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A diet based on plants, nuts and high-fibre grains lowered low-density lipoprotein cholesterol (LDL) more than a low-saturated-fat vegetarian diet, researchers reported. And the drop in LDL was big enough that dietary changes could be an alternative to statin medications for many people, they said.
"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".
One in four adults age 45 and older in the US takes the cholesterol-lowering drugs.
Dr Jenkins and his colleagues wanted to see how big an effect a diet based on the pillars of lower cholesterol could have on LDL numbers without statins.
They randomly split 351 Canadians with high cholesterol into three groups. One group got nutrition counselling promoting a low-saturated-fat diet for six months.
In the other two groups, dieticians helped participants fit more cholesterol-lowering foods, including soy milk, tofu, nuts, oats, peas and beans, into a healthy diet – meeting with some of them twice during the study, and with others seven times. All three diets were vegetarian. The average starting LDL was about 170 mg/dL.
Diet results after six months
After six months, people on the low-saturated-fat diet saw a drop in LDL cholesterol of 8 mg/dL, on average, according to findings reported online today in the Journal of the American Medical Association.
That compared to decreases of 24 and 26 mg/dL in participants on the cholesterol-lowering diets.
That drop is "really a lot", said Dr Yunsheng Ma, a nutrition and heart disease researcher from the University of Massachusetts Medical School in Worcester, who was not involved in the new study.
Volunteers in the cholesterol-lowering group were encouraged to consume about 1 g of plant sterols in an enriched margarine for every 4200 kJ of food they ate, as well as about 10 g of fibre in the form of oats, barley and psyllium, 22.5 g of soy protein, and 22.5 g of nuts, per 4200 kJ.
Diet is powerful
"A lot of people rely on the medication, but diet is really powerful, actually," Dr. Ma said. "People ignore that. They think if they're on statins, they can do anything they want, they can eat the high-fat foods because the statins are going to take care of that."
One in five participants dropped out before the full six months, and even those that didn't had a hard time sticking closely to the diet plans – but many still saw cholesterol benefits.
The researchers had everyone in the study who was taking statins go off the medication for the diet intervention. Dr Jenkins said 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. Others who aren't interested in adjusting their eating habits might be better suited to sticking with statins, Dr Jenkins added.
"If you want to sit on the couch with the six pack and the wings and watch other people exercise and you're quite determined not to do anything other than that, then we've got a medication for you," he said.
(Reuters Health, Genevra Pittman, August 2011)
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