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Cholesterol-lowering diet can compete with drugs

TORONTO, CANADA. Can a diet designed to lower cholesterol be as effective as treatment with statins? Apparently so, according to a recent study from the University of Toronto. The US National Cholesterol Education Program and the American Heart Foundation have both recently recommended the use of functional or cholesterol-reducing foods, categories of which include viscous fibers, soy protein, plant sterols, and nuts. For the first time, a study has compared a cholesterol-lowering diet with drug treatment in the same individuals.

Thirty-four healthy participants with hyperlipidemia - high levels of blood fats - spent a month on each of: a low saturated fat diet (comparison group), the same diet plus 20 mg lovastatin (a first-generation statin), and a specially-designed diet. This 'portfolio' diet contained plant sterols, soy-protein foods, almonds, oats, barley, psyllium, okra and eggplant. All of the diets were vegetarian. The average age of the participants was just over 58 years, and they had an average body mass index of just over 27. They received the treatments in random order, with a few weeks' break in-between, and had fortnightly blood tests.

Analysis showed that the portfolio diet reduced LDL ("bad") cholesterol by nearly as much as the statin (29.6 per cent against 33.3 per cent). The difference was significant, but both were equally able to reduce cholesterol to below the primary prevention cutoff of 3.4 millimoles per liter. Moreover, 26 per cent of the individuals reached their lowest cholesterol reading on the specially-designed diet. The comparison low saturated fat diet also reduced LDL cholesterol, but only by 8.5 per cent. The authors conclude that the portfolio diet is as effective at reaching current lipid goals for primary prevention as are first-generation statins. They add that these diets could "bridge the treatment gap between current therapeutic diets and newer statins".

Writing in an accompanying commentary, Dr Margo Denke from the University of Texas, explains that the study combines many previously successful interventions into a portfolio designed to achieve the maximum cholesterol lowering that diet can offer. She warns that implementing the portfolio diet requires a major commitment, and to some patients, the inconvenience will outweigh the risks of statins. However, she concludes that dietary therapy is an essential component of primary and secondary prevention of coronary disease.
Jenkins, D J A et al. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. American Journal of Clinical Nutrition, Vol. 81, February 2005, pp. 380- 387

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