Palate Paradigm

Government Likely to Reverse Recommendations About Cholesterol

For more than 50 years, the federal government has warned people that eating foods high in cholesterol could raise their cholesterol levels and lead to heart disease.

But that warning, which led many consumers to drop eggs from their diet and caused a 30% reduction in consumption, is likely to be retracted by the end of the year.

A preliminary report issued in December by the Dietary Guidelines Advisory Committee, stating that “cholesterol is not considered a nutrient of concern for overconsumption,” is expected to be reflected in the 2015 Dietary Guidelines that will be issued by the Agriculture and Health and Human Services departments in the coming months. However, warnings about high levels of LDL or ‘bad’ cholesterol in the blood, which have been linked to heart disease, will not be reversed.

Still, dieticians say the government is finally catching up to what research has shown for decades: that foods high in cholesterol do not have a direct correlation to heart disease, and the cause of high cholesterol is indeed a complex matter.

“People forget that the liver can make cholesterol,” said Paula Serafino-Cross, a registered dietician nutritionist at Baystate Medical Center. “I know someone who was slim and ate all the right foods and still had a heart attack. It’s a much more complex issue than we originally thought.”

Richard Wood agreed. “It’s great to see the government finally making progress, but this information is long, long overdue,” said the associate professor and director of the Center for Wellness, Education and Research at Springfield College. “Nutrition is a very individual matter. Some people can eat foods high in cholesterol with no ill effects, while the same foods cause a rise in others. But there are many, many steps between eating an egg yolk and developing atherosclerosis, or hardening of the arteries, and even though food may have a lot to do with heart health, so does exercise, smoking, stress, sleep, and the level of inflammation in the body.”

Nancy Dell told BusinessWest there is no one formula or “right” way of eating that works for everyone.

“The guidelines are finally catching up to what dieticians and health experts have known for years,” said the registered dietician, nutritionist, certified diabetes educator, and owner of Nancy Dell and Associates Nutrition Counseling.

She cited results from the Framingham Heart Study, which began in 1948 with 5,209 adult subjects from Framingham and is considered by researchers to be the gold standard, because it has continued and is now following a third generation of families. Dell said the study shows that, although LDL, or ‘bad’ cholesterol, is one of the risk factors for heart disease, other variables such as high blood pressure, obesity, smoking, and psychosocial factors play a role in the equation.

“The only three foods in our diet with really high levels of cholesterol are egg yolks, shrimp, and liver, but they don’t have a great impact on the cholesterol in blood,” Dell said. “And eggs are simply not an issue. People in a Tufts University study ate six eggs every day for eight weeks, and only two people had their cholesterol levels go up,” and those very minimally.

Wood concurred. He said Springfield College has run studies in which participants ate three eggs a day for a month, and only a small percentage saw any increase in their blood cholesterol.

“If the diet-heart hypothesis was true, everyone’s cholesterol would go up,” he said. “So, in essence, the risk of eating foods with high cholesterol levels is very small.”

Experts in the field of nutrition expect the government’s new dietary guidelines to contain recommendations to eat more vegetables, fruits, and whole grains and advise people to watch their intake of sodium and, more importantly, saturated fats.

But the latter is an ingredient many people ignore.

“I often get clients who schedule an appointment because they are concerned about their cholesterol levels; they tell me they are doing well because they have stopped eating foods with a high cholesterol count and are looking at the amount of cholesterol on food labels. But it’s the wrong thing to look at,” Dell said, explaining that trans fats and partially hydrogenated oil are much more damaging to health than foods high in cholesterol, and that carbohydrates and sugar also effect cholesterol in the bloodstream.

Critical Findings

Wood said the chemical reactions that take place in the body with regard to cholesterol are complex.

“Since it’s a fat, it doesn’t dissolve in water, so the body packages it into particles of different sizes,” he said, explaining that ‘good’ HDL particles remove cholesterol from the bloodstream and carry it away, while ‘bad’ LDL particles tend to stick to the artery walls and form plaque.

“Eating an excessive amount of carbohydrates can increase LDL, decrease HDL, and increase inflammation,” he continued, explaining that, after government warnings to eliminate foods high in cholesterol were issued, people began consuming products like margarine that were created by food manufacturers to mimic the real thing.

Dell explained how products such as Crisco are made. “If you take oil and add hydrogen to it, it becomes hard. People like the semi-solid texture, and it makes crackers and chips crispier and pie crusts flakier,” she said.

However, consuming it is far from heart-healthy. Dell said when 200 women in a Harvard study ate an extra 1.6 grams, or a third of a teaspoon, of trans fat a day, their risk of heart disease increased by 500%.

She also cited the example of a client whose cholesterol level shot up without warning.

“I talked to her about what she was eating and discovered she had started using fat-free coffee creamer every day. The first ingredient in it is partially hydrogenated oil, and she was consuming three to four grams a day without realizing it. A month after the woman stopped using the creamer, her cholesterol dropped by 50 points,” said Dell, adding that products such as microwave popcorn contain trans fat.

The particles the body forms to carry cholesterol through the bloodstream come in different sizes and shapes, and new research shows that people whose LDL cholesterol particles are predominantly small and dense have at least a threefold greater risk of coronary heart disease than people with large particles. In addition, some studies suggest that determining the number of small, dense particles in the blood provides a more accurate prediction of heart disease than simply measuring total LDL cholesterol.

Blood tests can measure particle size, and special diets that cut carbohydrates and sugar, but allow people to eat foods with a high fat content, have been created for individuals with an abundance of small LDL particles.

But clinicians fear that people will make their own assumptions if and when the dietary guidelines change.

“Some people may take the new information about cholesterol as an excuse to eat anything they want,” said Serafino-Cross. “But the government recommendations are not going to change much, particularly when it comes to the need to eat more vegetables, fruits, and whole grains. The consumption of vegetables in this country has gone down.”

Dell says strategies to increase good cholesterol in the bloodstream include losing weight, adding exercise to one’s daily routine, eliminating smoking, reducing white flour and sugar, and taking the supplement CoQ 10.

In addition, research has shown specific foods can help reduce LDL. Although eating them doesn’t cause a dramatic reduction, it can make a difference over an extended period of time. “Oats can reduce LDL by 2%; a half-cup of nuts a day can lower it by 4% to 24%; 10 grams of fiber can reduce the risk of heart disease by 17%; and an ounce of pistachios daily cuts LDL by 9%,” Dell said, citing results from studies.

She added that tea (with the exception of herbal varieties), fish, and whole soy foods, such as edaname and roasted soybeans, along with nuts and foods naturally high in fiber, can also help lower cholesterol. “But it’s better to get the fiber from fruits and vegetables. It doesn’t have the same effect when it has been separated and ground into food as when it is found in nature.”

Wood says it can be helpful for people to keep a dietary log of what they eat and how they are feeling. “Adding more vegetables is fine for everyone, but people need to look at the total amount of carbohydrates and sugar they are consuming as well as their total calorie consumption and how often they prepare foods as compared to buying prepared foods.”

Personal Prognosis

Each person’s body is different, and there is no formula that guarantees equal or positive results, especially since medication, exercise, sleep, stress, and other factors enter into the heart-health equation.

“Exercise reduces inflammation, and employing stress-management techniques can be helpful,” Wood said. “But it’s complicated, and most people would really benefit from meeting with a nutritionist who can investigate their eating patterns and how they relate to their current state of health.”

Serafino-Cross concurred. “People need to examine their overall dietary patterns. But most don’t want to do the hard work, which involves looking at everything they eat and cooking from scratch, as it takes a lot of effort.”

And although some people may need to be more strict than others, Dell told BusinessWest, “ultimately, it’s about finding a balance.”