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Diet Can Be as Effective as Statin Therapy in Lowering Cholesterol

A diet high in plant sterols, soy protein, viscous fibers and almonds lowers low-density lipoprotein (LDL) cholesterol essentially as much as lovastatin, Canadian researchers report.

In the study, 46 otherwise healthy patients with hyperlipidaemia were randomised to one of three groups: 1) a diet very low in saturated fats and high in whole-wheat cereals; 2) a dietary portfolio consisting of plant sterols 1.0 g/1000 kcal, soy protein 21.4 g/1000 kcal, viscous fibers 9.8 g/1000 kcal and almonds 14 g/1000 kcal; 3) lovastatin 20 mg/day plus the low-fat diet for a 1-month period. Mean age of the study group was 59 years and mean body mass index was 27.5.

Lead investigator David J. A. Jenkins, St. Michael's Hospital, Toronto, Ontario, Canada, and colleagues measured levels of C-reactive protein and fasting lipids at baseline and again at 2 and 4 weeks.

Mean decrease in LDL cholesterol level was 8.0% in the low fat diet group, 28.6% in the dietary portfolio group and 30.9% in the statin group. Mean reduction in C-reactive protein was 10.0% in the low-fat diet group, 28.2% in the dietary portfolio group and 33.3% in the lovastatin group.

Differences in efficacy between the dietary portfolio group and the lovastatin group were not statistically different for these two parameters, Dr. Jenkins reports. He adds that he believes this is the first report of a dietary effect on C-reactive protein levels.

Viscous fibers increase bile acid loss, plant sterols reduce cholesterol absorption and soy proteins reduce hepatic cholesterol synthesis and increase expression of LDL cholesterol messenger RNA. The dietary portfolio also has a direct anti-inflammatory effect, as does statin therapy, the investigators note.

The results of this small study "support an important role for dietary change" and reinforce recent dietary recommendations, which include various components of the dietary portfolio used in this study, Dr. Jenkins and colleagues write.

"Despite the effectiveness and safety of statins, there are still some individuals for whom physicians are reluctant to prescribe statins because of elevations of muscle and liver enzymes," they note. "There are also those who would prefer to control their blood lipid levels by nonpharmacologic means, particularly in view of recent, less satisfactory outcomes with statin use in older people."

An important next study, the researchers point out, is conducting a similar investigation in which patients assemble the diets themselves on a regular basis. In follow-up interviews of the study participants, only 40% indicated the dietary portfolio was "acceptable with little further modification."
JAMA 2003;290:4:502-510. "Effects of a Dietary Portfolio of Cholesterol-Lowering Foods vs Lovastatin on Serum Lipids and C-Reactive Protein"

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