Good Culinary News for Statin-Intolerant Patients

David T. Nash, MD

The real impact of nutritious menu changes at fast food chains like McDonalds remains to be seen, but these-along with modifying the dosage schedules of patients who appear to be statin-intolerant-may prove to have long-term salubrious effects.

There seem to be two realities of life associated with the battle to maintain a healthy weight and favorable cholesterol profile:

1. Many people don’t eat a Mediterranean or vegetarian diet. Both are safe and relatively inexpensive, and-like regular modestly intense exercise, which also has a positive effect on a variety of risk factors such as lipids-lower elevated LDL-C levels.

2. Adherence to statin therapy is relatively poor. At 1 to 2 years of follow-up, about 50% of patients are either noncompliant or have stopped taking the medication.

For these reasons, the news that McDonald’s and other fast food chains have taken an aggressive new stance to improve the health of their customers by offering nutritious alternatives to standard fare hamburger and fries is most welcome.

According to an article in the New York Times1 and a video posted on the Web site of the Wall Street Journal,2 McDonald’s will add salads, fruits, and raw cut vegetables in 20 of the company’s largest markets, which account for 85% of its total sales. And several other companies have followed suit. Some are now providing instant oatmeal portions that provide 8 grams of soluble fiber. This “dose” will result in a drop in LDL cholesterol levels that is equivalent to doubling the statin dose of most statin agents.

The real impact of nutritious menu changes remains to be seen, but these-along with modifying the dosage schedules of patients who appear to be statin-intolerant-may provide a long-term beneficial effect on the development of vascular disease and all its chronic disabling effects on the brain, heart, and vascular system.

Bottom line: a more intensive effort to improve patient involvement through broader food choices, encouragement and funding for exercise opportunities, and various combinations of each of these will reduce health care expenditures and chronic disability and increase life expectancies.

Both physicians and patients must join hands to adopt an aggressive stance in jointly reducing the epidemic of cardiovascular disease, which afflicts a large segment of the global population. An excellent start would be to concentrate on increasing adherence to both drug therapy and behavioral modifications to reduce LDL-C significantly.

1. Strom S. With Tastes Growing Healthier, McDonald’s Aims to Adapt Its Menu.New York Times. September 26, 2013.
2. Homework With a Side of Fries.Wall Street Journal. (Video). September 26, 2013.