A Statin-like Diet

A Statin-like Diet? A tough cholesterol-lowering diet (lots of fiber, plant sterols, soy, and nuts) is shown to be just as good as a statin in lowering LDL-cholesterol over a 4-week period . . .

Introduction Not everyone with high blood cholesterol levels wants, or is able, to take a statin drug. They may have firm naturopathic beliefs, or suffer from side effects of statins. Although there have been reports that one can lower raised cholesterol levels perfectly well by diet alone, there hasn't been a direct comparison between the effectiveness of both regimes in the same patient - until now. Scientists in Toronto have done a study of people with high cholesterol levels treated with a low-fat diet, a statin, and a so-called portfolio diet, in rotation. The portfolio diet contained foods with given amounts of substances that reduce cholesterol: fiber, soy protein, plant sterols, and nuts. The findings are reported in the American Journal of Clinical Nutrition, and are summarized here.

What was done Participants with high blood lipid levels were recruited; there were 20 men and 14 postmenopausal women who had an average age of 58 and an average body mass index (BMI) of 27. Three one-month treatments were given in a random order: a very-low-saturated-fat diet (the control diet), the same diet plus a statin (lovastatin), and the portfolio diet. The diets - all vegetarian - were calculated individually to provide calories enough for weight maintenance. The control diet used skim milk, fat-free cheese, yogurt, egg substitute, and liquid egg white to achieve low intake of saturated fat; a high fiber content was ensured with whole-wheat cereal and wheat-bran muffins containing sunflower oil. During the statin phase the participants took lovastatin (Mevacor®) at a dose of 20 mg daily. And the portfolio diet had 4 main components: • • • •

margarine enriched in plant sterols giving 1 g sterol per 1,000 calories oats, barley and psyllium to give 10 g fiber per 1,000 calories; okra (100 g) and eggplant (200 g) on alternate days soy protein as soy milk and soy meat analogs (burgers, dogs, deli slices) to give 21 g per 1,000 calories almonds (14 g per 1,000 calories)

Fasting blood samples were taken before the start of the study, and at weeks 2 and 4 of each diet/statin cycle. Blood lipids (total cholesterol, LDL-, HDL-cholesterol, triglycerides) were measured.

What was found The participants were diligent in recording their dietary intake accurately. The only 'side effect' reported was a slight increase in the frequency of defecation during the portfolio diet phase. Body weights remained unchanged during the study. The LDL-cholesterol levels were decreased by 8.5% after 4 weeks on the control diet, by 33% with the statin, and by 30% with the portfolio diet. While the slight advantage of the statin over the portfolio diet was statistically significant (i.e. it couldn't have occurred by chance alone), a quarter of the participants (9 of 34) achieved their lowest LDL-cholesterol levels while on the portfolio diet. Similar changes were seen in triglyceride levels, but there were no comparable improvements in HDL-cholesterol.

What this means This study shows, quite conclusively, that a diet composed of cholesterol-lowering foods given over a 4-week period can achieve the same benefit as a statin drug taken with a lowsaturated-fat diet. The reduction in the ten-year risk of coronary heart disease, reckoned according to the Framingham study guidelines, was the same for both forms of treatment. The strength of the study lies in the fact that the same patients were used for each form of treatment. Although there was a slightly greater decrease in LDL-cholesterol levels with statins, when the number of patients who achieved the recommended primary target level of 120 mg/mL (3.4 mmol/L) was counted, there was no difference between the effectiveness of the two treatments. Of course, this finding raises the question "Should everyone with raised cholesterol levels be eating this portfolio diet?" It's probably easier said than done. The ingredients are not necessarily cheap, and may not be acceptable to people over a period greater than a few weeks. However, the information will be useful, both to those who can't or won't take a statin, and for those with less severe increases in cholesterol levels who want to postpone the need for medication.