New research posted in the Journal of the American Medical Association shows positive findings in the non-pharmaceutical treatment of high cholesterol (hyperlipidemia).  High cholesterol is becoming an epidemic in Western Culture, and is a major risk factor for cardiovascular diseases, including heart attack and stroke, due to the formation of atherosclerotic plaques.  In the past decade, cholesterol lowering statin drugs such as atorvastatin (Lipitor), have become one of the most prescribed classes of drugs in North America.  In fact, 1 in 4 Americans over the age of 45 is currently taking a statin drug.  However, due to the growing list of acute and chronic adverse effects from these drugs, namely muscle and liver problems, statins should no longer be viewed as ‘the only‘ solution for high cholesterol, as they once were.

This new research shows that dietary counseling, and the incorporation of known cholesterol lowing foods in to the diet can significantly lower blood cholesterol levels in a matter of months.  Study participants started with an average blood cholesterol reading of 171 mg/dL at the study onset (normal is less than 160), which dropped by an average of 24 mg/dL during a 6 month span, resulting in readings well within the normal range.

These findings are exciting, since the dietary interventions used in the study do not even take advantage of the numerous well documented, naturally occurring, supplements and other dietary changes available.  In fact, I would classify the lipid lowering study diet consisting of “plant sterols, soy protein, viscous fibers, and nuts” as poor.  The combination of a more effective evidence based diet with supplemental niacin and good sources of fat (DHA/EPA from fish oil) would certainly show an even better cholesterol reducing ability.  Niacin alone stops the breakdown of fat → free fatty acids → bad cholesterol (LDL).

While these findings are very positive, they by no means replace the necessity for statin drugs in extreme instances.  The adverse effects of statins do not outweigh the potential complications arising from advanced hyperlipidemia.  While this study showed a 24 mg/dL reduction in blood cholesterol with diet alone, this is not nearly as effective as the 71 mg/dL average reducing from Lipitor.  They do however have a strong clinical implication in the treatment of mild to moderately high cholesterol.

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Effect of a Dietary Portfolio of Cholesterol-Lowering Foods Given at 2 Levels of Intensity of Dietary Advice on Serum Lipids in Hyperlipidemia

ABSTRACT

Context Combining foods with recognized cholesterol-lowering properties (dietary portfolio) has proven highly effective in lowering serum cholesterol under metabolically controlled conditions.

Objective To assess the effect of a dietary portfolio administered at 2 levels of intensity on percentage change in low-density lipoprotein cholesterol (LDL-C) among participants following self-selected diets.

Design, Setting, and Participants A parallel-design study of 351 participants with hyperlipidemia from 4 participating academic centers across Canada (Quebec City, Toronto, Winnipeg, and Vancouver) randomized between June 25, 2007, and February 19, 2009, to 1 of 3 treatments lasting 6 months.

Intervention Participants received dietary advice for 6 months on either a low− saturated fat therapeutic diet (control) or a dietary portfolio, for which counseling was delivered at different frequencies, that emphasized dietary incorporation of plant sterols, soy protein, viscous fibers, and nuts. Routine dietary portfolio involved 2 clinic visits over 6 months and intensive dietary portfolio involved 7 clinic visits over 6 months.

Main Outcome Measures Percentage change in serum LDL-C.

Results In the modified intention-to-treat analysis of 345 participants, the overall attrition rate was not significantly different between treatments (18% for intensive dietary portfolio, 23% for routine dietary portfolio, and 26% for control; Fisher exact test, P = .33). The LDL-C reductions from an overall mean of 171 mg/dL (95% confidence interval

[CI], 168-174 mg/dL) were −13.8% (95% CI, −17.2% to −10.3%; P < .001) or −26 mg/dL (95% CI, −31 to −21 mg/dL; P < .001) for the intensive dietary portfolio; −13.1% (95% CI, −16.7% to −9.5%; P < .001) or –24 mg/dL (95% CI, −30 to −19 mg/dL; P < .001) for the routine dietary portfolio; and −3.0% (95% CI, −6.1% to 0.1%; P = .06) or −8 mg/dL (95% CI, −13 to −3 mg/dL; P = .002) for the control diet. Percentage LDL-C reductions for each dietary portfolio were significantly more than the control diet (P < .001, respectively). The 2 dietary portfolio interventions did not differ significantly (P = .66). Among participants randomized to one of the dietary portfolio interventions, percentage reduction in LDL-C on the dietary portfolio was associated with dietary adherence (r = −0.34, n = 157, P < .001).

Conclusion Use of a dietary portfolio compared with the low−saturated fat dietary advice resulted in greater LDL-C lowering during 6 months of follow-up.

https://jama.ama-assn.org/content/306/8/831.short