According to the current scientific consensus, the diet has only a minor influence on the LDL concentration in the blood. But certain nutrients such as dietary fibre, omega-3 fatty acids, phytosterols and antioxidants did have an influence on LDL-C levels in preliminary studies. The team led by Stephen Kopecky from the Mayo Clinic in Rochester, USA, has now combined all these nutrients in one snack. The team suspects that this modified snack can lower LDL-C just as well as a dedicated drug.
The researchers examined their hypothesis by conducting a randomised cross-over study in which all subjects were given either the modified snack or a placebo snack for the duration of one month. The trial included 54 study participants (36 women and 18 men) who did not tolerate statins and were not taking any other lipid-lowering drugs. None of the participants had any cardiovascular disease. The average age was 49 years and the mean LDL-C level was 131 mg/dl. The subjects followed two four-week diet phases in random order. In the first phase, they received the modified snacks consisting of more than 5 grams of dietary fibre, 1 gram of omega-3 fatty acids, 1 gram of phytosterols, 1800 µmol of antioxidants and a caloric content of about 380 kcal.
In the second phase, participants received identical placebo snacks. In between both intervention phases there was a four-week washout phase. The subjects were instructed to replace their usual snacks with the modified snacks twice a day. Otherwise, they were not instructed to change their dietary or physical activity habits. At the beginning and end of each intervention phase, the researchers measured the lipid levels in the blood. They also measured the concentration of omega-3 fatty acids in the blood to ensure that the subjects were actually consuming the snacks. Adherence was measured at more than 95%, meaning that the participants really integrated the snacks into their daily routine.
The modified snacks lowered LDL-C levels by an average of 8.8% (p < 0.0001) compared to the placebo. Interestingly, some subjects even showed an LDL reduction of over 20%. The highest LDL reduction was around 40%, which corresponds to high-dose statin therapy. At the same time, the modified snacks were also able to lower total cholesterol in the blood, on average by 5.1% (p < 0.0001). Other blood values such as high-density lipoprotein cholesterol (HDL-C), triglycerides, glucose, insulin and high-sensitivity C-reactive protein (CRP) remained unchanged. The ApoE genotype had no influence on the results. No side effects of the snacks were reported.
The study shows that, contrary to the usual scientific consensus, a targeted diet can have a significant effect on LDL-C levels. After just one month, the LDL-C level was reduced by an average of 9% thanks to the medical snacks. The effect is comparable to a low-dose lipid-lowering therapy. The maximum reduction was even 40%. This type of medical snack consisting of dietary fibre, omega-3 fatty acids, plant sterols and antioxidants could be a tasty alternative for patients who cannot tolerate certain lipid-lowering drugs. For LDL-C, every little reduction counts: for every 40 mg/dl lower LDL-C, the risk of cardiovascular events can be reduced by 22%.
Kopecky et al. Reduction in Serum LDL Cholesterol Using a Nutrient Compendium in Hyperlipidemic Adults Unable or Unwilling to Use Statin Therapy: A Double-Blind Randomized Crossover Clinical Trial. The Journal of Nutrition, Volume 152, Issue 2, February 2022, Pages 458–465