Managing Cardiometabolic Risk

Other dietary measures to lower CVD risk and cholesterol levels

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Soluble fibres such as oat bran, pectin, and guar gum as well as viscous non-fermentable fibres such as psyllium help lower LDL cholesterol and glucose levels (49-52). Current guidelines recommend increasing fibre intake to 25 to 30 g per day (current daily fibre intake in North America is approximately 10 to 15 g), with an emphasis on vegetables, cereals, and fruits (5, 7, 10). Soluble fibres lower cholesterol levels by binding bile acids in the intestinal lumen, lessening the absorption and increasing fecal excretion of cholesterol (51). Besides their effect on serum lipid concentrations, soluble fibres such as psyllium also improve glycemic control (a 1.6% decrease of HbA1c after 8 weeks of treatment with 5.1 g b.i.d. of psyllium husk fibre) (50).
Plant sterol and plant stanol esters have proven effective in reducing total and LDL cholesterol (53, 54). Plant sterols are found in small quantities in many fruits, vegetables, nuts, seeds, cereals, legumes, and other plant sources or may be added to food products. Consuming 2 to 3 g of plant sterols per day has been shown to decrease total and LDL cholesterol levels by 9 to 20% respectively, without altering HDL cholesterol (55-58). The NCEP-ATP III and AHA recommend adding 2 g of plant sterols/stanols to the daily diet of patients at risk of CVD (9, 10, 59). In examining the potential of functional ingredients (viscous fibres and plant sterols, soy protein, and nuts), Jenkins et al. (60) compared their effectiveness on the plasma lipid profile to that of traditional first-generation statin treatments (lovastatin). Jenkins’ “portfolio” diet has been shown to reduce LDL cholesterol (30%) and induce clinically significant reductions in estimated CHD risk. As mentioned above, these dietary, functional ingredients have effects on the plasma lipid profiles similar to those of first-generation statin treatments (60).
Changing poor eating habits is an efficient and inexpensive way to improve cardiometabolic risk factors/markers. Current dietary guidelines make strong recommendations that are designed to reduce health complications in conjunction with other healthy practices such as regular physical exercise and smoking cessation. To maximize its chances of success, the ideal nutritional treatment should be personalized, intensive, and supervised by qualified health care professionals.

Reference

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10. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-97.

49. Jenkins DJ, Kendall CW, Vuksan V, et al. Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial. Am J Clin Nutr 2002; 75: 834-9.

50. Ziai SA, Larijani B, Akhoondzadeh S, et al. Psyllium decreased serum glucose and glycosylated hemoglobin significantly in diabetic outpatients. J Ethnopharmacol 2005; 102: 202-7.

51. Jenkins DJ, Wolever TM, Rao AV, et al. Effect on blood lipids of very high intakes of fiber in diets low in saturated fat and cholesterol. N Engl J Med 1993; 329: 21-6.

52. Sierra M, Garcia JJ, Fernandez N, et al. Therapeutic effects of psyllium in type 2 diabetic patients. Eur J Clin Nutr 2002; 56: 830-42.

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56. Patch CS, Tapsell LC and Williams PG. Plant sterol/stanol prescription is an effective treatment strategy for managing hypercholesterolemia in outpatient clinical practice. J Am Diet Assoc 2005; 105: 46-52.

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58. Gylling H and Miettinen TA. Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholesterolaemic NIDDM patients before and during sitostanol ester-margarine treatment. Diabetologia 1994; 37: 773-80.

59. Grundy SM. Stanol esters as a component of maximal dietary therapy in the National Cholesterol Education Program Adult Treatment Panel III report. Am J Cardiol 2005; 96: 47D-50D.

60. Jenkins DJ, Kendall CW, Marchie A, et al. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J Clin Nutr 2005; 81: 380-7.

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