Food and nutrition.pdf

38 Diet and Healthof coronary heart disease (CHD), but there is considerable variation insusceptibility to CHD between individuals. Results indicate that anelevated level of lipoprotein is a strong risk factor for CHD in theseindividuals; the risk is independent of age, sex, smoking status, and serumlevels of total cholesterol, triglyceride, or HDL-cholesterol. The higher levelof lipoprotein observed in patients with CHD is the result of geneticinfluence.The efficacy of hypercholesterolemic dietS lowering cholesterol andin some cases, in preventing CHD, has been convincingly demonstrated.Such efficacy does depend, however, on the vigour which the physicianand dietitian support dietary therapy. Many physicians have declareddietary therapy a failure without providing their patients with real dietaryadvice and support.Two factors that probably contribute to physicians disinterest indietary therapy are extensive advertising of hypercholesterolemic drugscompared with the little advertisingof dietary therapy and patientreluctance to alter diet and life-style. Getting patients to alter their lifestyleis often a challenging task. A recent surveysuggests, however, thatthe ~ublic is ready and able to embrace dietary therapy as the primarysolution to hypercholesterolemia.To further facilitate dietary therapy, recent research suggests thatcertain forms of fat (eg. fish and monounsaturated fatty acids) may behypocholesterolemic, especially if they replace saturated fatty acids in thediet. Food technology is improving daily in palatably, removing fat fromitems like cheese, chips, and crackers. Frozen yogurt has become a popularreplacement for ice cream. Fat substitutes, as they become available, mayalso facilitate compliance with a low-fat diet.Psyllium is an especially attractive hybrid intervention in that it iswell tolerated, lowers LDL-cholesterol by 10% to 20%, has no adverseeffects on triglycerides, high-density-lipoprotein (HDL) cholesterol, orserum glucose, and is readily available and fairly inexpensive. It has along history of use without any evidence of long-term adverse effects.It is estimated that oat bran supplementation (90 gm per day) was amuch more cost-effective method of lowering serum cholesterol than eithercholestyramine or colestipol. In addition, high-fibre diets may decreaserisk of colon cancer, improve glucose tolerance, lower blood pressure, andassist in weight loss.Many physicians think that they or their staff can tell the patienteverything he or she needs to know about hypercholesterolemic diets byissuing the usual, though imprecise, dietary admonitions (eg. avoid redmeat, whole fat dairy products, and egg yolks) and by photocopying afew sample menus. Without explanation and reinforcement, the patient