Nutritional Pearls: Can Diet Supplement Statins?
Bill is a 63-year-old male on a statin for hyperlipidemia. When discussing his lifestyle, it is clear that he is not eating well. He responds to your discussion about improving his diet by saying, “that’s why I take this pill, so I can eat what I want.”
How would you advise him?
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Answer: Diet can supplement cholesterol-lowering drugs.
When I was in medical school, I remember that one of my professors said, “I don't care about my diet, I’ll just take simvastatin and keep eating my thick, juicy steaks.” He believed that taking medication was just as good as eating healthy. Today, we now know that eating a steak is not as bad for you as he apparently thought (Note: Learn how a Mediterranean-style diet can improve your cholesterol enormously and the role of meat.
But what if your patient is already on a cholesterol-lowering medication? Should you make the effort to improve his diet? Today's research says you should and that your effort could be focused in just one area—whole grains.
The Research
Using data collected through NHANES (National Health and Nutrition Examination Survey), researchers at Tufts University focused their analysis on men and women (>45 years) with complete dietary and demographic information, including medication usage and cholesterol profiles. After excluding those who were taking cholesterol-lowering medications that were not statins, they were left with nearly 4300 people.
Using the dietary recalls completed for the study, the researchers were able to estimate the average amount of whole grains each person consumed on a daily basis. They then grouped those persons according to whether they consumed more than or less than 16 grams of whole grains per day (ie, a single serving).
Researchers compared the cholesterol scores of those who consumed >16 grams of whole grains with those who did not, then further comparing the scores of those taking statins with those who did not.
The Results
Individuals who took statins and ate >1 serving of whole grains per day were 62% less likely to have high total cholesterol than those who did not take cholesterol medication. Consuming <1 serving of whole grain while taking statins meant they were only 44% less likely to have high total cholesterol.
Further, a patient’s non-HDL-cholesterol score and total cholesterol to HDL ratio was 31 points lower in those who ate more whole grains versus only 20 points lower in those who ate less. The relationship between statins and whole grains and LDL cholesterol scores was not found to be significantly different.
Note: When the researchers looked at the cholesterol scores of those who were not taking cholesterol-lowering statins, the amount of whole grains they ate was not associated with their cholesterol score. It's clear that statins plus whole grains were what made the difference.
What’s the “Take Home”?
About 1/2 cup cooked brown rice or a single slice of whole grain bread contains about 16 grams or about 1 serving of whole grains. That's not very much at all. If prescribing statins, talk to your patient about switching to at least 1 serving of whole grains (or more) each day. Here's a guide to making better fiber choices that will help you increase your intake of whole grains.
Reference:
1. Wang H, Lichenstein A, Lamon-Fava S, Jacques P. Association between statin use and serum cholesterol concentrations is modified by whole-grain consumption: NHANES 2003-2006. Am J Clin Nutr. 2014;100:1149-1157.