Diet of Cholesterol-Lowering Foods Beats Low-Saturated Fat Diet in Lowering LDL
Supports the ideas of dietary strategies to lowering cholesterol; value of using recognized cholesterol-lowering foods
Aug. 23, 2011 - People with high cholesterol who received counseling regarding a diet that combined cholesterol-lowering
foods such as soy protein, nuts and plant sterols (natural plant alcohol) over 6 months experienced a greater reduction in their unhealthy
low-density lipoprotein cholesterol (LDL-C) than individuals who received advice on a low-saturated fat diet, according to a new study.
Efforts have been made to improve the ability of conventional dietary therapy to reduce serum cholesterol through the
inclusion of specific foods or food components with known cholesterol-lowering properties, singly or in combination (dietary portfolio),
according to background information on the study.
The long-term effect of such diets compared with conventional dietary advice has not previously been assessed, according
to the report in the August 24/31 issue of the Journal of the American Medical Association (JAMA).
David J. A. Jenkins, M.D., of St. Michael's Hospital and the University of Toronto, and colleagues conducted a
multi-center trial to determine whether advice to eat a dietary portfolio consisting of foods recognized by the U.S. Food and Drug
Administration as associated with lowering serum cholesterol achieved significantly greater percentage decreases in LDL-C levels compared with
a control diet at 6-month follow-up.
The control diet emphasized high fiber and whole grains but lacked components of the portfolio diet, which
emphasized dietary incorporation of plant sterols, soy protein, viscous fibers, and nuts.
Plant sterols are a natural alcohol from plants containing few calories. It is approved by the FDA for margarine or vegetable oil spreads, and salad dressings, according to the
State, Department of Agriculture.
Vicous (soluble) fibers lower serum cholesterol by reducing the absorption of dietary cholesterol. Examples are psyllium (Metamucil), methyl cellulose (Citrucel), guar gum, or ground flax seed, according to the University of Wisconsin, Family Medicine
The study included 351 participants with hyperlipidemia from 4 participating academic centers across Canada (Quebec City,
Toronto, Winnipeg, and Vancouver) randomized between June 2007 and February 2009 to 1 of 3 treatments.
Participants received dietary advice for 6 months on one of three diets - the low-saturated fat therapeutic diet (control) or a
or intensive dietary portfolio, for which counseling was delivered at different frequencies.
Routine dietary portfolio involved 2 clinic visits over 6 months and intensive dietary portfolio involved 7 clinic visits
over 6 months.
In the modified intention-to-treat analysis of 345 participants, the overall attrition rate was not significantly
different between treatments (18 percent for intensive dietary portfolio, 23 percent for routine dietary portfolio, and 26 percent for
The researchers found that the change in LDL-C levels from the beginning of the study to week 24 in the control diet
were - 3.0 percent or - 8 mg/dL.
In the routine and intensive dietary portfolio interventions, the respective percentage changes were - 13.1
percent or - 24 mg/dL and - 13.8 percent or - 26 mg/dL for LDL-C levels.
"Percentage LDL-C reductions for each dietary portfolio were significantly more than the control diet. The 2 dietary
portfolio interventions did not differ significantly. Among participants randomized to one of the dietary portfolio interventions, percentage
reduction in LDL-C on the dietary portfolio was associated with dietary adherence," the authors write.
"In conclusion, this study indicated the potential value of using recognized cholesterol-lowering foods in combination.
We believe this approach has clinical application. A meaningful 13 percent LDL-C reduction can be obtained after only 2 clinic visits of
approximately 60-and 40-minute sessions,” the authors write.
“The limited 3 percent LDL-C reduction observed in the conventional diet is likely to reflect the adequacy of the
baseline diet and therefore suggests that larger absolute reductions in LDL-C may be observed when the dietary portfolio is prescribed to
patients with diets more reflective of the general population.”
Note: Dr. Jenkins led a smaller but similar study released in 2003 that found similar results with these same diets. His
group said then, “Combining a number of foods and food components in a single dietary portfolio may lower LDL-C similarly to statins and so
increase the potential effectiveness of dietary therapy.” (Link
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