Some studies have such a peculiar design that it makes one wonder who provided the money to conduct the study.  Why would anyone seriously design a study to compare margarine containing a plant sterol additive with a Mediterranean diet? Why not study the effects of the plant sterol additive directly, and compare it with other additives in reducing cholesterol?  I was attracted to it because it shows that even after only four months, the Mediterranean diet lowers cholesterol, but a good study on plant sterols wouldn’t even need a Mediterranean diet group. It was a fairly inexpensive study, only 150 people over four months, and that didn’t give them much time to get into the benefits of a Mediterranean diet.  But this study design gives the margarine people a great big marketing advantage. A serious study of plant sterols compared to other food additives might sell more plant sterol additives, but not more margarine.

The article was about lowering cholesterol and ultimately about decreasing risk of cardiovascular disease. The key variable of interest was phytosterol additives (plant sterols). The study was conducted by V.G. Athyros, MD, of Aristotelian University in Greece, with seven co-authors, and was published in Nutrition, Metabolism & Cardiovascular Diseases in Nov. 2009. The researchers tested the participants who had mildly elevated cholesterol levels. Participants were assigned to a placebo group with a spread containing no additives, or to either a Mediterranean-style eating plan or a phytoesterol (a margarine with phytosterols added) plan.  By the end of the four months the Mediterranean diet group reduced risk based on cholesterol reduction by 24% to 32% and the phytosterols reduced by 26% to 30%.  (No reduction in the Placebo group). So the company that makes the margarine is touting that eating the margarine with phytosterols is just as good as eating the Mediterranean-style (real food) plan.

The conclusions of the researchers and the comment by the Tufts University Health and Nutrition Letter is:  “if you can’t stick to a Mediterranean-style eating pattern- which, ironically, more people in Mediterranean countries are drifting away from – foods enriched with phytosterols might be the next best thing.”  At least in the conclusions they didn’t put in a word for the margarine sponsor.

Because this is such a weird study, inserting margarine of all things in the middle of a study on the effects of phytosterols, I decided to take a moment to clarify and share my thoughts.

• Plant sterols are fairly natural ingredients – they are taken out of plants, and concentrated amounts were put into the margarine as an additive.
• Plant sterols do not require margarine as a delivery vehicle; you can obtain them in any number of ways; even, of all things, by eating plants.
• The margarine itself contains some saturated fat made by forcing hydrogen into vegetable oil – partially hydrogenated oil.
• Is the public being lead to believe that they can continue to eat the same way that gave them elevated cholesterol (plus other problems not studied), and solve it by spreading some margarine on their toast with a plant sterol additive?
• Should the public rely on the plant sterol margarine to do all the things that a Mediterranean diet can do for them?
• Eating the whole real foods of the Mediterranean-style plans, in addition to lowering cholesterol, also helps to control for weight management, which is a separate issue related to heart disease and cancer. I don’t think that even the margarine company believes that any additive can create a ‘super’ margarine that will help people accomplish weight loss.
• Fruits, oats, barley, dried beans, are all foods that are encouraged on the Mediterranean-style of eating; they all contain soluble fiber, which helps to reduce cholesterol naturally.
• Extra virgin olive oil one of the key ingredients of the Mediterranean-style of eating is an entirely separate mechanism that helps with heart health – zero olive oil in the margarine.

I’m thinking that there are numerous benefits from eating a Mediterranean-style plan besides just lowering cholesterol. I’m quite confident that adding sterol-enriched margarine to your American-style eating plan will not equate to optimal nutrition. There’s more to fruits, vegetables, whole grains, fish, nuts and legumes, extra virgin olive oil; the reduction of meats, cheese, saturated and trans fats, than just the reduction of cholesterol. The nutrients in the foods have hundreds of benefits in addition to the net reduction of cholesterol – we are only scratching the surface of learning what these benefits are.  We are learning of new studies, every single week that support moving toward real whole food.

I’m just worried that we Americans can’t get out of the desire for a quick and easy end to serious problems that have been created over decades. It doesn’t make sense to me to continue eating in a manner that may be more challenging for your body to maintain a lower mass, and think that we can slather on an “enriched” margarine, that will take care of everything.

It reminds me of the same concept that has kept the supplement industry afloat for so many years – ‘if you can’t eat right just take these supplements’. But of course, we’ve now learned that there are thousands of phytonutrients (plant nutrients in whole grains, fruits and vegetables) that are not in supplements. And study after study, shows that taking a specific supplement does not equate to eating real foods.

When I think of the proposal ‘if you can’t eat a Mediterranean-style diet, then the super margarine can do the job’ – I have day-mares (nightmares, in the day-time). Visions of white flour biscuits (made with saturated fat shortening) topped with ‘super’ margarine); toasted cheese sandwiches (sat fat cheese inside, with ‘super’ margarine on the outside of the bread for grilling; bacon and egg breakfast, with ‘super’ margarine on the toast ……. I need to stop because it’s making me too sad.

Yes, it is true that educating and helping the public inch along the path to healthy living is not magical – it’s hard work for individuals to learn to cook differently – a big commitment, to leave behind their white bread, meat and cheese, but I believe that the Mediterranean-style of eating has the potential to offer far more than a quick reduction in cholesterol, with no evidence that it persists after four months. I’ve not read that ‘super’ margarine can help reduce diabetes risk, cancer risk, or the other many benefits of real food as evidenced repeatedly in studies of the Mediterranean-style of eating. Nutrition can be yummy, as shown in this Cinco de Mayo Mango Salsa recipe.