Modifying Nutritional Components 

The role of diet is very important in controlling hyperlipidemias. A large number of dietary factors may influence lipid levels. These include modification of nutritional components, consumption of specific foods, use of food additives and supplements, and major dietary approaches.

1.Decreasing total fat intake and replacing saturated and trans fats with polyunsaturated and monounsaturated fats

The following food items contain high saturated fats; therefore, they should be avoided or be taken in moderation: fatty beef, lamb, pork, poultry with skin, beef fat (tallow), lard and cream, butter, cheese, dairy products made from whole or reduced-fat (2 percent) milk, baked goods and fried foods, palm oil, kernel oil, and coconut oil. When you take a lot of foods rich in trans fats, your “good” cholesterol (HDL)  decreases while your “bad” cholesterol  (LDL)  increases. This will mean that the rate of deposition of cholesterol in your tissues will be faster than its elimination. When this happens, you are prone to develop diseases of the heart and the blood vessels—otherwise known as cardiovascular diseases—arising from atherosclerosis. To find out if the food that you are about to take in contains trans fats, look at the “Nutrition Facts” of the product. You can also look at the “list of ingredients”. If “partially hydrogenated oil” is listed as one of the ingredients, then the food product contains trans fats. In a fieldwork study conducted in the United Kingdom in 2000-2001, the food groups listed in Table 1 were found to contribute greatly to the trans fat intake of adults. As much as possible, avoid them to avoid developing hyperlipidemia.

High levels of LDL in your system is bad for your health, and you should do whatever it takes to lower it. In line with this, the American Heart Association recommends that you lower your intake of trans fat, and limit your consumption of saturated fat to 5 to 6% of your total daily caloric intake. This recommendation can be achieved through the following ways:

• Eat a lot of fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts. In addition, reduce your intake of red meat and sugary foods and beverages.
• Use naturally occurring, unhydrogenated, and plant-derived oil, such as canola, corn, safflower, sunflower, or olive oil most of the time.

-Select processed foods made with unhydrogenated oil rather than partially hydrogenated or hydrogenated vegetable oils or saturated fat.
-Use soft margarine as a substitute for butter and choose soft kinds of margarine over harder stick forms. Look for “0 g trans fat” on the “Nutrition Facts” label and no hydrogenated oil in the “Ingredients List”.
-Doughnuts, cookies, crackers, muffins, pies, and cakes are examples of foods that may contain trans fat. Limit how frequently you take them.
-Reduce intake of commercially fried foods and baked goods made with shortening or partially hydrogenated vegetable oil. These foods contain a significant amount of fat, most probably trans fat.
-A small amount of trans fat occurs naturally in meat and dairy products, so select lean cuts of meat, fish, and low-fat milk.

2. Limiting dietary cholesterol, and lowering total cholesterol, LDL cholesterol, and triglyceride levels

3.  Reducing saturated fat intake to 7 percent of total calories and limiting cholesterol to 200 mg per day
The strongest link between saturated fatty acid and cholesterol has been established by some epidemiological studies, where it was found out that the high intake of saturated fatty acids  led to increased level of the low-density lipoprotein (LDL) cholesterol, which is considered “bad” because it brings and deposits cholesterol in the peripheral tissues, such as the muscles and blood vessels—among other organs. To avoid the unhealthy effects of saturated fatty acids it is recommended that they should be substituted with unsaturated fatty acids in the diet. Concrete examples of the different sources of each type of fatty acid are enumerated in some references;  all you have to do is to take more of the foods containing unsaturated fatty acids and less of the saturated ones.

4.  Reducing LDL cholesterol levels by 9 to 12 percent
Supporting researches:·
-Meta-analysis of 224 studies of dietary intervention showed that changes in total cholesterol levels were affected primarily by changes in intake of saturated and polyunsaturated fats, and dietary cholesterol.
-A recent meta-analysis of 60 controlled trials showed that replacing trans fats with polyunsaturated fats from non-hydrogenated oils is the most effective measure for improving blood lipid profiles
-Meta-analysis of 67 controlled trials of dietary soluble fiber as a single intervention showed that the effects on total cholesterol and LDL cholesterol levels were modest. For example, the addition of three 28-g servings of oats per day decreases LDL cholesterol levels by 5 mg per do (0.13 mmol per L).
-Some persons have little change in lipid levels despite significant changes in fat and cholesterol intake. This observed variation may be explained by genetic factors or insulin resistance.

Consuming Specific Foods
-Tree nuts are high in unsaturated fats and low in saturated fats. Recent reviews concluded that consumption of tree nuts can reduce LDL cholesterol levels by 2 to 19 percent compared with lower-fat and Western diets. Nuts are calorie-dense and therefore should be iso calorically substituted for other foods. Recommended amounts range from 1 to 3 oz per day, at least five days per week.
-Soy protein can also be used to replace foods high in saturated fats and trans fats. A meta-analysis concluded that soy protein supplementation leads to small reductions in total cholesterol and LDL cholesterol levels (about 5 and 4 mg per dL [0.13 and 0.10 mmol per L], respectively), as well as small increases in HDL cholesterol levels (about 0.8 mg per dL [0.02 mmol per L]). The typical amount of soy protein used in studies has been 1.0 to 1.5 oz per day.
-Alcohol consumption is associated with an increase in HDL cholesterol levels of as much as 9 to 13 mg per dL (0.23 to 0.34 mmol per L) when non-drinkers are compared with the highest consumers. In an eight-week controlled study of postmenopausal women, alcohol consumption (15 g per day, equivalent to one drink) lowered LDL cholesterol levels by 7.8 mg per dL (0.20 mmol per L), but HDL cholesterol levels only increased significantly when alcohol consumption was increased to 30 g per day.

Using Food Additives And Supplements
-Plant stanols and sterols were found to lower LDL cholesterol levels in persons at risk of coronary heart disease. This was the finding of a meta-analysis of 41 trials showing that 2 g per day of either stanols or sterols reduces LDL cholesterol levels by 10 percent. These effects are additive with other diet or drug interventions. Fortified foods (e.g. Promise Activ and Benecol spreads) typically have 0.5 to 1 g of sterols or stanol per serving. The approximate cost for the recommended  2  g of stanols or sterols from fortified foods is $0.60 to $1.20 per day.
-Two marine-derived omega-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid, lower triglyceride levels in a dose-dependent fashion. However, their effects on cardiovascular mortality probably result in more from their antiarrhythmic, anti-inflammatory, and other effects than from their effects on lipid levels. A systematic review showed that plant-derived alpha-linoleic acid has no effect on lipid levels.
-Extracts of Chinese red yeast rice (a traditional dietary seasoning of Monascus purpureus) have several ingredients, including naturally occurring lovastatin (a monacolin K, 5 mg to 10 mg per typical daily dose). A meta-analysis of 93 trials concluded that red yeast rice lowers total cholesterol, LDL cholesterol, and triglyceride levels. The magnitude of this effect is similar to that of statin medications. Red yeast rice is an option for patients who cannot tolerate statins because of muscle aches as side effects.

Major Dietary Approaches
-Both low-fat and low-carbohydrate diets affect lipid levels. Comparing these approaches, low-fat diets had the most favorable effects on total cholesterol and LDL cholesterol levels, whereas low-carbohydrate diets had the most favorable effects on triglyceride and HDL cholesterol levels.
-The Mediterranean diet is characterized by a high consumption of monounsaturated fats (primarily from olive oil) and low consumption of saturated fats. Other characteristics include limited consumption of red meat, dairy products, eggs, and poultry, increased consumption of fish, tree nuts, vegetables, and whole grains; and moderate consumption of wine. When two versions of a Mediterranean diet were compared with a low-fat diet, the Mediterranean diets lowered the total-to-HDL cholesterol ratio more than the low-fat diet.
-The Portfolio Diet (Table 2) is a plant-based diet that is a composite of four additional LDL cholesterol-lowering components: (1) soluble fiber, (2) soy and other vegetable proteins, (3) plant sterols, and (4) almonds. Based on investigations, the Portfolio Diet has been shown to reduce LDL cholesterol levels by 29 to 35 percent, comparable to a combination of a diet low in saturated fats and cholesterol plus 20 mg of lovastatin daily. Among those who took Portfolio Diet foods, 32 percent achieved LDL cholesterol reductions of more than 20 percent after one year.