According to a national study, not only are you likely to lower your cholesterol levels by means of medical nutrition therapy, you may be able to avoid having to take cholesterol medication, or having to increase your dose if you're already taking one. And you'll probably lose weight in the process, which also helps your heart.

The research results are based on data from 377 patients with high cholesterol who were counseled by 52 registered dietitians (RD’s) at 24 sites in 11 states.

In the group of 175 patients who started the study with triglycerides less than 400 milligrams per deciliter of blood (mg/dL), and who had their cholesterol measured before they changed or added medication, 44.6 percent either reduced their levels of "bad" cholesterol by at least 15 percent, or reached their cholesterol goal.

The results reflect progress in approximately eight months, after three or more appointments with a dietitian. But the results add further evidence that medical nutrition therapy, as it is called, can make a big difference in a patient's life.

All of the RD’s in the study based their advice to their patients on the latest research-based evidence about eating habits and cholesterol levels available at the time of the study: the American Dietetic Association's 1998 Medical Nutrition Therapy Hyperlipidemia Protocol.

Since that time, the ADA has updated the clinical guideline based on new research, which means that patients who see an RD’s today may have even more success.

"Everyone knows that nutrition is important for cholesterol management, and that a registered dietitian is the professional most thoroughly trained to help patients choose foods wisely," says lead author Kathy Rhodes. "But this is the first national study to show what happens when high-risk patients work with RD’s to follow nutrition guidelines grounded in the best evidence."

Key nutrition issues in the 1998 guidelines used in the study include reducing saturated and trans fat and increasing "healthy" fats such as olive oil; increasing soluble and insoluble fiber; eating fish twice a week; increasing fruits and vegetables; regular exercise and healthy weight management. Information about food-label reading and dining out was also included.

To get uniform data, the researchers gave lead RD’s from each state training on the cholesterol and nutrition guidelines, and on the data collection practices used in the study.

The study included only patients between the ages of 25 and 70 years who had high cholesterol levels, or triglyceride levels over 200 mg/dL, and who met other inclusion criteria including no recent changes in their cholesterol medication status.

Patients whose doctors changed their cholesterol medication status, either by starting them on a drug for the first time, or increasing their dose before assessing the effect of diet change, were not included in the analysis. But for the 219 patients who didn't have any change in their medication status, the impact of the RD counseling became apparent in the first year after the initial visit.

"Although some patients may already be eating a relatively healthy diet, medical nutrition therapy can increase patient's knowledge of 'cardioprotective foods' and assist them in individualizing the guidelines to fit their preferences and lifestyle," says co author Martha Weintraub. A significant number of patients reduced the fat in their diets to less than 30 percent of calories, as recommended for a heart health. Many participants also lost weight and/or increased the number of days each week on which they exercised for 30 minutes or more.

"Often, we see heart patients who are on multiple cholesterol medications but have never seen a dietitian. And even when a patient with high cholesterol does get to see an RD, their care team may not allow enough time to see how effective diet is before they add additional treatment," says Rhodes. "We hope that this demonstration of how well cholesterol can be lowered without medication or increases in medication will be very useful for patients and physicians, and perhaps insurers too."
References:
1. Kathy Rhodes, et al. The Lipid Management Nutrition Outcomes Project: Perspectives from a National Experience in Protocol Implementation and Nutrition Outcomes Tracking. Journal of the American Dietetic Association  (Vol. 108, Issue 2, Pages 332-339).