What diet is best to lower cholesterol?


salad with chickpeas and nuts

Should health professionals consider the cholesterol-lowering benefits of a vegan diet? writes Oscar Klass

Between July 2014 and June 2015, lipid modifying agents were the second most commonly dispensed class of medication on the PBS, with some 23,000,000 items dispensed, costing the government just over $824 million.

During that same timeframe, atorvastain and rosuvastatin were the two most commonly subsidised drugs by volume on PBS.1 This is an established trend that is unlikely to change in the future.

For uncomplicated cases, PBS guidelines state that a prescriber must provide “lifestyle and dietary prescription and/or refer for medical nutrition therapy” before a patient qualifies for PBS subsidy.

During my time in community pharmacy, I have found that the advice offered to patients before starting a statin is limited—few patients receive a clear message entailing which diet they should follow, and execution is usually at the patients’ discretion.

One’s diet can be a highly sensitive and passionate subject. Mealtime is an essential component to our human social fabric. Activities such as catching up for a BBQ, the Sunday roast, or dinner at a restaurant are entrenched as mechanisms for socialising with friends and family.

Think about it: when was the last time you met with a friend without a culinary pre-commitment?

Furthermore, the reductionist nature of science tends to focus on a single given nutritional element at a time. Consequently, the public and health professional are bombarded with headline-like statements such as “Cholesterol doesn’t cause heart disease,” and “Butter is back”.

Celebrity cooking shows, pop-up internet ads, and self-proclaimed exercise gurus all work synergistically to sensationalise one thing, while demonising another—leaving the average consumer dazed and confused when making basic dietary decisions, like what to eat for lunch.

These factors make it even more important for health professionals to deliver a clear message to our patients when addressing the question, “What diet is best to lower cholesterol?”

We need one definitive dietary recommendation to ensure quality use of medicines, as dietary interventions should be fully explored before resorting to a lifetime of lipid modifying medications. I propose that a whole-food plant-based diet should be that recommendation.

A whole-food plant-based diet is one derived entirely from plant-based sources. It is primarily composed of vegetables, fruits, nuts, legumes and grains and avoids processed foods, such as refined sugars, added salt and oil.

It is essentially adopting a vegan lifestyle—without the philosophical beliefs regarding animal rights and the use of animal based products.

The Australian Dietetics Association states that “With good planning, it is still possible to obtain all the essential nutrients on a vegan diet”. Similarly, the American Dietetic Association agrees that a well-planned vegan diet is appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood and adolescence.3

With regards to addressing high cholesterol levels, it is well established within the medical community that dietary intake of trans and saturated fats is a major modifiable risk factor for an unfavorable lipid profile.

Food derived from animal products, such as meat, dairy and eggs, is the primary source of saturated fat in a standard western diet. A whole-food plant-based diet is the most effective way to minimise dietary intake of trans and saturated fats, while completely avoiding dietary cholesterol.

This diet has numerous health benefits, but importantly, can quickly lead to improvements in LDL-C and HDL levels,4,5 and reduce the risk of coronary artery disease and stroke.6

In observational studies, people who report adhering to a vegan diet have a healthier BMI compared to other vegetarian diets and omnivores.7

As health professionals, our own personal beliefs or perceived limitations should not influence our response when asked, “What diet is best to lower cholesterol?”

With proper planning and support, a whole-food plant-based diet is a scientifically sound and safe recommendation for all patients with elevated cholesterol levels.

As Dr Kim Williams, a vegan and immediate past-president of the American College of Cardiology said, “there are two kinds of cardiologists: vegans and those who haven’t read the data.”

 

  1. Expenditure and prescriptions twelve months to 30 June 2015. PBS Information Management Section Pharmaceutical Policy Brach.
  2. Australian Dietetics Association, http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/vegan-diets/
  3. Craig WJ, Mangels AR; Position of the American Dietetic Association: vegetarian diets, J Am Diet Assoc. 2009 Jul; 109(7): 1266-82
  4. Ferdowsian HR, Barnard ND, Effects of plant-based diets on plasma lipids. Am J Cardiol. 2009 Oct 1; 104(7):947-56. doi: 10.1016/j.amjcard.2009.05.032.
  5. Masarei JR, Rouse IL, Lynch WJ, Robertson K, Vandongen R, Beilin LJ. Vegetarian diets, lipids and cardiovascular risk. Aust N Z J Med. 1984 Aug; 14(4):400-4.
  6. Dinu M et al. Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2016 Feb 6:0.
  7. Spencer et al. Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int J Obes Relat Metab Disord. 2003 Jun;27(6):728-34.

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