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Effective cholesterol reduction with dietary changes

TORONTO, CANADA. A reduction in the intake of saturated fat (less than 7% of total energy intake) and cholesterol (less than 200 mg/day) is usually the first step in the battle against high cholesterol levels. The effect of these changes, unfortunately, is rather small with an expected reduction in low-density lipoprotein cholesterol (LDL) between 4 and 13%. Adding statin drugs (lovastatin, pravastatin, simvastatin, etc.) to this diet (STEP II diet) can increase the reduction in LDL to between 28 and 35%. Statin drugs are, however, by no means free of adverse effects, so many people now prefer other means of cholesterol reduction.

It is well established that viscous fiber, plant sterols, soy products, and almonds all help reduce LDL cholesterol levels. Medical researchers at St. Michael's Hospital now report that including all these items in the standard STEP II cholesterol reduction diet is just as effective as adding statin medications. Their randomized, double-blind, placebo-controlled clinical trial involved 25 men and 21 postmenopausal women with high LDL levels (higher than 158 mg/dL or 4.1 mmol/L). The participants were randomized to eat just the STEP II diet plus a placebo capsule, the STEP II diet plus a capsule containing 20 mg of lovastatin or the STEP II diet with added plant sterols (1.0 g per 1000 kcal) in the form of a plant sterol ester-enriched margarine, viscous fiber (9.8 g per 1000 kcal) from oats, barley and psyllium, soy protein (21.4 g per 1000 kcal) as soy milk or meat substitutes, 14 g of almonds per 1000 kcal of diet plus a placebo capsule.

After 4 weeks the LDL level in the control group (STEP II diet + placebo) was down by 8%, the LDL/HDL ratio up by 3%, and the level of C-reactive protein down by 10%. In the statin group LDL level dropped by 30.9%, the LDL/HDL ratio by 28.4%, and the C-reactive protein by 33.3%. In the enhanced diet group (STEP II diet + placebo + plant sterols, etc.) the LDL level dropped by 28.6%, the LDL/HDL ratio by 23.5%, and the C-reactive protein level by 28.2%. The researchers conclude that the enhanced diet is just as effective as statin drugs in reducing LDL cholesterol and C-reactive protein levels. The benefits of the enhanced diet were evident within 2 weeks of starting it. They also point out that the estimated reduction in the risk of coronary heart disease was similar in the statin group (25.8%) and the enhanced diet group (24.9%).
Jenkins, David J.A., et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C- reactive protein. Journal of the American Medical Association, Vol. 290, July 23/30, 2003, pp. 502-10

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