Food combinations for cholesterol lowering

Abstract

Reducing elevated LDL-cholesterol is a key public health challenge. There is substantial evidence from randomised controlled trials (RCT) that a number of foods and food components can significantly reduce LDL-cholesterol. Data from RCT have been reviewed to determine whether effects are additive when two or more of these components are consumed together. Typically components, such as plant stanols and sterols, soya protein, b-glucans and tree nuts, when consumed individually at their target rate, reduce LDL-cholesterol by 3 -9 %. Improved dietary fat quality, achieved by replacing SFA with unsaturated fat, reduces LDL-cholesterol and can increase HDL-cholesterol, further improving blood lipid profile. It appears that the effect of combining these interventions is largely additive; however, compliance with multiple changes may reduce over time. Food combinations used in ten 'portfolio diet' studies have been reviewed. In clinical efficacy studies of about 1 month where all foods were provided, LDL-cholesterol is reduced by 22-30 %, whereas in community-based studies of .6 months' duration, where dietary advice is the basis of the intervention, reduction in LDL-cholesterol is about 15 %. Inclusion of MUFA into 'portfolio diets' increases HDL-cholesterol, in addition to LDL-cholesterol effects. Compliance with some of these dietary changes can be achieved more easily compared with others. By careful food component selection, appropriate to the individual, the effect of including only two components in the diet with good compliance could be a sustainable 10 % reduction in LDL-cholesterol; this is sufficient to make a substantial impact on cholesterol management and reduce the need for pharmaceutical intervention.

Health Canada’s Proposal to Accept a Health Claim about Soy Products and Cholesterol Lowering

“…The claim is not intended as a clinical guideline for cholesterol and heart disease management, and the magnitude of effect would understandably be expected to be lower than for drugs. In the long term, the estimated reduction in LDL cholesterol levels associated with the consumption of soy products can have a significant impact in reducing cholesterol concentrations at the population level, an important modifiable risk factor for cardiovascular disease [91].…”

Effects of Poly-Bioactive Compounds on Lipid Profile and Body Weight in a Moderately Hypercholesterolemic Population with Low Cardiovascular Disease Risk: A Multicenter Randomized Trial

“…We estimated that the minimum statistical difference of 16 mg/dL, represents a sustainable 10% reduction in LDL-c and is a substantial impact on cholesterol management; a reduction that is similar to that of consuming soluble fiber or fitosterols. If the mean LDL-c concentration of the participants was 160 mg/dL the reduction expected will be 16 mg/dL [28].…”

Proposition de Santé Canada d'accepter une allégation santé au sujet des produits à base de soya et de la diminution du cholestérol

“…L'allégation n'a pas pour but de servir de ligne directrice clinique pour la gestion du cholestérol et de la coronaropathie; de plus, il est évident qu'on s'attend à ce que l'ampleur de l'effet soit inférieure aux médicaments. À long terme, la diminution estimée des taux de cholestérol LDL associée à la consommation de produits de soya peut avoir d'importantes incidences sur la réduction des concentrations de cholestérol pour la population, un facteur de risque modifiable considérable pour les maladies cardiovasculaires [91].…”