Abstract
The characteristics of patients with CVD have changed: whereas smoking prevalence declines, obesity and metabolic syndrome are on the rise. Unfortunately, the traditional low-fat diet for the prevention of cardiovascular disease (CVD) still seems to be the “mainstream knowledge” despite contradicting evidence. But lowering LDL-cholesterol by the wrong diet even may be counterproductive, if sd-LDL is raised and HDL is lowered. New insights into the pathophysiology of insulin resistance and its influence on the effects of dietary changes have led to a better approach: (1) the higher a patient's insulin resistance, the more important is the glycemic load of the diet. (2) Fat quality is much more important than fat quantity. (3) The best principle for a reduced calorie intake is not fat counting, but a high volume diet with low energy density, which means fibre rich vegetables and fruits. (4) And finally, satiation and palatability of a diet is very important: there is no success without the patient's compliance. Thus, the best approach to the dietary prevention of CVD is a Mediterranean style low-carb diet represented in the LOGI pyramid. Dietary guidelines for the prevention of CVD should to be revised accordingly.
Highlights
In nutritional medicine evidence is more difficult to obtain than in cardiovascular drug studies, where RCTs with hard end-points are the gold standard
Controlled dietary intervention studies have demonstrated that low-carb-high-fat (LCHF) diets or low-glycaemic-index (LOGI) diets in comparison to low-fat-high-carb (LFHC) diets double the weight loss achieved over 6 months [67,68,69,70,71,72,73]
The aforementioned cited evidence convincingly argues for a change in dietary recommendations towards the prevention of coronary heart disease (CHD)
Summary
In nutritional medicine evidence is more difficult to obtain than in cardiovascular drug studies, where RCTs with hard end-points are the gold standard. When people eat less of one kind of food, they will likely exchange it for a different one, because they usually eat “ad libitum”, meaning until they are satisfied. It is always about exchanging one food item for another one—and the main question is, which changes are best for our patient’s health. The intention of this paper is to stimulate discussions about whether the current guidelines should be adapted to the latest evidence and to give an insight into the ongoing debate, which diets are best for the prevention of cardiovascular disease
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