Cholesterol takes back seat to whole diet in USDA recommendations

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It’s all about the whole diet, say experts in a draft of scientific findings on the U.S. Food and Drug Administration (USDA) website. The results, published for comment through April 8, offer diets for physicians to consider with their patients when working to improve cardiovascular risks, heart disease, obesity, and other health concerns.

A central feature of this personalized diet approach is 17 customizable dietary patterns that allow clinicians and their patients to discuss what they find most appealing. “They’re formulated on healthier choices, but they’re not eliminating foods,” said 2015 Dietary Guidelines Advisory Committee chair Barbara E Millen, DrPh, RD, in an interview with Cardiovascular Business. Millen, former professor at Boston University School of Medicine and president of Millennium Prevention in Westwood, Mass., is also a researcher in the Framingham Heart study.

In particular, Millen cites three of the diets -- the Healthy Mediterranean, the Healthy U.S.-style Pattern, and the Healthy Vegetarian -- as examples of meeting nutrient recommendations, ensuring neither under- nor overconsumption of key nutrients. These diets hit targets for fruits, vegetables, dairy and other key dietary components. “The patterns are such that you don’t have to eliminate any third to achieve the recommendations we’re making,” Millen said.

Changes to the guidelines reflect the different way nutritional epidemiologists are looking at food, emphasizing that each food not only has a variety of nutritional components on its own, but also works in concert with a diet as a whole. While that isn’t new  among nutritionists, the whole diet approach should make more sense to the public when physicians talk to them about changing the way they eat to have a healthier life.

“From my patient experience and my consumer experience I think that it’s going to create, I hope, a whole new level of conversations. I hope that it’s going to put consumers in greater charge, if you will, with their lifestyle change. If they can be helped to see the options and the food-based approaches that make sense, I hope that they get that much more excited about the control they have over their own health management and prevention,” Millen said.

Specific cholesterol recommendations have not been included in this document; however, the committee did not ignore cholesterol, Millen noted. When assessing goals of prior guidelines, they found that at the population-level average consumption was around 200 mg, 100 mg lower than previous marks.

“We didn’t ignore it. We looked at it in relation to current levels of consumption and didn’t choose to focus on it, because where we need to focus now is on the other things that are part of our diet consumed at higher levels that really do have a continuing relationship to metabolic risk that we know we need to be addressing, given what we see in our population,” Millen said.

This was not, however, intended to imply a reduced risk. As the potential guidelines highlight, significant diet-disease relationships have been identified and incorporated into the provided healthy diet programs.

Instead, Millen noted, the drivers for low-density lipoprotein (LDL) cholesterol and triglycerides remain saturated and polyunsaturated fats. “[Physicians and patients] can manipulate the level of risk and can up or downtick the LDL and triglyceride levels based on the dietary patterns the patient is consuming,” she said.

Using these diets, these levels could be adjusted, allowing physicians to not only lower the consumed cholesterol to reduce risk, but reduce caloric intake to bring patient’s incident overweight or obesity that may compound their cardiovascular risk under more control.

“[Physicians] may choose to focus first on weight loss because we know with weight loss comes improvement of cardiovascular disease risk profile. And over time, as the patient becomes successful, [physicians] may then begin to tweak more and more on some of these other aspects of diet that can help [them] become more successful, if you will, in reducing the metabolic risk. So the physician really has some options to work with,” Millen said.

These guidelines provide patients and healthcare providers with prevention-based risk reduction techniques, Millen offered. “To get where we need to go in terms of turning the tide, we really need to shift the paradigm in our healthcare system.”