ProLipid

The following is a summary of the facts and recommendations concerning a heart-healthy diet issued by the National Cholesterol Education Program's Adult Treatment Panel in their most recent report. You can download the report here. Please click on a statement to read the complete recommendation:

1. Avoid saturated fat, too much raises LDL cholesterol
2. Weight loss reduces LDL cholesterol
3. Less than 7% of total calories should come from saturated fatty acids
4. Trans fatty acids raise LDL cholesterol levels
5. Reduce dietary cholesterol intake
6. Monounsaturated fatty acids lower LDL cholesterol when they replace saturated fatty acids in the diet
7. Polyunsaturated fatty acids lower LDL cholesterol and the risk of coronary heart disease (CHD) relative to saturated fatty acids
8. Unsaturated fatty acids are no worse than carbohydrates in terms of LDL cholesterol
9. Dietary fat recommendations should emphasize reduction in saturated fatty acids
10. Carbohydrate intake should be limited to 60 percent or less of total calories
11. Soluble fiber reduces LDL cholesterol
12. Plant sterol esters or phytosterols reduce LDL cholesterol
13. Soy protein can help lower LDL cholesterol
14. Omega-3 fatty acids (n-3 fatty acids) likely reduce the risk of atherosclerosis and heart attacks
15. Lowering homocysteine through folate intake has not been proven to reduce the risk of coronary heart disease
16. It is still unproven whether supplementation with antioxidants such as Vitamin C and E reduces the risk of coronary heart disease
17. No more than 2 alcoholic drinks per day for men and no more than 1 alcoholic drink per day for women.
18. Low salt intake lowers blood pressure or prevents its rise
19. The use of herbal or botanical supplements to reduce the risk of coronary heart disease is not recommended
20. High protein, high total fat and saturated fat diets such as the Atkins Diet are not recommended

#1: Avoid saturated fat, too much raises LDL cholesterol

There is a dose-response relationship between saturated fatty acids and LDL cholesterol levels. Diets high in saturated fatty acids raise serum LDL cholesterol levels. Reduction in intakes of saturated fatty acids lowers LDL cholesterol levels.

Back to the top.

#2: Weight loss reduces LDL cholesterol

Weight reduction of even a few pounds will reduce LDL levels, regardless of the nutrient composition of the weight loss diet. However, weight reduction achieved through a calorie-controlled diet low in saturated fatty acids and cholesterol will enhance and sustain LDL cholesterol more effectively.

Recommendation:
Weight loss through reduced caloric intake and increased levels of physical activity should be encouraged in all overweight individuals. Prevention of weight gain should also be emphasized.

Back to the top.

#3: Less than 7% of total calories should come from saturated fatty acids

High intakes of saturated fatty acids are associated with a high population rate of coronary heart disease (CHD). Reduction in intake of saturated fatty acids will reduce the risk of CHD.

Recommendation:
A therapeutic diet to maximize the reduction of LDL cholesterol should contain less than 7 percent of total calories as saturated fatty acids .

Back to the top.

#4: Trans fatty acids raise LDL cholesterol levels

Trans fatty acids raise serum LDL cholesterol levels. Through this mechanism, higher intakes of trans fatty acids should increase the risk of CHD. Prospective studies support an association between higher intakes of trans fatty acids and CHD. However, trans fatty acids are not classified as saturated fatty acids, nor are they included in the recommendations for a saturated fatty acid intake of less than 7 percent of calories in the Therapeutic Lifestyle Changes (TLC) Diet.

Recommendation:
Intake of trans fatty acids should be kept low. The use of liquid vegetable oil, soft margarine and trans fatty acid-free margarine is encouraged instead of butter, stick margarine and shortening .

Back to the top.

#5: Reduce dietary cholesterol intake

Higher intakes of dietary cholesterol raise serum LDL cholesterol levels in humans. Through this mechanism, higher intakes of dietary cholesterol should incresae the risk of coronary heart disease. Reducing cholesterol intakes from high to low decreases serum LDL cholesterol in most people.

Recommendation:
Less than 200 mg per day of cholesterol should be consumed in the Therapeutic Lifestyle Changes (TLC) Diet to maximize the amount of LDL cholesterol reduction that can be achieved through a reduction in dietary cholesterol .

Back to the top.

#6: Monounsaturated fatty acids lower LDL cholesterol when they replace saturated fatty acids in the diet

Monounsaturated fatty acids lower LDL cholesterol relative to saturated fatty acids. Monounsaturated fatty acids do not lower HDL cholesterol or raise triglycerides.
Dietary patterns that are rich in monounsaturated fatty acids provided by plant sources, rich in fruits, vegetables and whole grains and low in saturated fatty acids are associated with decreased CHD risk. However, the benefits of replacing saturated fatty acids with monounsaturated fatty acids has not been adequately tested in controlled clinical trials.

Recommendation:
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 such as plant oils and nuts .

Back to the top.

#7: Polyunsaturated fatty acids lower LDL cholesterol and the risk of coronary heart disease (CHD) relative to saturated fatty acids

Linoleic acid, a polyunsaturated fatty acid, reduces LDL cholesterol levels when substituted for saturated fatty acids in the diet. Polyunsaturated fatty acids can also cause small reductions in HDL cholesterol when compared with monounsaturated fatty acids. Controlled clinical trials indicate that substitution of polyunsaturated fatty acids for saturated fatty acids reduces the risk of coronary heart disease (CHD).

Recommendation:
Polyunsaturated fatty acids are one form of unsaturated fatty acids that can replace saturated fat. Most polyunsaturated fatty acids should be derived from liquid vegetable oils, semi-liquid margarines and other margarines low in trans fatty acids. Intakes of polyunsaturated fat can range up to 10 percent of total calories .

Back to the top.

#8: Unsaturated fatty acids are no worse than carbohydrates in terms of LDL cholesterol

Unsaturated fatty acids do not raise LDL cholesterol concentrations when substituted for carbohydrates in the diet.

Recommendation:
It is unnecessary to restrict total fat intake for the sole purpose of reducing LDL cholesterol levels, provided saturated fatty acids are reduced to goal levels (<7% of total calories) .

Back to the top.

#9: Dietary fat recommendations should emphasize reduction in saturated fatty acids

The percentage of total fat in the diet, independent of caloric intake, has not been documented to relate to body weight or risk of cancer in the general population. Short-term studies suggest that very high fat intakes (>35 percent of calories) modify metabolism in ways that could promote obesity. On the other hand, very high carbohydrate intakes (>60 percent of calories) aggravate some of the lipid and nonlipid risk factors common in the metabolic syndrome.

Recommendation:
Dietary fat recommendations should emphasize reduction in saturated fatty acids. Furthermore, for anyone with lipid disorders or the metabolic syndrome, extremes of total fat intake?either high or low?should be avoided. In such cases, total fat intake should range from 25?35 percent of calories. For anyone with the metabolic syndrome, a total fat intake of 30?35 percent may reduce lipid and nonlipid risk factors .

Back to the top.

#10: Carbohydrate intake should be limited to 60 percent or less of total calories

When carbohydrates are substituted for saturated fatty acids, LDL cholesterol levels drop. However, very high intakes of carbohydrate (>60 percent of total calories) are accompanied by a reduction in HDL cholesterol and a rise in triglycerides. These latter responses are sometimes reduced when carbohydates are consumed with viscous fiber. However, it has not been proven that viscous fiber can fully negate the triglyceride-raising or HDL-lowering actions of a very high intake of carbohydrates.

Recommendation:
Carbohydrate intake should be limited to 60 percent of total calories. A lower intake (50 percent of calories) should be considered for people with the metabolic syndrome who have elevated triglycerides or low HDL cholesterol. Regardless of intake, most of the carbohydrate intake should come from grain products, especially whole grains, vegetables, fruits and fat-free or low-fat dairy products .

Back to the top.

#11: Soluble fiber reduces LDL cholesterol

5?10 grams of viscous fiber (soluble fiber] per day reduces LDL cholesterol levels by approximately 5 percent.

Recommendation:
The use of dietary sources of viscous fiber is a therapeutic option to enhance LDL cholesterol lowering .

Back to the top.

#12: Plant sterol esters (phytosterols) reduce LDL cholesterol

Adaily intake of 2?3 grams per day of plant stanol/sterol esters (phytosterols) will reduce LDL cholesterol by 6?15 percent.

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

Back to the top.

#13: Soy protein can help lower LDL cholesterol

Ahigh intake of soy protein can cause small reductions in LDL cholesterol levels, especially when replacing animal food products.

Recommendation:
Food sources containing soy protein are acceptable as replacements for animal food products containing animal fats .

Back to the top.

#14: Omega-3 fatty acids ("n-3 fatty acids") may reduce the risk of atherosclerosis and heart attacks

The mechanisms whereby n-3 ("omega-3") fatty acids may reduce coronary events are unknown and may be multiple. Prospective data and clinical trial evidence in secondary coronary heart disease (CHD) prevention suggest that higher intakes of n-3 fatty acids reduce risk of coronary events and coronary mortality.

Recommendation:
Higher dietary intakes of n-3 fatty acids in the form of fatty fish or vegetable oils are an option for reducing risk of CHD. This recommendation is optional because the strength of the evidence is only moderate. ATP III (Adult Treatment Panel III of the NCEP) supports the American Heart Association's recommendation that fish be included as part of a CHD risk-reduction diet. Fish is generally low in saturated fat and may contain some cardioprotective n-3 fatty acids. However, a dietary recommendation for a specific amount of n-3 fatty acids is not being made .

Back to the top.

#15: Lowering homocysteine through folate intake has not been proven to reduce the risk of coronary heart disease

According to the Institute of Medicine, the Recommended Dietary Allowance (RDA) for folate for adults is 400 micrograms per day, and the upper limit is 1000 micrograms per day. There are no published controlled clinical trials to show whether lowering homocysteine levels through dietary intake or supplements of folate and other B vitamins will reduce the risk of coronary heart disease (CHD).

Recommendation:
ATP III (Adult Treatment Panel III of the NCEP) endorses the Institute of Medicine's RDA for dietary folate, namely, 400 micrograms per day. Folate should be consumed mainly from dietary sources .

Back to the top.

#16: It is still unproven whether supplementation with antioxidants such as Vitamin C and E will reduce the risk of coronary heart disease

Oxidative stress and LDL oxidation appear to be involved in atherogenesis. However, clinical trials to date have failed to demonstrate that supplementation of the diet with antioxidants will reduce the risk of coronary heart disease (CHD).

Recommendation:
Evidence of CHD risk reduction from dietary antioxidants is not strong enough to justify a recommendation for antioxidant supplementation to reduce the CHD risk in clinical practice. ATP III (Adult Treatment Panel III of the NCEP) supports current recommendations of the Institute of Medicine's RDA for dietary antioxidants, namely 75mg and 90mg of Vitamin C per day for women and men and 15mg per day of Vitamin E .

Back to the top.

#17: No more than 2 alcoholic drinks per day for men and no more than 1 alcoholic drink per day for women

Amoderate intake of alcohol in middle-aged and older adults may reduce the risk of coronary heart disease (CHD). However, a high intake of alcohol produces multiple adverse effects.

Recommendation:
No more than two drinks per day for men and no more than one drink per day for women should be consumed. A drink is defined as 5 ounces of wine, 12 ounces of beer or 1.5 ounces of 80-proof whiskey. Anyoe who doesn't drink should not be encouraged to initiate regular alcohol consumption .

Back to the top.

#18: Low salt intake lowers blood pressure or prevents its rise

JNC VI (Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure; Sixth Report) provides a review of the evidence to support the concept that lower salt intake lowers blood pressure or prevents its rise. One clinical trial further shows that the effects of a dietary pattern high in fruits, vegetables, low-fat dairy products, whole grains, poultry, fish and nuts and low in fats, red meat and sweets??foods that are good sources of potassium, calcium and magnesium??to reduce blood pressure are enhanced by a diet low in salt.

Recommendation:
The Diet and Health report and JNC VI recommend a sodium intake of <2400 mg/d (maximum 100 mmol/day, 2.4g sodium or 6.4g sodium chloride). JNC VI further recommends maintaining an adequate intake of dietary potassium (approximately 90 mmol per day) and enough dietary calcium and magnesium for general health. ATP III (Adult Treatment Panel III) affirms these recommendations for individuals undergoing cholesterol management in clinical practice .

Back to the top.

#19: The use of herbal or botanical supplements to reduce the risk of coronary heart disease is not recommended

Despite widespread promotion of several herbal or botanical dietary supplements for prevention of coronary heart disease (CHD), little data exists concerning product standardization, controlled clinical trials for efficacy and long-term safety and drug interactions. Clinical trial data is not available to support the use of herbal and botanical supplements in the prevention or treatment of heart disease.

Recommendation:
ATP III (Adult Treatment Panel III of the NCEP) does not recommend the use of herbal or botanical dietary supplements to reduce the risk of coronary heart disease (CHD). However, health care professionals should consult with patients to establish whether such products are being used because of the potential for drug interaction .

Back to the top.

#20: High protein, high total fat and saturated fat diets such as the Atkins Diet are not recommended

High protein, high total fat and saturated fat weight loss regimens have not been demonstrated in controlled clinical trials to produce long-term weight reduction. In addition, their nutrient composition does not appear to be conducive to long-term health.

Recommendation:
High protein, high total fat and saturated fat weight loss regimens are not recommended for weight reduction in clinical practice .

Back to the top.