Report to Doctors: Dietary Interventions for Cholesterol Lowering Effective but Underutilized

Dietary intervention to lower serum LDL-cholesterol (LDL-C) is effective, yet underutilzsed in general family practice, reports a June 2009 article published in the Australian Family Physicians journal.

A year long trial showed an average LDL cholesterol lowering of 13%, with about one-third of subjects achieving a reduction greater than 20%. An important difference in the results related to the individual's adherence to dietary advice. The most effective dietary strategies are replacing saturated and trans fatty acids with poly- and monounsaturated fats and increasing intake of plant sterols. Losing weight and increasing soluble fibre and soy protein intake can also lower serum cholesterol and may be considered when recommending a nutritionally balanced, cholesterol lowering diet.

Updated Mediterranean Diet Pyramid From Oldways

Despite the fact that calories from fats may account for upwards of 40% of a Mediterranean diet, many studies show reduced incident of cardiovascular diseases in those populations that follow the traditional eating habits of this region.

Certainly, there is no single Mediterrean cuisine. The aromas, flavors and recipes vary widely from Spain and Italy to Greece and Lebanon and then across North Africa. Moreover, not all foods of these regions are necessarily healthful. Oldways, a leading advocate of traditional, healthful eating has released a revised Mediterranean diet pyramid to provide clear direction.

The major change in this updated Mediterranean Diet Pyramid, writes the staff of Oldways, is that all plant foods (fruits, vegetables, grains, nuts, legumes, seeds, olives and olive oil) are grouped together to emphasize the health benefits they provide. A new addition to the Mediterranean Diet Pyramid is herbs and spices—for reasons of both health and taste. Increasingly, nutritional science is identifying active micro-nutrients in herbs, spices and other plant compounds that collectively may deliver health benefits well beyond what is provided by the better known vitamins, minerals, proteins, fats and carbohydrates.

The Oldways pyramid also points out the healthfulness of fish and shellfish, and suggest that it is beneficial to eat fish and shellfish at least two times per week.

Other specific recommendations of Oldways include:

• Make olive oil your primary source of dietary fat
• Eat low to moderate amounts of cheese and yogurt daily
• Drink a moderate amount of wine (one to two glasses per day for men, one glass per day for women)
• Snack on almonds instead of fat-free cookies.
• Spread avocado on a sandwich to replace the mayonnaise.

Father's Day Gourmet & Cholesterol Management

The science is clear and convincing. Therapeutic nutrition---that incorporates 2g of plant sterols, over 10g of soluble fiber, monounsaturated fats replacing saturated and trans fats, and reduced animal sources of protein-- can achieve cholesterol reductions comparable to many of the widely prescribed medications.

With my daughter, we have created a delicious, natural, cholesterol-lowering Father’s Day menu.

We recommend recipes for lunch, a snack and dinner. With a single serving of each dish, you will enjoy:

• 2g of natural plant sterols from foods and taken through the course of the day.
• 30g of total fiber
• 7 grams of heart healthy soluble fiber.
• 1g Omega-3 fatty acids (EPA/DHA)
• Only 150mg of dietary cholesterol (from the chicken and salmon)
• Saturated fat is below 7 percent of total calories.
• Monounsaturated fats equal about 23% of total calories.

Overall, we are nearly in-line with the recommendations of the National Cholesterol Education Program, but we fall a bit short on the heart healthy soluble fiber.

So look to breakfast to finish your therapy. Here are some simple guidelines. A good morning start would be an oat cereal and fruit. If you are looking for something a bit more interesting, there are a number of oat pancake recipes that can be found online. Stay away from the ones with butter and lots of eggs in the ingredients. Either way, you should get you to the 10g minimum recommendations for soluble fiber.

In my life, I actually shoot for the higher, 20-25g recommendation. The only way I have been able to achieve this goal is with psyllium husk or concentrated oat bran. I dissolve a tablespoon of one of these fibers into my morning juice. A heaping tablespoon of the psyllium husk, for instance, delivers 9g of heart health soluble fiber. Most people can tolerate such a dosage, but it is probably something you need to work up to.

The Menu

Luncheon
Mediterranean Salmon Salad
Chick Peas with Oregano
Roasted Asparagus
Whole Grain Bread or Whole Wheat Roll

Snack
Kardea Gourmet Nutrition Bar with 1g plant sterols, 7g fiber, and 7g protein.

Dinner
1st Course
Gazpacho: Quick, Bold & Delicious

2nd Course
Chicken Balsamic Reduction
Steamed Broccoli
Barley Pilaf

Dessert
Sorbet of Your Choosing
Fresh Berries or Sliced Ripe Peaches.

Sources of Good Fats for Natural Cholesterol Management

Natural cholesterol managers seek to obtain 25-35% of their calories from fats, striving for zero trans fats, less than 7% from saturated fats, and no more than 10% and 20% of their calories from polyunsaturated and monounsaturated fats respectively. We have extolled the virtures of extra-virgin olive oil , but many people are asking us for more information on the levels of these fatty acids in the products they consume. Here is a good chart from the Harvard School of Public Health:

And if you are looking to build a framework for natural cholesterol managementt, consider our extra-virgin olive oil with added plant sterols (.5g plant sterols from plant sterol esters).