If you were told you had high cholesterol, would you rather take a statin or attempt to control things by making changes in your diet? Quick fixes in the form of medications seem to be the preferable course for lots of people when confronted with a health problem. Rather than quit smoking, lose weight, start exercising, or elect the host of health-promoting behaviors we hear so much about, many opt instead for a pill or pills to cure their ills. In this week's podcast, however, Rick and I talk about a study using a selection of foods to effectively lower cholesterol, as reported in JAMA. Such a diet may potentially help people avoid taking a statin for the same purpose.
The study was conducted in Canada and recruited about 350 people with elevated LDL (the 'bad' cholesterol) cholesterol to one of three strategies: a garden-variety high fiber/whole grain diet, a diet containing what investigators called a "portfolio" of known cholesterol lowering foods along with two sessions of counseling over six months, or the same portfolio with intensive counseling comprised of seven sessions over the six month period.
Here's what they found: folks who consumed the portfolio of cholesterol lowering foods and had the intensive counseling were able to reduce their LDL cholesterol an average of 26 mg/dL! Those who had only two counseling sessions also turned in impressive results, while those who instituted the standard issue dietary changes saw an average of an 8mg/dL drop. Wow! Seems like a fairly easy way to achieve a good result with regard to lowering LDL cholesterol.
Which foods constituted the portfolio? So-called plant sterols were one of them. After an internet search I learned that specific margarines are good sources of these, so perhaps switching to one of these products is a good idea since the authors suggest that by themselves they may reduce LDL by 5%. Other foods included tree nuts and peanuts, soy-based products such as tofu and soy milk, and 'viscous fibers' such as oatmeal, psyllium and barley. What I like about this food list is its easily available at almost any grocery store so there's no need to purchase expensive or hard to find prepared foods that meet the guidelines. Many people are already consuming these foods anyway, so doing more of the same may be simpler than a wholesale revamping of one's diet. And most of these foods taste good, unlike many supplements purported to lower cholesterol but have all the appeal of sawdust.
I like this study because as always, I advocate for putting power into the hands of patients, who, after all, are most vested in their own health. Moreover, anytime a medication can be avoided I'm all for it, since as Rick and I discuss so often, no medication comes without side effects, and statins are no exception.
One caveat must be noted about this study: it was a vegetarian diet comprised of the aforementioned portfolio plus whatever other non-animal foods people chose. It would be interesting to see how the portfolio might affect LDL cholesterol in those who still chose to eat meat.
Other topics this week include use of an antibiotic in people with COPD in NEJM, unintentional discontinuation of medications following hospitalization in JAMA, and 24 hour ambulatory blood pressure for making an accurate diagnosis in the Lancet. Until next week, y'all live well.