Given a choice, most people would likely prefer a dietary or other alternative to taking a drug, if only to avoid potential side-effects. When it comes to lowering cholesterol levels, many folks may be able to steer clear of using medications or reduce their dependence on these by modifying their diet. These, at least, are what new results from a just completed study published in the Journal of the American Dietetic Association.

The study is based on data garnered from 377 patients between the ages of 25 and 70 years who had high cholesterol levels or triglyceride levels over 200 mg/dL, who also met other criteria including having had no recent changes to their cholesterol medication. All the participants underwent dietary counseling by 52 registered dietitians (RDs) at 24 sites in 11 states. Neither the R.D.s nor their patients were paid to participate in the study.

All of the R.D.s in the study based their patient advice on the research-based evidence concerning diet and cholesterol levels available at the time, the American Dietetic Association's 1998 Medical Nutrition Therapy Hyperlipidemia Protocol (Since the ADA has updated the guidelines to reflect newer research).

One-hundred and seventy-five patients who started the study with triglycerides less than 400 milligrams per deciliter of blood (mg/dL), and who had their cholesterol measured before changing or adding medication, 44.6 percent either experienced a drop in "bad" cholesterol by at least 15 percent, or reached their cholesterol goal.

The results obtained took about eight months and involved three or more appointments with a dietitian, and underscore the fact that medical nutrition therapy can have a major impact on a patient's life.

"Everyone knows that nutrition is important for cholesterol management, and that a registered dietitian is the professional most thoroughly trained to help patients choose foods wisely," says lead author Kathy Rhodes, Ph.D., R.D., manager of Nutrition Services with the U-M Cardiovascular Medicine program at Domino's Farms and the U-M Cardiovascular Center. "But this is the first national study to show what happens when high-risk patients work with R.D.s to follow nutrition guidelines grounded in the best evidence."

The 1998 guidelines that were utilized as part of the study include reducing saturated and trans fat and increasing "healthy" fats such as olive oil; eating fish twice a week; consuming more fruits and vegetables; increasing soluble and insoluble fiber; and getting regular exercise and healthy weight management help. Participants were also given useful information about food-label reading and dining out.

Some private commercial health insurance plans cover appointments with registered dietitians, but many do not. Dietitian visits by older persons with diabetes or kidney disease is covered by Medicare. ”It is important for people to check their specific health insurance plan to see whether nutrition is covered,” Rhodes says. “But even if individuals need to pay for the appointments out of their own pocket, they may find that an R.D.'s advice will pay off in the long run,” she added.

"Although some patients may already be eating a relatively healthy diet, medical nutrition therapy can increase patient's knowledge of 'cardioprotective foods' and assist them in individualizing the guidelines to fit their preferences and lifestyle," says study co-author Martha Wintraub, MPH, R.D. A significant number of patients reduced their fat intake to less than 30 percent of calories, as recommended to promote heart health. Many study participants also lost weight and/or increased the number of days each week on which they exercised 30 minutes or more.

"Often, we see heart patients who are on multiple cholesterol medications but have never seen a dietitian. And even when a patient with high cholesterol does get to see an R.D., their care team may not allow enough time to see how effective diet is before they add additional treatment," says Rhodes. "We hope that this demonstration of how well cholesterol can be lowered without medication or increases in medication will be very useful for patients and physicians, and perhaps insurers too."

Journal reference: JADA, Vol. 108, No. 2, Feb. 2008.

University of Michigan Health System (2008, March 6). Many Patients Can Reach LDL Cholesterol Goal Through Dietary Changes Alone, Study Shows. ScienceDaily. Retrieved March 6, 2008, from http://www.sciencedaily.com­ /releases/2008/03/080304105817.htm