I do not believe that my review was overly optimistic concerning the effectiveness of a cholesterol-lowering diet.1 First, a cholesterol-lowering diet is most effective if patients receive intensive, personalized, individual counseling. Although the two trials cited by Lancaster and colleagues used individual counseling, the patients were counseled on general nutritional principles as taught in a population approach for implementation of a cholesterol-lowering diet.2,3 These trials achieved results consistent with the population approach to dietary modification cited in Table 4 of my review. They were "omitted" in my review because of space considerations; population trials involving 10 000 or fewer individuals were not included.Second, small changes in the dietary intake of the population can be effective in lowering cholesterol levels. In the United States, the decline in serum cholesterol levels4 is consistent with the progressive decline in the saturated fat intake of the nation.5
Denke MA. Efficacy of Individualized Dietary Advice for Lowering Cholesterol-Reply. Arch Intern Med. 1995;155(15):1684–1685. doi:10.1001/archinte.1995.00430150180024
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