A Statin-like Diet?

A tough cholesterol-lowering diet (lots of fiber, plant sterols, soy, and nuts) is shown to be
just as good as a statin in lowering LDL-cholesterol over a 4-week period . . .

Introduction

Not everyone with high blood cholesterol levels wants, or is able, to take a statin drug. They
may have firm naturopathic beliefs, or suffer from side effects of statins. Although there have
been reports that one can lower raised cholesterol levels perfectly well by diet alone, there
hasn't been a direct comparison between the effectiveness of both regimes in the same patient
- until now. Scientists in Toronto have done a study of people with high cholesterol levels
treated with a low-fat diet, a statin, and a so-called portfolio diet, in rotation. The portfolio
diet contained foods with given amounts of substances that reduce cholesterol: fiber, soy
protein, plant sterols, and nuts. The findings are reported in the American Journal of Clinical
Nutrition, and are summarized here.

What was done

Participants with high blood lipid levels were recruited; there were 20 men and 14 post-
menopausal women who had an average age of 58 and an average body mass index (BMI) of
27. Three one-month treatments were given in a random order: a very-low-saturated-fat diet
(the control diet), the same diet plus a statin (lovastatin), and the portfolio diet.

The diets - all vegetarian - were calculated individually to provide calories enough for weight
maintenance. The control diet used skim milk, fat-free cheese, yogurt, egg substitute, and
liquid egg white to achieve low intake of saturated fat; a high fiber content was ensured with
whole-wheat cereal and wheat-bran muffins containing sunflower oil. During the statin phase
the participants took lovastatin (Mevacor®) at a dose of 20 mg daily. And the portfolio diet
had 4 main components:

• margarine enriched in plant sterols giving 1 g sterol per 1,000 calories

• oats, barley and psyllium to give 10 g fiber per 1,000 calories; okra (100 g) and
eggplant (200 g) on alternate days
• soy protein as soy milk and soy meat analogs (burgers, dogs, deli slices) to give 21 g
per 1,000 calories
• almonds (14 g per 1,000 calories)

Fasting blood samples were taken before the start of the study, and at weeks 2 and 4 of each
diet/statin cycle. Blood lipids (total cholesterol, LDL-, HDL-cholesterol, triglycerides) were
measured.
What was found

The participants were diligent in recording their dietary intake accurately. The only 'side
effect' reported was a slight increase in the frequency of defecation during the portfolio diet
phase. Body weights remained unchanged during the study.

The LDL-cholesterol levels were decreased by 8.5% after 4 weeks on the control diet, by 33%
with the statin, and by 30% with the portfolio diet. While the slight advantage of the statin
over the portfolio diet was statistically significant (i.e. it couldn't have occurred by chance
alone), a quarter of the participants (9 of 34) achieved their lowest LDL-cholesterol levels
while on the portfolio diet.

Similar changes were seen in triglyceride levels, but there were no comparable improvements
in HDL-cholesterol.

What this means

This study shows, quite conclusively, that a diet composed of cholesterol-lowering foods
given over a 4-week period can achieve the same benefit as a statin drug taken with a low-
saturated-fat diet. The reduction in the ten-year risk of coronary heart disease, reckoned
according to the Framingham study guidelines, was the same for both forms of treatment.

The strength of the study lies in the fact that the same patients were used for each form of
treatment. Although there was a slightly greater decrease in LDL-cholesterol levels with
statins, when the number of patients who achieved the recommended primary target level of
120 mg/mL (3.4 mmol/L) was counted, there was no difference between the effectiveness of
the two treatments.

Of course, this finding raises the question "Should everyone with raised cholesterol levels be
eating this portfolio diet?" It's probably easier said than done. The ingredients are not
necessarily cheap, and may not be acceptable to people over a period greater than a few
weeks. However, the information will be useful, both to those who can't or won't take a statin,
and for those with less severe increases in cholesterol levels who want to postpone the need
for medication.