Dr. John Day, Cardiologist

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Does Cholesterol Still Matter? The New Nutrition Guidelines

Did you see the latest headlines that it is OK to eat cholesterol according to the new nutritional guidelines?  Are eggs now officially considered “healthy” again and how can we make sense of these ever shifting nutritional guidelines?

The New Nutrition Guidelines

To begin with, the guidelines have not officially changed yet.  We are still stuck with the last set of guidelines from 5 years ago.  It should be noted that we get new national nutritional guidelines every 5 years.

All of the stir in the media is because of a leaked report from the nation’s top nutrition advisory panel that will soon be going to the Department of Health and Human Services and the Department of Agriculture.  The official new dietary guidelines are not expected out until the end of the year.

As there are many powerful lobbyists in Washington DC, not all of these recommendations from the Dietary Guidelines Advisory Committee will make it into the final draft of the national nutrition guidelines.  These guidelines are very important as school lunches, how doctors counsel their patients, and how food companies advertise their products are all based on these guidelines.

Is it OK to eat cholesterol again?

Probably the biggest news leaked from this report is that “cholesterol is no longer important.”  To many this may seem like nutrition guidelines are flip-flopping yet again.

First of all, the cholesterol story is very complicated. Here is what we do know:

1. The plaque that builds up within the arteries of our heart is often comprised of cholesterol.

2. High levels of LDL (bad cholesterol) as well as triglycerides significantly increase your risk of a heart attack.

3. The cholesterol that we eat does not significantly influence cholesterol levels for about 75% of people.

The major cardiology groups in the U.S. dropped the importance of dietary cholesterol in their 2013 guidelines.  The American Heart Association and the American College of Cardiology both stated that there were not any strong data to recommend cutting dietary cholesterol for most people.  It is expected that the official U.S. nutritional guidelines will do the same.

People Sensitive to Dietary Cholesterol

Does this mean we can now eat as many eggs as we want?  Not quite so fast.  We do know that in about a quarter of people that eating cholesterol rich foods will raise their cholesterol levels.  Also, for people who have already had a heart attack they may want to continue to limit the cholesterol in their foods.

How do you know if you are part of the 25% of people that are sensitive to dietary cholesterol?  Probably the easiest way to check is to have your doctor repeat a fasting lipid panel (blood test) if you choose to eat more cholesterol rich foods.  Dietary cholesterol is only found in animal products like meat and dairy.

Why is my cholesterol high?

You may be wondering what is causing your cholesterol to be high if cholesterol in foods does not matter for most people.  Here are the big causes of why your cholesterol may be too high.

1. Trans fats.

The goal for trans fats in our diets should be zero.  These are man-made fats.

For trans fats you cannot trust labels on your favorite foods.  As long as there is less than 0.5 mg of trans fat then food manufacturers may report “zero.”  This is very deceptive but yet is allowed by food manufacturers under U.S. law.  To help protect you and your family, avoid products that say anything “hydrogenated” or “partially hydrogenated” on the ingredient list.

Most Americans eat about 3 grams of this toxic fat each day.  If you eat fried food, fast food, pastries, processed foods, or use the unhealthy vegetable oils you are getting this deadly trans fat.

Any trans fat in the diet can dramatically raise cholesterol levels.

2. Saturated fats

The bad saturated fats are another cause of high cholesterol for many people.  This is why lean animal meats have been recommended for quite some time.

This is another area where new research may change future recommendations.  We still do not fully understand which saturated fats are “bad” and which ones are “good.”  Certainly, the saturated fats in nuts and seeds seem to be cardiac protective.  Stay tuned on this one.

3. You are not getting enough exercise

Exercise can have a profound effect on cholesterol levels. Exercise can raise our good cholesterol (HDL) and lower our bad cholesterol (LDL).

4. You are eating sugar or foods that behave like sugar

As your total cholesterol is also based on triglycerides levels, any sugar or foods that behave like sugar in your body (think refined grains), will raise your triglycerides.  If you want to lower your total cholesterol and triglycerides then avoid added sugars, fruit juices (real whole fruit is very healthy), and simple carbohydrates (99% of breads, pastas, crackers, etc.).

5. You are part of the 25% that are sensitive to dietary cholesterol.

As mentioned above, you might just be one of those people that cannot eat much cholesterol in your diet without significantly bumping your cholesterol levels.

6. Bad genes

While most people feel there is nothing we can do about “bad genes” quite the opposite is true.  Through a healthy lifestyle we can “turn off” bad genes and “turn on” good genes.  Just because you were born with bad cholesterol genes doesn’t mean you have to take a “statin” cholesterol lowering drug for the rest of your life.

What other changes are expected in the new U.S. Nutritional Guidelines?

1. Salt Guidelines May Loosen

Our last nutritional guidelines stated that we should keep our daily sodium intake to below 2,300 mg.  However, recent science has challenged this and the Institute of Medicine recently stated that there are no strong data that we should keep salt below 2,300 mg.  It will be interesting to see if the salt guidelines loosen.

2. Lobby Groups Will Oppose Recommendations to Eat Less Animal Meat (Especially Red and Processed Meats)

While the Dietary Guidelines Advisory Committee is recommending more of a plant-based diet with less red meat and processed meats it is expected that lobbyist groups will kill these recommendations in the final guidelines.

The big industrial meat farms are not helping our health or the environment.  Thus, we will likely continue to see wording encouraging us to eat a lot of animal meat in the U.S.

3. We may have our first sugar guidelines

Due to powerful lobby groups, our government has never set official sugar recommendations.  With mounting evidence building ever higher, our government may be finally forced to create some sort of a sugar guideline.

With the average American child now consuming 250 pounds of sugar each year, sugar guidelines are long overdue.  Bucking intense political pressure from lobbyist groups, the World Health Organization (WHO) recently recommended keeping our added sugars below 5% of our daily caloric intake.

4. “My Plate” Probably Won’t Change

The “My Plate” push from the last set of guidelines isn’t expected to change much.  In some ways this is good as our government will continue to encourage us to eat more fruits and vegetables.

However, the other half of “My Plate” will continue to remain very controversial.  Our government is expected to continue to recommend whole grains, low-fat dairy, and lean animal meats.  Emerging scientific data will continue to challenge these later recommendations.

My Views of the New Nutritional Guidelines

While our government is making some progress on the nutritional front, they are still way behind the scientific data.  Over the course of human kind, we have been very good at adapting and thriving from many different cultural diets.

For example, the Mediterranean people have thrived on the traditional Mediterranean Diet.  Asians have thrived on the traditional Asian Diet.  The Tarahumara Native Americans have thrived on their traditional diet.  This list goes on and on.

The only diet that our health suffers from is the “Standard American Diet” (SAD).  Our bodies simply do not thrive in a processed or prepared food environment loaded with sugar, refined grains, and other “Frankenfoods.”

In my opinion, past dietary guidelines have done far more harm than good.  2 in every 3 Americans are now overweight or obese, based in large part, to bad past guidelines.  Millions of Americans now suffer tremendously from many chronic medical conditions that could prevented or even reversed with a “traditional diet.”

The real enemy isn’t the mg of sodium or cholesterol in our diets but rather processed foods, prepared foods, sugar, refined grains, and other “Frankenfoods and Frankenmeats.”

Let this be my call to return to eating real foods!

Please share with me your views on the new nutritional guidelines.

Disclaimer

If you suffer from high cholesterol or are at risk for cardiovascular disease please discuss what diet you should be eating with your physician first before considering any changes based on the content of this article.