Slapping more spread on your bread has never been a prescription for a healthy heart - until now. Benecol, a new margarine containing an ingredient extracted from wood pulp, arrived on supermarket shelves last week and is said to lower cholesterol levels by up to 10 per cent.
The ingredient that does this - plant stanol ester - is also found in soya, wheat, maize and rye. It is a cholesterol impostor, mimicking the structure of cholesterol, but is apparently not itself absorbed. The upshot is a physical block on the normal uptake of cholesterol by the bloodstream, where it may congest arteries and contribute to a heart attack.
The evidence backing Benecol is impressive, enabling the manufacturers to make the on-pack claim 'helps actually lower cholesterol'. One study published in the New England Journal of Medicine showed how subjects in Finland who included Benecol in their daily diet for a year saw their total cholesterol levels fall by one tenth. LDL cholesterol (the 'bad' type that tends to deposit in the arteries) fell by up to 14 per cent whereas HDL (the 'good' type that tends to be excreted from the body) did not change. No side effects were reported.
Raisio, the Finnish company that developed Benecol, say these types of reductions can be expected when two to three servings of the spread are eaten per day. If true, this makes the spread about half as effective as statins, the most commonly prescribed drugs for lowering high cholesterol levels. The obvious difference is that whereas the drugs can only be obtained with a doctor's prescription, Benecol is freely available from the chiller cabinet.
According to Sue Dibb, co-director of the Food Commission, Benecol blurs the line between food and medicine more than ever before. 'We've already got so-called "functional foods", but this is the first product to specifically target a segment of the population with a particular disease risk factor. Shouldn't this mean that it should be available from the pharmacy, not the supermarket?' she asks.
Dr Andrew Salter, nutritional biochemist and cholesterol expert at Nottingham University's Faculty of Agriculture and Food Sciences, says we've got to take seriously anything that potentially gets cholesterol levels down. But he admits to some niggling safety doubts. 'There's no evidence that these compounds aren't safe, but they haven't had to go through the same sorts of procedures as would be necessary for a pharmaceutical agent.' Raisio argue that over 200,000 Finnish consumers have been eating their product without ill effect for the past three years. Advocates of the spread also point out that heart disease kills nearly 100,000 Britons under 65 each year.
'It is estimated that by reducing cholesterol levels by 10 per cent, you reduce the risk of heart attack by 20 per cent,' says Professor Gilbert Thompson, medical consultant to McNeil Consumer Nutritionals Europe, the subsidiary of Johnson & Johnson that distributes Benecol.
Benecol is targeted at middle-aged men who may not have a high enough cholesterol level to warrant drug treatment, but for whom moderately raised levels are still a risk. The margarine is meant to replace other fat-based spreads in the diet, and it definitely shouldn't be considered an alternative to a healthy balanced diet or a healthy lifestyle.
'Benecol only addresses one risk factor for a multifactorial disease,' says Amanda Wynne of the British Nutrition Foundation. 'Probably the most effective ways of reducing heart disease are to give up smoking and be more physically active.' But what about eating the margarine if your cholesterol levels are normal or even low already - could reducing them further do you any harm? According to most experts, this worry is probably unfounded. 'In the situation of dietary cholesterol deprivation the body simply boosts its own internal production to compensate,' says Helen Yates, a state-registered dietician who promotes Benecol. The body produces its own cholesterol - enough to maintain good health. Research of a couple of years ago suggesting a link between low cholesterol, depression and suicide has subsequently been debunked - not least because of evidence from Japan, where cholesterol levels stay far lower than those in the Western world without any ill effect.
Nevertheless, the Government's Food Advisory Committee (FAC) and the Advisory Committee on Novel Foods and Processes (ACNFP) both state that products containing stanol ester are 'not nutritionally appropriate for young children and breast-feeding women'.
According to the FAC, it's up to GPs, other health professionals and the media to inform consumers of this fact. But in practice it's much more likely to be simple economics that guards against the inappropriate use of this new food-medicine hybrid: at up to £2.49 for a 250g tub, it's five times more expensive than most other branded spreads. The irony is that those most likely to benefit from Benecol - low-income groups with the highest prevalence of heart disease - are those least likely to be able to afford it.
The fat file
Cholesterol is manufactured by the body and is also found in offal, eggs and shellfish.
Small amounts are required for the manufacture of sex hormones, vitamin D and bile.
70 per cent of Britons are estimated to have a level above the desirable maximum.
The dietary component with the biggest impact on cholesterol levels is saturated fat.
Scientists now think it is oxidised cholesterol that clogs arteries. Eating fruit and veg helps mop up the free radicals that promote the oxidation process.
Slightly raised levels shouldn't worry people with healthy lifestyles and no family history of heart disease. Groups most at risk are post-menopausal women and men under 65.
