American Heart Association Step 1 Diet
The American Heart Association (AHA) advocates the so-called “Step 1″ diet to reduce elevated serum cholesterol levels. This diet allows a maximum of 30% of energy from fat (with less than 10% of total energy from saturated fat) and is high in carbohydrates.
To evaluate the effect of this diet, AHA initiated a study. Their respondents were 55 overweight, sedentary postmenopausal women (mean age, 59 years) for a period of 10 weeks. During the study period, the percent of energy from total fat and saturated fat and the intake of cholesterol decreased significantly, while the percent of energy from complex carbohydrates and simple carbohydrates increased. Mean body weight fell by 2%, total cholesterol fell by 8%, LDL cholesterol fell by 6%, and HDL cholesterol fell by 16%. The only dietary change that predicted a decrease in HDL cholesterol concentration was an increase in the proportion of energy from simple sugars like glucose, sucrose, fructose, lactose, and maltose.
Although the AHA Step 1 diet decreased total and LDL cholesterol levels in this group of women, it decreased HDL cholesterol by an even greater proportion. In women, a low HDL cholesterol concentration is a stronger independent predictor of cardiovascular disease risk than is elevated total cholesterol or LDL cholesterol. Therefore, women who follow AHA guidelines for lowering their serum cholesterol may actually be increasing their risk of heart disease. Statistical analysis suggested that the increase in intake of simple sugars was responsible for the reduction in HDL cholesterol levels. That observation is consistent with other studies showing that increasing intake of refined sugar lowers HDL cholesterol. Therefore, while a low-fat, high-carbohydrate diet may be beneficial, complex carbohydrates should be emphasized, such as whole grains, legumes, fruits, vegetables, nuts, and seeds.
The Step I diet restricted total fat to no more than 30 percent of total calories, saturated fat to no more than 10 percent of total calories, and cholesterol to less than 300 mg/day.
Step 1 Diet of AHA is intended as the starting point for patients who had high cholesterol levels.
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