Viscous Soluble Fiber: Recommendations from the National Cholesterol Education Program

NCEP Discussion (excerpt): Because of the favorable effects of viscous fiber (soluble fiber from oats, fruit pectins, guar, beans and psyllium) on LDL cholesterol levels, the NCEP recommends that the therapeutic diet be enriched by foods that provide at least 5-10 grams of viscous fiber daily (Source of Soluble Fiber Chart). Even higher intakes of 10-25 grams per day can be beneficial.

NCEP Evidence Statement: 5-10 grams of viscous fiber per day reduces LDL cholesterol levels by approximately 5 percent (Strength of Evidence: A2, B1).

NCEP Recommendation: The use of dietary sources of viscous fiber (soluble fiber from certain sources) is a therapeutic option to enhance LDL lowering.

Plant Sterols: Recommendations from the National Cholesterol Education Program

NCEP Evidence Statement: Daily intakes of 2-3 grams per day of plant stanol/sterol esters will reduce cholesterol by 6-15 percent Strength of Evidence (A2, B1)

NCEP Recommendation: Plant stanol/sterol esters (2g/day) are a therapeutic option to enhance LDL cholesterol lowering.

National Cholesterol Education Program: Assessing the Science

The National Cholesterol Education Program brings together the wisdom of many individuals and organizations* in the medical community to undertake an assessment of the available scientific evidence related to cholesterol management. The NCEP has developed a methodology to rate the strength of the available evidence and has issued an extensive set of recommendations. The evidence is defined in terms of two categories:

Type of Evidence
A Major randomized controlled clinical trials (RCTs)
B Smaller RCTs and meta-analyses of other clinical trials
C Observational and metabolic studies
D Clinical Experience

Strength of Evidence
1 Very Strong
2 Moderately strong evidence
3 Strong trend

I have posted this blog as a reference for future posts.

*Member organizations of the NCEP include National Heart, Lung & Blood Institute (NIH), American Academy of Family Physicians, American College of Cadiology, American College of Preventive Medicine, American Diabetes Association, American Dietetics Association, American Hospital Association, American Medication Association, American Red Cross, Association of Black Cardiologists, Food and Drug Administration, Centers for Disease Control, American Nurses Association.

Monounsaturated Fats: Recommendations from National Cholesterol Education Program

NCEP Evidence Statement: Monounsaturated fatty acids lower LDL cholesterol relative to saturated fatty acids. Monunsaturated fatty acids do not lower HDL cholesterol nor raise triglycerides. Strength of Evidence: A1, B2

NCEP Evidence Statement: Dietary patterns that are rich in monounsaturated fatty acids provided by plant sources and rich in fruits, vegetables, and whole grains and low in saturated fatty acids are associated with decreased CHD (cardiac heart disease). However, the benefits of replacement of saturated fatty acids with monounsaturated fatty acids has not been adequately tested in controlled clinical trials. Strength of Evidence C1

NCEP Recommendations: Monounsaturated fatty acids are one form of unsaturated fatty acid that can replace saturated fatty acids. Intake of monounsaturated fatty acids can range up to 20 percent of total calories. Most monounsaturated fatty acids should be derived from vegetable sources, including plant oils and nuts.

NBC News Reports: Plant Sterols-A Natural, Safe & Easy Way to Lower Cholesterol

Wednesday, April 8, 2008
Reported by: Joe Vignolo, Denise Nakano, NBC News

A natural, safe and easy way to lower cholesterol. It's been around forever, but chances are, it's one alternative medicine you have never heard of.

"Nowadays, it is no longer good enough to know your total cholesterol level. You really need to know your breakdown - the breakdown between the good and the bad," said cardiologist Dr. Daniel Rader. This is the bad stuff: too much LDL, or bad cholesterol, circulating in the blood. It builds up in the arteries, slowly narrowing them or forming clots. And that can lead to heart attack or stroke.

Medicine can help, "but, there are an awful lot of people who have cholesterol levels that are higher than they should be, but not so high that they really need medication," said Dr. Rader.

Diet and exercise work. And, Dr. Rader says, so can eating phyto or plant sterols, naturally found in fruits, vegetables, nuts and seeds, added to other foods like spreads and snack bars, or taken as a supplement.

"There's no question that phytosterols, or plant sterols, are one of the best proven - if you will - 'alternative' methods of lowering cholesterol, short of drug therapy," said Dr. Rader.

Dr. Rader is a specialist in preventive cardiac medicine. He is a strong believer in plant sterols for people with high cholesterol who don't yet show signs of heart disease. He says they have almost no side effects and are safe for children and teens.

Research finds they can reduce bad cholesterol by 10 to 15 percent. And you can use them in combination with cholesterol-lowering prescription drugs. "I've never had really serious cholesterol trouble, but each time I went to the doctor, she was warning me that it was inching up," said David Hollenberg, who tried plant sterols. Hollenberg says he has never been shy about alternative medicine and decided to give a plant sterols supplement a try. He doesn't know yet what impact they have had on his cholesterol, but he thinks it is worth a try.

"Plant sterols are one of the rare things in the alternative medicine world that actually have been studied, have been proven to work, and are actually endorsed by people like me: card-carrying, regular doctors who actually think that this really makes sense to do," said Dr. Rader.
If you decide to try plant sterols to lower your cholesterol, dose really matters. To be effective, you must take it every day and be sure you're getting enough. For example, one or two tablespoons of sterol-containing spread a day has what you need.

Kardea Nutrition foods with plant sterols.

Kardea Exhibiting at Dietetic Conferences

As part of our ongoing efforts to work with those health professionals working directly with individuals seeking to improve their cardiovascular health through positive nutrition, Kardea will be exhibiting at the Food & Nutrition Conference & Expo , the national conference of the American Dietetic Association. The conference will be held in Chicago on October 25-28, 2008. In the Spring, 2008, we also will be presenting our system for natural cholesterol management at the Florida, New York, New Jersey, Connecticut and Massachusetts State Dietetic Conferences.

Zetia/Vytorin Study: A Perspective

You may have heard the considerable debate regarding the cholesterol-lowering medication, Zetia. Unlike statins which affect your cholesterol production, this drug blocks the absorption of both dietary and biliary (liver-produced) cholesterol into the blood stream. The drug is intended to provide individuals who cannot reduce LDL cholesterol using diet and exercise with an alternative to high dosages of statin medications. It also was developed for those who simply cannot tolerate statins.

In a recent controversial study reported in the New England Journal of Medicine, the effects of taking Zetia and the statin, Zocor, combined (together known as the drug Vytorin) was compared to the effects of taking Zocor only.

Here are results:

The group taking the two drugs experienced an LDL cholesterol decline that was 27% greater than the Zocor-only group.

Despite the increased lowering of LDL cholesterol in the group that received both medications, both groups saw arterial plaque build at rate that was similar (although those on the combination drug saw a somewhat larger, but not statistically significant, increase).

This finding is at odds with our traditional understanding of the favorable relationship between lower LDL cholesterol and atherosclerosis.

The trial, however, did not directly address whether lowering of LDL cholesterol with the combination drug reduces heart attacks, strokes and other cardiovascular “events.” The combination drug may or may not provide an additional benefit.

So how is the medical community responding?

An editorial in the New England Journal of Medicine observes that “it seems prudent to encourage patients whose LDL cholesterol levels remain elevated despite treatment with an optimal dose of a statin to redouble their efforts at dietary control and regular exercise,” leaving Zetia for special situations. Yet, well trained, qualified doctors continue to prescribe the combination drug more broadly, believing that a single study does not unseat established wisdom.

The human body is profoundly complex, and we simply do not know with certainty how any particular approach will affect our long term health and longevity. We can only play the odds as we know them today. This requires that each of us take an educated approach to our health. Kardea aims to enable the members of its community to make more informed decisions about cholesterol management and natural nutrition.