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The Effect of a Plant-Based Diet on Plasma Lipids in Hypercholesterolemic Adults: A Randomized Trial

Christopher D. Gardner, PhD; Ann Coulston, MS, RD; Lorraine Chatterjee, MS; Alison Rigby, PhD, MPH, RD; Gene Spiller, PhD; and John W. Farquhar, MD
[+] Article, Author, and Disclosure Information

From Stanford University Medical School and Stanford University Medical Center, Stanford, and Health Science Research Studies Center, Los Altos, California.

Acknowledgments: The authors gratefully acknowledge the work of Karla J. Oliveira, MS, RD, for menu design and prestudy diet assessment; Pat Kolar for her work as study coordinator; and David Ahn, RD, PhD, for data programming and statistical analyses.

Grant Support: By NIH grant R01 HL57386 and by Human Health Service grant M01-RR00070, General Clinical Research Centers, National Center for Research Resources, National Institutes of Health.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Christopher D. Gardner, PhD, Hoover Pavilion, N229, 211 Quarry Road, Stanford, CA 94305-5705; e-mail, mailto:cgardner@stanford.edu.

Current Author Addresses: Drs. Gardner, Rigby, and Farquhar and Ms. Chatterjee: Hoover Pavilion, N229, 211 Quarry Road, Stanford, CA 94305-5705.

Ms. Coulston: 1386 Cuernavaca Circulo, Mountain View, CA 94040-3571.

Dr. Spiller: Health Research and Studies Center, 340 Second Street, Suite 7, Box 338, Los Altos, CA 94023-0338.

Author Contributions: Conception and design: C.D. Gardner, A. Coulston, G. Spiller, J.W. Farquhar.

Analysis and interpretation of the data: C.D. Gardner, A. Coulston, A. Rigby, G. Spiller, J.W. Farquhar.

Drafting of the article: C.D. Gardner, A. Coulston, A. Rigby, G. Spiller, J.W. Farquhar.

Critical revision of the article for important intellectual content: C.D. Gardner, A. Coulston, A. Rigby, G. Spiller, J.W. Farquhar.

Final approval of the article: C.D. Gardner, A. Coulston, A. Rigby, G. Spiller, J.W. Farquhar.

Provision of study materials or patients: C.D. Gardner, L. Chatterjee.

Statistical expertise: C.D. Gardner.

Obtaining of funding: C.D. Gardner, J.W. Farquhar.

Administrative, technical, or logistic support: A. Coulston, L. Chatterjee.

Collection and assembly of data: C.D. Gardner, L. Chatterjee, A. Rigby.

Ann Intern Med. 2005;142(9):725-733. doi:10.7326/0003-4819-142-9-200505030-00007
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It is well established that elevated low-density lipoprotein (LDL) cholesterol concentrations are a risk factor for cardiovascular diseases and that dietary modification is considered a first approach to their treatment and control (12). For several decades, dietary modification for lipid management traditionally focused on avoiding saturated fat and cholesterol (35). Previous examples of dietary interventions targeting LDL cholesterol level often reported only modest lipid improvements, leading some to consider diet a relatively ineffective therapy (6). However, recent developments have suggested that the traditional focus of lipid management may have been overly simplistic and that diets might be more effective if more attention was focused on including certain foods or factors rather than just avoiding saturated fat and cholesterol. Effective refinements of dietary strategies for lipid management could decrease the gap in effectiveness between dietary approaches and drug therapy.


diet ; lipids ; plasma ; plants

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Figure 1.
Mean 4-week changes (±SE) in plasma lipid and lipoprotein levels.

The data presented are least-squares means adjusted individually for baseline concentrations of each variable. The 4-week changes from baseline in total cholesterol concentrations for the Low-Fat (n  = 61) and Low-Fat Plus (n  = 59) groups were −4.1% and −7.9%, respectively (p  = 0.014). Similarly, the changes were −4.6% and −9.3% for low-density lipoprotein (LDL) cholesterol (p  = 0.016), −5.5% and −7.7% for high-density lipoprotein (HDL) cholesterol (p  = 0.13), and 0.9% and 0.1% for triglycerides (p  > 0.2).

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Figure 2.
Raw data for 4-week changes in low-density lipoprotein (LDL) cholesterol level of individual study participants.

Each bar represents the result of a single participant, and the results have been sorted from largest decrease to largest increase from left to right, for each group.

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Submit a Comment/Letter
Lowering LDL and HDL with the same intervention
Posted on May 5, 2005
Matthew Menken
World Federation of Neurology Research Group on Medical Education
Conflict of Interest: None Declared

The authors have added to our growing knowledge of the interventions by means of which to lower LDL cholesterol. However, the plant-based diet in this study also lowers HDL cholesterol. This is worrisome.

It is not unusual in practice to encounter patients with LDL cholesterol values that exceed guideline recommendations (<80 mg/dL), yet who have progressive vascular disease. Conversely, it is rare in practice to encounter patients with very high HDL cholesterol values (>80 mg/dL), and who have progressive vascular disease.

At the present time, we have few effective and well tolerated interventions to raise HDL cholesterol. Thus virtually all of the clinical research to date has focused upon lowering LDL cholesterol levels in defined populations. Plainly, comparable clinical studies to raise HDL cholesterol cannot yet be carried out.

Until and unless such HDL cholesterol studies are done, we should limit LDL-lowering interventions in practice to those strategies that are HDL-neutral, or which raise HDL cholesterol at the same time.

Conflict of Interest:

None declared

Submit a Comment/Letter

Summary for Patients

Improving Cholesterol Levels: Is a Low-Fat Diet High in Plant-Based Foods Better than a Typical Low-Fat Diet?

The summary below is from the full report titled “The Effect of a Plant-Based Diet on Plasma Lipids in Hypercholesterolemic Adults. A Randomized Trial.” It is in the 3 May 2005 issue of Annals of Internal Medicine (volume 142, pages 725-733). The authors are C.D. Gardner, A. Coulston, L. Chatterjee, A. Rigby, G. Spiller, and J.W. Farquhar.


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