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Objective: To determine whether the cholesterol-lowering effect of a plant-based low-fat diet can be improved by a flexible control design that controls the extent of fat reduction based on the individual response of blood cholesterol. Design: Randomized, double-blind intervention study. Setting: A hotel in Prerow, Germany. Subjects: A total of 32 participants (21 female and 11 male participants) with total cholesterol level45.7 mmol/l. Intervention: The control group consumed a plant-based low-fat diet with constantly 20% of energy as fat; the intervention group received a diet with either 20 or 15% of energy as fat, depending on the serum cholesterol response of the preceding week. A flexible control design based on the individual cholesterol response during a run-in period of 1 week was used within a low-fat intervention. Results: During the run-in period, the consumption of a plant-based low-fat diet led to a reduction in total cholesterol by 1876 mmol/l (Po0.001), in LDL cholesterol by 1979 mmol/l (Po0.001) and triglycerides by 1373 mmol/l (Po0.001). During the feedback control period, an additional reduction in total cholesterol by 1378 (Po0.001) and in LDL cholesterol by 17711 (Po0.001) was observed compared to 15715 and 7718 in the control group. The effect of an additional feedback control was only marginal and not statistically significant compared to the effect of the low-fat diet alone. Conclusions: On a level of fat intake already reduced to 20% of energy, the use of a feedback control to adapt the fat content of the diet depending on the individual serum cholesterol response was not more effective in reducing blood cholesterol levels than a plant-based low-fat diet alone.

Summary Background Acetylsalicylic acid (ASA) may cause difficult-to-treat symptoms of the airways, skin, or gastrointestinal tract in hypersensitive patients. Due to the chemical relationship between salicylic acid and ASA, a role of a low-salicylate diet has been discussed. Methods This review evaluates whether low salicylate diets are meaningful from an allergological or nutritional–physiological perspective. Results The body’s arachidonic acid metabolism plays a crucial role in the pathogenesis of ASA intolerance. Despite their chemical affinity, ASA and salicylic acid affect the arachidonic pathway differently. The intake of salicylic acid with food is low compared to therapeutic doses of ASA. There is increasing evidence that protective effects of a high fruit and vegetables diet is related in part to the intake of salicylates. In salicylate-low diets, fruit and vegetables are reduced, harboring the risk of an insufficient diet and malnutrition. Conclusion Dietary therapy in ASA-intolerant patients is not recommended.

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