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  • Cholesterol, for decades, it's been demonized as the reason so many people have heart disease.

  • We've been watching it and avoiding it like the plague.

  • Why? Does that do any good? The answer may surprise and depress you

  • This is Healthcare Triage.

  • Okay, let's start with heart disease, which is still pretty much the biggest killer in the industrial world.

  • Most of the problems come from atherosclerosis, where the walls of blood vessels

  • thicken and fatty plaques form. Later, clots can develop

  • or fragments of plaques can break off and clog up other vessels. If those blockages

  • occurring vessels that feed the heart

  • you have a heart attack.If those vessels feed the brain, you have a stroke

  • neither is good. And look, you need cholesterol. It's not poison.

  • Your liver makes about a thousand milligrams of it a day, cuz you need it to make

  • certain vitamins and hormones.

  • It's necessary to make cell walls, and it helps digest and move fat around your body.

  • It gets around in two forms. Low-density lipoprotein, or LDL cholesterol is the bad kind.

  • It's the one that's been implicated in causing atherosclerosis.

  • But there's also high-density lipoprotein, and that's the good cholesterol

  • Now there are many things that have been linked to heart disease and atherosclerosis is just one of them.

  • Plus, the right medical treatment about cholesterol to focus on is debatable

  • Is it the total amount? The LDL level only?

  • The ratio about the RHEL? Something else?

  • All hotly contested. But what wasn't contested, at least not terribly publicly,

  • was that we should avoid cholesterol in our food and that

  • is where the dietary recommendations come in. For a long long time,

  • we've been told that we should limit our intake of cholesterol to no more than

  • three hundred milligrams a day.

  • That's not a lot, just one egg has about 220 milligrams of cholesterol in it.

  • So you know with two-egg-omelet will be a bad idea

  • Forget the three-egg-omelet. Mattered you ate nothing else with cholesterol all day

  • Cholesterol warnings have been in effect since the 1960s, since 1994,

  • laws required food in the United States to report cholesterol values on nutrition labels

  • So people could make more informed choices, and we cut out eggs

  • we cut out meat, we cut out shrimp.

  • Some of us even cut out milk, which was a good idea for other reasons. And that sucked.

  • Today the average adult male in the United States consumes about three

  • hundred forty milligrams of cholesterol a day.

  • And experts complain that's not good enough.

  • Plus, I ate egg white omelette. Have you tried them? Tasteless

  • Was it necessary? To the research, turns out there have been good studies

  • on whether dietary cholesterol affect the level of cholesterol in your blood.

  • For instance, a 2004 study took people and randomized them to one of two groups.

  • One was given the equivalent of more than three eggs a day per 30 days,

  • and the other got a placebo. Then they switched group. They measured their serum cholesterol after each intervention period.

  • What they found and what's been found in many other studies

  • is that about 70 percent of people are what we call hypo responders to dietary cholesterol.

  • This means that after consuming three eggs a day for 30 days,

  • they've seen no real increase in their plasma cholesterol ratios.

  • Their cholesterol levels have almost no relationship to what they eat.

  • There have been many randomized controlled trials in this area.

  • In 2013, researchers published a systematic review of all recent studies

  • just from 2003 year after.

  • Twelve of the met criteria and seven of them control for background diet.

  • Most of the studies the controlled for background diet found that altering

  • cholesterol consumption had no effect

  • on the concentration of blood LDL cholesterol. A few studies could only

  • detect differences in small subgroups of people

  • with certain genes or a predisposition to problems. In other words,

  • in most studies, all people didn't respond to changes in their intake of cholesterol.

  • in just a few, a minority of patients responded to changes in their dietary cholesterol.

  • Have recommendations change for the publication and any studies?

  • No~ I still get lectures from people telling me that this or that has too

  • much cholesterol in it. But all that may be about to change.

  • In December, a dietary guidelines summit committee,

  • met to discuss possible changes to the next set of dietary guidelines for the United States to be released this year.

  • After their meeting, the published report

  • You can go look at it. It said and I quote "Cholesterol is not considered a nutrient of concern for over consumption.

  • I'm sure that will come as a surprise to the vast

  • majority of Americans and people worldwide,

  • who for decades have been watching the cholesterol intake religiously.

  • It's very possible that the US government might finally change their

  • dietary guidelines this year to reflect this back.

  • But we don't yet know for sure. Now that doesn't mean the bad levels of

  • cholesterol in your blood are dangerous,

  • it also doesn't mean that all the people on drugs to help produce their

  • cholesterol level don't need them.

  • it's now thought that it's the consumption of saturated and trans fats perhaps,

  • which make more of difference and that's what we should focus on.

  • But we haven't been totally evidenced based on our fat recommendations either

  • and that's the subjective of next week's Healthcare Triage.

Cholesterol, for decades, it's been demonized as the reason so many people have heart disease.

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Cholesterol Isn't Quite as Bad as You've Been Told

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    少少 posted on 2015/08/16
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