The food you avoid taking statins, according to the Mayo Clinic

It is among the main 'bullets' that go directly to heart health, along with hypertension, diabetes, obesity and overweight, smoking and a sedentary lifestyle (in addition to the risk due to distinction of sex, heredity, suffering from stress, alcohol abuse and the influence of sex hormones…). All these 'horsemen of the apocalypse', together or separately, are behind the deadliest pathologies on the planet: cardiovascular diseases.

New guidelines on cholesterol, diabetes and the heart Patricia Matey

We recently reported that, in the world, the list of deaths from cardiovascular diseases amounts to 17.5 million a year. In Spain, according to the Spanish Society of Cardiology, 119,853 people died from cardiovascular causes in 2020, which represented 24.3% of total deaths.

One priority objective of primary care physicians is the early detection of patients at cardiac risk. And one of the aims of cardiologists and of public health in general is to prevent primary events and monitor those who have 'fallen' into cardiovascular disease.

And now comes the first study to show that dietary intervention can be as effective as cholesterol-lowering drugs.

According to the Spanish Heart Foundation, "between 50% and 55% of the adult population has high cholesterol levels and the vast majority are unaware that they have this problem." And they comment: "Your cholesterol, more than a number".

Food-medicines

But the new research reveals that "food as medicine" is a simple and viable solution to lower blood 'damn lipids' in many patients who can't or won't take statins.

The data comes from the 'Journal of Nutrition' and shows that, for many people, an approach like the one mentioned above ("food as medicine") can be as effective as cholesterol-lowering drugs, without the need for drastic changes in lifestyle.

"Based on the results seen in our study, using this type of food as a medicine approach expands options for medical professionals and patients," said Stephen Kopecky, a cardiologist and director of the Statin Intolerance Clinic within the Mayo Clinic. "There are many patients who are unwilling or unable to take them, but this formula can help control their high cholesterol or hyperlipidemia with a realistic food-based intervention."

By substituting just a small portion of what hyperlipidemic patients ate with Step One Foods (a twice-daily dosed feeding system with products precisely formulated to help lower LDL cholesterol), the researchers found that the reductions were rapid and highly significant. Ultimately, participants saw an average 9% decrease in LDL (bad) cholesterol within 30 days, with some experiencing LDL reductions of more than 30%.

During the intervention phase, participants ate a variety of Step One Foods whole-food-based snacks, from chocolate bars to strawberry-banana smoothies, but supplemented with real ingredients, such as nuts, which are known to have an impact. positive in cholesterol profiles. These study foods were specifically formulated to provide a nutrient package of whole dietary fiber, plant sterols, omega-3 fatty acids, and antioxidants. Participants were instructed to consume these snacks in exchange for similar foods that they were already consuming.

And the discussion comes

Speaking to El Confidencial, Dr. Esther Merino, a cardiologist at the Quirónsalud Madrid University Hospital, recalls that "it is important to bear in mind that at work they are offered snacks that we can include in the group of functional foods, which are enriched foods that provide a benefit beyond the food itself. For example, yogurts enriched with plant sterols reduce cholesterol. The study bars with phytosterols would be within the same group. There are patients who can benefit from them, especially in primary prevention (before have had any cardiovascular event.) People who have already had a heart attack require more drastic reductions in their cholesterol levels that often require drugs."

Reasons why you should consume functional foods Juan Montagu

For their part, Esther Anzola Pérez, CEO of the Neolife Clinical Group, and Laura Pérez Naharro, from the same clinic's nutrition team, give their opinion: "The clinical trial shows how 80% of an intervention group (18 men and 36 women ) manage to reduce LDL cholesterol concentrations in 30 days with 'real' meal replacements in bar format. Very little time to assess the effectiveness."

It is true, they point out, that "the products of the work are made from ingredients that can be part of a healthy diet, such as dates, seeds, nuts, oat bran, berries. The formulation is well studied to stand out in the contribution of fiber, omega-3 essential fatty acids, plant phytosterols and antioxidants. However, under this study we are falling into the concept of nutritionism. That is, basing the quality of a product or food on specific nutrients. We can get those same nutrients in a breakfast incorporating oat flakes, fruit, nuts and seeds. Or in a dinner through a salmon fillet with broccoli and fruit for dessert. With the same calories and generating satiety. Something essential to achieve a certain adherence and that it does not happen with the consumption of substitutes".

The researchers note that "nutrition contributes to 5 of the 7 modifiable risk factors for heart disease, but getting patients to change their diet is incredibly challenging," said Elizabeth Klodas, co-author of the paper. "This study underscores what is possible when we succeed. The implications of achieving such a significant impact on cholesterol from a small food-based intervention are profound. We could change the health of our country in 30 days."

Point by point

"We cannot prove that the reason why the participants lower their cholesterol levels is thanks to the bars. Well, we must take into account that the people intervened have stopped consuming 2 meals a day with this 190-calorie substitute. Decreasing, during 30 days, their total caloric intake. Have their cholesterol levels dropped thanks to the substitute or because they have lost fat by being in a caloric deficit?", the Neolife experts ask.

Although it is promoted under the name of 'real food', "it is still a processed food with too many ingredients. As a snack, it can be a suitable alternative on a timely basis, but it should never displace real real food. Traditional dishes, elaborations that require chewing and satisfies, that can be combined with real life", they add.

For the cardiologist at Quirón, "dietary measures are first proposed to the patient. If these are insufficient, the diet is supplemented with functional foods, such as red rice yeast or plant sterols... If you see that adequate cholesterol levels are not achieved according to their characteristics, a statin should be prescribed. These drugs save millions of lives every year. In secondary prevention it is even more difficult to achieve cholesterol goals. When a person has already had a heart attack or stroke, the cholesterol figures that should be achieved they're much lower and it's the rare patient who can get it through diet."

And he insists: "The trial has been carried out on a few patients, 18 men and 36 women. They are few and very young with very little follow-up. More studies are required that include older patients and more months of follow-up to see if the The reduction lasts over time. Remember that statins not only lower cholesterol levels, but also produce an anti-inflammatory effect on the arteries that greatly helps patients at risk. We call them the pleiotropic effects of modern antilipid drugs and they are the other benefits that offers to the cardiovascular system beyond lowering cholesterol.

They discover a new and powerful benefit of statinsPatricia Matey

For example, he emphasizes, "the anti-inflammatory effect of the endothelium, which is the inner layer of the arteries, which makes them more impermeable to cholesterol deposits. Cholesterol becomes embedded in the interior of the arteries, and statins make the interior of they are more impermeable and make it difficult for plaque to attach. Cholesterol often becomes embedded because the endothelium is inflamed and, as the endothelial cells are further apart, it is possible for cholesterol to attach. These drugs deflate the endothelium."

Why does cholesterol rise with age?

It should be borne in mind that "there are several factors that raise blood cholesterol. In the case of women, with menopause, estrogen levels decrease, therefore, the cholesterol that was made from them does not take place and is reflects an increase in blood. On the other hand, with the passage of time, the effect of bad habits is more accentuated. We not only have to look at cholesterol levels, surely we can also appreciate less muscle mass and a greater accumulation of fat in the abdominal area. 5 years of bad habits do not have the same impact as 30", highlights Dr. Anzola.

Recommends: "To improve the lipid profile, we emphasize that it is essential to increase fiber intake through plant-based foods, fruits, vegetables, whole grains and legumes. Vegetables should appear in all main meals along with quality protein sources , minimally or little processed. And prioritize the consumption of foods rich in polyunsaturated fats (olive oil, nuts, seeds)".