A Case for Regularly Obtaining Nutrition History Food for Thought

May 20, 2024

"This case demonstrates the potential effect of dietary changes on cholesterol levels. Typically, patients with primary severe hypercholesterolemia, defined as an LDL cholesterol level of 190 mg/dL or higher, are at increased risk of atherosclerotic cardiovascular disease and are given guideline-directed statin therapy due to their elevated risk for future coronary events.¹ A careful dietary history can be valuable in identifying patients who might benefit from dietary changes rather than a statin prescription. This patient was consuming a diet high in saturated fats, including red meats, eggs, and coconut oil.² A behavioral modification approach was appropriate because she had multiple areas for improvement in her diet and no history of diabetes, cardiovascular disease, or hypertension. However, this conservative approach may not be appropriate for patients with cardiovascular risk factors and/or genetic hypercholesterolemia.

This nutritional approach is especially important in the current climate where “fad diets,” such as the ketogenic, paleolithic, or Atkins diets, may promote rapid weight loss but risk elevating LDL cholesterol levels.³ Responses to dietary cholesterol and fat are highly individualized, so immediately treating these patients with a statin compounds the harm, consigning them to lifetime usage without addressing the root cause. The dietary habits emphasized by the 2021 American Heart Association dietary guidance capture the ideal changes that patients should make to reduce cholesterol levels and optimize heart health.² Highlights include choosing healthy sources of protein (plants, fish, lean cuts, and low-fat products), favoring liquid plant oils, opting for minimally processed foods and added sugars, and limiting alcohol consumption."