You Ask, I Answer: Butter or Margarine?

I am concerned with heart health (I am on a statin), so am I better off with grass-fed butter (paying attention to portion control) or a "Smart Balance" type, trans-fat-free margarine?

-- Greg (last name withheld)
(city withheld), IA

In your case, I highly recommend using a trans-fat-free margarine (or a vegetable oil-based spread, like Smart Balance) fortified with phytosterols.

Clinical trials have shown that adding 2 grams of phytosterols a day to the diets of patients on statins results in lower total cholesterol levels than statins alone.

Each tablespoon of Smart Balance provides 80 calories and 0.5 grams of phytosterols. This means it takes 320 calories to get your suggested phytosterol intake.

I mention this because it is important to remember that waist circumference is the best predictor of heart disease risk.

Bottom line -- you still need to be mindful of calories, no matter what type of fat you are spreading on your toast.

I have come across a fair number of people who inaccurately think the 20 or 30 extra pounds they are carrying on them are no longer a threat to their health since they are on statins. Not so!

You Ask, I Answer: Phytosterols

Can you tell us more about this phytosterol fad I'm seeing lately in yogurt and multi-vitamins?

What are phytosterols and why do we need them?

Don't we just get them from eating vegetables?

Why would we need a supplement?

-- "gd"
Via the blog

Whereas cholesterol is a sterol (that is a steroid with an alcohol group attached, for any chemistry geeks out there) essential in maintaining cell structures in animals, phytosterols play the same role in plant foods.

Not surprisingly, cholesterol is found only in animal products (meats and dairy) and phytosterols are exclusive to plant foods.

The term "phytosterols" is actually an umbrella one that includes sterols (the three main ones being beta sitosterol, campesterol, and sitgmasterol) as well as stanols (naturally occurring plant compounds.)

Clinical research has determined that 2 grams of phytosterols a day help reduce LDL ("bad" cholesterol) levels by as much as 20%.

This is due to the fact that they compete with cholesterol for absorption in the digestive tract.

There are a few caveats, though.

Although phytosterols are present in plant foods (mainly nuts, seeds, and their respective oils), you need a LOT of calories to reach that 2 gram (2,000 milligram) goal.

For instance, 2 tablespoons of peanut butter contain 55 - 60 milligrams, and an ounce of pistachios adds up to roughly 35 milligrams.

And so came the development of functional foods (mainly yogurt drinks, like Promise Activ, and vegetable spreads) with high amounts of phytosterols added in.

Advertisers were in hog heaven -- now many of their products could be advertised as "cholesterol lowering."

However, phytosterols have only been proven effective in people with high cholesterol levels.

In other words, I don't see any reason why someone with a normal cholesterol profile would need to start consuming 2 grams of phytosterols a day.

Additionally, even people who benefit from their consumption need to realize that this is another situation where more is not better, since phytosterols interfere with the absorption of fat-soluble vitamins (A, D, E, and K) and compounds like lycopene.

Remember, too, that nutrition is really about a combination of nutrients and components -- not just two or three.

I lean more towards the "the healthier your overall diet, the more nutrition you are getting" camp than the "eat whatever you want and down supplements and multi-vitamins" one.