The Quest for a Cholesterol-decreasing Diet: Should We Subtract, Substitute, or Supplement?

rvecent reports from the National Cholesterol Educa-tion Program have documented the continued decrease of serum cholesterol levels in U.S. adults. Using data from the National Health and Nutrition Examination Surveys, the mean cholesterol level for adults, ages 20 to 74 years, was shown to have decreased from 5.69 mmol/L (220 mg/dL) in 1960 to 1962 to 5.30 mmol/L (205 mg/dL) in 1988 to 1991 (1). This decrease was observed in essentially all race and sex subgroups and was most marked in the past 10 years. Although cho-lesterol-decreasing drugs have increased in use, it is likely that most of this decrease in cholesterol levels was because of modifications of lifestyle, especially diet. Despite the optimistic data on decreases in popu-lation-wide cholesterol levels, it is still estimated tha