From Dr N. D. Harris, FRPharmS
SIR,-Your short report on the beneficial effect of combining Benecol with statins (PJ, July 22, p120) is very interesting and potentially important for those with high blood cholesterol, especially if statins give inadequate results. However, there are several points requiring comment.
The daily intake of plant stanol ester spread reportedly used (3g) is only about one 10th of the recommended daily intake (RDA) on the pack (24-36g). I am awaiting confirmation of this from the authors of the original report.
This difference in intake is important because the product has a significant energy content (712.5kJ, 172.5 kcal per median 30g RDA) and the absorption of fats is not affected - the effect is specific to cholesterol. This level of energy intake represents about one 10th of that in a modestly weight reducing diet for a 55-year-old female (1/12th of that for a male). Health-conscious members of the public may mistakenly believe that products such as Benecol can be taken freely without adding to their energy intake and pharmacists should be aware of this when asked for dietary advice.
Finally, the intriguing question remains to be settled as to whether those whose cholesterol is currently well-controlled with statins could combine a lower statin dose with Benecol. This would reduce the risks of hepatotoxicity and muscle damage associated with statins.
Norman Harris
Bushey, Hertfordshire
Our report was misleading. Patients in the trial received 3g of plant stanol ester daily (given as 36g Benecol spread). - EDITOR.