A Guide for Dietary Reduction of Serum Cholesterol Level in Patients With Hyperlipemia
THE dilemma of the practitioner in choosing a satisfactory method of controlling blood lipids is illustrated by Dr. Philip L. White1 in his introduction to the Symposium on Significance of Lowered Cholesterol Levels: “Pressure from the patients and their families, pressure from the promoters of certain drugs, and his own determination to apply the most beneficial measures to these patients have left the physician in a frustrating position.” One member of the panel suggests that patients and their families should rely on the “informed individual physician,” but, through no fault of his own, the individual physician is often not informed. Out of the welter of suggestions for reducing blood lipids, he often finds the dietary approach the most practical.
It is true we cannot speak conclusively about the dietary factors influencing serum lipids, the optimum proportion of nutrients, the chemical characteristics of fats causing serum lipid changes, or the long-term benefits of treatment. However, we are currently justified in using the knowledge obtained from well-controlled dietary experiments to reduce the patient’s blood cholesterol.
Let us follow a hypothetic patient with evidence of atherosclerotic disease. We first make sure he is a good candidate for dietary treatment. We rule out conditions that temporarily alter serum cholesterol level. Weight loss, diarrhea, fever, and medications such as desiccated thyroid, estrogens, nicotinic acid, or sitosterol reduce serum cholesterol levels temporarily; whereas rapid weight gain, cortisone, testosterone, or corticotropin (ACTH) raise it. He is not on a self-imposed diet, another possible factor influencing serum lipid . . .