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Nutrition, Vitamins & Supplements for Seniors
Magic Bullet to Zap Cholesterol May Be Visit with a
Dietitian
 Many patients can reach LDL cholesterol goal
through dietary changes alone
March 4, 2008 - Worried about your cholesterol? You
certainly have plenty of company among senior citizens. One idea for
help may be a few appointments with a registered dietitian, to get some
sound advice about how to shape up your eating habits, according to a
new national study led by University of Michigan Health System
researchers. Almost half of those in this study reduced bad cholesterol
at least 15 percent.
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Not only are you likely to lower your cholesterol
levels, 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 new results, published in the February issue of
the Journal of the American Dietetic Association, are based on data from
377 patients with high cholesterol who were counseled by 52 registered
dietitians 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 R.D.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
R.D. today may have even more success.
The study was funded by the ADA and its Clinical
Nutrition Management Dietetic Practice Group, and based on a framework
developed for a pilot project carried out in Michigan by the Michigan
Dietetic Association and led by U-M cardiovascular dietitians.
“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, Ph.D., R.D., manager of
Nutrition Services with the U-M Cardiovascular Medicine program at
Domino’s Farms and the U-M Cardiovascular Center. “But this is the first
national study to show what happens when high-risk patients work with
R.D.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.
Called the Lipid Management Nutrition Outcomes
Project or LMNOP, the national study was launched by Rhodes and her U-M
colleagues Melvyn Rubenfire, M.D., and Martha Weintraub, MPH, R.D.,
after the successful completion of the Michigan-wide pilot project.
Rubenfire, Weintraub and Christina Biesemeier, M.S., R.D., FADA, of
Vanderbilt University are co-authors of the new study.
 The study gives us an important “real world”
picture of what happens when R.D.s try to implement evidence-based
nutrition guidelines in daily practice, Rhodes notes.
Some commercial health insurance plans are
beginning to cover appointments with registered dietitians, but many
still do not. Only dietitian visits for diabetes or kidney disease are
covered by Medicare. It is important for people to check their specific
health insurance plan to see whether nutrition is covered, Rhodes says.
But even if individuals need to pay for the appointments out of their
own pocket, they may find that an R.D.’s advice will pay off in the long
run, she says.
To get uniform data, the researchers brought lead
R.D.s from each state to U-M for training on the cholesterol and
nutrition guidelines, and on the data collection practices used in the
study. R.D.s at Veterans Affairs hospitals got their training by phone
conferencing. R.D.s then returned to their own practices, trained their
colleagues and implemented the ADA guidelines.
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. Neither the R.D.s
nor their patients were paid to participate in the study.
The “real world” aspect of this study included the
disappointing finding that many patients dropped out of nutrition
counseling after one or two visits, when three or four sessions with an
R.D. is recommended to make and sustain truly effective changes in
eating habits. Lack of insurance coverage was a major factor in this
dropout rate.
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 R.D.
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 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 R.D., 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.”
Editor’s Notes:
To learn more about how eating habits can influence
cholesterol levels, or to find an R.D., visit the ADA’s web site at
www.eatright.org. For more on U-M Cardiovascular Medicine and its
nutrition services, visit
www.med.umich.edu/cvc/prevention. Reference: JADA, Vol. 108, No. 2,
Feb. 2008.
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