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The objectives of this article are to review clinical trials that have examined the effects of probiotics on low-density lipoprotein cholesterol (LDL-C) and to assess the potential of probiotic intake as a therapeutic lifestyle change (TLC) dietary option. Twenty-six clinical studies and two meta-analyses are reviewed. Significant LDL-C reductions were observed for four probiotic strains: Lactobacillus reuteri NCIMB 30242, Enterococcus faecium, and the combination of Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12. Two synbiotics, L. acidophilus CHO-220 plus inulin and L. acidophilus plus fructo-oligosaccharides, also decreased LDL-C. Of the probiotics examined, L. reuteri NCIMB 30242 was found to best meet TLC dietary requirements by 1) significantly reducing LDL-C and total cholesterol, with robustness similar to that of existing TLC dietary options, 2) improving other coronary heart disease risk factors, such as inflammatory biomarkers, and 3) having "generally recognized as safe" (GRAS) status. Based on these results, the probiotic L. reuteri NCIMB 30242 is a viable candidate both for future TLC dietary studies and as a potential option for inclusion in TLC dietary recommendations.

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BACKGROUND: The findings of animal and human studies suggest that a certain component in milk enhances food folate bioavailability. OBJECTIVE: The objective was to evaluate whether cow milk enhances the bioavailability of food folate in humans. DESIGN: Thirty-one young women were fed low-folate diets on a 4-d rotation with (n=17) or without (n=14) cow milk for 8 wk. Plasma and erythrocyte folate and plasma total homocysteine (tHcy) concentrations were monitored. RESULTS: Plasma folate concentrations steadily declined in both the milk and the nonmilk groups; however, the declines were not significantly different between groups (P=0.09). In contrast, erythrocyte folate concentrations declined only in the nonmilk group and remained unchanged in the milk group; the difference between the 2 groups was significant (P=0.01). Plasma tHcy concentrations significantly increased in the nonmilk group and remained unchanged in the milk group; the difference between the 2 groups was significant (P=0.02). CONCLUSION: The inclusion of cow milk in the diet enhanced the bioavailability of food folate as assessed by the changes in erythrocyte folate and plasma tHcy concentrations but not in plasma folate concentrations. The mechanisms of action by the components of cow milk remain to be investigated.

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BACKGROUND: Many Americans are not getting the recommended amounts of calcium in their diet. Since dairy foods provide most of the calcium in the diet, the number of recommended servings of dairy products may need to be revised. OBJECTIVE: 1. To determine the calcium intake of various age groups that met or exceeded the intake of dairy products recommended by the Food Guide Pyramid (FGP). 2. To determine the optimal level of dairy consumption that ensures a low prevalence of inadequate calcium (Ca) intake by Americans. METHODS: Using data from the Continuing Survey of Food Intake by Individuals, 1994-96, 1998, (CSFII) and the National Health and Nutrition Examination Survey, 1999-2000 (NHANES) we determined the calcium intake in individuals who met the recommended daily dairy servings as well as the minimum number of dairy servings required for the mean Ca intake of various age groups to exceed their respective Adequate Intakes (AI). RESULTS: Objective 1: Meeting or exceeding the FGP dairy recommendation led to calcium intakes that met recommended levels. However, very few individuals in all age groups met or exceeded the number of dairy servings recommended by FGP. Objective 2: Results indicated that in children 2-8 yrs, 2 dairy servings/d were required for the mean Ca intake (835 +/- 72 and 822 +/- 68 mg/d, in CSFII and NHANES IV, respectively) to exceed the AI. In children 9-18 yrs, 4 dairy servings/d) were required for the mean Ca intake of the group (1540 +/- 93 and 1518 +/- 86 mg/d) to exceed the AI. Similar data were observed in adults 19+ yrs, e.g., in adults 51+ yrs, 3 dairy servings/d were required for the mean Ca intake of the group (1241 +/- 53 and 1217 +/- 53 mg/d) to exceed the AI. CONCLUSION: Groups that met or exceeded the FGP dairy recommendations were more likely to have a mean calcium intake above the AI but had an average intake of about one serving higher than current recommendations. In individuals 9 yrs and older, 3-4 servings of dairy products are needed to meet or exceed the Ca AI and to ensure a low prevalence of inadequate Ca intake.

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Cardiovascular disease kills nearly as many Americans each year as the next seven leading causes of death combined. The prevalence of cardiovascular disease and most of its associated risk factors is markedly higher and increasing more rapidly among African Americans than in any other racial or ethnic group. Improving these statistics may be simply a matter of improving diet quality. In recent years, a substantial and growing body of evidence has revealed that dietary patterns complete in all food groups, including nutrient-rich dairy products, are essential for preventing and reducing cardiovascular disease and the conditions that contribute to it. Several cardiovascular risk factors, including hypertension, insulin resistance syndrome, and obesity, have been shown to be positively influenced by dietary patterns that include adequate intake of dairy products. The benefits of nutrient-rich dietary patterns have been specifically tested in randomized, controlled trials emphasizing African American populations. These studies demonstrated proportionally greater benefits for African Americans without evidence of adverse effects such as symptoms of lactose intolerance. As currently promoted for the prevention of certain cancers and osteoporosis, regular consumption of diets that meet recommended nutrient intake levels might also be the most effective approach for reducing cardiovascular disease risk in African Americans.

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