Changing Cholesterol Guidelines



CHOLESTEROL EXPERTS are throwing out the numbers and changing the restrictions. Those serving on the 2015 U.S. Dietary Guidelines Committee agree: “in itself, cholesterol in food doesn’t appear to raise blood cholesterol levels,” according to a summary report in U.S. News.

In 2013, the American Heart Association (AHA) raised its daily upper cholesterol limit from 160 mg/dl to 300 mg/dl (one egg has about 200 mg of cholesterol). The guidelines advisors, who previously agreed with the 300 mg/dl limit, now recommend dropping the cholesterol guideline entirely. (Going one step farther, the International Network of Cholesterol Skeptics denies that cholesterol has anything to do with cardiovascular disease.)

Meanwhile, the fortunes of eggs have been rising. Not only no longer forbidden, they are beginning to be seen as healthy. In fact, the beneficial nutrients in egg yolks may “counter the effects of cholesterol,” according to Dr. Frank Hu, professor of nutrition at the Harvard School of Public Health, in the New York Times. “Starting your day with a breakfast of scrambled eggs will have a better impact on your overall cholesterol profile than a bagel or bowl of sugary cereal.” Eggs are also seen as a good source of nutrients such as choline, which may contribute to lowering inflammation and improving memory.

Among the more serious dietary villains causing high blood cholesterol, number one is sugar, when it exceeds the body’s need for energy and storage capacity and is converted to fat in the liver, according to New York nutrition expert Marion Nestle. Once converted, the fat circulates in the blood and can block arteries.

Saturated fats are also enjoying a better reputation. Of 150 participants in a NIH study published in 2014, those on the diet lower in carbohydrates and higher in fat saw their HDL (good) cholesterol levels rise more sharply, along with a lowering of their Framingham risk scores (the gold standard for predicting heart attacks) compared to participants on the lower-fat, higher-carb diet. All were instructed to limit either carbs or fat but not overall calories. The higher-fat group also lost more weight, on average eight pounds, possibly because the lower-fat group lost more muscle than fat.

The higher fat group consumed a little more than 13 percent of their calories from saturated fat (compared to the 5 to 6 percent recommended by the AHA), although the majority of the fat consumed was unsaturated – from fish, nuts and olive oil. This group had a total fat intake of more than 40 percent of daily calories, compared to less than 30 percent for the other group.

Both groups were encouraged to eat vegetables but only “some” beans and fruit. “I’ve been a strong advocate of moving saturated fat down the list of priorities in dietary recommendations,” Dr. Ronald Krauss, past chair of the American Heart Association’s dietary guidelines committee, told the New York Times. The reason: the role carbohydrates play in causing metabolic syndrome problems such as diabetes.

While diets high in saturated fat can increase LDL (bad) cholesterol levels, there’s another wrinkle in the cholesterol numbers game. Similar LDL concentrations in different people can create a higher risk if the LDL particles are small and dense, the kind of particles that increase with the consumption of refined carbohydrates (in processed foods). These particles are more often found in patients with heart disease and other metabolic syndrome issues. Saturated fat, on the other hand, tends to make LDL particles that are larger, more buoyant and less likely to clog arteries, according to Dr. Krauss.

And then there’s the issue of statins (cholesterol-lowering drugs like Lipitor), which are being recommended for more and larger categories of people with every study. Statins appear to prevent heart problems even in people with high LDL levels but no sign of clogged arteries, benefits that grow over time. A Scottish study followed 6,600 men, ages 45-64 with high LDL levels, for more than 20 years, with only half the men taking statins during the first five years. Among that group, 20 years later, the risk of heart-related deaths was 27 percent lower, and death from other causes 13 percent lower, compared to the group who delayed taking statins for the first five years.

Recent recommendations call for giving statins to healthy people who have LDL cholesterol levels of 190 mg/dl or higher, and to those with lower LDL levels who have other risk factors – in what is now called “preventive cardiology.” In other statin news, they seem to spur surgical wound healing by promoting the growth of blood vessels and lowering inflammation, which reduce healing time. Their inflammation-reducing effects can also help prevent gum disease and suggest the possibility of beneficial effects in the brain to reduce the risk of dementia.

A few outlying nay-sayers still worry about side effects of statins, such as muscle pain, and a Huffington Post blog suggest statins might be unnecessary for many as well as unsafe because of side effects.  For those who can’t bear the side effects of statins, a vaccine that controls blood cholesterol has worked well in animal studies and might be much more effective.

When the 2015 Dietary Guidelines are published, more of this information should be clarified, although diet advice has done so many flip-flops to date that the future may remain unpredictable.

–Mary Carpenter

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