Maybe your doctor should write up a grocery list to help lower your cholesterol, suggests a small study that showed a rigid diet seemed as effective as cholesterol-lowering pills.
Of course, sticking to that diet may not be easy.
"People interested in lowering their cholesterol should probably acquire a taste for tofu and oatmeal," said study co-author David Jenkins of the University of Toronto.
The study, published this month in the American Journal of Clinical Nutrition, was funded in part by almond promoters and a major food company.
Jenkins, Canadian research chair in metabolism and nutrition at Toronto, and Dr. Cyril Kendall, also of the University of Toronto, studied 55 middle-aged men and women who had high cholesterol and were at risk for heart disease.
The participants were already on a heart-healthy diet. They were then prescribed a diet that included more specific foods, such as raw almonds, tofu and other soy foods, viscous fibers such as oatmeal, barley, okra and eggplant, and plant sterol-enriched margarine.
After a year, the group who stuck faithfully to the new eating plan lowered their cholesterol by an average of 29 percent. Jenkins said the rate was comparable to results from participants who had taken a statin drug for one month before starting the diet, as well as general studies of patients on such drugs.
The group of participants who did not follow the diet as strictly still lowered their cholesterol by 10 percent to 20 percent. "That's still pretty good, and the point is, the more closely you follow the diet, the better you do," said Kendall.
Cholesterol for those who didn't stick to the new diet remained about the same.
'Buck the trend'
The soy, nut and fiber diet is promoted by the Almond Board of California, which helped fund the study along with Unilever. Unilever makes Take Control margarine, a cholesterol-lowering spread that's available in the United States, Europe and Australia, but not Canada.
The diet includes low-fat dairy products, smaller portions of lean meats and skinless poultry and substituting soy products for animal foods when possible. The more dieters combine foods rich in viscous fiber — oat bran, barley, okra and eggplant — as well as raw almonds, peanuts and walnuts, the more their cholesterol dropped, according to the study.
Dr. Alice H. Lichtenstein, a professor of public health and nutrition at Tufts University in Boston, said the study was scientifically solid, but the diet is so strict she believes most North Americans would find it hard to follow in the real world.
"It's a great diet and they started with a very motivated group of individuals who were used to consuming a low-fat or vegetarian diet," Lichtenstein said in a telephone interview. "But I think that for the general population, we have to be realistic — and it's unlikely that they're going to be able to adhere to something like this."
That mind-set is what Jenkins hopes to change.
The real world is "a relatively hostile place" when it comes to healthy eating, he said. "We're asking people to buck the trend."