For decades, doctors told their patients to eat margarine instead of butter. The idea was that people who ate cholesterol-rich butter would raise their level of blood cholesterol. Then public health experts realized that it might not be possible to lower cholesterol with margarine because of the unhealthy trans fats in margarine. About 20 years ago, companies developed margarine specifically designed to lower cholesterol because it contains plant compounds that prevent cholesterol absorption. Does eating this type of margarine really help normalize lipid levels?
Can You Lower Cholesterol with Margarine?
Q. My doctor told me to use Promise margarine, no other spreads. Over a month or so, my cholesterol dropped to 100. It has been stable for more than 20 years. Is Promise responsible?
A. Promise Activ, Benecol, Smart Balance and Take Control margarine were all launched as a means of lowering cholesterol. They contain plant sterols or plant stanol esters. Regular consumption of such products in place of butter can lower LDL cholesterol by 7 to 12 percent (Trautwein et al, Nutrients, Sep. 7, 2018).
Although the food companies suggest that you lower cholesterol with margarine alone, doctors may also prescribe a statin and suggest consuming stanol-containing margarine in addition (Han et al, Scientific Reports, Aug. 19, 2016). People who follow this regimen can lower their LDL and total cholesterol even more than with a statin by itself. Certainly, people taking prescription statins can lower their serum lipids more with this combination than with cholesterol-lowering margarine alone.
Going Beyond a Plan to Lower Cholesterol with Margarine:
Very few cardiologists recommend relying on such stanol-fortified spreads to lower cholesterol. They might point out the benefits of a combined approach: diet, exercise and weight loss (Clifton, Pathology, Feb. 2019). A dietary portfolio can be helpful in cholesterol control. What should you do?
Employing a Dietary Portfolio:
Several years ago, research from Canada showed that a vegetarian diet containing cholesterol-lowering foods was significantly more effective than the conventional dietary recommendation of simply reducing saturated fat intake (Jenkins et al, JAMA, Aug. 24/31, 2011).
In the study, 350 volunteers were randomized into three groups. One group cut back on saturated fat. Another group learned how to utilize a dietary portfolio of cholesterol-lowering margarine, soluble fiber from oats, barley and psyllium, as well as nuts and soy protein instead of animal products over the course of two clinic visits of up to an hour each. The third group went through more intensive training involving seven clinic visits to learn about implementing the dietary portfolio approach.
Over the six months of the study, both groups following the dietary portfolio lowered their LDL cholesterol. Their results were significantly better than those of the people following a conventional low-fat diet. Cholesterol-lowering foods such as soluble fiber, nuts, soy and margarine containing plant sterols turned out to be effective for getting bad cholesterol under control. A recent review of controlled studies demonstrated that adopting a dietary portfolio can reduce LDL cholesterol and the estimated 10-year risk of heart disease (Chiavaroli et al, Progress in Cardiovascular Diseases, May-June 2018).
To control your cholesterol with diet, lower both trans fat and saturated fat intake, increase soluble fiber and substitute low-glycemic index carbohydrates such as vegetables for high-glycemic processed carbohydrates like bread, crackers and cookies. You can lower cholesterol with margarine, but don’t rely on margarine alone. Regular exercise can also improve heart health whether or not cholesterol levels drop.
You may wish to review our Guide to Cholesterol Control and Heart Health or listen to our most recent interview with Dr. Steve Nissen of the Cleveland Clinic. It is Show 1147: How Do You Control Your Cholesterol?