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CONTINUING PROFESSIONAL DEVELOPMENT
to reduce the absorption of dietary fat.
This should not be seen as a substitute
for sensible dietary advice or as an excuse
to overindulge in high-fat energy-dense
foods. High-fat foods are often also high in
refined carbohydrates, sodium and other
components that may increase CVD risk.
KEY LEARNING POINTS
Diet remains a cornerstone in the
management of dyslipidaemia as a risk
factor for cardiovascular disease (CVD).
Alpha-CD is likely to be of greatest
benefit in patients whose dyslipidaemia
is related to high dietary intake of fat,
especially saturated fats, and who find
it difficult to reduce these foods in their
diet. Patients should be advised to take
2 g of alpha-CD (FBCx) after high-fat
Doses of alpha-CD should be separated
from fat-soluble vitamin supplements
and meals that are mainly comprised
of healthy fats such as olive oil, oily fish,
avocados, nuts and seeds.
1. Wang H, Blumberg JB, Chen CY, et al. Dietary modulators of
statin efficacy in cardiovascular disease and cognition. Mol
Aspects Med 2014;38:1–53.
2. Torres N, Guevara-Cruz M, Velázquez-Villegas LA, et al. Nutrition
and atherosclerosis. Arch Med Res 2015;46(5):408–26.
3. Australian Government Department of Health. Cardiovascular
disease. 2015. At: www.health.gov.au/internet/main/
4. Phan BA, Toth PP. Dyslipidemia in women: etiology and
management. Int J Womens Health 2014;6:185–94.
5. Canaway R, Manderson L. Quality of life, perceptions of health
and illness, and complementary therapy use among people
with type 2 diabetes and cardiovascular disease. J Altern
Complement Med 2013;19(11):882–90.
6. Forouhi NG, Koulman A, Sharp SJ, et al. Differences in
the prospective association between individual plasma
phospholipid saturated fatty acids and incident type 2
diabetes: the EPIC-InterAct case-cohort study. Lancet Diabetes
7. Chowdhury R, Warnakula S, Kunutsor S, et al. Association of
dietary, circulating, and supplement fatty acids with coronary
risk: a systematic review and meta-analysis. Ann Intern Med
8. Delgado-Lista J, Perez-Martinez P, Lopez-Miranda J, et al.
Long chain omega-3 fatty acids and cardiovascular disease: a
systematic review. Br J Nutr 2012;107 Suppl 2:S201–13.
9. Kwak SM, Myung SK, Lee YJ, et al. Efficacy of omega-3 fatty acid
supplements (eicosapentaenoic acid and docosahexaenoic
acid) in the secondary prevention of cardiovascular disease:
a meta-analysis of randomized, double-blind, placebo-
controlled trials. Arch Intern Med 2012;172(9):686–94.
10. James MJ, Sullivan TR, Metcalf RG, et al. Pitfalls in the use of
randomised controlled trials for fish oil studies with cardiac
patients. Br J Nutr 2014;112(5):812–20.
11. Dalen JE, Devries S. Diets to prevent coronar y heart
disease 1957–2013: what have we learned? Am J Med
12. National Heart Foundation of Australia. Saturated and trans fats.
2015. At: www.heartfoundation.org.au/healthy-eating/food-
13. Nestel P, Clifton P, Colquhoun D, et al. Indications for omega-3
long chain polyunsaturated fatty acid in the prevention
666 kJ) per fat-containing meal. The best
effects from alpha-CD are likely to be
experienced by people who consume a
diet high in saturated fats, while those
who maintain a diet containing mostly
healthy fats in moderate amounts are less
likely to experience benefits. Given the
amount of fat being eliminated via
faeces, gastrointestinal (GI) effects may
be predicted and some trial participants
have reported stomach ache, nausea and
bloating, especially in higher doses.29
Phyto (plant) sterols/stanols
Just as fibre sources such as alpha-CD
inhibit the absorption of dietary fats,
plant sterols and stanols reduce the
absorption of cholesterol in the gut.31
These substances act by displacing
cholesterol from mixed micelles in the
small intestine and thus partially reducing
cholesterol absorption.32 They are found
naturally in the diet at levels varying
from <60 mg to >500 mg/2000 kcal,33
and may also be added to products
such as margarine, breakfast cereal and
low-fat varieties of milk and yoghurt.
Recent reviews confirm that 2 g daily of
plant sterols/stanols inhibits cholesterol
absorption/re-absorption and reduces
LDL cholesterol by 8–10%, and that
these effects are additive to statins in
patients with dyslipidaemia. Plant sterols
and stanols do not appear to affect
HDL cholesterol, but preliminary evidence
suggests they reduce TGs by 6–9% in
patients with hypertriglyceridaemia.34
Combining plant sterols with fish oils may
have additive effects in lowering TG blood
levels.35 Whether plant sterols/stanols
also inhibit the absorption of fat-soluble
vitamins, in particular beta-carotene,
remains a matter of discussion.36
To assist with cholesterol reduction, the
National Heart Foundation of Australia
recommends the consumption of 2–3 g
of plant sterols per day, as part of a
healthy diet low in saturated and trans
fat and high in oily fish, wholegrains,
fruits and vegetables.
To avoid potential
beta-carotene deficiency, it recommends
concurrent consumption of at least one
serve of high beta-carotene-containing
foods per day, for example, carrots,
pumpkin, broccoli, spinach, squash,
apricots, mangoes and rockmelon.
At present clinical trial data using
hard cardiovascular endpoints is still
lacking. Most trials have been short term
and there appears to be substantial
variability in the response of different
individuals.34,38,39 Some authors have
raised concerns about the potential
toxicity of supplemental plant sterols/
stanols, especially in individuals with
sitosterolaemia or specific genetic
polymorphisms.39–42 There are also
concerns regarding the production
of sterol oxidation products during
processing and storage that may
contribute to inflammation.
Further research is warranted.
Prebiotics and probiotics
Another potential benefit of fibre is its
effect on the gut microbiome. The role
of the gut microbiome in CVD risk has
recently become a topic of interest, as
aberrant microbiota profiles have been
associated with metabolic disease and
some probiotic strains have been shown
to lower blood lipids. High intake of
fermentable fibres and plant polyphenols
appear to regulate microbial activity in the
gut. This may in part be related to the role
some dietary fibres play as metabolic fuel
sources (prebiotics) for beneficial microbes
(probiotics). Thus CVD-prevention
recommendations that promote the
consumption of high-fibre plant foods
such as fruit, vegetables and whole grains
may also provide benefits by feeding
beneficial microbial communities.
Dietary recommendations for the
management of dyslipidaemia often
recommend reducing saturated fats while
increasing oily fish and plant-based foods.
Many edible plants contain fibre and
phytonutrients that may help manage
dyslipidaemia, either directly or by acting
as a prebiotic food source for beneficial
bacteria in the gut.
Dietary recommendations to consume
25–30 g of dietary fibre and limit
saturated fats to less than 7% of daily
energy intake are prudent but not always
easy to implement. Especially in the
transitionary period, some patients may
benefit from supplements such as 2 g
alpha-CD (FBCx) after high-fat meals,
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