by Marion Nestle
Aug 23 2011

New study: healthy diets produce health benefits

The latest issue of JAMA has a paper on a “portfolio” of dietary means to reduce blood cholesterol levels.

The paper is likely to get lots of press because it concludes that consuming the “portfolio”—a combination of plant sterols, soy protein, viscous fibers, and nuts—does a better job of lowering LDL-cholesterol (the “bad” kind) than does dietary advice to reduce saturated fat.

The paper is unusually difficult to read  (see the Abstract, for example).  But besides that, I interpret the study in part as a drug trial.

One look at the Abstract and I immediately suspected that this study must have been sponsored by a maker of plant sterol margarines.


Plant sterols are well established to reduce blood cholesterol levels.  Unilever, which makes Take Control margarines, is one of the sponsors.

As I interpret it, the study shows:

  • Advising people who weigh an average of 76 kg (167 pounds) to consume a healthy diet doesn’t work.  Study subjects did not change their diets by much during the six months of the trial.  No news here.
  • Advising people to add things to their diets has a better chance of succeeding than advising taking things away (like saturated fat).
  • All of the portfolio items have been established to lower blood cholesterol in clinical trials, although the evidence for soy protein seems a bit iffy these days.
  • The study does not distinguish between the relative effects of soy protein, fiber, or cholesterol lowering margarines. If soy is eliminated, that leaves fiber and margarines. I’m guessing the margarines were the critical factor. Hence: a partial drug trial.

And because my book on calories is coming out next March, I must point out that the study groups reported losing  losing small amounts of weight, which means they must also have reduced their calorie intake.  Weight loss alone should help with blood cholesterol.

The take-home message: if you really do substitute nuts, sources of fiber, and healthy foods for whatever less healthful foods you used to eat, you ought to get some health benefit, with or without plant sterol margarines.

QED: Healthy diets produce health benefits.

It’s always nice to see that confirmed.



  • Margeretrc

    First, kudos for pointing out that the study was backed by a commercial interest, making it suspect from the get go. However, the rest of your article is disturbing. Correct me if I’m wrong, but it seems you (and the people who conducted the study are assuming that lowering cholesterol is a healthy thing to do. But that has not been proven, by any stretch. There are at least as much data showing an association between higher cholesterol and reduced mortality as there is the opposite. For all we know, higher cholesterol is a symptom of something else that is causing CVD, not the cause. People die of a heart attacks who have low or average cholesterol as well as do some who have high cholesterol. Lowering cholesterol, whether by diet or drugs, is like treating the symptoms of a cold or flu and expecting the virus itself to be banished by the drugs. Is there any data from the above study that lowering cholesterol led to any other health benefits, such as reduced CVD? Was it even a clinical trial at all? As to LDL being “the bad cholesterol”, that, too is unproven. At least one clinical trial whereby LDL was lowered using drugs showed no significant difference in CVD or mortality from placebo group. There is more than one kind of LDL–big and fluffy, which comes from sat. fat in the diet and is harmless and perhaps even beneficial, and VLDL, which comes from carbohydrates in the diet and is, indeed, implicated in the formation of plaque and CVD. We need to stop pointing the finger at a substances that is a critical part of our make up and critical to health, particularly as science has failed miserably to show any causative relationship between it and CVD, and look at other possible causes. We are wasting a lot of time and money chasing down an alley which has already been shown to be blind and need to reverse and change direction!

  • Albert E.

    Academics, having once published a position, will never “reverse and change direction”, even though that might be the sensible and ethical thing to do. Nope, they usually die fighting for their obsolete pet opinions. That’s why it takes a couple of generations to advance scientific thinking on any front. Cholesterol and salt are two issues waiting for the old farts to finish dying off so meaningful thought and research can commence in earnest. Some universities, like NYU don’t even try any more to advance science…or even respect it — just foment pop science to pull in donations and sell books. Private corporations are left to do the progressive research.

  • Mitzi

    As a person married to a salt-sensitive hypertensive and getting a Ph.D. in biochemistry, I can say the long-standing medical consensus that diets high in salt and cholesterol contribute to heart disease still stands. Have you ever seen the videos of surgeons pulling strands of fatty material out of blood vessels? Seen a platelet-separating machine clog with fat from a man’s bloodstream? Declines in prostate cancer death since 1994 have been linked in some circles to the spread of statins (lower cholesterol limits cell growth), not the cancer treatments themselves. A diet low in junk and high in fruits, vegetables, whole grains, legumes, nuts, and seeds has cured long-standing digestive problems for me. Meat, even if grass-fed, brings problems back. As for the salt, as the cook of the house, I can adjust my husband’s BP by 20 points each, systolic and diastolic, merely by salt content of food. Corporations trying to justify foisting stroke promoting crap on people (now with immune support!) aren’t doing “progressive” research. Real nutrition isn’t progressive or sexy or profitable. It’s what my grandmother told me to eat as a kid-veggies, fruit, and “roughage”, with a treat of nuts and chocolate now and then.

  • Anthro

    Thank you Mitzi!


    @Albert E. (Ah, the pseudonym of the day from our resident troll). We are well aware that you hate science, NYU, and public health professors, so why not stop wasting space–literally and figuratively?



    citations please? You make some strong assertions that are not backed by the preponderance of evidence as I get it from my cardiologist.

  • Benecol brand was invented by Raisio in Finland and is marketed by Raisio or its allies. Unilevel does not own or market Benecol. Benecol and Take Control, or pro.activ in Europe, are competitors in fact.

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  • Anthro

    I am seeing this study touted all over the web as “evidence” that “X” is better than lowering saturated fat.

    Too bad these articles are not accompanied by a link to this post.

    Since consuming these margarines really amounts to taking a drug (as you point out), I think I’ll stay with my low-dose statin as well as my “eat good food, not too much, mostly plants” diet plan.

    (My cholesterol is normal since I lost 45 lbs; I take the statin to keep my levels extra low as early onset heart disease runs in my family.)

  • Well, I will start by saying that I am as laymen as they come…HOWEVER, I have read a ton of books about fat, why we get fat, food, cholesterol, sugar, insulin, blah-blah-blah and I have come to this conclusion…
    Could it be possible that there is not a one-size-fits-all approach to diet and nutrition? Could it be that some people benefit from low-fat diets while others from high protein diets?
    Am I an idiot? I don’t know. All I know is that I only feel really crappy *and gain weight* when I eat a lot of dairy and refined starch/sugar. If I avoid those things, I feel great. Could it be that the overly refined “health foods” high in fiber, low in fat but made in a factory could be contributing to “western diseases”? Could it be that there is MONEY to be made and thus we will be forever kept in the dark?

  • Jon

    One aspect of it is that of course they’re going to say “healthy diet WITH OUR PRODUCT versus unhealthy diet without our product”. It’s no different than the 19th-century skull-measuring, comparing white men to black women, and northern European skulls to Peruvian skulls. (Taller people have bigger skulls.) Except, while Stephen Jay Gould concluded that these biases were unconscious, I have to wonder in the case of corporate health studies.

  • Tonysolo

    Anthro, pretty cool that you have a cardiologist who provides you with citations.

    Anyhow, see here for a review of the research:

    25-to-4 strikes me as a preponderance, wouldn’t you say?

  • Margeretrc

    @Anthro, Lets see, citations; “Fat and Cholesterol are good for you”, Uffe Ravnskov, M.D., “Good Calories, Bad Calories”, “What if it’s all been a Big Fat Lie” (a New York Times article), “The Soft Science of Dietary Fat”, (an article in Science) and “Why We Get Fat”, by Gary Taubes, “Know Your Fats”, Mary Enig, PhD,, “The Great Cholesterol Con”, Malcolm Kendrick, M.D., “Statins and the Misguided War on Cholesterol”, Duane Graveline, M.D., These are just some of the books and articles I’ve read that have led me to believe that we’ve been misled. It all started with a fraudulent “study” by Ancel Keys, where he cherry picked 6 or 7 out of 22 countries for whom data was available to show an association between sat. fat, cholesterol, and heart disease. If you take all 22 countries, there is no association between cholesterol or sat fat and heart disease. There is an association between sugar consumption and heart disease. But associations/correlations, even when present, don’t prove causation, but the “experts” seem to have ignored that little detail for decades.
    @Mitzi, “Have you ever seen the videos of surgeons pulling strands of fatty material out of blood vessels? Seen a platelet-separating machine clog with fat from a man’s bloodstream?” No, I haven’t, but I don’t doubt that it occurs. However, pulling strands of fatty material out of a blood vessel or seeing a platelet machine clogged with fat from a man’s blood stream is far from proof that that fat came from the fat or cholesterol the person ate! It fact, it could have come from polyunsaturated vegetable oils he ate (autopsies have shown that plaques contain a lot of polyunsaturated oils) or the sugar and starch he ate (insulin converts glucose from sugars and starches into triglycerides, which are carried in Very Low Density Lipoprotein particles, which are, indeed implicated in plaque formation. None of the cholesterol or fat we eat goes directly into the blood stream as is. That is a total myth. We make cholesterol (from glucose–surprise!) as needed and then use it in making cell membranes, hormones, and sundry other necessary structures and substances, including vitamin D. “Declines in prostate cancer death since 1994 have been linked in some circles to the spread of statins (lower cholesterol limits cell growth), not the cancer treatments themselves.” The key words being “linked in some circles”. Again, linking does not prove a direct connection. Read any of Duane Graveline’s books for some serious downsides of taking Statins. If the clinical trial data showed that benefits outweighed negative side effects, perhaps it would be worth it, but the NNT for most Statins is 100 or more. That, to me, is not even close. And that is only for men under the age of 55 who already have heart disease. No benefits have been shown for any other group.

  • MargaretRC

    @anthro, I submitted a comment with a long list of citations, but I don’t see it. If it doesn’t show up after a bit, I will repost.

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  • Kat

    @Margeretrc, I am compelled to point out your misguided and entirely incorrect statement:

    “None of the cholesterol or fat we eat goes directly into the blood stream as is. That is a total myth. We make cholesterol (from glucose–surprise!) as needed and then use it in making cell membranes, hormones, and sundry other necessary structures and substances, including vitamin D. ”

    May I recommend an excellent text, widely used in upper division colleges/universities and some medical schools when teaching Biochemistry/Metabolism. This book is available on Google Books, nearly in its entirety and is very well-written:
    Lippincott’s Illustrated Reviews: Biochemistry, 4th Ed.
    Please read Chapter Chapter 15 beginning on pg 173 and Chapter 18 beginning on pg 219) to clear up your incorrect information on lipid & cholesterol metabolism. I recommend this book for anyone who wants to do a little self-teaching of metabolism.

    Also, unless you think that the entire worldwide scientific establishment is in cahoots with [insert your most hated group here], then you would know that the peer-review process and publication in peer-reviewed journals is the ultimate reception for scientific findings. Men’s Health, and other lay publications should not be considered “go-to” sources for health and medical information. Try PubMed instead.

    There’s even this free video from the KhanAcademy giving a nice overview of cardiovascular disease for those interested:

    While I certainly don’t belong in the Eat-All-the-Fat-You-Want gang, I’m also not a low-fat-zelot. Yes, I’m a middle-of-the-roader, not an extremest. We all know that Americans eat too much food and don’t move their bodies enough. Period. Too many calories in, not enough calories out. This makes us fat (over 65% of us, at least). Increased body weight has all sorts of consequences, as we all know. Fat is metabolically active tissue, and if we have excess amounts of fat, we’ll have more of those chemicals impacting our health systemically. We eat too much processed food and not enough REAL food, whole fruits and non-starchy vegetables, etc. Add this to a highly stressed lifestlye, and here we have the perfect fixins’ for a metabolic time-bomb.

    To the dismay of many readers here though, there is no one simple “bad guy” in the battle for human health. It’s not JUST about the saturated fat. Or just about the carbs. Or just about the HFCS. Or just about the inactivity. Or just about the fiber. Or just about the white foods. Or just about genetics. Or just about the way your family ate/interacted when you were little. It’s MANY many factors, and until the common folks understand this, we will continue to have this silly fight over this 16th piece of the pie vs. that 16th piece of the pie.

  • Margeretrc

    @Kat, thank you for your (condescending) comments. I couldn’t find access to the particular Biochem text you referenced, but I was able to find out quite a few sites with information on fat and cholesterol metabolism and my statements stand. Fats we eat are in triglyceride form and cannot be absorbed as such. They need to be broken down into their fatty acid and glycerol components, which can then be used to create ATP or reassembled and stored as fat. Triglycerides are not free floating in the blood stream, but are carried in carriers such as chylomicrons and VLDL. Cholesterol, which–true–does not need to be broken down to be absorbed nevertheless is also not free floating in the blood stream, but carried by the various lipoprotein particles. And from what I could find out, cholesterol can be synthesized from varioius precursors, most prominently Acetyl-CoA, which, if I recall my Kreb’s cycle correctly, (yes, I did study Biochemistry, albeit a long time ago) is a breakdown product of, among other things, glucose. Perhaps it isn’t the only precursor, but it is one.
    And while I don’t think the “entire worldwide scientific establishment is in cahoots with [insert your most hated group here],” I am familiar with the peer review process and know it is not infallible. My sources include a wide variety of sources, not just Mens’ Health. How about Science? Scientific American? I read them, too. Articles get published that shouldn’t and don’t get published that should, so no, I’m not going to limit my research to peer reviewed literature–not that I have access to a lot of it. In most cases, I have to depend on reading, with my critical thinking cap on, literature by people who do have access to the peer reviewed journals, for example Uffe Ravnskov, M.D., Gary Taubes, and Duane Graveline, M.D., to name a few.
    “We all know that Americans eat too much food and don’t move their bodies enough. Period. Too many calories in, not enough calories out.” Perhaps you might want to read Gary Taubes’ “Good Calories, Bad Calories” or “Why We Get Fat” or writings by myriad others with eminent qualifications who show that this view is vastly over simplified and doesn’t begin to explain WHY Americans are eating too much food and getting fat as a result. I don’t dispute that they are eating too much and moving too little–the laws of thermodynamics do apply to humans–but humans aren’t inanimate systems wherein calories consumed and calories expended are independent variables. The whole system is regulated by a myriad of hormones, not the least of which is insulin, too much of which can have a devastating effect on the calories consumed and calories expended. Perhaps it has something to do with the low fat propaganda and the low fat (high sugar and starch) products that have inundated the market ever since it first began its insidious spread through our collective consciousness. Perhaps there are other factors–I’ve only just scratched the surface in my research. But I don’t believe it’s coincidental that the meteoric rise in obseity, T2 diabetes and heart disease in this country and around the western world began right around the time we started getting the message that fat, particularly saturated fat, and cholesterol are bad for us. Food for thought?

  • Plant sterol supplements have never been shown to prevent heart attacks or provide any other health benefits. Unfortunately, LDL cholesterol is a surrogate endpoint and does not always translate into a lower risk of heart disease (e.g., hormone replacement therapy, torcetrapib). So, lacking a large clinical trial in which one group receives plant sterol supplements while the other arm receives placebo and the patients are followed for at least several years to count the number of heart attacks, strokes, deaths, and adverse events, we are left with no real evidence for plant sterol supplements. Personally, I doubt such a trial will ever be conducted.

    I wrote a post on plant sterols last year that summarized the state of the research:

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