Hearth Health: To lower cholesterol, adding certain foods may beat eating a low-fat diet

THE QUESTION People trying to lower their cholesterol naturally generally try to eat less saturated fat, which can elevate cholesterol. Might a better option be eating more foods known for their cholesterol-lowering properties?

THIS STUDY involved 351 adults, most in their mid-50s, who had hyperlipidemia, or high levels of fats in the blood, including an LDL (low-density lipoprotein) cholesterol level that averaged 171 milligrams per deciliter (mg/dL). None were taking cholesterol-lowering drugs, such as statins, when the study began. They were randomly assigned to eat a low-fat diet, high in fiber and whole grains but void of specific cholesterol-lowering foods, or to add those foods to their regular diet. Cholesterol-lowering foods included margarine enriched with plant sterols; viscous fibers such as oats and barley; soy protein from soy milk, tofu or soy “meats”; peanuts and nuts from trees; and peas, beans and lentils. All participants met periodically with nutritionists, though the number of sessions varied. After six months, cholesterol levels of those who had added the cholesterol-lowering foods had fallen 24 to 26 mg/dL, or 13 to 14 percent, on average, compared with an eight-point (3 percent) drop for the low-fat group. Variations in nutrition counseling did not affect the results. Also, weight loss was virtually the same among participants, averaging three to four pounds; blood pressure dropped more, on average, among people who ate the cholesterol-lowering foods.

WHO MAY BE AFFECTED? People with high levels of LDL cholesterol, considered the bad type. It can cause plaque to build up on the inside of artery walls, leading to coronary artery disease and possibly a heart attack. An LDL level of 100 mg/dL is optimal, and a level of 160 or more is considered high, raising the risk for heart disease. A simple blood test is used to measure cholesterol levels.

CAVEATS The study did not determine whether particular foods were more effective than others at lowering cholesterol. Most participants were not overweight and were eating a relatively healthful diet at the start of the study; whether others could expect similar results is unclear. The study was funded in part by three food companies; eight of the 20 authors had received fees from the companies.

FIND THIS STUDY Aug. 24/31 issue of the Journal of the American Medical Association.

LEARN MORE ABOUT cholesterol at www.nhlbi.nih.gov/health and www.heart.org.

Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.