Low-Cholesterol Diet as Good as Drugs

Conventional wisdom says most people can't do it. But a recent study says otherwise. Unlike the drugs, the diet has no side effects and costs little.

Last year, David J.A. Jenkins, MD, PhD, DSc, showed that a vegetarian diet combining four types of cholesterol-lowering foods works as well as cholesterol-lowering drugs known as statins. The study is featured in the July 23/30 issue of The Journal of the American Medical Association. Dr. Jenkins is the director of the clinical nutrition and risk factor modification center at St. Michael's Hospital in Toronto, Canada, and professor of nutritional sciences at the University of Toronto.

Of significance is that the diet was tested directly against statins and showed the same benefit.

Jenkins' team signed up 25 men and 21 healthy postmenopausal women. All had high cholesterol levels. Their average age was 59 and they were overweight but not obese. All started the study by stopping use of all statin drugs (used by 21 of the volunteers, all looking for a dietary alternative). A month before starting the study, all the volunteers followed their own low-saturated-fat diets that were similar to diets recommend for people with elevated cholesterol.

The study involved 46 men and women, average age 59, overweight, but not obese with high cholesterol levels. Researchers randomly assigned each of them to:

• The control group. These people ate a diet very low in saturated fats (less than 7% of total calories as saturated fats). The diet was based mainly on low-fat dairy products and whole-grain cereals.
• The statin group. These people ate the same diet as those in the control group. But they also took a statin known as lovastatin (sold as Mevacor).
• The "dietary protocol" group. These people ate a combination of cholesterol-fighting foods. It had four basic components: plant sterols in the form of a cholesterol-lowering margarine; soy proteins; sticky or soluble fibers such as fruits, vegetables, oats, and legumes; and almonds. (For a sample menu, see the end of this article.)

After a month, the control group's cholesterol went down by 8%. That's pretty good -- but the statin group had a 30.9% cholesterol drop. Yet without taking the drug, the "dietary protocol" group had almost the same result -- a 28.6% drop in cholesterol.

There's more. Study participants also had drops in C-reactive protein, or CRP. The higher one's CRP level, the higher the risk of heart disease. The control group had a 10% drop in CRP. The statin group had a 33.3% CRP drop. The dietary protocol group had a 28.2% drop.

You Can Do It
James W. Anderson, MD, professor of medicine and clinical nutrition at the University of Kentucky and president of the Obesity Research Network has long advocated a heart-healthy diet based on restricted fats, sticky fiber, and soy protein.

What the Jenkins study shows is that if people enhance a heart-healthy diet with three things -- soluble fiber, soy protein, and plant sterols and stanols -- they can get substantially better cholesterol reduction. With the combination of rather modest dietary change and this, they can get 30% cholesterol reduction.

In his study, the successful dieters ate four types of cholesterol lowering foods:

• Soy. "We were looking at soy-based meat substitutes such as soy burgers, soy hot dogs, and soy cold cuts," Jenkins says. "And we also used soy milk as a dairy substitute."
• Sticky fiber. Study patients used the natural psyllium product Metamucil -- many used it to thicken their soy milk -- and ate oat-bran cereal and barley-based soups.
• Plant-sterol enriched margarine. This Unilever product is sold in the U.S. as Take Control and in other countries as Becel/Flora pro.activ. A similar product is Benecol from McNeil Nutritionals. Sterols and stanols are naturally occurring substances in plants.
• Nuts. Study patients ate a handful of almonds every day.

If you prefer pills, plant sterols and sticky fiber are available in capsule form. Be cautious with sterol-enriched spreads because they are high in calories. Some of the products have hydrogenated fats. Thus, read labels and avoid trans fats.

If switching to this type of diet sounds daunting, remember, even small changes to the diet have big health effects. And you don't have to change your eating habits all at once.

Try a little of all of these foods. A handful of almonds and some of the soy foods to begin. Try soy milk with breakfast cereal, try soy substitutes. Try oats -- oat bran is a good breakfast. Add a few things, like vegetable barley soup. If you find ones you like, eat them more often. If you do that each day, have one or two and build up, you soon should get a measurable effect on you cholesterol levels.

Meanwhile, Jenkins is working with several food manufacturers. Those who provided foods for the study include Loblaw Brands Ltd, the Almond Board of California, Unilever Research, the Hain-Celestial Group, Nestle Canada Inc., Kraft Foods, Proctor & Gamble Inc., Bartlett Farms, Barwell Food Sales Inc., and Burnbrae Farms Ltd.

They are on the road with industrial collaborators to make these foods palatable and presenting an alternative to the starting dose of statins.

More information on stanols and sterols is available at www.benecol.com  and www.takecontrol.com