"Maybe we can't completely change habits of eating acquired by many North Americans and Europeans after decades of exposure to the inducements of 'snap, crackle, pop,'" Dr. David Jenkins, professor of nutritional science at the University of Toronto and director of the Clinical Nutrition and Risk Factor Modification Center at St. Michael's Hospital in Toronto, told United Press International. "But we have shown that a certain dietary approach works to at least lower 'bad cholesterol,' and that it should be the first line of treatment before physicians begin handing out pills."
Jenkins and his team randomly assigned 46 men and women with high LDL cholesterol -- the so-called bad cholesterol -- to one of three vegetarian diet groups. The control group, those not on lovastatin -- a popular cholesterol-lowering drug -- or the specific diet being tested, ate meals low in saturated fats found in animal products such as beef and butter. The second group had the same low-fat diet, plus a daily 20-milligram treatment of lovastatin.
The last group received a diet high in foods identified in previous clinical trials to have cholesterol-lowering properties. They include foods such as oat bran bread and cereal, soy drinks, fruit and soy deli slices and roasted almonds. A typical dinner was tofu baked with eggplant, onions and sweet peppers, pearled barley and vegetables.
The investigators found the dietary approach used with the third group lowered levels of LDL cholesterol by almost 29 per cent, almost identical statistically to the 30.9 percent decrease among lovastatin users.
Jenkins said such dietary intervention probably works well to reduce cholesterol because humans are evolutionarily adapted to what he calls the "ape diet" -- a diet very high in fiber, nuts, vegetable proteins and plant sterols preferred by large primates.
"The U.S. Food and Drug Administration acknowledges that these foods are legitimate heart disease risk-reduction agents," Jenkins said. "The American Heart Association and the National Cholesterol Education Program advocate their use in a healthy diet. We have taken it a step further and proven, in a clinically-controlled setting, that these foods have an almost identical effect on lowering LDL cholesterol as cholesterol-reducing drugs."
As he and colleagues reported in the July 23 issue of the Journal of the American Medical Association, Jenkins noted an estimated 1 million people in Great Britain and 6 million people in North America currently are treating high cholesterol by using statin drugs.
Data published in 2003 in the journal Diabetes Care indicate the annual cost of statin therapy, medication, monitoring and adverse events is between $600 and $2,1000 per person, depending on the LDL cholesterol level being treated.
"I am not into statin bashing, heart disease is real and these drugs are saving lives every day," Jenkins said. "What I want to do is simply raise the question, again and again, of what should -- and easily could -- be the initial therapeutic approach to high LDL cholesterol for anyone. This study confirms that the answer to that question is, simply, a change of diet," he added.
"These results are potentially important, given the expense, safety concerns, and intolerance related to statin use," Dr. James Anderson, professor of medicine and clinical nutrition at the University of Kentucky in Lexington, wrote in an editorial accompanying the study. "The findings suggest that intensive nutritional therapy that includes low intake of saturated fat, trans-fatty acid, and cholesterol, with emphasis on soy protein, soluble fiber, plant sterols, and almonds, may be a useful first-line intervention for select patients with dyslipidemia (high LDL cholesterol)," Anderson continued.
"This new study reinforces the fact that there are first-line lifestyle choices that people can make to reduce heart risk such as exercise, no smoking, diets rich in fruits, vegetables, nuts, and legumes, and, if they have heart disease, (or are at high risk), fish consumption," Dr. Beatrice Golomb, a statin researcher for the National Institutes of Health and assistant professor of medicine at the University of California, San Diego, told UPI.
"Statins offer major benefits for the prevention of heart disease and stroke," Golomb explained. "And statin therapy appears to extend average life expectancies among middle aged or moderately elderly men at high risk of heart disease. But the same benefit has not appeared among women, the older elderly or men at lower cardiac risk. For these groups, possible side effects of statin therapy could have particular importance."
For example, Golomb said, among the older elderly, any treatment-related reduction in muscle function or thinking ability is a matter of survival, not a quality of life issue. "Even moderate losses in either area may affect survival," she commented.
In his editorial, Anderson concluded: "Dietary management is an essential part of the treatment for lipid disorders, although adherence to strict and intensive dietary interventions requires motivation by patients, encouragement by physicians, and, perhaps, counseling by dietitians and nutrition experts. For most patients, dietary intervention should be the first line of therapy (perhaps for 6 to 12 weeks) before introducing pharmacotherapy for hyperlipidemia."
The study was funded by the Natural Sciences and Engineering Research Council of Canada, the Canada Research Chair program, the Almond Board of California, Loblaws Brands Ltd., Yves Fine Foods (now Hain-Celestial Group) and Unilever Canada.