In a study reported in the July 23-30 issue of the Journal of the American Medical Association researchers at the University of Toronto, led by Professor David J.A. Jenkins, reported that those on a high fiber vegetarian diet with an emphasis on soy protein, psyllium, and nuts lowered their cholesterol nearly as much as those who were taking statins.
The one-month study involved 46 participants (25 men and 21 postmenopausal women) with high cholesterol who were divided into three groups: portfolio (experimental), statin, and control. The participants, whose average age was 59, had a body mass index that averaged 27.6. A body mass index of 25 to 29.9 is considered overweight. A BMI over 30 is considered obese.
Statins vs. Diet
The portfolio group was able to achieve almost as much cholesterol reduction as the statin group through diet and no medication.
Along with the reduction of cholesterol, the portfolio diet reduced the C-reactive protein concentration in the blood of the participants. C-reactive protein measures inflammation in the arteries and is part of the immune reaction that protects a person who is injured. A high level of C-reactive protein causes redness, pain, and swelling and can damage the inner lining of arteries and cause clots to break off from the arteries and block the flow of blood. Reduction of C-reactive protein has not been previously reported with conventional cholesterol-lowering diets. Recent reports have shown that high levels of C-reactive protein in the blood increase a person's chances of suffering a heart attack or stroke.
At the beginning of the study all the participants had a total cholesterol between 250 and 260 with an LDL over 160. People with results over 250 are often placed on statin medication to reduce their cholesterol.
All three groups believed they were receiving statin drugs. The lovastatin (Mevacor) tablets were crushed and placed into vegetarian capsules. The placebo capsules, containing lactose and blue food coloring, looked identical to the lovastatin. All the participants were directed to take one capsule in the evening for all 28 days of the study.
Statins, the drugs of choice to lower blood cholesterol, are marketed under the following brand names: Mevacor (lovastatin), Lescol (fluvastatin), Lipitor (atorvastatin), Pravachol (pravastatin), Zocor (simvastatin), and the new more potent Crestor (rosuvastatin). They act on an enzyme in the liver that controls the production of cholesterol. The most common side effects are nausea, diarrhea, constipation, and muscle aching. An 80 milligram dose of Crestor was found to cause kidney problems and in some cases protein or blood in the urine.
Statin Drug Found Life Threatening
Because statins occasionally cause elevated levels of liver enzymes, people on these drugs are advised to have their liver function tested periodically. According to Dr. Jenkins an estimated six million people in North America are currently being treated with statins to lower their cholesterol.
Data published in the journal Diabetes Care, June 2002, says that the annual cost of statin therapy, medication, monitoring and adverse effects is between $600 and $2,100 per person, depending on the LDL cholesterol level being treated. Treating everyone with an LDL of 130 or higher would cost between 6.5 and 10.6 billion dollars annually.
The portfolio group averaged 78 grams of fiber a day while the other two groups averaged 57 grams daily. The average American eats less than15 grams of fiber daily. Both the American Heart Association and the American Cancer Society recommend at least 30 grams of fiber daily.
Portfolio Diet Emhasizes Fiber
The portfolio group took the Metamucil three times daily. According to Proctor and Gamble, the parent company of this product, "Metamucil is a bulk fiber laxative for treating occasional constipation and restoring regularity. Its active ingredient is psyllium husk, a natural plant fiber with a high percentage of soluble fiber. Clinical studies have shown that, taken daily, 7 grams of soluble fiber from psyllium husk, the amount of three doses of Metamucil, when part of a heart-healthy diet low in saturated fat and cholesterol, may help reduce heart disease risk by lowering cholesterol."
Their portfolio diet included 1 oz. (28 g) of almonds daily. The inclusion of almonds was surprising because nuts are considered high in fat and could lead to weight gain. Dr. Cyril Kendall, one of the members of the research team, told Vegetarians in Paradise, "Almonds contain monounsaturated fat to maintain good HDL levels." He explained that HDL is the good cholesterol.
"Studies on nuts demonstrated lipid advantages," said Kendall. "The FDA now allows health claims for nuts." Kendall was referring to the International Tree Nut Council's Nutrition Research and Education Foundation's petition to the Food and Drug Administration to allow the following health claims to be placed on nuts: 1. "Diets containing one ounce of nuts per day can reduce your risk of heart disease." 2. "Eating a diet that includes one ounce of nuts daily can reduce your risk of heart disease."
The FDA responded to the petition on July 14, 2003 by allowing the following claim:
"Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts [, such as name of specific nut,] as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease. [See nutrition information for fat content.]"
Typical Portfolio Meals
VIP asked Dr. Kendall why the portfolio group did not eat a vegan diet. Because the other two groups were ingesting 200 mg of cholesterol daily by consuming skim milk, cheese, yogurt, and egg whites , the portfolio group needed to match that number to avoid being challenged by other scientists. The decision was made to include butter and eggs in the portfolio regimen. The portfolio group received 1 egg a week and 9 grams of butter daily.
In an article "Diet First, Then Medication for Hypercholesterolemia," Dr. James W. Anderson of the College of Medicine, University of Kentucky, Lexington, in that same July 23-30 issue of the Journal of the American Medical Association, states, " Also, because the treatment diets were prepackaged and provided to study participants, it is unclear, as the authors suggest, whether adherence or outcomes would be similar for patients who would have to assemble similar foods for themselves on a routine basis."
Portfolio in a Real Life Situation
The "real world situation" might also solve some of the complaints voiced by the participants. The lack of variety of foods was mentioned by 40% while 27% complained that the volume of food was too great. A smaller number, 13%, said they required meat as part of their meals. The portfolio diet was found acceptable by 40% of the group, some of whom said they planned to continue the diet. The five most popular foods were almonds, ground soy that simulated ground beef, oat bran cereal, oat bran bread, and plant sterol margarine.
Dr. Anderson concluded his editorial by writing, "Dietary management is an essential part of the treatment for lipid disorders, although adherence to strict and intensive dietary interventions requires motivation by patients, encouragement by physicians, and, perhaps, counseling by dietitians and nutritional experts. For most patients, dietary intervention should be the first line of therapy (perhaps for 6 to 12 weeks) before introducing pharmacotherapy for hyperlipidemia."
Reading this information, vegans can only respond, "We told you so!" Before pushing pills first, the medical industry needs to advise people to change their lifestyles, especially their eating habits. Give patients specifics on a low-fat, high fiber vegan diet instead of telling them that a dietary approach is "too difficult," "too extreme," or "spartan." It's easier for the physician with little knowledge of nutrition to say, "Take one pill each evening and eat a healthy diet."
Physicians need to write "Low-fat, High-fiber Vegan Diet" on prescription pads instead of Mevacor, Lipitor, or any of those other statins that may end up destroying people's muscles and livers. A high-fiber, low-fat vegan diet with some accompanying exercise is a more logical choice. A poor diet may have caused the cholesterol problem initially. Why not use diet to reverse the problem? As for Metamucil, anyone eating a varied high fiber diet with fruits, vegetables, legumes, whole grains and plenty of water doesn't need it.