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Why cholesterol-lowering diets should still be encouraged in the face of effective pharmaceutical interventions

Emory University School of Medicine, Department of Family and Preventive Medicine, 69 Butler Street, SE, Atlanta, GA 30303-3219, E-mail: efrank{at}fpm.eusch.org

Dear Sir:

There are at least5 more reasons, in addition to those mentioned by Denke (1) in her editorial, why cholesterol-lowering diets should still be encouraged in the face of effective pharmaceutical interventions. First, dietary choices are available to everyone, many times every day. Certainly, some cholesterol-lowering foods may be more expensive than their cholesterol-raising equivalents. However, many cholesterol-free, low-fat foods (especially plant-based foods that naturally have such characteristics) can be inexpensive, simple food choices. It is worth remembering that although the food technologies Denke mentions may solve some problems, they are unlikely to solve all diet-related problems and may create others.

Second, heart disease risk reduction is not limited to cholesterol lowering, and diets constructed to reduce cholesterol may also reduce other heart disease risks. For example, diets that emphasize intake of cholesterol-free plant products are also high in antioxidants. Furthermore, such diets tend to lower risks of other chronic diseases.

Third, diets are in the hands of individuals and do not require the intervention of a health care provider. This independence may be considered advantageous by some (although others might see the absence of health provider monitoring as a disadvantage).

Fourth, eating lower on the food chain, as occurs with many lower-fat and lower-cholesterol diets, has positive environmental benefits. For example, fewer resources are required to feed a pound of soy protein directly to a human than to feed it to a cow and produce a few ounces (estimates vary) of cow protein for human consumption.

Finally, everyone must eat, although not everyone must take drugs. Making the best of required choices seems an obvious step toward health promotion.

REFERENCES

1. Denke MA. Revisiting the effectiveness of the National Cholesterol Education Program's Step I and Step II diets: cholesterol-lowering diets in a pharmaceutically driven world. Am J Clin Nutr 1999;69:581–2.[Free Full Text]

This Article Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Frank, E. Search for Related Content PubMed Articles by Frank, E. Agricola Articles by Frank, E.