Dietary reduction of serum cholesterol concentration: Authors' reply

TL;DR: It is believed that the lack of success of the eight trials to which Ramsay and colleagues refer was due not to a failure of the recommended diet to lower cholesterol concentration but to the fact that the authors are unable to make people eat what they want them to.

Abstract: fat 26% of energy; ratio of polyunsaturated to saturated fatty acids 0-75; cholesterol 314 mg/day) in both sexes. This lower concentration (means 3-72 mmol/l in men and 3 86 mmol/l in women) was constantly found throughout the following seven months of the study. We are convinced that a similar, or probably even stronger, effect on cholesterol concentrations would be seen in an identical study of patients with hypercholesterolaemia. In conclusion, we believe that the lack of success of the eight trials to which Ramsay and colleagues refer was due not to a failure of the recommended diet to lower cholesterol concentration but to the fact that we are unable to make people eat what we want them to. This is the main problem to be solved for the health professionals concerned with primary prevention of arterial disease. How do we improve the degree to which dietary advice is followed? The statement of Ramsay and colleagues that dietary treatment must be unpleasant to be effective was also strongly contradicted in our study. A sociological evaluation of the participants' perception of the experimental diet showed that it was well accepted and well liked.6 We emphasise finally that serum cholesterol concentration is only one of several risk markers of atherothrombotic disease that are influenced by diet. A step 1 type diet may also favourably affect systolic blood pressure and the components of blood coagulation and fibrinolysis.\