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A dietary portfolio approach to cholesterol reduction: Combined effects of plant sterols, vegetable proteins, and viscous fibers in hypercholesterolemia

  • David J.A. Jenkins
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • Cyril W.C. Kendall
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • Dorothea Faulkner
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • Edward Vidgen
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • Elke A. Trautwein
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • Tina L. Parker
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • Augustine Marchie
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • George Koumbridis
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • Karen G. Lapsley
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • Robert G. Josse
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • Lawrence A. Leiter
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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  • Philip W. Connelly
    Affiliations
    From the Clinical Nutrition and Risk Factor Modification Center and the Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto; Departments of Nutritional Sciences, Medicine, Biochemistry, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto; Unilever Health Institute, Unilever R[amp ]D Vlaardingen, The Netherlands; and the Almond Board of California, Modesto, CA.
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      Abstract

      Plant sterols, soy proteins, and viscous fibers are advised for cholesterol reduction but their combined effect has never been tested. We therefore assessed their combined effect on blood lipids in hyperlipidemic subjects who were already consuming a low[ndash ]saturated fat, low-cholesterol diet before starting the study. The test (combination) diet was 1 month in duration and was very low in saturated fat and high in plant sterols (1 g/1,000 kcal), soy protein (23 g/1,000 kcal), and viscous fibers (9 g/1,000 kcal) obtained from foods available in supermarkets and health food stores. One subject also completed 2 further diet periods: a low-fat control diet and a control diet plus 20 mg/d lovastatin. Fasting blood lipids, blood pressure, and body weight were measured prior to and at weekly intervals during the study. The combination diet was rated as acceptable and very filling. The diet reduced low-density lipoprotein (LDL)-cholesterol by 29.0% [plusmn] 2.7% (P [lt ] .001) and the ratio of LDL-cholesterol to high-density lipoprotein (HDL)-cholesterol by 26.5% [plusmn] 3.4% (P [lt ] .001). Near maximal reductions were seen by week 2. In the subject who took Mevacor and control diets each for 4 weeks, the reduction in LDL:HDL-cholesterol on Mevacor was similar to the combination diet. We conclude that acceptable diets of foods from supermarkets and health food stores that contain recognized cholesterol-lowering dietary components in combination (a dietary portfolio) may be as effective as the starting dose of older first-line drugs in managing hypercholesterolemia.
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