherland and his team in a study involving both sexes over all age groups [Association of plasma noncholesterol sterol levels with severity of coronary heart disease. Nutr Metab Cardiovasc Dis 1998;8:386–391].

The Scandinavian Simvastatin Survey Study (4S study) also identified a subpopulation of coronary artery disease patients with low endogenous synthesis of cholesterol and high absorption of cholesterol and plant sterols. The subjects of this subpopulation had the highest levels of plant sterols and the highest risk of recurrent coronary events despite lower levels of serum cholesterol due to simvastatin ingestion [Baseline serum cholestanol as predictor of recurrent coronary events in subgroup of Scandinavian simvastatin survival study. Finnish 4S Investigators. BMJ 1998;316:1127–1130]

Larger epidemiological studies reported similar data. Results of the PROCAM-study showed that patients afflicted with myocardial infarction or sudden cardiac death had increased plant sterol concentrations [Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Munster (PROCAM) study. Nutr Metab Cardiovasc Dis 2006;16:13–21]. Upper normal levels of plant sterols were associated with a three-fold increase of risk for coronary events among men in the highest tertile of coronary risk according to the PROCAM-algorithm.

Similar data are available for the plant sterol campesterol from the MONICA/KORA-study. In this prospective study, campesterol correlated directly with the incidence of acute myocardial infarction [Abstract 4099: elevated campesterol serum levels–a significant predictor of incident myocardial infarction: results of the population-based MONICA/KORA follow-up study 1994–2005. Circulation 2006;114:II_884].

This is all epidemiological evidence, of course, but it supported by several animal, in vitro and clinical experiments that, I think, give us genuine cause for concern. Again, from the European Heart Journal paper [Weingartner O, et al Controversial role of plant sterol esters in the management of hypercholesterolaemia. Europlean Heart Journal 2009;30:404-409]:

Current experimental findings from our own research group show that a diet supplementation with plant sterol esters that is equivalent to a commercially available spread induces endothelial dysfunction and leads to an increase of ischaemic stroke size in wild-type mice [Vascular effects of diet supplementation with plant sterols. J Am Coll Cardiol 2008;51:1553–1561].

…in a clinical study, we demonstrated that patients who were consuming plant sterol ester enriched margarine had increased concentrations of plant sterols in cardiovascular tissue [Vascular effects of diet supplementation with plant sterols. J Am Coll Cardiol 2008;51:1553–1561].

Further mechanistic data suggest that vascular deposits of sterols, when compared with cholesterol, result in increased oxidation and release of oxygen radicals [Oxidized plant sterols in human serum and lipid infusions as measured by combined gas-liquid chromatography-mass spectrometry. J Lipid Res 2001;42:2030–2038].

…the induction of apoptosis is not limited to tumour cells, but extends also to vascular cells. Recent in vitro experiments demonstrated that the plant sterol sitosterol exerts a strong cytotoxic propensity inducing apoptosis in human endothelial cells, revealing detrimental effects on the vasculature [Beneficial or harmful influence of phytosterols on human cells? Br J Nutr 2008;100:1183–1191].

In fact, the first experimental study reporting negative cardiovascular effects dates back to the year 2000. Ratnayake et al.  [Vegetable oils high in phytosterols make erythrocytes less deformable and shorten the life span of stroke-prone spontaneously hypertensive rats. J Nutr 2000;130:1166–1178 reported that increased serum levels of plant sterols increase rigidity of erythrocytes and shorten the life span of stroke-prone spontaneously hypertensive (SHRSP) rats.

These findings were the reason for Health Canada, the federal department responsible for helping Canadians maintain and improve their health, to raise significant safety issues and not to allow functional foods enriched with plant sterol esters to be sold in Canada.

I am sure you must be very busy, but please take some time to consider this evidence. From what I can see from the research, we have no evidence at all that sterols/stanols improve clinical outcomes, and considerable evidence linking them with potential for harm. Until we have positive evidence regarding outcomes, wouldn’t the most prudent and safety-conscious thing be to not recommend sterols/stanols (as NICE does)?

Thank you for your explanation regarding your corporate partners. If the funds derived from this relationship are so low, why not sever the link and have no conflict of interest at all, here?

I look forward to hearing from you.

Kind regards

John Briffa

On the 6th August, I got this response from Professor Weissberg:

Dear Dr Briffa

Thank you for your further email on this subject. I am aware of a large number of publications, of varying quality and validity, on the subject of plant stanols and sterols and their potential benefits and harms. I would prefer not to enter into a debate on any one of them since they all have their strengths and weaknesses.

So, as with so much in science, interpretation of the data is not as straightforward as is sometimes presented. Nevertheless, we are agreed that, ideally, one would like to see appropriately designed outcome trials to test their role in protection against cardiovascular events. In the absence of such data (and I doubt they will ever be produced), it is a matter of judgement as to whether or not plant stanols should be included as part of a wider strategy to reduce cardiovascular risk, and different national bodies have come to different conclusions.

In drawing this correspondence to a close I would conclude by saying that the BHF only enters into partnerships after careful consideration of all the pros and cons of so doing. As discussed previously, the main objective of the partnership with Unilever is to utilise their considerable reach to help us highlight the risk of CVD to women.

I thank you for your interest in this project and assure you we take seriously all feedback we receive.

Yours

Notice here how Professor Weissberg makes no comment at all on the specifics of the studies, nor puts up one scrap of evidence to refute the concerns raised. And what are we to glean from his writing: “In drawing this correspondence to a close…” To me, that gives the impression Professor Weissberg wants to hear no more from me (or perhaps anyone else) on the matter. Case closed!

I think we deserve better to be honest. I genuinely believe that, based on the evidence, there is a case to answer regarding the health effects of sterols, and it’s simply not good enough for Professor Weissberg to dismiss the evidence based on rhetoric to do with, supposedly, the evidence being of ‘varying quality and validity’. This is true of all science, so is Professor Weissberg suggesting we just go back to the dark ages and believe what suits us?

How many people do you imagine look to the BHF as being a reliable and credible organisation dedicated to our heart health? Lots, I would imagine. How do you think they would feel to know that when legitimate concerns are raised about products they recommend (some of which are made by a company the BHF partners with), their medical director just flatly refuses to engage with the science?

There is absolutely no evidence that sterols benefit health, but it seems the BHF is going to recommend them anyway, even in light of significant evidence suggesting they have the potential for harm.

Professor Weissberg seems to claim that the BHF’s relationship with Unilever does not compromise them. In fact, Unilever is helping them raise awareness about the risk of cardiovascular disease in women! I wonder how many of these women will be concerned enough to put their faith in utterly bogus food products enriched with sterols?

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45 Responses to The medical director of the British Heart Foundation does not want to engage with the troubling science on sterols

  1. Maggie 9 August 2013 at 6:54 am #

    I believe Professor Weissberg did the equivalent of sticking his fingers in his ears and going “la la la la”.

  2. Dr John Briffa 9 August 2013 at 7:06 am #

    Maggie

    Yes, either that, or he’s sticking two fingers up in the air at me (and the rest of us).

  3. Anne 9 August 2013 at 7:07 am #

    As I wrote before, these spreads contain trans fats, and I have this from the horse’s mouth from Benecol when I asked them outright if they contained trans fats. Here is from their email to me:

    “Trans fats are only present within Benecol® foods at a very low level. The amount of trans fats in the Benecol® spreads are amongst the lowest in the market when compared to “comparable products in the marketplace.

    Well it might only be “the lowest in the market when compared….” but trans fats are known to be harmful to the heart and vascular system. It’s shocking that the BHF supports products containing trans fats.

  4. Chris 9 August 2013 at 7:09 am #

    Dr B, thank you so much fo this great work!

  5. Sheila 9 August 2013 at 7:18 am #

    I can’t believe that BHF are supporting and promoting these products – and they are expensive to buy! Terrible. I am certainly going to spread the word and enlighten those, like me, who ate /drank them on a regular basis!

  6. Diane Smith 9 August 2013 at 7:32 am #

    As a women in her 40′s, I am one the BHF’s target group of women who ‘need’ to be made aware of the risk of heart disease and I am disgusted and horrified at what they are doing. The BHF to me looks like nothing more than a marketing arm of Unilever.

  7. Christoph Dollis 9 August 2013 at 7:50 am #

    Fantastic post, Dr. Briffa. I was pleasantly surprised to see Health Canada had made the right call.

    On another matter, be aware that the “click here” button for “To read some of the dozens of 5-star reviews for this book” in your ad is a broken link.

  8. Christoph Dollis 9 August 2013 at 7:51 am #

    It’s shocking that the BHF supports products containing trans fats.

    Trans fats exist throughout nature, so I wouldn’t go that far. However, artificial trans fats appear to be unhealthy.

  9. Anna Betz 9 August 2013 at 7:54 am #

    Huge appreciation for challenging the BHF on their own terms.
    This kind of challenge is asking for more transparency that we all deserve. Invested interests by private companies whose main objectives are not informed by ethics but by profit needs to be made visible.
    You shine the light one of those uncomfortable shadows, that are hidden from the public. Thank you for pulling back the curtain. Who is the BHF really accountable to? Who is their CEO accountable to? What are we going to do with our realisation?

  10. NM 9 August 2013 at 7:54 am #

    Thank you once again for revealing the corruption at the core of the BHF. Note how the organisation strains every sinew to give its sponsors’ dubious products the benefit of the doubt. It grips tightly on the frayed thread of an irrelevant surrogate marker as the totality of its justification! And note their sponsor, despite their allegedly “small” funding, has its philosophical sinews drawn across and through the whole organisation.

    Now compare the BHF’s craven behaviour here to the dismissive way it treats strategies that “coincidentally” threaten their sponsors. Such threatening strategies are not simply vague hypothesis from left-field freaks. These are strategies that actually support themselves with more than surrogate-outcomes and confounded epidemiology. Strategies like avoiding an over-abundance of processed starches as the keystone of a diet; like repudiating easily-oxidised, omega-6-heavy seed oils; and like finding alternatives where possible to pharmacological intervention. Does the BHF give such strategies the benefit of the doubt, as it bends over backwards to do for Sterols and so forth? No – except in very limited contexts, they attack these “unprofitable” strategies with a vehemence inversely proportional to the support they give their sponsors’ dubious products.

    It is not thus a conspiracy theory to suggest the BHF is corrupt, but merely the deft application of Occam’s Razor. But this is not a moustache-twirling, self-conscious, evil-cackling corruption. Would that it were, it would be easier to extirpate! Instead, the corruption manifests itself as a subtle osmotic transfer between the interests of its sponsors, its exalted academic sinecures and the general industrial-complex-philosophies that underlie its every action. There is no one individual who “knows” the truth but malevolently hides it. I am sure that Professor Weissberg, for example, believes to his absolute depths that he is a profoundly honourable man, untainted and untaintable. I’m sure he honestly considers Dr Briffa to be a troublesome gadfly, maliciously vomiting on The Professor’s magnificent corpus! And that’s precisely why this corruption is so insidious and hopeless to reform. It’s systemic, deep, unconscious and metastasised across the whole body of the organisation, and every attempt to reveal it evinces a strong defensive immune response.

    Finally, and as for The Professor’s passive-aggressive attempt to tell Dr Briffa to know his place and shut the f*ck up (“In drawing this correspondence to a close”). This has a technical term in Formal Rhetoric: Being a Complete Arsehole.

  11. Anne 9 August 2013 at 8:02 am #

    I wrote: “It’s shocking that the BHF supports products containing trans fats”.

    Christopher wrote “Trans fats exist throughout nature, so I wouldn’t go that far. However, artificial trans fats appear to be unhealthy.”

    The trans fats in these sterol/stanol spreads are artifical trans fats Christoper ! It is how they make the spread thick and not runny, that’s why I asked Benecol if they contained trans fats !

  12. Anonymous 9 August 2013 at 8:05 am #

    Anne,

    We know trans fats are bad, however it is quite surprising how PR machines work to convince us what it healthy/natural. For instance, did you know that butter contains more trans fats than margarine spreads?

    If you want to check this it can be found here:
    McCance and Widdowson’s (eds.) The Composition of Foods. Royal Society of Chemistry; 6th Summary ed. edition (October 29, 2002)

  13. Dr John Briffa 9 August 2013 at 8:22 am #

    Anonymous

    The chemical structure of naturally-occurring trans fats is generally not the same as those that are industrially produced ones, and epidemiological evidence suggests that the health effects are not the same either: industrially produced ones are linked with increased cardiovascular disease risk but the naturally occurring ones are not. See:

    Jakobsen MU, et al. Intake of ruminant trans fatty acids and risk of coronary heart disease. Int J Epidemiol. 2008;37(1):173-82

    and

    Bendsen NT, et al. Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies. Eur J Clin Nutr. 2011;65(7):773-8

  14. NM 9 August 2013 at 8:24 am #

    Anonymous: I’m sure Unilever would be delighted with your straw-man; sadly, however, the transfats in butter are different from the artificial transfats produced in hydrogenation. The body has evolved to process the former, but not the latter.

  15. Dr John Briffa 9 August 2013 at 8:28 am #

    NM

    Yes, I don’t want to come over all ‘conspiracy theorist’, but I’ve found it pays to be wary of ‘anonymous’ posters spreading misinformation.

  16. Loren Grant 9 August 2013 at 8:31 am #

    I am not surprised ….the BHF like its US counterpart seems to be more and more a front organisation for the food industry. In the teeth of all the contrary evidence they persist with the fantasy that whole grains are ‘heart healthy’ and that saturated fat causes heart disease.

  17. Stephen 9 August 2013 at 8:37 am #

    As is the case with a number of health related charities there seems to be so much vested interest from influential parties that frankly it appears they will do anything to obfuscate the truth. I have never understood alongside selling secondhand furniture and tea towels why the BHF don’t spend more effort on education and prevention of heart disease. Of course the cynic in me would say this does not follow the money.

    Thank you Dr Briffa for engaging with BHF on behalf of a growing number of us who want BHF to listen and take note of new important scientific findings.

  18. William L. Wilson, M.D. 9 August 2013 at 9:04 am #

    John—I suspect when you were a young lad in the classroom the teachers dreaded having you in the classroom. As my attorney always says, you certainly do know how to “slice and dice” them with your words. Nice job!

  19. Michael Allen 9 August 2013 at 9:32 am #

    Thanks for your efforts on behalf of those of us who don’t have the necessary science to make sound judgements. The response you received is depressing but unfortunately not at all surprising.

  20. Jennifer 9 August 2013 at 9:34 am #

    John, many thanks, yet again.
    Having jumped off the polypharma bandwagon earlier this year, as previously posted by me, I am enjoying splendid health and vitality! This is due to:-
    1) reading your book, and loosing 2 stones.
    2) educating myself about nutrition by reading links from this and other forums.
    3) throwing away the out-moded dietary and pharmaceutical advice of my GP.
    4) educating myself about type 2 meds, statins and antihypertensives, and by introducing changes to my lifestyle and food intake, thus safely eliminating them all.
    My personal, anecdotal story doesn’t stand a cat in hell’s chance of influencing the powers that be. When such eloquent, convincing research is being ignored by influential organisations, how on earth are we going to improve the health status of the majority?
    But of course, improving health status by free, natural methods, would deeply affect the financial status of all the vested interests making a mint by their promotion of dubious medications and “food”.
    Please keep your efforts going.

  21. Liz Smith 9 August 2013 at 9:54 am #

    With all the talk about the salaries of the charity chiefs in the paper, I wish we could publicise the amount of drivel that the public are brain washed with. Perhaps people will not subscribe to the requests for money.

    Prof Weissberg obviously heard the saying when he was a lad, “when in doubt, keep your gob tightly shut!”

  22. Faye 9 August 2013 at 10:28 am #

    Unilever and the BHF have such a strong influence. A few years ago, when I attended the Whittington for a regular (underactive) thyroid appointment, my cholesterol was towards the higher end of normal. Almost the first thing the doctor said was “What do you have on your toast in the morning, butter or margarine?”. When I answered “neither”, she paused for a moment, said “oh” and then carried on with a 5-10 minute monologue about how important it was that I should use cholesterol reducing margarine in my diet and also listing foods I shouldn’t eat, including eggs. At the end she asked “Well, what do you have on your toast?”. I told her I rarely had toast. Fortunately I knew enough about margarine in general not to want to use it and I certainly didn’t feel comfortable with the thought of eating cholesterol reducing margarine.

  23. Sandy 9 August 2013 at 10:45 am #

    “Follow the money!!”
    Sponsors have long recognised that a charity will not “bite the hand that feeds them.” Tthe charities are “independent” as they are seen to have many sponsors with no strings attached. Even if they do not endorse a sponsor they will not actively disagree with the sponsor’s poition which comes down to the same thing.
    Advice is to take any medical charity recommendation with an extremely large pinch of salt.

  24. Sheulee Roy 9 August 2013 at 12:42 pm #

    Thank you for taking the time, again and again and again…
    Hilarious passive aggression, reminded me of Alan Statham in Green Wing, somewhat unwilling simply to answer the question.
    Something has got to give. I was cheered to see the Carbloaded website and film exist. Perhaps, just maybe, it will have significant reach to challenge those profiting from pushing processed foods. And their blinkered pals.

  25. Laturb 9 August 2013 at 1:20 pm #

    Look, many, many ‘health’ charities are not at all interested in facts that question their ideology. For them the sick and dying equal profit. The last the thing they want to see are educated and healthy people making their own lifestyle decisions.
    Keep up the great work.

  26. Veronica Lacaille 9 August 2013 at 2:08 pm #

    Your Canada example is not entirely correct. I believe that Health Canada has recommended against, but not banned it. Just last week I noticed “added plant sterols” advertised on my hubby’s OJ. (Not that I drink processed OJ.)

  27. Dr John Briffa 9 August 2013 at 2:32 pm #

    Veronica

    The Health Canada comment refers to a time when, indeed, this body disallowed plant sterols in food. This decision was overturned around 2009/2010. It’s a bit difficult to find out how this about-face came about and the basis for it, because the last time I looked, it seemed as though prior information about the ‘ban’ had been erased.

    I have no idea if or to what degree industry was involved in the changing of the policy.

  28. eddie watts 9 August 2013 at 2:58 pm #

    and why are they raising awareness in women alone? why not men?
    what is more annoying is that women do not benefit from cholesterol lowering, at least men seem to get some benefit from it even if it (almost certainly) comes from something other than the actual cholesterol lowering.
    thank you for this

  29. Janet Mitchell 9 August 2013 at 5:14 pm #

    Could it be they are appealing to women more, because generally it is women that do more of the shopping ! Sorry guys but I think this is true.

    Please note I would not touch Flora margarine with a 10 foot pole let alone have it in my kitchen

    All the best Jan

  30. helen 10 August 2013 at 5:47 am #

    Seems the folk at BHF have the same disease as their counterparts in Australia …head in sand-itis.

  31. Ted Hutchinson 10 August 2013 at 8:42 am #

    Perhaps the reluctance to fund longer term trials of plant stanols can be found here?l
    Plant stanols induce intestinal tumor formation by up-regulating Wnt and EGFR signaling in Apc Min mice.

  32. Dr McD 10 August 2013 at 9:26 am #

    I am dismayed by Peter Weissberg’s lazy and dismissive reply to your well researched arguments and his premature attempt to close any debate. As a fellow academic, I consider his level of response to be inadequate and that he needs to be prepared to engage in scientific debate. Reading his CV I see that his Chair (professorship) has been sponsored by BHF since 1994 and, to quote him, the BHF has ” supported me through most of my career”.
    Could he perhaps be unwilling to bite the hand that feeds him?

  33. steve 10 August 2013 at 9:39 pm #

    Plant sterols are absorbed, but do not in meaningful amounts unless one is a hyper-absorber or suffers with sitosterolemia stanols are not. Stanols can be helpful in getting to LDL-P goal which appears to be more meaningful in CAD risk than LDL-C

  34. William L. Wilson, M.D. 11 August 2013 at 1:21 am #

    Jennifer:

    Go for it. You are the future.

  35. Christopher Palmer 11 August 2013 at 9:10 am #

    Historically the medical profession have preceived women to have a reduced risk of heart disease when compared to men, and the differences may arise because the hormonal distinctions may be a benefit to females.

    Janet Mitchell may be correct about them targetting the fairer sex who may do most of the shopping and who may make the decisions about what goes in the cart, but I think women now represent a maleable market for the vendors to traget. Their minds have been massaged for around two decades now, by print media that delights in dishing out nonsensical advice.

    From a commercial perspective the makers of this cr4p see the market for males as being mature, whereas the market for women is less mature and has greater scope for development.

    The BHF and Peter Weissberg have now overlooked former medical perceptions about women and the reduced risk of heart disease, and they have done so in their enthusaims for talking up the market for ‘prevention’, be that for cholesterol lowering pharmacuticals or cholesterol reducing functional foods.

    I’ll make a prediction. If women heed this advice in increasing numbers and become more cholesterol aware then the outcomes will be increased incidence of cancers, multiple sclerosis, Alzheimers, and other conditions in females. The other health ‘charities’ stand to gain from this too.

  36. John Mason 11 August 2013 at 10:46 am #

    Its difficult to get a man to understand something when his salary depends upon his not understanding it.

  37. Gregory Barton 11 August 2013 at 11:26 am #

    Dr B. Thank you for exposing this epic scandal.

    At first I couldn’t believe that the BHF was recommending a potentially dangerous product. Nor could I believe that they are in cahoots with Unilever. However, a little googling revealed that your claims are, indeed, correct.

    “In combination with a balanced diet, eating foods that provide you with 2-2.5g of plant sterols or stanols every day can have an additional cholesterol-lowering benefit.”
    http://www.bhf.org.uk/heart-matters-online/march-april-2013/medical/ask-the-experts/stanols-and-sterols.aspx

    and,

    “The good news is that we’ve teamed up with Flora pro.activ to raise awareness of heart disease amongst women and get more women thinking about how they can help reduce their risk with simple lifestyle changes such as lowering cholesterol through diet.

    As part of our partnership Flora pro.activ will donate £750,000 over the next three years in support of our life-saving work.”
    http://www.bhf.org.uk/get-involved/how-your-company-can-help/flora-proactiv.aspx

    The BHF needs to be sued.

  38. Robert Park 12 August 2013 at 11:02 am #

    The mention of plant sterols reminded me that Dr Terry Wahls cured herself of MS through diet that contained large amounts of vegetables, especially the dark green variety. I attempted to follow her recommendations but could not consume anything close to the amount she was taking and, oddly, began to suffer from unusual and unpleasant bowel movements. I soon abandoned her recommended diet but it took weeks to recover from this adverse-like side effect. This may not have any connection to plant sterols but I am certain that we humans are not intended to eat like rabbits.

    See: http://www.youtube.com/watch?v=KLjgBLwH3Wc

  39. dave P 12 August 2013 at 6:57 pm #

    Well Dr Briffa according to todays Express it would seem you have some justification – Well Done !

  40. Bronwen 16 August 2013 at 6:59 pm #

    Cows fed on grass produce milk containing healthy trans-fats, including CLA. (Personally, I am entirely devoted to Irish butter, no doubt stuffed with trans-fats of the superior sort).
    Now here is the kicker …………. human breast milk, which contains a higher proportion of fat than does cow’s milk, also contains trans fats of the superior sort. But human breast milk does not contain sterols, nor does it contain hydrogenated anythings.
    Butter is good and breast is best.

  41. Ed Terry 18 August 2013 at 2:51 pm #

    Another interesting article in Lipids, Vol. 35, no.3 (2000), “Influence of Sources of Dietary Oils on the Life Span of Stroke-Prone Spontaneously Hypertensive Rats” looked at the effects of the life span using varying dietary fats.

    At the end of the Abstract, it states that “These results suggest that the fatty acid profile of vegetable oils plays no important role on the life span of SHRSP rat. However, phytosterols
    in the dietary oils and in liver and brain were inversely correlated with the mean survival times,indicating that the differential effects of vegetable oils might be ascribed, at least
    partly, to their different phytosterol contents.

    The phytosterols seems to affect the red blood cell membrane stability. Makes sense since cholesterol is the preferred sterol when building RBCs.

  42. Christopher Palmer 21 August 2013 at 7:50 pm #

    “Makes sense since cholesterol is the preferred sterol when building RBCs”

    How right you are, and isn’t it all too easily overlooked that cholesterol is itself a sterol, but it is evidently a sterol with a distinction and a distinguished place in biology, generally embraced by the biology and physiology of the ‘fleshy’ species, while the photosynthesising and ‘leafy’ species residing in the lower echelons of the food chain have little need of cholesterol and make do with less sophisticated plant sterols.

    Cholesterol is the primary foundation molecule from which the steriodal hormones are formed, and the sex hormones of mammals and ‘us’ all belong to the class of steriodal hormones. so the distinction between run of the mill plant serols and cholesterol could be a component of any explanation as to why mammals, perhaps, have more interesting – certainly more ‘satisfying’ – sex lives than your average cabbage.

    Our relationship with cholesterol is almost certainly one we ought to class as adaptive, which is why dietary cholesterol can be passed from guts to body. The fact that our guts tend to reject plant sterols and stanols to have them passed out with stools suggests that the relationship with plant serols and stanols is maladaptive.

    The makers of these so-called functional foods with added stanols and sterols claim they work becuase some of the dietary cholesterol that would other wise be absorbed is rejected and passed out with the stools in asscoiation with sterols or stanols. The claims are that plant sterols and stanols tend to block the absorbtion of cholesterol. The discriminating aspect of this gives the clue to the lie.

    The guts discriminate because we do not have an especially adaptive relationship with plant sterols or stanols, but we have such an adaptive and agreeable relationship with cholesterol that we can sythesize all the cholesterol we need even if there is none present in the diet. The greater majority o cells can synthesise cholesterol, although the cells of the liver are deeply involved in the synthesisng, cycling, and recycling of cholesterol.

    The structural integrity and stability of cell memebranes matters, for one they are strikingly comprised of lipophiles (fats) which helps to contain an otherwise predominantly hydrophilic environement within. Second memebranes muist be flexible and semi-permeable sotheat they can permit passage of the things (metabolites etc) that should pass through the membrane, while denying passsage to the things that should not. The degree of permeability is a balance of homestatsis in one sense and dynamic in another, and it is crucial to well-being and orderly function. If any lipids or lipophillic types undermine this integrity and stability resident in the membrane(s) the security of the cell(s) is(are) placed under significant risk and threat.

  43. Greengoddess 23 August 2013 at 3:56 pm #

    British Heart Foundation, on their website nutrition section, also provide a helpful (!) link to the British Nutrition Foundation whose founding partners include – Tate and Lyle, Walkers Crisps, Kelloggs, Coco cola and ABF foods, who boast they are the world’s second larger sugar producer http://www.abf.co.uk/. The delight they experience in this market is pictured on the front of their 2012 interim report.

    In this context one can easily see why the BHF dietary advice is to fill up on carbs. Their entire section on healthy eating is contrary to the evidence on weight loss and CVD prevention.

    Sadly, the great British diet and general attitude to taking little responsibility for ones health is underwritten and promoted by the producers and endorsers of toxic junk……and I have little optimism that this will change.

  44. Richard 5 September 2013 at 1:54 pm #

    Way to go Dr Briffa, another great example of the rubbish the general public are being fed ;-). Unilever’s reach is far and wide, they must be feeling the pressure and drop in sales!

    keep up the good fight,

    Richard

Trackbacks/Pingbacks

  1. British Heart Foundation’s medical director supports use of statins with data that doesn’t support the use of statins | Dr Briffa's Blog - A Good Look at Good Health - 30 December 2013

    […] However, this piece in the Times also quoted sources from charities that are wholehearted supporters of statins. One source is Professor Peter Weissberg, the medical director of the British Heart Foundation (BHF). Back in August, I had a personal exchange with Professor Weissberg, when asked him to validate the BHF’s support of the use of sterol-enriched foods in the diet. I pointed out that not only was there no evidence of any health benefits for such foods, there was also considerable evidence that sterols might have adverse affects on health and wellbeing. It didn’t take long for Professor Weissberg to disengage from the subject, and you can decide for yourself whether this man’s medical opinion is trustworthy by reading the exchange I had with him here. […]

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