The sunny side of cholesterol

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Last month, when an advisory panel recommended an update to federal nutrition guidelines, Americans zeroed in on one particular bit of information: Cholesterol in food is not as terrible as we once had heard it to be.

What does the change mean? Well, for starters, egg lovers everywhere can breathe a collective, if cautionary, sigh of relief.

Collective because, says Dr. John P. Erwin III, associate professor at the Texas A&M College of Medicine: “For many years, we were advising you shouldn’t eat them because of high cholesterol. But we know that the actual way cholesterol is processed in the body doesn’t necessarily increase cholesterol levels in the bloodstream. It’s a process in the liver and other systems in the body.”

Cautionary because what you eat still matters, and cholesterol in your food tends to come with dangerous traveling companions, namely saturated and trans fats.

Nonetheless, the advisory panel’s suggestions, which are sent to the Department of Health and Human Services and the Department of Agriculture and usually adapted with little change, declare that cholesterol in food is no longer a “nutrient of concern.”

The proposed guidelines don’t give a pass to chowing down excessively on high-cholesterol favorites such as eggs and shrimp. Instead, they encourage Americans to follow practices of “healthy eating, healthy physical activity, healthy drinking,” says Penny Kris-Etherton, distinguished professor of nutrition at Penn State University and national physician spokeswoman for the American Heart Association.

“Don’t pay attention to just one single nutrient,” she says. “That’s the message American Heart is trying to give. Pay attention to the main message, and that’s to consume a healthy dietary pattern. Be guided by that, not, ‘Oh well, there are no cholesterol recommendations, so I can eat all the eggs I want.’”

Explains Sara Asberry, a registered dietitian at the University of Texas at Dallas: “Part of where the confusion may have started is that typically foods high in saturated fat are often higher in cholesterol. The relationship assumed to be dietary cholesterol equated to serum cholesterol.”

What the research has shown, however, is that saturated fat and trans fats are what make high-cholesterol foods harmful. “Dietary cholesterol does not seem to have an effect on serum cholesterol,” Asberry says. “If there is an effect at all, it is marginal at best.

“What ends up happening is that higher intakes of fat can lead to plaque buildup on artery walls.” Plus, foods high in fat tend to be high in calories, which can lead to obesity, Asberry says. “The bigger we are, the harder our heart is having to pump.”

The basics

A slight interjection here for a cholesterol lesson, courtesy of the American Heart Association’s website, Our bodies, in particular our livers, make all the cholesterol we need. That’s called blood cholesterol, or serum cholesterol, and its two types, LDL and HDL, are what’s measured when we go to the doctor.

When we eat a diet high in saturated and trans fats, LDL cholesterol levels (the bad cholesterol) are increased, Kris-Etherton says. Excess cholesterol that is transported in LDL can become artery-choking plaque, which can lead to strokes and heart attacks, she says.

“The key thing people have to pay attention to,” Kris-Etherton says, “is that there are foods and nutrients that increase blood cholesterol more so than dietary cholesterol.”

Namely, those saturated and trans fats, which are found in solid fats and a lot of animal fats. In the United States, cheese is the No. 1 source of saturated fats, Kris-Etherton says. Other culprits include full-fat dairy products as well as palm kernel oil and coconut oil.

Trans fat, which makes processed foods last longer and taste better, isn’t much kinder to the arteries. Although many manufacturers have eliminated it, “you can find it in fast-food products like store-bought frosting,” Asberry says.

“What seems to be worse from what I’ve seen is that sugar-free has more trans fats than products with sugar,” she says. “Processed foods can be manipulated, and you don’t always know what you’re eating anymore.”

Such foods are a result of “the whole panic over cholesterol and fat intake,” Erwin says, “which led to a whole industry developing artificial low-fat food products that aren’t the best for us.”

“I think a lot of people with good intentions try to minimize their intake of various subcomponents in their diet and have gotten sidetracked and hurt their health a little trying to do the right thing,” says Erwin, who is also governor-elect from Texas for the American College of Cardiology. “They’re not able to follow through with labeling and what that means.”

So let the experts make it easy with a one-word synopsis of the recent recommended guidelines: moderation.

‘Real foods’

Stick with “real foods, whole foods,” Erwin says. The guidelines “have taken away some of those particular navigational buoys, if you will, and tell people to focus on plant-based eating. It doesn’t mean having a steak every night. It means nuts and fish and chicken and legumes, those sort of things.”

It also doesn’t mean to avoid certain favorites, says Erwin, who makes a point of chewing his food slowly and who boxes half his restaurant meals to eat the next day.

“For years and years and years, I’ve told my heart patients, those at highest risk, not to prohibit foods they really love. Just be sure they minimize them. If someone has a filet, baked potato with sour cream and butter, and salad with too much dressing once a month, that won’t hurt them. What they need to do is change the day-to-day routine so they’re taking in more of these healthy foods and minimizing those that fall outside of that.” (Courtesy of


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