Pia Salo, MD, PhD, told NutraIngredients.com that many health care professionals do accept food solutions to cholesterol management, but they do not not always remember them when talking to patients.

The information from pharmaceutical companies, which typically have far higher marketing budgets than food companies, is more powerful.

"There is more of it. It is a tradition that they market to doctors. We have just started doing it," said Dr Salo.

Raisio Benecol has had a tradition of presenting research on plant stanols and sterols at international medical congresses (and at local congresses through its partners), whi. But this is rather like preaching to the converted, as the doctors attending have already made the decision to listen to the lecture.

The company has now launched a dedicated website at www.cholesterol-update.info to give general practitioners information at their finger-tips. Although part of the marketing of this will be at congress and opinion-leader level, the idea is that the information should trickle down, through marketing and advertising, to the office of the general practitioner.

Numerous clinical trials in controlled settings have reported that daily consumption of 1.5 to 3 grams of phytosterols/-stanols can reduce total cholesterol levels by eight to 17 per cent. Dr Salo said epidemiological studies indicate that this could result in a 25 per cent reduction in coronary heart disease.

This means that making more doctors aware of the potential of cholesterol-lowering foods could have major public health benefits.

"General practitioners should have some knowledge of diet, as they are the first line of advice," said Dr Salo. "People look up to and listen to their opinions."

However she does not advocate food – be it everyday diet or functional foods – as a one-size-fits-all approach.

When assessing the best course of action, a doctor needs to look at the individual patient and evaluate the global risk according to a number or risk factors – such as lipid results, whether they are obese, whether they have high blood pressure, and whether they are a smoker.

But she does believe that diet and pharmaceuticals can go hand-in-hand.

In the US, for instance, since 2001 the National Cholesterol Education programme sets out diet as the first step in cholesterol management, sterols and stanols as the next step, and pharmaceuticals as the third step.

If a patient is very high risk they may not go through all the steps, but in general Dr Salo praised this as "a very sensible way of working."

"We all eat every day. Diet is always there."

A paediatrician, Dr Salon's advice is to instil healthy diet practices from childhood. If that is not enough and, when they enter their 30s and 40s, adults need to advance to the next level in cholesterol management, then they have the option of functional foods.

In Finland, more young doctors are showing an interest in dietary medicine as part of their training, but that may not be the same in all countries.

The health-epidemiological retrospective observational study published recently in the journal Nutrition, Metabolism and Cardiovascular Diseases involved 1631 French people (58.5 per cent male) with at least two risk factors for CVD. Twenty-four per cent of the participants were on anti-diabetic medication and about 90 per cent were receiving anti-hypertensive therapy.

The researchers report that only 15 per cent of the population (244 people) were consuming the margarines, and of these only 89 people consumed the recommended daily amount.

In the UK, a report from the Department of Health published in January said that premature deaths from coronary heart disease in the country have fallen by

35.9 per cent since 1996 – progress attributed to "extra investment and reform in tackling coronary heart disease".

The report, entitled Shaping the Future, estimate the numbers of lives saved by stain drugs but did not measure the impact of dietary approaches or functional foods.

High cholesterol levels, hypercholesterolaemia, have a long association with many diseases, particularly cardiovascular disease (CVD), the cause of almost 50 per cent of deaths in Europe, and reported to cost the EU economy an estimated €169bn ($202bn) per year.