Nutritional Pearls: Controlling Cholesterol Through Lifestyle Modification

Joseph is a 34-year-old overweight man with elevated cholesterol levels. He has not yet started taking a statin, and tells you that he would prefer any lifestyle modifications you could suggest to help bring his levels down.

How would you advise your patient?
(Answer and discussion on next page)


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Answer: Small, incremental changes that you can live with for the long term are your best strategy for improving your diet.

Focusing on improving your health, while a positive goal, can sometimes be a little bit of a downer: "Reduce your risk of death with X," or "Prevent [some serious disease] with Y," or "Manage your [chronic condition] by eating more Z." You'd think we were all living in terror of eating the wrong thing.

It's particularly nice, then, to be able to share some good news: people do seem to be improving their diets.

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The Research

A team of researchers in the United Kingdom made use of anonymized information gathered through the Health Survey for England, a yearly survey of a nationally representative sample on health, demographic, and other information that started in 1991. Trained nurses measure participants' height, weight, and blood pressure and take blood samples for testing cholesterol levels, among other health details.

The authors focused on the measures of total cholesterol, comparing the results from the 1991-92 and 2011-12 survey years, noting that the average total cholesterol score had fallen in the intervening years. In those same years, however, more people were using cholesterol-lowering drugs, specifically statins.

We know how much each specific statin and its various strengths can be expected, on average, to affect people's cholesterol scores. With that information, the researchers were able to estimate how much the two-decade drop in cholesterol scores was due to people taking statins.

The Results

The good news I mentioned? Only about 33% of the reduction in people's cholesterol scores was due to taking cholesterol-lowering medications. Better still, the authors note that the Health Survey for England also captures how much people exercised—an amount that has "not increased substantially during this period," as they put it. That means that 66% of that cholesterol drop is likely to be because people changed their diets—presumably for the better. That's huge!

What’s the “Take-Home”?

At this point I would tell my patients, "You're doing great! Don't stop!" Small, incremental changes that you can live with for the long term are your best strategy for improving your diet—and thereby, your health. Following a Mediterranean-style diet is an easy, tasty way to do just that

Kypridemos C, Bandosz P, Hickey GL, et al. Quantifying the contribution of statins to the decline in population mean cholesterol by socioeconomic group in England 1991 - 2012: a modelling study. PLOS ONE. April 9, 2015. DOI: 10.1371/journal.pone.0123112