Cholesterol-Lowering Foods Boost Benefits of Cutting Saturated Fat

Eating a diet high in cholesterol-lowering foods can improve the effectiveness of cutting down on saturated fat, according to a new Canadian study. The randomized clinical trial was the first, according to researchers, to test the effectiveness of a portfolio of cholesterol-lowering foods, combined with clinical counseling, in real-world conditions.

Alice H. Lichtenstein, DSc, director of Tufts HNRCA Cardiovascular Nutrition Laboratory, comments, This study emphasizes the importance of focusing on dietary patterns of food intake and not just a single nutrient, in this case saturated fat.

David J. A. Jenkins, MD, of St. Michaels Hospital and the University of Toronto, and colleagues tested 351 patients with high LDL (bad) cholesterol. The average LDL at the studys start was 171 mg/dL. Participants were randomly assigned to a control diet focused on lowering saturated-fat intake or a diet also low in saturated fat but emphasizing foods known to combat high cholesterol. The foods in this dietary portfolio included those containing added plant sterols (such as found in some spreads), soy protein, nuts and foods high in viscous fiber, such as oats, barley and legumes. Participants on this plan also received either two or seven diet-counseling sessions.

Patients in the control group were not allowed to eat any of the cholesterol- fighting foods. Although 51 patients had been taking statins, they discontinued them at least two weeks before the study began.

After six months, those consuming cholesterol-lowering foods saw drops of 13%-14% in LDL, with extra counseling linked to slightly greater improvement, compared to a statistically insignificant 3% drop on the low-saturated fat regimen. They also saw improvements in the ratio of total cholesterol to healthy HDL cholesterol. This study indicates the potential value of using recognized cholesterol-lowering foods in combination, Dr. Jenkins and colleagues concluded. We believe this approach has clinical application.

The fact that the low-saturated fat control diet, which also emphasized high fiber and whole grains, achieved only a 3% LDL reduction suggests that the study groups diet was already skewed toward combating unhealthy cholesterol. Researchers therefore speculated that the additional 10%-11% LDL reduction associated with the cholesterol-lowering foods regimen, while significant, might actually understate the potential benefit. They commented, Larger absolute reductions in LDL cholesterol may be observed when the dietary portfolio is prescribed to patients with diets more reflective of the general population.

TO LEARN MORE: JAMA, August 24/31, 2011; abstract at jama.ama-assn.org/content/306/8/831.abstract.

Foods That Fight Bad Cholesterol

• The US Food and Drug Administration (FDA) has approved health claims for these foods for improving cholesterol and combating coronary heart disease:
• Plant sterol/stanol esters (at least 0.65 grams plant sterol esters per serving of spreads and salad dressings; at least 1.7 grams plant stanol esters per serving of spreads, salad dressings, snack bars and dietary supplements)
• Almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts, walnuts (1.5 ounces per day)
• Soy protein (at least 6.25 grams per serving)
• Soluble fiber or beta-glucan soluble fiber (at least 0.75 grams per serving) from oat bran, rolled oats, whole oat flour, whole grain barley or dry milled barley, Oatrim, psyllium husk (at least 1.7 grams per serving)
• Fruits, vegetables and grains that contain at least 0.6 grams of soluble fiber per serving