Lifestyle Approaches and Dietary Strategies to Lower LDL-Cholesterol and Triglycerides and Raise HDL-Cholesterol

https://doi.org/10.1016/j.ecl.2008.11.010Get rights and content

This article discusses specific dietary factors as well as dietary patterns that affect the major coronary heart disease (CHD) lipid risk factors (ie, LDL-C, HDL-C, and TG). Based on a very large evidence base, it is clear that diet and lifestyle practices can markedly affect these major CHD lipid risk factors, and consequently decrease CHD risk substantively.

Section snippets

Saturated Fatty Acids

Saturated fatty acids (SFA) raise LDL-C in a dose-dependent manner.8 The major sources of SFA in the United States are fatty red meats and full-fat dairy products.8 Tropical oils, including palm oil, palm kernel oil, and coconut oil, also are high in SFA. SFA intake has been positively correlated with CHD risk in several observational studies.9 In the Seven Countries Study, collective intake of the four major long-chain saturated fatty acids (eg, lauric, myristic, palmitic, and stearic acid)

Soluble Fiber

Dietary fiber is the nondigestible carbohydrate components of plants. Observational studies have demonstrated an inverse association between dietary fiber and CHD risk,48 and clinical trials have shown an LDL-C lowering effect of dietary fiber.49 The primary mechanism for the reduction in LDL-C is via decreased absorption of cholesterol and bile acids.50, 51, 52 Soluble fiber is present in foods such as beans, oats, barley, and some fruits and vegetables.49 Based on observational and clinical

Therapeutic Lifestyle Change Diet

The NCEP ATP III guidelines recommend the Therapeutic Lifestyle Change (TLC) diet with therapeutic options for maximal LDL-C lowering (Table 3).4 The estimated reduction in LDL-C for the TLC diet is shown in Table 4. Lichtenstein and colleagues106 evaluated the effects of the TLC diet (15% protein, 58% carbohydrate, 30% fat) versus a typical Western diet (15% protein, 47% carbohydrate, 38% fat) on lipids and lipoproteins in a controlled setting. Thirty-six participants with LDL-C higher than

Omega 3 Fatty Acids

Omega-3 (n-3) fatty acids are polyunsaturated fatty acids of marine (primarily eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) and plant (principally alpha-linolenic acid [ALA]) origin. Direct sources of EPA and DHA are fatty fish, fish oil, fortified foods, and more recently, DHA-rich algal oil supplements. EPA, and to some extent DHA, also can be derived from ALA. ALA is an essential fatty acid because it cannot be synthesized by humans and therefore must be consumed in the diet.

Very Low Carbohydrate Diet

Some scientists have begun advocating a very low carbohydrate diet (VLCD) for treatment of dyslipidemia because it is effective in lowering TG and raising HDL-C (Fig. 6).180 In contrast, a low-fat, high-carbohydrate diet tends to raise TG and lower HDL-C. There generally is a small decrease or no change in total- or LDL-C following a VLCD; however, there is a shift in the distribution of LDL particle size resulting in a decreased number of atherogenic small, dense LDL particles, and an increase

Summary

Food-based dietary guidelines have been issued that meet the recommended levels of nutrients described herein (Table 6). Adhering to these guidelines is expected to lower TC, LDL-C, and TG, and increase HDL-C, and, thereby reduce CVD risk. This dietary pattern is low in SFA, TFA, and dietary cholesterol, and emphasizes unsaturated fats. It also promotes consumption of fruits, vegetables, whole grains, low-fat/skim dairy products, lean meats, poultry, and fish (ie, two servings per week with

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