FW: CRSupport Group-- very high fiber diet paper attached (PMID 11288049)

[Guest guest]

This was sent to me by a well respected CRONIE. It contains more about the

Portfolio Diet. I've started adding guar at each meal, eggplant, a bit more

soy to my diet.

______________________________________________________

From CRONIE Carol:

I have been very busy with my job and have not been keeping up

much with the CR talk, but recently read your message about

surprising blood lipid test results.

I attached a paper by the esteemed nutrition researcher

. He is the developer of the GI index. In this paper,

compared the effects of three diets: 1)standard AHA therapeutic

diet, 2) whole-grain vegetarian diet, and 3) limited starch very high

fiber fruit, vegetable, and nut diet. The third option resulted in

stellar improvements in blood lipids and colonic function within

only one week. However, (who used himself as one of the

subjects) later wrote that this diet (consisting of up to 5 kg of

fruits and vegetables per day) was impractical and incompatible

with modern life. His subsequent efforts focused on more contrived

ways of achieving the same results with less bulk ( PMID: 12876093,

PMID: 14527636).

I hope that you find it helpful. It did not change my way of thinking

or eating, because I had begun to veer in that direction years ago,

but I was most gratified to read of his results.

Metabolism. 2001 Apr;50(4):494-503.

Effect of a very-high-fiber vegetable, fruit, and nut diet on serum

lipids and colonic function.

DJ, Kendall CW, Popovich DG, Vidgen E, Mehling CC, Vuksan V,

Ransom TP, Rao AV, Rosenberg-Zand R, Tariq N, Corey P, PJ, Raeini

M, Story JA, Furumoto EJ, Illingworth DR, Pappu AS, Connelly PW.

Clinical Nutrition and Risk Factor Modification Center, Department

of Medicine, Division of Endocrinology and Metabolism, St. 's

Hospital, Toronto, Quebec, Canada.

We tested the effects of feeding a diet very high in fiber from

fruit and vegetables. The levels fed were those, which had originally

inspired the dietary fiber hypothesis related to colon cancer and heart

disease prevention and also may have been eaten early in human

evolution. Ten healthy volunteers each took 3 metabolic diets of 2 weeks

duration. The diets were: high-vegetable, fruit, and nut

(very-high-fiber, 55 g/1,000 kcal); starch-based containing cereals and

legumes (early agricultural diet); or low-fat (contemporary therapeutic

diet). All diets were intended to be weight-maintaining (mean intake,

2,577 kcal/d). Compared with the starch-based and low-fat diets, the

high-fiber vegetable diet resulted in the largest reduction in

low-density lipoprotein (LDL) cholesterol (33% +/- 4%, P <.001) and the

greatest fecal bile acid output (1.13 +/- 0.30 g/d, P =.002), fecal bulk

(906 +/- 130 g/d, P <.001), and fecal short-chain fatty acid outputs (78

+/- 13 mmol/d, P <.001). Nevertheless, due to the increase in fecal

bulk, the actual concentrations of fecal bile acids were lowest on the

vegetable diet (1.2 mg/g wet weight, P =.002). Maximum lipid reductions

occurred within 1 week. Urinary mevalonic acid excretion increased (P

=.036) on the high-vegetable diet reflecting large fecal steroid losses.

We conclude that very high-vegetable fiber intakes reduce risk factors

for cardiovascular disease and possibly colon cancer. Vegetable and

fruit fibers therefore warrant further detailed investigation. Copyright

2001 by W.B. Saunders Company

Publication Types:

* Clinical Trial

* Randomized Controlled Trial

PMID: 11288049 [PubMed - indexed for MEDLINE]

-------------------------------------------

Also of interest:

Comp Biochem Physiol A Mol Integr Physiol. 2003 Sep;136(1):141-51.

The Garden of Eden--plant based diets, the genetic drive to conserve

cholesterol and its implications for heart disease in the 21st century.

DJ, Kendall CW, Marchie A, AL, Connelly PW,

PJ, Vuksan V.

Clinical Nutrition and Risk Factor Modification Center, St.

's Hospital, 61 Queen Street East, Ont., M5C 2T2, Toronto, Canada.

It is likely that plant food consumption throughout much of human

evolution shaped the dietary requirements of contemporary humans. Diets

would have been high in dietary fiber, vegetable protein, plant sterols

and associated phytochemicals, and low in saturated and trans-fatty

acids and other substrates for cholesterol biosynthesis. To meet the

body's needs for cholesterol, we believe genetic differences and

polymorphisms were conserved by evolution, which tended to raise serum

cholesterol levels. As a result modern man, with a radically different

diet and lifestyle, especially in middle age, is now recommended to take

medications to lower cholesterol and reduce the risk of cardiovascular

disease. Experimental introduction of high intakes of viscous fibers,

vegetable proteins and plant sterols in the form of a possible Myocene

diet of leafy vegetables, fruit and nuts, lowered serum LDL-cholesterol

in healthy volunteers by over 30%, equivalent to first generation

statins, the standard cholesterol-lowering medications. Furthermore,

supplementation of a modern therapeutic diet in hyperlipidemic subjects

with the same components taken as oat, barley and psyllium for viscous

fibers, soy and almonds for vegetable proteins and plant sterol-enriched

margarine produced similar reductions in LDL-cholesterol as the

Myocene-like diet and reduced the majority of subjects' blood lipids

concentrations into the normal range. We conclude that reintroduction of

plant food components, which would have been present in large quantities

in the plant based diets eaten throughout most of human evolution into

modern diets can correct the lipid abnormalities associated with

contemporary eating patterns and reduce the need for pharmacological

interventions.

Publication Types:

* Review

* Review Literature

PMID: 14527636 [PubMed - indexed for MEDLINE]

JAMA. 2003 Jul 23;290(4):502-10.

Comment in:

* JAMA. 2003 Jul 23;290(4):531-3.

* JAMA. 2003 Nov 26;290(20):2660; author reply 2660-1.

Effects of a dietary portfolio of cholesterol-lowering foods vs

lovastatin on serum lipids and C-reactive protein.

DJ, Kendall CW, Marchie A, Faulkner DA, Wong JM, de Souza R,

Emam A, TL, Vidgen E, Lapsley KG, Trautwein EA, Josse RG, Leiter

LA, Connelly PW.

Clinical Nutrition and Risk Factor Modification Center, St 's

Hospital, Toronto, Ontario, Canada. cyril.kendall@...

CONTEXT: To enhance the effectiveness of diet in lowering

cholesterol, recommendations of the Adult Treatment Panel III of the

National Cholesterol Education Program emphasize diets low in saturated

fat together with plant sterols and viscous fibers, and the American

Heart Association supports the use of soy protein and nuts. OBJECTIVE:

To determine whether a diet containing all of these recommended food

components leads to cholesterol reduction comparable with that of

3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins).

DESIGN: Randomized controlled trial conducted between October and

December 2002. SETTING AND PARTICIPANTS: Forty-six healthy,

hyperlipidemic adults (25 men and 21 postmenopausal women) with a mean

(SE) age of 59 (1) years and body mass index of 27.6 (0.5), recruited

from a Canadian hospital-affiliated nutrition research center and the

community. INTERVENTIONS: Participants were randomly assigned to undergo

1 of 3 interventions on an outpatient basis for 1 month: a diet very low

in saturated fat, based on milled whole-wheat cereals and low-fat dairy

foods (n = 16; control); the same diet plus lovastatin, 20 mg/d (n =

14); or a diet high in plant sterols (1.0 g/1000 kcal), soy protein

(21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds (14

g/1000 kcal) (n = 16; dietary portfolio). MAIN OUTCOME MEASURES: Lipid

and C-reactive protein levels, obtained from fasting blood samples;

blood pressure; and body weight; measured at weeks 0, 2, and 4 and

compared among the 3 treatment groups. RESULTS: The control, statin, and

dietary portfolio groups had mean (SE) decreases in low-density

lipoprotein cholesterol of 8.0% (2.1%) (P =.002), 30.9% (3.6%) (P<.001),

and 28.6% (3.2%) (P<.001), respectively. Respective reductions in

C-reactive protein were 10.0% (8.6%) (P =.27), 33.3% (8.3%) (P =.002),

and 28.2% (10.8%) (P =.02). The significant reductions in the statin and

dietary portfolio groups were all significantly different from changes

in the control group. There were no significant differences in efficacy

between the statin and dietary portfolio treatments. CONCLUSION: In this

study, diversifying cholesterol-lowering components in the same dietary

portfolio increased the effectiveness of diet as a treatment of

hypercholesterolemia.

Publication Types:

* Clinical Trial

* Randomized Controlled Trial

PMID: 12876093 [PubMed - indexed for MEDLINE]

[Guest guest]

> This was sent to me by a well respected CRONIE. It contains more

about the

> Portfolio Diet. I've started adding guar at each meal, eggplant, a

bit more

> soy to my diet.

> ______________________________________________________

[snip]

Hi All,

Relatedly is:

DJ, Kendall CW, Marchie A, Augustin LS.

Too much sugar, too much carbohydrate, or just too much?

Am J Clin Nutr. 2004 May;79(5):711-2. No abstract available.

PMID: 15113706 [PubMed - in process]

EDITORIAL

Too much sugar, too much carbohydrate, or just too much?1,2

JA , Cyril WC Kendall, Augustine Marchie and Livia SA

Augustin

2 Reprints not available. Address correspondence to DJA ,

Clinical Nutrition and Risk Factor Modification Center, St 's

Hospital, 61 Queen Street East, Toronto, Ontario, Canada M5C 2T2. E-

mail: cyril.kendall@....

See corresponding article on page 774.

In this issue of the Journal, Gross et al (1) show that since 1963

carbohydrate intakes have increased by 126 g/d, with high-fructose

corn syrup constituting 10% of total energy intakes. At the same

time, the incidence of diabetes has increased by 47%. This important

study highlights many key issues related to diet and lifestyle for

the 21st century and beyond. Is the increased incidence of diabetes

the result of an increased consumption of high-fructose corn syrup

alone or of the consumption of the wrong type of carbohydrate in

general? Or, does it reflect a total carbohydrate intake that is too

high? Does this question belie the fact that we are now simply eating

too much and exercising too little?

CARBOHYDRATE COMPARED WITH SUGAR

The panel that developed the dietary reference intakes established a

low recommended dietary allowance for carbohydrate, 130 g (26% of a

2000-kcal diet), which is based on brain utilization and is in

keeping with the trend established by the new dietary focus on

carbohydrate restriction. Weight-loss diets in this category include

the Atkins diet, which recommends carbohydrate intakes of <20 g/d

during its induction phase. However, in view of the constraints

imposed by other macronutrients, in terms of both health and the

nature of the current food supply, another term was coined—

the " acceptable macronutrient distribution range " (2). According to

the acceptable macronutrient distribution range, 45-65% of total

energy as carbohydrate is advocated. At this range, no upper level of

sugar intake was established, but a maximum intake of 25% of energy

was suggested. The article by Gross et al would have been useful as

part of this debate.

Concerns about sugar being linked to concerns about refined

carbohydrates in general are not new. These concerns have been

expressed in the writings of Cleave (3), Yudkin (4), and Burkitt and

Trowell (5). As the antithesis of fiber-rich foods, refined

carbohydrates are linked to a wide array of chronic diseases,

including colon cancer, diabetes, and cardiovascular disease.

However, clear data on sugar consumption and specific diseases are

not readily available. Fructose has been shown to raise serum

triacylglycerol concentrations and possibly LDL-cholesterol

concentrations (6), and refined carbohydrates may reduce circulating

HDL-cholesterol concentrations. However, strong associations between

sucrose and fructose intakes and heart disease or diabetes have not

been shown, nor is there a clear indication that obesity is directly

caused by increased sugar consumption or carbohydrate intake in

general.

Furthermore, fructose—the major component of high-fructose corn syrup—

has a low glycemic index, 20% that of glucose and 29% that of bread.

Fructose has even been proposed as a carbohydrate source that may be

of benefit in type 2 diabetes and at intakes of 60 g/d has been shown

to lower hemoglobin A1c concentrations (7). However, the concern

about the effects of fructose on serum triacylglycerol and HDL

cholesterol remains (8).

EMPTY CALORIES

A further concern has been the lack of association between refined

sugars and essential nutrients, vitamins, and minerals. In common

with certain starchy foods, saturated fats, and alcohol, energy from

refined sugars is considered to be " empty calories. " As we prepare

for a future of progressively reduced physical activity, the

nutritional density, as opposed to nutrient density, ie, the

consumption of essential nutrients per calorie, will have to increase

so that requirements can be met at the lower caloric intakes

necessitated by lower energy expenditure. Over the past decade, there

has been concern about adequate intakes of vitamins and minerals,

such as folate, thiamine, calcium, magnesium, and potassium. These

concerns no longer relate to acute deficiency syndromes but to the

long-term effects on health and the emergence of chronic diseases,

including cardiovascular disease, certain cancers, osteoporosis, and

hypertension.

REDUCED INTAKES OF TRADITIONAL STARCHY FOODS

Ironically, over the past 200 y or more, the increased consumption of

refined-carbohydrate foods appears to have gone hand-in-hand with a

reduced intake of traditional starchy foods, including truly whole-

grain (pumpernickel) breads, cracked wheat (bulgur and tabouleh),

dried peas, beans, and lentils. These foods are more slowly digested,

have a lower glycemic index, and—in general—are more nutritionally

replete than are their currently consumed counterparts (Table 1).

Part of the reason for the increased consumption of refined

carbohydrates may be that even starchy foods may taste sweet if they

are rapidly digested by salivary amylase, which may contribute to the

appeal of high-glycemic-index foods. Corn syrup and other sugars

enhance the appeal of such foods. In this way, the glycemic load

(glycemic index x total available carbohydrate) of the modern diet is

likely to increase by a process of hedonic selection and

overconsumption. High-glycemic-index and high-glycemic-load diets are

associated with an increased risk of heart disease, diabetes, and

certain cancers (9-13). Therefore, as we progressively eliminate

traditional starchy foods from the diet, we may lose the protection

that slow-release carbohydrate foods, such as pumpernickel bread,

peas, beans, and lentils and their associated nutrients, provide

against many major chronic diseases.

TABLE 1 The glycemic index of some traditional and contemporary

foods1

JUST TOO MUCH FOOD

Gross et al also note that, in the period since 1980, energy intakes

have increased by 500 kcal/d. Data on physical activity were not

available to these authors and, similarly, they had to rely on food

disappearance data rather than on food intake data. These limitations

did not diminish the authors' hypothesis that increased calorie

intakes contribute to obesity. In further support of their

hypothesis, no data suggest that we are now exercising more at work

or at play, but rather the reverse—we are becoming more sedentary.

Furthermore, as noted by Gross et al, the dietary data were obtained

over time in the same population. Thus, if we are in fact not eating

more, we would have to postulate that we have also become wasteful

over the past 2 decades. We need to add wastefulness to sloth and

gluttony to categorize ourselves, for we are certainly becoming more

obese.

Thus, the article by Gross et al raises many important issues. The

most important of these issues is the increased consumption of highly

processed, nutrient-depleted carbohydrate foods, especially those

that contain high-fructose corn syrup as a key component. An

increased consumption of these foods is associated with an increased

incidence of type 2 diabetes, which itself is rising at an alarming

rate. However, although high-fructose corn syrup is the focus of the

article by Gross et al, perhaps the greatest value of their article

is its emphasis on the quality of dietary carbohydrates and the

questions it raises about the total amount of food consumed and the

amount of energy expended. These concerns are a wake-up call for

radical lifestyle reassessment. For the first time, exercise has

become part of the dietary recommendations associated with the

dietary reference intakes. One hour of moderate to vigorous exercise

is recommended daily. If dramatic changes in exercise recommendations

are required, what should we be doing about the food supply?

REFERENCES

Gross LS, Li L, Ford ES, Liu S. Increased consumption of refined

carbohydrates and the epidemic of type 2 diabetes in the United

States: an ecological assessment. Am J Clin Nutr 2004;79:774–9.

Food and Nutrition Board, Institute of Medicine. Dietary reference

intakes for energy, carbohydrate, fiber, fat, fatty acids,

cholesterol, protein, and amino acids (macronutrients). Washington,

DC: National Academy Press, 2002.

Cleave TL. Sucrose intake and coronary heart-disease. Lancet

1968;2:1187.

Yudkin J. Dietary fat and dietary sugar in relation to ischaemic

heart disease and diabetes. Lancet 1964;41:4–5.

Burkitt DP, Trowell HC. Dietary fibre and Western diseases. Ir Med J

1977;70:272–7.[Medline]

Swanson JE, Laine DC, W, Bantle JP. Metabolic effects of

dietary fructose in healthy subjects. Am J Clin Nutr 1992;55:851–6.

[Abstract]

Osei K, Bossetti B. Dietary fructose as a natural sweetener in poorly

controlled type 2 diabetes: a 12-month crossover study of effects on

glucose, lipoprotein and apolipoprotein metabolism. Diabet Med

1989;6:506–11.[Medline]

Crapo PA, Kolterman OG, Henry RR. Metabolic consequence of two-week

fructose feeding in diabetic subjects. Diabetes Care 1986;9:111–9.

[Abstract]

Salmeron J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC.

Dietary fiber, glycemic load, and risk of non-insulin-dependent

diabetes mellitus in women. JAMA 1997;277:472–7.[Abstract]

Ludwig DS, Pereira MA, Kroenke CH, et al. Dietary fiber, weight gain,

and cardiovascular disease risk factors in young adults. JAMA

1999;282:1539–46.[Abstract/Free Full Text]

Liu S, Willett WC, Stampfer MJ, Hu FB, et al. A prospective study of

dietary glycemic load, carbohydrate intake, and risk of coronary

heart disease in US women. Am J Clin Nutr 2000;71:1455–61.

[Abstract/Free Full Text]

Franceschi S, Dal Maso L, Augustin L, et al. Dietary glycemic load

and colorectal cancer risk. Ann Oncol 2001;12:173–8.[Abstract]

Augustin LS, Dal Maso L, La Vecchia C, et al. Dietary glycemic index

and glycemic load, and breast cancer risk: a case-control study. Ann

Oncol 2001;12:1533–8.[Abstract]

[Guest guest]

Hi folks:

Incidentally, I have the original 'Portfolio Diet' study in my

Outlook Express email account in PDF format. If anyone is interested

to see it, and will tell me how to shift a PDF document over to here,

I will be happy to do so.

Rodney.

> This was sent to me by a well respected CRONIE. It contains more

about the

> Portfolio Diet. I've started adding guar at each meal, eggplant, a

bit more

> soy to my diet.

> ______________________________________________________

>

> From CRONIE Carol:

>

> I have been very busy with my job and have not been keeping up

> much with the CR talk, but recently read your message about

> surprising blood lipid test results.

>

> I attached a paper by the esteemed nutrition researcher

> . He is the developer of the GI index. In this paper,

> compared the effects of three diets: 1)standard AHA therapeutic

> diet, 2) whole-grain vegetarian diet, and 3) limited starch very

high

> fiber fruit, vegetable, and nut diet. The third option resulted in

> stellar improvements in blood lipids and colonic function within

> only one week. However, (who used himself as one of the

> subjects) later wrote that this diet (consisting of up to 5 kg of

> fruits and vegetables per day) was impractical and incompatible

> with modern life. His subsequent efforts focused on more contrived

> ways of achieving the same results with less bulk ( PMID: 12876093,

> PMID: 14527636).

>

> I hope that you find it helpful. It did not change my way of

thinking

> or eating, because I had begun to veer in that direction years ago,

> but I was most gratified to read of his results.

>

>

> Metabolism. 2001 Apr;50(4):494-503.

>

> Effect of a very-high-fiber vegetable, fruit, and nut diet on

serum

> lipids and colonic function.

>

> DJ, Kendall CW, Popovich DG, Vidgen E, Mehling CC,

Vuksan V,

> Ransom TP, Rao AV, Rosenberg-Zand R, Tariq N, Corey P, PJ,

Raeini

> M, Story JA, Furumoto EJ, Illingworth DR, Pappu AS, Connelly PW.

>

> Clinical Nutrition and Risk Factor Modification Center,

Department

> of Medicine, Division of Endocrinology and Metabolism, St. 's

> Hospital, Toronto, Quebec, Canada.

>

> We tested the effects of feeding a diet very high in fiber from

> fruit and vegetables. The levels fed were those, which had

originally

> inspired the dietary fiber hypothesis related to colon cancer and

heart

> disease prevention and also may have been eaten early in human

> evolution. Ten healthy volunteers each took 3 metabolic diets of 2

weeks

> duration. The diets were: high-vegetable, fruit, and nut

> (very-high-fiber, 55 g/1,000 kcal); starch-based containing cereals

and

> legumes (early agricultural diet); or low-fat (contemporary

therapeutic

> diet). All diets were intended to be weight-maintaining (mean

intake,

> 2,577 kcal/d). Compared with the starch-based and low-fat diets, the

> high-fiber vegetable diet resulted in the largest reduction in

> low-density lipoprotein (LDL) cholesterol (33% +/- 4%, P <.001) and

the

> greatest fecal bile acid output (1.13 +/- 0.30 g/d, P =.002), fecal

bulk

> (906 +/- 130 g/d, P <.001), and fecal short-chain fatty acid

outputs (78

> +/- 13 mmol/d, P <.001). Nevertheless, due to the increase in fecal

> bulk, the actual concentrations of fecal bile acids were lowest on

the

> vegetable diet (1.2 mg/g wet weight, P =.002). Maximum lipid

reductions

> occurred within 1 week. Urinary mevalonic acid excretion increased

(P

> =.036) on the high-vegetable diet reflecting large fecal steroid

losses.

> We conclude that very high-vegetable fiber intakes reduce risk

factors

> for cardiovascular disease and possibly colon cancer. Vegetable and

> fruit fibers therefore warrant further detailed investigation.

Copyright

> 2001 by W.B. Saunders Company

>

> Publication Types:

>

> * Clinical Trial

> * Randomized Controlled Trial

>

>

> PMID: 11288049 [PubMed - indexed for MEDLINE]

>

> -------------------------------------------

>

> Also of interest:

>

> Comp Biochem Physiol A Mol Integr Physiol. 2003 Sep;136(1):141-51.

> The Garden of Eden--plant based diets, the genetic drive to

conserve

> cholesterol and its implications for heart disease in the 21st

century.

>

> DJ, Kendall CW, Marchie A, AL, Connelly PW,

> PJ, Vuksan V.

>

> Clinical Nutrition and Risk Factor Modification Center, St.

> 's Hospital, 61 Queen Street East, Ont., M5C 2T2, Toronto,

Canada.

>

> It is likely that plant food consumption throughout much of

human

> evolution shaped the dietary requirements of contemporary humans.

Diets

> would have been high in dietary fiber, vegetable protein, plant

sterols

> and associated phytochemicals, and low in saturated and trans-fatty

> acids and other substrates for cholesterol biosynthesis. To meet the

> body's needs for cholesterol, we believe genetic differences and

> polymorphisms were conserved by evolution, which tended to raise

serum

> cholesterol levels. As a result modern man, with a radically

different

> diet and lifestyle, especially in middle age, is now recommended to

take

> medications to lower cholesterol and reduce the risk of

cardiovascular

> disease. Experimental introduction of high intakes of viscous

fibers,

> vegetable proteins and plant sterols in the form of a possible

Myocene

> diet of leafy vegetables, fruit and nuts, lowered serum LDL-

cholesterol

> in healthy volunteers by over 30%, equivalent to first generation

> statins, the standard cholesterol-lowering medications. Furthermore,

> supplementation of a modern therapeutic diet in hyperlipidemic

subjects

> with the same components taken as oat, barley and psyllium for

viscous

> fibers, soy and almonds for vegetable proteins and plant sterol-

enriched

> margarine produced similar reductions in LDL-cholesterol as the

> Myocene-like diet and reduced the majority of subjects' blood lipids

> concentrations into the normal range. We conclude that

reintroduction of

> plant food components, which would have been present in large

quantities

> in the plant based diets eaten throughout most of human evolution

into

> modern diets can correct the lipid abnormalities associated with

> contemporary eating patterns and reduce the need for pharmacological

> interventions.

>

> Publication Types:

>

> * Review

> * Review Literature

>

>

> PMID: 14527636 [PubMed - indexed for MEDLINE]

>

>

> JAMA. 2003 Jul 23;290(4):502-10.

> Comment in:

>

> * JAMA. 2003 Jul 23;290(4):531-3.

> * JAMA. 2003 Nov 26;290(20):2660; author reply 2660-1.

>

>

> Effects of a dietary portfolio of cholesterol-lowering foods vs

> lovastatin on serum lipids and C-reactive protein.

>

> DJ, Kendall CW, Marchie A, Faulkner DA, Wong JM, de

Souza R,

> Emam A, TL, Vidgen E, Lapsley KG, Trautwein EA, Josse RG,

Leiter

> LA, Connelly PW.

>

> Clinical Nutrition and Risk Factor Modification Center, St

's

> Hospital, Toronto, Ontario, Canada. cyril.kendall@u...

>

> CONTEXT: To enhance the effectiveness of diet in lowering

> cholesterol, recommendations of the Adult Treatment Panel III of the

> National Cholesterol Education Program emphasize diets low in

saturated

> fat together with plant sterols and viscous fibers, and the American

> Heart Association supports the use of soy protein and nuts.

OBJECTIVE:

> To determine whether a diet containing all of these recommended food

> components leads to cholesterol reduction comparable with that of

> 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors

(statins).

> DESIGN: Randomized controlled trial conducted between October and

> December 2002. SETTING AND PARTICIPANTS: Forty-six healthy,

> hyperlipidemic adults (25 men and 21 postmenopausal women) with a

mean

> (SE) age of 59 (1) years and body mass index of 27.6 (0.5),

recruited

> from a Canadian hospital-affiliated nutrition research center and

the

> community. INTERVENTIONS: Participants were randomly assigned to

undergo

> 1 of 3 interventions on an outpatient basis for 1 month: a diet

very low

> in saturated fat, based on milled whole-wheat cereals and low-fat

dairy

> foods (n = 16; control); the same diet plus lovastatin, 20 mg/d (n =

> 14); or a diet high in plant sterols (1.0 g/1000 kcal), soy protein

> (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds

(14

> g/1000 kcal) (n = 16; dietary portfolio). MAIN OUTCOME MEASURES:

Lipid

> and C-reactive protein levels, obtained from fasting blood samples;

> blood pressure; and body weight; measured at weeks 0, 2, and 4 and

> compared among the 3 treatment groups. RESULTS: The control,

statin, and

> dietary portfolio groups had mean (SE) decreases in low-density

> lipoprotein cholesterol of 8.0% (2.1%) (P =.002), 30.9% (3.6%)

(P<.001),

> and 28.6% (3.2%) (P<.001), respectively. Respective reductions in

> C-reactive protein were 10.0% (8.6%) (P =.27), 33.3% (8.3%) (P

=.002),

> and 28.2% (10.8%) (P =.02). The significant reductions in the

statin and

> dietary portfolio groups were all significantly different from

changes

> in the control group. There were no significant differences in

efficacy

> between the statin and dietary portfolio treatments. CONCLUSION: In

this

> study, diversifying cholesterol-lowering components in the same

dietary

> portfolio increased the effectiveness of diet as a treatment of

> hypercholesterolemia.

>

> Publication Types:

>

> * Clinical Trial

> * Randomized Controlled Trial

>

>

> PMID: 12876093 [PubMed - indexed for MEDLINE]