Sunday, December 8, 2019

Retrospective #295: Dietary cholesterol: “no longer considered a nutrient of concern…”

In mid-December 2014 my wife heard a story on NBC’s ‘Today Show’ about dietary cholesterol.” Later that day we both heard a similar story on PBS’s “All Things Considered.”  So, to know more, I did a Google News search on “dietary cholesterol” (the cholesterol in food, like eggs and shrimp). The first story that came up was from Fox News. It wasn’t very good. The message was distorted with “contributions” from the AP and Reuters.
Still, the essence was that the subcommittee of the 2015 Dietary Guidelines Advisory Committee responsible for making recommendations announced to the full DGAC committee at its final meeting that it is their recommendation that DIETARY CHOLESTEROL NO LONGER BE ‘CONSIDERED A NUTRIENT OF CONCERN FOR OVERCONSUMPTION.’  
The final report, “Dietary Guidelines for Americans,” was scheduled to be published in 2015. “While those agencies could ignore the committee’s recommendations, major deviations are not common,” The Washington Post said.
“Five years ago, I don’t think the Dietary Guidelines diverged from the committee’s report,” Naomi K. Fukagawa, the 2010 vice chair, told The Washington Post. Fukagawa says she supports the change on cholesterol. “Walter Willett, chair of the nutrition department at the Harvard School of Public Health, also called the turnaround a ‘reasonable move,’” The Post reported. “There’s been a shift of thinking,” he said. Finally, at last, I say.
The Titanic really IS changing course. (See: The Nutrition Debate #12: “Turning the Titanic,” also #162, #189, #202, and #292). And this is MAJOR, except that, SATURATED FAT is being left behind; it is still “the bad guy,” according to the DGA. But it’s good news for people who long for shrimp. I actually know one, a medical doctor, who “passed” on shrimp being passed around as h’ordeuvres at a cocktail party, and others who eat egg whites (no yolk) for breakfast. (See: The Nutrition Debate #176, “Eggs, Cholesterol and Choline,” #211, “Eggs and Satiety,” and #225, #228 and #265.
The danger, of course, with the Titanic changing course, is in which way it is turning w/r/t cholesterol.  Think eroded endothelial layers, advanced glycation end products (AGEs), and clogged arteries from rancid and oxidized LDLs in overused and overheated “vegetable” oils. (#21, “The Dangers of Polyunsaturated Fats,” also #20, #22, #23, and #24.)
Those are the health outcomes that can be expected from the 2013 AHA/ACC recommendation that 1) while the target for total dietary fat consumption be omitted to allow fats in the diet to increase to replace the formerly much too high (60%) Dietary Guidelines recommendation for carbohydrates, and 2) that saturated fat be further reduced from the previous 7% - 10% of total calories to 5% - 6%. With this 1-2 punch the result will be that we consume more Mono and Polyunsaturated fats. And while monounsaturated fats (olive oil, avocado) are good, PUFAs are very BAD.
That’s exactly where the Titanic is being steered by Robert Eckel, who was co-chair of the 2013 ACC/AHA guidelines committee and a past president of the American Heart Association. While he conceded that there is “insufficient evidence” to make a recommendation to support dietary restrictions of cholesterol, he said “a three-to four-egg omelet isn’t something I’d ever recommend to a patient at risk for cardiovascular disease.” Some myths die hard. 
The WaPo story recalls the origins of the cholesterol myth. In 1913 a Russian scientist at the Czar’s Medical Institute in St. Petersburg fed cholesterol to rabbits for four to eight weeks and saw that the cholesterol harmed them. Then in the 1960s an American graduate student, Lawrence Rudel, noted that when the Russian fed cholesterol to white rats, it had no effect. Later, Ancel Keys acknowledged the difference between obligate herbivores (rabbits) and mammals. Even Keys, father of the diet/heart hypothesis (saturated fat + cholesterol → heart disease), later said:
“There’s no connection whatsoever between the cholesterol in food and cholesterol in the blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”
And, Archives of Internal Medicine (2009), “Updated Findings of the Framingham Study,” Dr. William Castelli, Director:
“In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol. . . we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories weighed the least and were the most physically active.” 


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