Cholesterol-Lowering Diet Reduces Blood Cholesterol to
Similar Degree as Prescription Statin Drug (Lovastatin) in
Head-to-Head Clinical Trial
________________________________________
by James Meschino, DC, MS
Dr. James Meschino practices in Toronto, Ontario. He can be contacted at www.
renaisante.com. For more information, including a brief biography, a printable version
of this article and a link to previous articles, please visit his columnist page online: www.
chiroweb.com/columnist/meschino.
A recent study published in The American Journal of Clinical Nutrition showed that the
cholesterol-lowering effect of newer dietary strategies (portfolio diet) could be similar to
the effects of daily ingestion of 20 mg of lovastatin, in a population of 34 hyperlipidemic
participants. In the study design, each hyperlipidemic participant underwent all three
one-month treatments in random order as an outpatient. The three treatments were as
follows:
1. a diet very low in saturated fat [the control diet];
2. the control diet plus 20 mg per day of lovastatin;
3. a diet high in plant sterols (1,000 mg per 1,000 kcal), soy protein foods
(soy milks and soy burgers (21.4 grams per 1,000 kcal), almonds (14 grams per
1,000 kcal), and viscous fibers from oats, barley, psyllium, and the vegetables
okra and eggplant (10 grams per 1000 kcal) [the portfolio diet].
After four weeks on the control diet plus lovastatin, patients' cholesterol levels dropped
by approximately 34.5 percent, compared to a drop by 29.1 percent for those on the
portfolio diet. Those following only a diet very low in saturated fat witnessed an 8.5
percent reduction in blood cholesterol after four weeks. Although the absolute
difference between the lovastatin group and the portfolio group was significant after
four weeks, nine participants (26 percent of the population) achieved their lowest LDL
cholesterol concentrations with the portfolio diet.
This study illustrates the effectiveness of combining recently recommended dietary
components, as set out by the National Cholesterol Education Program – Adult
Treatment Panel III and the American Heart Association, to maximize the cholesterol-
lowering effect available using dietary practices. Viscous fiber, soy protein, plant sterols
and almonds have all been recognized for their ability to lower cholesterol. Viscous fiber
increases excretion of bile acids (preventing their reabsorption and subsequent
conversion into cholesterol within the liver), plant sterols reduce cholesterol absorption,
soy protein is reported to reduce hepatic cholesterol synthesis and increase hepatic
LDL cholesterol receptor activity (which would help clear excess cholesterol from the
bloodstream), and almonds have been shown to provide a number of cholesterol-
lowering effects due to the presence of monounsaturated fats, plant sterols, vegetable
proteins, fiber and other phytonutrients.
Diet and lifestyle changes have always been recommended as the first line of treatment
in mild hyper-lipidemia and type 2 diabetes. In recent years, studies involving statin
drugs (e.g., lovastatin, simvastatin, etc.) have been successful in reducing
cardiovascular disease and all-cause mortality. As such, many physicians now
prescribe these drugs as the first line of treatment (primary prevention) in patients
presenting with high cholesterol or hyperlipidemia, instead of using documented dietary
measures as the first treatment option. This approach appears to be unwarranted, as
studies now indicate that dietary measures can produce similar levels of success
regarding cholesterol reduction without risk of the side-effects associated with statin
drug use.
Side-Effects of Statin Drugs
Many experts caution against the use of statin drugs as a means of primary prevention
to lower cholesterol, due to the serious nature of the side-effects that can arise from
their use. Statin drugs such as lovastatin (Mevacor) inhibit the enzyme known as 3-
hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase. This enzyme catalyzes
the conversion of HMG-CoA to mevalonate, a rate-limiting step in the biosynthesis of
cholesterol, which primarily occurs in the liver.
Two commonly cited side-effects of statin drugs involve liver damage (as evidenced by
elevated blood levels of the liver enzymes) and myopathy, manifested as muscle pain,
tenderness or weakness with creatine kinase (CK) above 10 times the upper limit of
normal (ULN). Myopathy sometimes takes the form of rhabdomyolysis with or without
acute renal failure secondary to myoglobinuria, and rare fatalities have occurred.
According to some studies, approximately 11 percent of patients had elevations of CK
levels of at least twice the normal value on one or more occasions.
Other documented side-effects associated with statin drugs include muscle cramps,
myalgia, arthralgias, dysfunction of certain cranial nerves (including alteration of taste,
impairment of extraocular movement, facial paresis), tremor, dizziness, vertigo, memory
loss, paresthesia, peripheral neuropathy, peripheral nerve palsy, psychic disturbances,
anxiety, insomnia, depression, hypersensitivity reactions,pancreatitis, hepatitis,
including chronic active hepatitis, cholestatic jaundice, fatty change in liver; and rarely,
cirrhosis, fulminant hepatic necrosis, and hepatoma; anorexia, vomiting,alopecia,
pruritus, a variety of skin changes (e.g., nodules, discoloration, dryness of skin/mucous
membranes, changes to hair/nails), gynecomastia, loss of libido, erectile dysfunction,
progression of cataracts (lens opacities), ophthalmoplegia, along with laboratory
abnormalities:elevated transaminases, alkaline phosphatase, (gamma)-glutamyl
transpeptidase, and bilirubin; thyroid function abnormalities.
Dietary Measures Should Be Used First
Due to the unknown effects of long-term use of statin drugs (usage over many years),
combined with the known side-effects documented to date, many experts and expert
panels subscribe to the notion that dietary measures should be the first line of defense
to reduce high cholesterol levels in the primary prevention of cardiovascular disease.
The recent study by D. Jenkins, et al., provides substantial support to this end.
This study should be of interest to holistic health doctors, who are concerned with
natural approaches to the prevention and treatment of health conditions, and helping
patients reduce risk of adverse side-effects caused by the overuse and abuse of
certain drugs – common features of the current health care system.
It also should be noted that supplementation with gugulipid and policosanol, two natural
health supplements, has been shown to lower cholesterol and triglycerides to a similar
degree as many commonly prescribed prescription drugs, with occurrence of fewer and
less severe side-effects. Natural health practitioners interested in this subject should
familiarize themselves with the studies related to these two natural agents.
Conclusion
In summary, by introducing hyperlipidemic patients to the cholesterol-lowering dietary
approach used by D. Jenkins, et al., in the primary prevention of cardiovascular
disease, many individuals can avoid the use of statin drugs, eliminating the risk of liver
damage and other problems associated with these medications. In more stubborn
cases, the concurrent supplementation of 75 mg of guggulsterones (e.g., 1,000 mg
gugulipid, three times per day, standardized to 2.5 percent guggulsterone content) and
10 mg of policosanol per day, can be used to further reduce blood cholesterol and
triglyceride levels.
Treatment goals in the primary prevention of cardiovascular disease include LDL-
cholesterol concentrations below 160 mg/dL (4.15 mmol/L), with no more than one risk
factor, and at or below 120 mg/dL (3.4 mmol/L) with two or more risk factors. In the case
of secondary prevention (i.e., the patient has previously suffered a cardiovascular
event or established cardiovascular disease), an LDL cholesterol concentration at or
below 100 mg/dL (2.6 mmol/L) is advised.
In regards to primary prevention, according to the Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (III), drug therapy is
recommended when "diet" has failed to reduce LDL cholesterol concentrations to below
120 mg/dL (3.4 mmol/L) in persons with two or more risk factors or in persons who have
a calculated 10-year coronary heart disease risk of 10 percent to 20 percent, according
to the Framingham cardiovascular disease prediction equation.
In many cases of hyperlipidemia, the use of aggressive dietary strategies, as outlined in
this article, in combination with gugulipid and policosanol (when diet alone is not
sufficient) in the primary prevention of cardiovascular disease, can help eliminate
reliance on statin drugs, which carry the risk of many unpleasant and sometimes
serious side-effects.
Resources
1. Jenkins D, Kendall C, Marchie A, Faulkner D, Wong J, et al. Direct comparison of a dietary
portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J
Clin Nutr. 200;81:380-7.
2. www.drugs.com (lovastatin).
3. Singh K, Chander R, Kapoor NK. Guggulsterone, a potent hypolipidaemic, prevents
oxidation of low density lipoprotein. Phytother Res 1997;11:291-4.
4. Canetti M, Moreira M, Más R, et al. A two-year study on the efficacy and tolerability of
policosanol in patients with type II hyperlipoproteinaemia. Int J Clin Pharmacol Res 1995;15(4):
159-65.
Similar Degree as Prescription Statin Drug (Lovastatin) in
Head-to-Head Clinical Trial
________________________________________
by James Meschino, DC, MS
Dr. James Meschino practices in Toronto, Ontario. He can be contacted at www.
renaisante.com. For more information, including a brief biography, a printable version
of this article and a link to previous articles, please visit his columnist page online: www.
chiroweb.com/columnist/meschino.
A recent study published in The American Journal of Clinical Nutrition showed that the
cholesterol-lowering effect of newer dietary strategies (portfolio diet) could be similar to
the effects of daily ingestion of 20 mg of lovastatin, in a population of 34 hyperlipidemic
participants. In the study design, each hyperlipidemic participant underwent all three
one-month treatments in random order as an outpatient. The three treatments were as
follows:
1. a diet very low in saturated fat [the control diet];
2. the control diet plus 20 mg per day of lovastatin;
3. a diet high in plant sterols (1,000 mg per 1,000 kcal), soy protein foods
(soy milks and soy burgers (21.4 grams per 1,000 kcal), almonds (14 grams per
1,000 kcal), and viscous fibers from oats, barley, psyllium, and the vegetables
okra and eggplant (10 grams per 1000 kcal) [the portfolio diet].
After four weeks on the control diet plus lovastatin, patients' cholesterol levels dropped
by approximately 34.5 percent, compared to a drop by 29.1 percent for those on the
portfolio diet. Those following only a diet very low in saturated fat witnessed an 8.5
percent reduction in blood cholesterol after four weeks. Although the absolute
difference between the lovastatin group and the portfolio group was significant after
four weeks, nine participants (26 percent of the population) achieved their lowest LDL
cholesterol concentrations with the portfolio diet.
This study illustrates the effectiveness of combining recently recommended dietary
components, as set out by the National Cholesterol Education Program – Adult
Treatment Panel III and the American Heart Association, to maximize the cholesterol-
lowering effect available using dietary practices. Viscous fiber, soy protein, plant sterols
and almonds have all been recognized for their ability to lower cholesterol. Viscous fiber
increases excretion of bile acids (preventing their reabsorption and subsequent
conversion into cholesterol within the liver), plant sterols reduce cholesterol absorption,
soy protein is reported to reduce hepatic cholesterol synthesis and increase hepatic
LDL cholesterol receptor activity (which would help clear excess cholesterol from the
bloodstream), and almonds have been shown to provide a number of cholesterol-
lowering effects due to the presence of monounsaturated fats, plant sterols, vegetable
proteins, fiber and other phytonutrients.
Diet and lifestyle changes have always been recommended as the first line of treatment
in mild hyper-lipidemia and type 2 diabetes. In recent years, studies involving statin
drugs (e.g., lovastatin, simvastatin, etc.) have been successful in reducing
cardiovascular disease and all-cause mortality. As such, many physicians now
prescribe these drugs as the first line of treatment (primary prevention) in patients
presenting with high cholesterol or hyperlipidemia, instead of using documented dietary
measures as the first treatment option. This approach appears to be unwarranted, as
studies now indicate that dietary measures can produce similar levels of success
regarding cholesterol reduction without risk of the side-effects associated with statin
drug use.
Side-Effects of Statin Drugs
Many experts caution against the use of statin drugs as a means of primary prevention
to lower cholesterol, due to the serious nature of the side-effects that can arise from
their use. Statin drugs such as lovastatin (Mevacor) inhibit the enzyme known as 3-
hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase. This enzyme catalyzes
the conversion of HMG-CoA to mevalonate, a rate-limiting step in the biosynthesis of
cholesterol, which primarily occurs in the liver.
Two commonly cited side-effects of statin drugs involve liver damage (as evidenced by
elevated blood levels of the liver enzymes) and myopathy, manifested as muscle pain,
tenderness or weakness with creatine kinase (CK) above 10 times the upper limit of
normal (ULN). Myopathy sometimes takes the form of rhabdomyolysis with or without
acute renal failure secondary to myoglobinuria, and rare fatalities have occurred.
According to some studies, approximately 11 percent of patients had elevations of CK
levels of at least twice the normal value on one or more occasions.
Other documented side-effects associated with statin drugs include muscle cramps,
myalgia, arthralgias, dysfunction of certain cranial nerves (including alteration of taste,
impairment of extraocular movement, facial paresis), tremor, dizziness, vertigo, memory
loss, paresthesia, peripheral neuropathy, peripheral nerve palsy, psychic disturbances,
anxiety, insomnia, depression, hypersensitivity reactions,pancreatitis, hepatitis,
including chronic active hepatitis, cholestatic jaundice, fatty change in liver; and rarely,
cirrhosis, fulminant hepatic necrosis, and hepatoma; anorexia, vomiting,alopecia,
pruritus, a variety of skin changes (e.g., nodules, discoloration, dryness of skin/mucous
membranes, changes to hair/nails), gynecomastia, loss of libido, erectile dysfunction,
progression of cataracts (lens opacities), ophthalmoplegia, along with laboratory
abnormalities:elevated transaminases, alkaline phosphatase, (gamma)-glutamyl
transpeptidase, and bilirubin; thyroid function abnormalities.
Dietary Measures Should Be Used First
Due to the unknown effects of long-term use of statin drugs (usage over many years),
combined with the known side-effects documented to date, many experts and expert
panels subscribe to the notion that dietary measures should be the first line of defense
to reduce high cholesterol levels in the primary prevention of cardiovascular disease.
The recent study by D. Jenkins, et al., provides substantial support to this end.
This study should be of interest to holistic health doctors, who are concerned with
natural approaches to the prevention and treatment of health conditions, and helping
patients reduce risk of adverse side-effects caused by the overuse and abuse of
certain drugs – common features of the current health care system.
It also should be noted that supplementation with gugulipid and policosanol, two natural
health supplements, has been shown to lower cholesterol and triglycerides to a similar
degree as many commonly prescribed prescription drugs, with occurrence of fewer and
less severe side-effects. Natural health practitioners interested in this subject should
familiarize themselves with the studies related to these two natural agents.
Conclusion
In summary, by introducing hyperlipidemic patients to the cholesterol-lowering dietary
approach used by D. Jenkins, et al., in the primary prevention of cardiovascular
disease, many individuals can avoid the use of statin drugs, eliminating the risk of liver
damage and other problems associated with these medications. In more stubborn
cases, the concurrent supplementation of 75 mg of guggulsterones (e.g., 1,000 mg
gugulipid, three times per day, standardized to 2.5 percent guggulsterone content) and
10 mg of policosanol per day, can be used to further reduce blood cholesterol and
triglyceride levels.
Treatment goals in the primary prevention of cardiovascular disease include LDL-
cholesterol concentrations below 160 mg/dL (4.15 mmol/L), with no more than one risk
factor, and at or below 120 mg/dL (3.4 mmol/L) with two or more risk factors. In the case
of secondary prevention (i.e., the patient has previously suffered a cardiovascular
event or established cardiovascular disease), an LDL cholesterol concentration at or
below 100 mg/dL (2.6 mmol/L) is advised.
In regards to primary prevention, according to the Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (III), drug therapy is
recommended when "diet" has failed to reduce LDL cholesterol concentrations to below
120 mg/dL (3.4 mmol/L) in persons with two or more risk factors or in persons who have
a calculated 10-year coronary heart disease risk of 10 percent to 20 percent, according
to the Framingham cardiovascular disease prediction equation.
In many cases of hyperlipidemia, the use of aggressive dietary strategies, as outlined in
this article, in combination with gugulipid and policosanol (when diet alone is not
sufficient) in the primary prevention of cardiovascular disease, can help eliminate
reliance on statin drugs, which carry the risk of many unpleasant and sometimes
serious side-effects.
Resources
1. Jenkins D, Kendall C, Marchie A, Faulkner D, Wong J, et al. Direct comparison of a dietary
portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J
Clin Nutr. 200;81:380-7.
2. www.drugs.com (lovastatin).
3. Singh K, Chander R, Kapoor NK. Guggulsterone, a potent hypolipidaemic, prevents
oxidation of low density lipoprotein. Phytother Res 1997;11:291-4.
4. Canetti M, Moreira M, Más R, et al. A two-year study on the efficacy and tolerability of
policosanol in patients with type II hyperlipoproteinaemia. Int J Clin Pharmacol Res 1995;15(4):
159-65.
