Easy diet shift helps re­duce choles­terol

DOC­TORS’ NOTES

The Hamilton Spectator - - HEALTH - DAVID JENK­INS AND JOHN SIEVENPIPER

If you’re strug­gling to lower your choles­terol with or with­out drugs, it’s pos­si­ble to use food to achieve your tar­get.

It’s called the Di­etary Port­fo­lio, an ev­i­dence-based di­etary ap­proach to re­duc­ing your choles­terol rec­om­mended by the cur­rent clin­i­cal prac­tice guide­lines of the Cana­dian Car­dio­vas­cu­lar So­ci­ety. We’ve had good re­sults test­ing it on pa­tients with high choles­terol in clin­i­cal tri­als and in the clinic here in Toronto for about 15 years. On av­er­age, peo­ple who stick to all com­po­nents of this eat­ing plan can de­crease their LDL or “bad” choles­terol by as much as 30 per cent, with most re­duc­ing their LDL choles­terol by about 13 per cent to 14 per cent. Those who pre­vi­ously had very un­healthy di­ets tend to ex­pe­ri­ence even greater re­duc­tions.

Us­ing this ap­proach, you aim to con­sume the fol­low­ing each day:

— 45 grams of nuts, which is about a hand­ful

— 20 grams of sticky vis­cous fi­bre — 50 grams of plant pro­tein — two grams of plant sterols As an ex­am­ple, for break­fast, you might have oat­meal with soy milk and blue­ber­ries or other fruit on top.

Lunch might in­clude a lentil soup with 100-per-cent oat bran bread and a plant sterol-en­riched mar­garine fol­lowed by peanuts and an ap­ple. Maybe try a tofu stir­fry for din­ner.

In our clinic at St. Michael’s Hos­pi­tal, we see pa­tients who would like to try an al­ter­na­tive to med­i­ca­tions.

Some­times peo­ple feel strongly that they don’t want to start tak­ing drugs, but they also fear the heart at­tacks and strokes that can come with high LDL choles­terol. That’s an­other rea­son to con­sider the Di­etary Port­fo­lio, which was de­vel­oped with fund­ing from the Cana­dian In­sti­tutes for Health Re­search, Nat­u­ral Sci­ences and the En­gi­neer­ing Re­search Coun­cil of Canada, as well as Loblaw, Unilever, Al­mond Board of Cal­i­for­nia, var­i­ous soy man­u­fac­tur­ers and the Saskatchewan Pulse Grow­ers.

Over the years, we found that the choles­terol-low­er­ing foods had a mod­est abil­ity to re­duce LDL choles­terol when tested alone. But it wasn’t un­til we put them to­gether in a port­fo­lio of choles­terol-low­er­ing foods that we were able to get a drug­like ef­fect.

Each of the foods in the diet does some­thing dif­fer­ent to com­bat high choles­terol.

The plant sterols stop choles­terol from be­ing ab­sorbed. The sticky fi­bres block ab­sorp­tion of bile acid, which is made from choles­terol. Soy, beans and pulses stop the liver from pro­duc­ing choles­terol and in­crease the num­ber of re­cep­tors on cells that clear LDL choles­terol from the blood. Nuts per­form all four func­tions.

Th­ese are all the ways that LDL choles­terol can be kept low in our blood — and the four food com­po­nents of the Di­etary Port­fo­lio work to­gether and as a com­ple­ment to lower blood choles­terol.

Some pa­tients find the Di­etary Port­fo­lio easy to fol­low. Some don’t — but it’s very com­mon to slip up when it comes to di­ets, be­cause temp­ta­tions are ev­ery­where and ev­ery­one has to eat. That’s why it’s best to start with any change you can make. We don’t need 100 per cent ad­her­ence to have some suc­cess — we want you to make changes that are sus­tain­able and this plan al­lows you choices.

Think of it as a set of tar­gets to be lay­ered into one’s back­ground diet. Choose foods from each cat­e­gory that you en­joy and try to meet the tar­get. If you can take one out of four com­po­nents to start, then that’s bet­ter than none. Maybe next week you can try two and so on. We don’t want per­fec­tion to be the en­emy of the good.

It’s amaz­ing how much diet can in­flu­ence your choles­terol. One of our pa­tients, a man in his 50s, was very mo­ti­vated to avoid drugs. His LDL choles­terol was high, but he got this level down by about 50 per cent us­ing the Di­etary Port­fo­lio alone.

Oth­ers use the diet as an ad­junct to their statin and/or other choles­terol-low­er­ing med­i­ca­tions to help achieve their LDL choles­terol tar­gets. One such pa­tient, a man in his 70s, used a com­bi­na­tion of two med­i­ca­tions in­clud­ing a statin plus the Di­etary Port­fo­lio to re­duce his LDL choles­terol by 78 per cent — 56 per cent be­yond what he was achiev­ing with the two med­i­ca­tions alone. We’ve had suc­cess with pa­tients who have all kinds of other health prob­lems, and who are at all stages of life. It can be done.

David Jenk­ins pi­o­neered the Glycemic In­dex and Di­etary Port­fo­lio. He is the Canada Re­search Chair in Nutri­tion and Me­tab­o­lism in the de­part­ments of Nu­tri­tional Sci­ences and Medicine at the Univer­sity of Toronto. He serves as di­rec­tor of the Clin­i­cal Nutri­tion and Risk Fac­tor Mod­i­fi­ca­tion Cen­tre, a sci­en­tist in the Li Ka Shing Knowl­edge In­sti­tute and a staff physi­cian in the Di­vi­sion of En­docrinol­ogy and Me­tab­o­lism at St. Michael’s Hos­pi­tal. John Sievenpiper is an as­so­ciate pro­fes­sor in the Univer­sity of Toronto’s Depart­ment of Nu­tri­tional Sci­ences, a sci­en­tist at the Li Ka Shing Knowl­edge In­sti­tute and a staff physi­cian in the Di­vi­sion of En­docrinol­ogy and Me­tab­o­lism at St. Michael’s Hos­pi­tal. He is a mem­ber of the Cana­dian Car­dio­vas­cu­lar So­ci­ety Clin­i­cal Prac­tice Guide­lines Com­mit­tee for Dys­lipi­demia.

DREAM­STIME

Nuts are a choles­terol-re­duc­ing food. Eat­ing about a hand­ful a day is rec­om­mended to help lower your LDL.

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