Harvard Heart Letter

Low-fat diets place third of three in cholesterol-lowering power

It's high time to retire the low-fat diet as the default approach for lowering cholesterol. Better options? A Mediterranean-type diet or one that includes a "portfolio" of cholesterol-lowering foods. Both convincingly beat low-fat diets in head-to-head trials. Both also focus on foods and what you should eat rather than on nutrients you need to avoid.

In six trials that included 2,650 overweight men and women, those assigned to a Mediterranean-type diet lost more weight and had bigger improvements in cholesterol, blood pressure, blood sugar, and markers of inflammation like C-reactive protein (American Journal of Medicine, September 2011). A report from the developers of the so-called portfolio diet showed that it lowered harmful LDL cholesterol by 13%, compared with just 3% for a low-fat diet (Journal of the American Medical Association, Aug. 24–31, 2011).

There's no such thing as the Mediterranean diet. Following a Mediterranean-type diet means eating fruits, vegetables, grains, beans, nuts, and seeds every day, and these foods make up the lion's share of food items. Fat, much of it from olive oil, may account for up to 40% of daily calories. Small portions of cheese or yogurt are usually eaten each day, along with a serving of fish, poultry, or eggs. Red meat makes an appearance now and then. Small amounts of red wine are typically taken with meals. This eating pattern is low in saturated fat and high in fiber, healthy fats, vitamins, minerals, and phytonutrients.

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