Millions plagued with high levels of bad cholesterol resort to cholesterol-reducing statin drugs or avoid foods high in saturated fat, such as ice cream, red meat and butter. But new research indicates that a cholesterol-friendly diet rich in soy products and tree nuts can decrease LDL more effectively than a low-saturated-fat diet.
The study, published in the Journal of the American Medical Association on Tuesday, found that people who ate a healthy diet filled with cholesterol-lowering foods experienced a 13 percent decrease in their LDL cholesterol levels. Those who followed a diet low in saturated fats experienced only a 3 percent decrease. A report in the Los Angeles Times very aptly said that the research showed that what you eat may be more important than what you don't eat.
There's no question that statins have made a major difference in terms of cardiovascular disease control, said study author Dr. David Jenkins, from the University of Toronto. But at least for now, he added, we can only get so far with statins.
Jenkins created a portfolio diet that includes regular consumption of tree nuts and high amounts of fiber from oats, barley and vegetables. The diet replaces butter with plant sterol-enriched margarine and substitutes soy-based products for meat.
Jenkins and his colleagues randomly split 351 Canadians with high cholesterol into three groups. Each group followed one of three diets - an intensive portfolio diet, a routine portfolio diet and a high-fiber, low-saturated-fat diet rich in produce and whole grains, which is commonly recommended to those who have had a heart attack or need to lower their cholesterol.
Participants in the intensive and routine diets were given more cholesterol-lowering foods including soy milk, tofu, nuts, oats, peas and beans. All diets were vegetarian.
After six months, people on the low-saturated-fat diet saw a drop in LDL cholesterol of 8 milligrams per deciliter. That compared to 24 mg/dL and 26 mg/dL decreases in participants on the cholesterol-lowering diets.
Replacing sources of saturated fat, such as red meat and dairy products, with sources of healthy fats, such as nuts and soy products, will definitely have greater benefits than replacing red meat and dairy products with carbohydrates, said Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard School of Public Health, according to an ABC News report.
Even though the components of the portfolio diet are well-known for their cholesterol-reducing properties, the research is the first to test the relative effects of those dietary interventions in a real-world comparison, and to gauge how readily people can understand and implement such a diet in everyday life.
Subjects in the intensive group got seven sessions of instruction and guidance while those in the routine group got one 60-minute session plus a 40-minute refresher. Both groups reaped almost equal benefits.
One in five of the participants dropped out before the full six months and even those that didn't had a hard time sticking closely to the diet plans. Despite this, many still saw cholesterol benefits.
Doctors generally tell high-cholesterol patients to change their diet and lifestyle before prescribing cholesterol-reducing statin drugs. Only when noninvasive measures don't work do doctors prescribe drugs.
Jenkins told Reuters that the question of how diet and statins could lower LDL in tandem is for future research. But for those who like the idea of changing their diet instead of going on medications, this is a reasonable option, he said. In some cases for people with very high cholesterol levels, diet isn't enough to get LDL down to a healthy level without statins.
The study had a six-month followup and many experts felt that a longer period was necessary to understand the long-term effects of the portfolio diet. A Cleveland Clinic cardiologist, Dr. Steve Nissen, stressed that researchers did not directly measure rates of coronary heart disease - just LDL cholesterol - so the health effects of the portfolio diet are not yet clear. Nissen also felt that those on statins should not dump their drugs for tofu. Moreover, a vegetarian or plant-based diet would be tougher for meat eaters to follow.
A high overall cholesterol level makes a person nearly twice as likely to suffer a heart attack or stroke as someone whose total cholesterol falls into a healthy range.