What are the most effective lifestyle changes for improvements in lipid profiles?

The Buzz: Various lifestyle modifications can benefit lipid profiles

Citation: "Diet and Exercise in the Management of Hyperlipidemia" AFP, 81;9 May 1, 2010 1097-1101

Summary: This review article is a compilation of various primary studies and meta analysis regarding specific life style modifications and their affect on lipids. Data summarized below:

• Limit saturated fats to < 7% of calories and eliminate trans fats = LDL ↓9-12%
• Increase intake of soluble fiber (3 oz oats per day, psyllium supplement) = LDL  ↓ 5 mg/dL  
• Isocalorically increase consumption of tree nuts ( .5 oz almonds, walnuts, or pecans per day) = LDL ↓ 2-19%
• 1.5 oz soy protein per day - tofu and soy foods to replace meats = ↓ LDL 5mg/dL
  ↑ HDL 0.8 mg/dL 
•  One alcoholic drink for females, two for males = ↓  LDL 7.8 mg/dL
  ↑ HDL 9-13 mg/dL 
• 1 oz Promise, Active, or Benecol spread per day  = ↓ LDL 10% 
• Increase intake of marine omega-3 fatty acids (EPA/DHA) = ↓ Triglycerides in a dose-dependant fashion
• Mediterranian Diet = ↓ total cholesterol:HDL ratio > 12% 
• Portfolio Diet  = ↓ LDL 29-35% 
• Aerobic exercise >120 min/week = ↓ LDL 4mg/dL
  ↑ HDL 1.9 - 2.5 mg/dL

Other pearls include:

• Dietary advice from physicians results in ↓ cholesterol 6.2/ mg/dL and ↓ LDL 7.0 mg/dL.
• Dietary advice from a dietitian results in and additional ↓ cholesterol 9.7 mg/dL.
• The greatest reduction results from avoidance of saturated and trans fats, increase in polyunsaturated and monunsaturated fats, moderate ETOH intake, supplementation with plant sterols or stanols (eg Promise spread), and isocalorically increasing consumption of tree nuts

Commentary: This study helps to quantify the effects of commonly recommended lifestyle modifications on lipid levels. Some of the recommendations, although showing impressive reductions in lipids, require a motivated patient. 

By: Steven Winiarski D.O.