Advertisement

Current Atherosclerosis Reports

, Volume 6, Issue 6, pp 492–498 | Cite as

A Dietary portfolio: Maximal reduction of low-density lipoprotein cholesterol with diet

  • Cyril W. C. Kendall
  • David J. A. Jenkins
Article

Abstract

Over the past two decades, cholesterol-lowering drugs have proven to be effective and have been found to significantly reduce the risk of coronary heart disease (CHD). However, diet and lifestyle factors are still recognized as the first line of intervention for CHD risk reduction by the National Cholesterol Education Program and the American Heart Association, which now advocate use of viscous fibers and plant sterols, and soy protein and nuts, respectively. In a series of metabolically controlled studies, we have combined these four cholesterol-lowering dietary components in the same diet (ie, a dietary portfolio of cholesterol-lowering foods) in an attempt to maximize low-density lipoprotein cholesterol reduction. We have found that the portfolio diet reduced low-density lipoprotein cholesterol by approximately 30% and produced clinically significant reductions in CHD risk. These reductions were the same as found with a starting dose of a first-generation statin drug.

Keywords

National Cholesterol Education Program Plant Sterol Vegetable Protein Coronary Heart Disease Risk Reduction Plant Stanol Ester 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease.JAMA 1984, 251:351–364.Google Scholar
  2. 2.
    The Lipid Research Clinics Coronary Primary Prevention Trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering.JAMA 1984, 251:365–374.Google Scholar
  3. 3.
    Downs JR, Clearfield R, Weis S, et al.: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998, 279:1615–1622.PubMedCrossRefGoogle Scholar
  4. 4.
    Heart Protection Study Collaborative Group: MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002, 360:7–22.CrossRefGoogle Scholar
  5. 5.
    Shepherd J, Cobbe SM, Ford I, et al., for the West of Scotland Coronary Prevention Study Group: Prevention of coronary disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995, 333:1301–1307.PubMedCrossRefGoogle Scholar
  6. 6.
    Shepherd J, Blauw GJ, Murphy MB, et al.: Prospective Study of Pravastatin in the Elderly at Risk. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002, 360:1623–1630.PubMedCrossRefGoogle Scholar
  7. 7.
    Knowler WC, Barrett-Connor E, Fowler SE, et al.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002, 346:393–403.PubMedCrossRefGoogle Scholar
  8. 8.
    Jenkins DJ, Popovich DG, Kendall CW, et al.: Effect of a diet high in vegetables, fruit, and nuts on serum lipids. Metabolism 1997, 46:530–537.PubMedCrossRefGoogle Scholar
  9. 9.
    Jenkins DJ, Kendall CW, Popovich DG, et al.: Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism 2001, 50:494–503.PubMedCrossRefGoogle Scholar
  10. 10.
    Jenkins DJ, Kendall CW, Faulkner D, et al.: A dietary portfolio approach to cholesterol reduction: combined effects of plant sterols, vegetable proteins, and viscous fibers in hypercholesterolemia. Metabolism 2002, 51:1596–1604.PubMedCrossRefGoogle Scholar
  11. 11.
    Jenkins DJ, Kendall CW, Marchie A, et al.: A dietary portfolio of cholesterol lowering foods versus a statin on serum lipids and c-reactive protein. JAMA 2003, 290:502–510.PubMedCrossRefGoogle Scholar
  12. 12.
    Jenkins DJ, Kendall CW, Marchie A, et al.: The effect of combining plant sterols, soy protein, viscous fibers, and almonds in treating hypercholesterolemia. Metabolism 2003, 52:1478–1483.PubMedCrossRefGoogle Scholar
  13. 13.
    Kromhout D, Arntzenius AC, van der Velde EA: Diet and coronary heart disease: the Leiden Intervention Trial. Bibl Nutr Dieta 1986, 37:119–120.PubMedGoogle Scholar
  14. 14.
    Ornish D, Brown SE, Scherwitz LW, et al.: Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990, 336:129–133.PubMedCrossRefGoogle Scholar
  15. 15.
    de Lorgeril M, Salen P, Martin JL, et al.: Mediterrean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction. Final report of the Lyon Diet Heart Study. Circulation 1999, 99:779–785.PubMedGoogle Scholar
  16. 16.
    Singh RB, Dubnov G, Niaz MA, et al.: Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet 2002, 360:1455–1461.PubMedCrossRefGoogle Scholar
  17. 17.
    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2497.CrossRefGoogle Scholar
  18. 18.
    Krauss RM, Eckel RH, Howard B, et al.: AHA dietary guidelines revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000, 102:2284–2299.PubMedGoogle Scholar
  19. 19.
    United States Food and Drug Administration: Food labeling: health claims; soluble fiber from certain foods and coronary heart disease. [Docket No. 96P-0338]. 1998.Google Scholar
  20. 20.
    United States Food and Drug Administration: FDA final rule for food labeling: health claims: soy protein and coronary heart disease. Federal Register 64, 57699–57733. September 26, 1999.Google Scholar
  21. 21.
    United States Food and Drug Administration: FDA authorizes new coronary heart disease health claim for plant sterol and plant stanol esters. Washington, DC: US FDA, Docket Nos. 001-1275, OOP-1276, 2000.Google Scholar
  22. 22.
    United States Food and Drug Administration: Food labeling: health claims; soluble fiber from whole oats and risk of coronary heart disease. [Docket No. 95P-0197], 15343–15344. 2001.Google Scholar
  23. 23.
    United States Food and Drug Administration: Food labeling: health claims: nuts & heart Disease. Federal Register. [Docket No. 02P-0505]. 2003.Google Scholar
  24. 24.
    Fahrenbach MJ, Riccardi BA, Grant WC: Hypocholesterolemic activity of mucilaginous polysaccharides in White Leghorn cockerels. Proc Soc Exp Biol Med 1966, 123:321–326.PubMedGoogle Scholar
  25. 25.
    Kritchevsky D: Influence of dietary fiber on bile acid metabolism. Lipids 1978, 13:982–985.PubMedCrossRefGoogle Scholar
  26. 26.
    Vahouny GV, Tombes R, Cassidy MM, et al.: Dietary fibers: V. Binding of bile salts, phospholipids and cholesterol from mixed micelles by bile acid sequestrants and dietary fibers. Lipids 1980, 15:1012–1018.PubMedCrossRefGoogle Scholar
  27. 27.
    Jenkins DJ, Leeds AR, Gassull MA, et al.: Decrease in postprandial insulin and glucose concentrations by guar and pectin. Ann Intern Med 1977, 86:20–23.PubMedGoogle Scholar
  28. 28.
    Bourdon I, Yokoyama W, Davis P, et al.: Postprandial lipid, glucose, insulin, and cholecystokinin responses in men fed barley pasta enriched with beta-glucan. Am J Clin Nutr 1999, 69:55–63.PubMedGoogle Scholar
  29. 29.
    Thacker PA, Solomon MO, Aherne FX, et al.: Influence of propionic acid on the cholesterol metabolism of pigs fed hypercholesterolemic diets. Can J Animal Sci 1981, 61:969–975.CrossRefGoogle Scholar
  30. 30.
    Braaten JT, Wood PJ, Scott FW, et al.: Oat beta-glucan reduces blood cholesterol concentration in hypercholesterolemic subjects. Eur J Clin Nutr 1994, 48:465–474.PubMedGoogle Scholar
  31. 31.
    Jenkins DJ, Wolever TM, Leeds AR, et al.: Dietary fibres, fibre analogues, and glucose tolerance: importance of viscosity. BMJ 1978, 1:1392–1394.PubMedCrossRefGoogle Scholar
  32. 32.
    Sirtori CR, Agradi E, Conti F, et al.: Soybean-protein diet in the treatment of type-II hyperlipoproteinaemia. Lancet 1977, 1:275–277.PubMedCrossRefGoogle Scholar
  33. 33.
    Anderson JW, Johnstone BM, Cook-Newell ME: Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med 1995, 333:276–282.PubMedCrossRefGoogle Scholar
  34. 34.
    Baum JA, Teng H, Erdman JW Jr, et al.: Long-term intake of soy protein improves blood lipid profiles and increases mononuclear cell low-density-lipoprotein receptor messenger RNA in hypercholesterolemic, postmenopausal women. Am J Clin Nutr 1998, 68:545–551.PubMedGoogle Scholar
  35. 35.
    Crouse JR 3rd, Morgan T, Terry JG, et al.: A randomized trial comparing the effect of casein with that of soy protein containing varying amounts of isoflavones on plasma concentrations of lipids and lipoproteins. Arch Intern Med 1999, 159:2070–2076.PubMedCrossRefGoogle Scholar
  36. 36.
    Jenkins DJ, Kendall CW, Jackson CJ, et al.: Effects of high- and low-isoflavone soyfoods on blood lipids, oxidized LDL, homocysteine, and blood pressure in hyperlipidemic men and women. Am J Clin Nutr 2002, 76:365–372.PubMedGoogle Scholar
  37. 37.
    Weggemans RM, Trautwein EA: Relation between soy-associated isoflavones and LDL and HDL cholesterol concentrations in humans: a meta-analysis. Eur J Clin Nutr 2003, 57:940–946.PubMedCrossRefGoogle Scholar
  38. 38.
    Lovati MR, Manzoni C, Gianazza E, et al.: Soy protein peptides regulate cholesterol homeostasis in Hep G2 cells. J Nutr 2000, 130:2543–2549.PubMedGoogle Scholar
  39. 39.
    Castiglioni S, Manzoni C, D’Uva A, et al.: Soy proteins reduce progression of a focal lesion and lipoprotein oxidiability in rabbits fed a cholesterol-rich diet. Atherosclerosis 2003, 171:163–170.PubMedCrossRefGoogle Scholar
  40. 40.
    Law M: Plant sterol and stanol margarines and health. BMJ 2000, 320:861–864.PubMedCrossRefGoogle Scholar
  41. 41.
    Lees AM, Mok HY, Lees RS, et al.: Plant sterols as cholesterol-lowering agents: clinical trials in patients with hypercholesterolemia and studies of sterol balance. Atherosclerosis 1977, 28:325–338.PubMedCrossRefGoogle Scholar
  42. 42.
    Jones PJ: Cholesterol-lowering action of plant sterols. Curr Atheroscler Rep 1999, 1:230–235.PubMedGoogle Scholar
  43. 43.
    Fraser GE, Sabate J, Beeson WL, Strahan TM: A possible protective effect of nut consumption on risk of coronary heart disease. The Adventist Health Study. Arch Intern Med 1992, 152:1416–1424.PubMedCrossRefGoogle Scholar
  44. 44.
    Hu FB, Stampfer MJ, Manson JE, et al.: Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study. BMJ 1998, 317:1341–1345.PubMedGoogle Scholar
  45. 45.
    Albert CM, Gaziano JM, Willett WC, Manson JE: Nut consumption and decreased risk of sudden cardiac death in the Physicians’ Health Study. Arch Intern Med 2002, 162:1382–1387.PubMedCrossRefGoogle Scholar
  46. 46.
    Kris-Etherton PM, Yu-Poth S, Sabate J, et al.: Nuts and their bioactive individual constituents: effects on serum lipids and other factors that affect disease risk. Am J Clin Nutr 1999, 70(Suppl):504s-511s.PubMedGoogle Scholar
  47. 47.
    Jenkins DJ, Kendall CW, Marchie A, et al.: Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine and pulmonary nitric oxide. A randomized controlled crossover trial. Circulation 2002, 106:1327–1332.PubMedCrossRefGoogle Scholar
  48. 48.
    Hyson DA, Schneeman BO, Davis PA: Almonds and almond oil have similar effects on plasma lipids and LDL oxidation in healthy men and women. J Nutr 2002, 132:703–707.PubMedGoogle Scholar
  49. 49.
    Spiller GA, Miller A, Olivera K, et al.: Effects of plant-based diets high in raw or roasted almonds, or roasted almond butter on serum lipoproteins in humans. J Am Coll Nutr 2003, 22:195–200.PubMedGoogle Scholar
  50. 50.
    Sabate J, Haddad E, Tanzman JS, et al.: Serum lipid response to the graduated enrichment of a Step I diet with almonds: a randomized feeding trial. Am J Clin Nutr 2003, 77:1379–1384.PubMedGoogle Scholar
  51. 51.
    Kay R: Diets of early Miocene African hominoids. Nature 1977, 268:628–630.CrossRefGoogle Scholar
  52. 52.
    Milton K: Hunter-gatherer diets—a different perspective. Am J Clin Nutr 2000, 71:665–667.PubMedGoogle Scholar
  53. 53.
    Teaford MF, Ungar PS: Diet and the evolution of the earliest human ancestors. Proc Natl Acad Sci 2000, 97:13506–11351.PubMedCrossRefGoogle Scholar
  54. 54.
    Popovich DG, Jenkins DJ, Kendall CW, et al.: Health implications of the Western lowland gorilla diet. J Nutr 1997, 127:2000–2005.PubMedGoogle Scholar
  55. 55.
    Goodall AG: Feeding and ranging behaviour of a mountain gorilla group (Gorilla gorilla beringei) in the Tshinda-Kahuzi region (Zaire). In Primate Ecology. Edited by Clutton-Brock TH. London: Academic Press; 1977:449–479.Google Scholar
  56. 56.
    Goodall J. The Chimpanzees of Gombe: Patterns of Behavior. Cambridge, MA: Harvard University Press; 1986.Google Scholar
  57. 57.
    Fossey D. Observations on the home range on one group of mountain gorillas (Gorilla gorilla beringei). Animal Behav 1974, 22:568–581.CrossRefGoogle Scholar
  58. 58.
    Clark AG, Glanowski S, Nielsen R, et al.: Inferring nonneutral evolution from human-chimp-mouse orthologous gene trios. Science 2003, 302:1960–1963.PubMedCrossRefGoogle Scholar
  59. 59.
    Eaton SB, Konner MJ: Paleolithic nutrition. A consideration of its nature and current implications. N Engl J Med 1985, 312:283–289.PubMedCrossRefGoogle Scholar
  60. 60.
    Cordain L, Miller JB, Eaton SB, Mann N: Macronutrient estimations in hunter-gatherer diets. Am J Clin Nutr 2000, 72:1589–1592.PubMedGoogle Scholar
  61. 61.
    Cordain L: Cereal grains. Humanity’s double-edged sword. World Rev Nutr Diet 1999, 84:19–73.PubMedCrossRefGoogle Scholar
  62. 62.
    Keys A: Mediterranean diet and public health: personal reflections. Am J Clin Nutr 1995, 61(Suppl):321s-332s.Google Scholar
  63. 63.
    Cleave TL, Campbell GD, Painter NS: Diabetes, Coronary Thrombosis and the Saccharine Disease. Bristol, England: Wright; 1969.Google Scholar
  64. 64.
    Burkitt DP, Trowell HC: Refined Carbohydrate and Disease. New York: Academic Press; 1975.Google Scholar
  65. 65.
    Willett WC, Stampfer MJ, Manson JE, et al.: Intake of trans fatty acids and risk of coronary heart disease among women. Lancet 1993, 341:581–585.PubMedCrossRefGoogle Scholar
  66. 66.
    Jenkins DJ, Kendall CW, Vuksan V: Viscous fibers, health claims, and strategies to reduce cardiovascular disease risk. Am J Clin Nutr 2000, 71:401–402.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • Cyril W. C. Kendall
    • 1
  • David J. A. Jenkins
    • 1
  1. 1.Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada

Personalised recommendations