The Cholesterol Confusion
Half- truths are injurious to your health!
If someone told you “smoking is beneficial for health”, at the
most it may amuse you, but you would easily discard it as false. No half- truth
about it.
However, when in the garb of a truthful statement,
misleading falsehood is propagated, that too in what now-a-days is turning out to be the fastest
mode of communication-the social media-it has the propensity to cause harm of
great magnitude.
Such a message has been in circulation recently, captioned:
“Cholesterol is
finally officially removed from Naughty List”.
Yes, the 300gm per day limit on dietary cholesterol is
relaxed. But this is nothing new or extra-ordinary, because dietary
cholesterol- that is raw cholesterol in diet like egg yolk, has low propensity
to raise blood cholesterol in the quantity consumed (each egg yolk has 186
mg of cholesterol). However, what raises blood cholesterol most is
saturated fats and trans fats.
The danger from the circulating message is the lumping
together of foods containing ONLY cholesterol, like eggs and seafood, including
shrimp and lobster with foods containing BOTH cholesterol and saturated fats
& trans fats, like dairy products,
meat, and some processed foods.
Both are not the same. The 2015-2020 US guidelines have NOT
recommended butter, full-fat dairy products, and meat as safe, as wrongly
mentioned in the circulating message.
The US guidelines can be seen from: http://health.gov/news/dietary-guidelines-digital-press-kit/2016/01/top-10-things-you-need-to-know/
The relevant sections reproduced verbatim, say the following:
5. Healthy eating patterns limit added sugars. Less than 10% of your daily calories should
come from added sugars. ChooseMyPlate.gov provides more information about added
sugars, which are sugars and syrups that are added to foods or beverages when
they are processed or prepared. This does not include naturally occurring
sugars such as those consumed as part of milk and fruits.
6. Healthy eating patterns limit saturated and trans fats.
Less than 10% of your daily calories should come from saturated fats. Foods
that are high in saturated fat include butter, whole milk, meats that are not
labeled as lean, and tropical oils such as coconut and palm oil. Saturated
fats should be replaced with unsaturated fats, such as canola or olive oil
So please do not mix up foods containing cholesterol ONLY, with foods containing BOTH cholesterol and
saturated fats & trans fats.
While the former can be had in moderate amounts, the
recommendation for saturated fats is not more than 10% of total calories, and
trans fats - as low as possible. And yes, sugar should be restricted.
The second half- truth reads : “Cholesterol doesn't cause heart disease”.
Yes, cholesterol in the blood is important for many body functions. Yes, the majority of the cholesterol is produced by your liver. Yes, many (not majority of) people who have heart attacks have normal cholesterol levels. And yes, cholesterol doesn’t CAUSE heart disease the way the TB germ produces TB or the polio virus causes polio.
In fact, we still don’t what is THE cause of heart disease.
But we do know the following :
1.
That atherosclerosis is a disease of multiple
causality. That there are various factors (we call ‘risk factors’) which singly
or in combination increase your chances of having atherosclerotic coronary artery
disease (CAD).
2.
That cholesterol is one of the most important of
these risk factors and studies on millions of people world wide show that CAD
is a continuous function of cholesterol levels even within the range we once
considered "normal."
3.
Other risk factors are high blood pressure,
diabetes, smoking abdominal obesity,
diet, physical inactivity, ageing, male gender (at least in the young), occurrence
of coronary disease in family members etc.
4.
Different set of risk factors operate in
different people. In some patients, high cholesterol alone may indeed be the
dominant cause; for example people with genetically very high cholesterol
levels; in others, hypertension is the dominant cause, for example in the
Japanese; in still others, cigarette smoking may be the dominant cause. But in most people multiple factors act synergistically
to cause CAD.
5.
That more than a century of laboratory and human
findings show that some abnormality in lipids (fats circulating in the blood
like LDL and HDL cholesterol, triglycerides etc) is highly associated with
atherogenesis. Although LDL cholesterol (LDLC) level is the commonest and most
easily measured abnormality linked to atherosclerosis, in many patients LDLC
may be normal and other abnormalities in the blood may be the reason for the
disease -such as low HDL cholesterol, high triglycerides, high Non HDLC, LDL particle number or size, HDLC particle
number or size, apoB concentration, , Lp(a), hsCRP, homocystein etc.. That is why, although LDLC is our
primary target, we also look at complete lipid profile and other chemicals in
blood.
6.
That whatever the cause, the final pathway for
atherosclerosis is inflammation of the inner lining of arteries (making it
sticky) due to above mentioned factors and entry of cholesterol containing
lipoproteins into this lining creating atherosclerosis.
7.
And finally, that whatever the cause, studies on millions of
patients worldwide since decades have shown that reducing blood
cholesterol-whether by diet and exercise or by drugs or by both- causes a
substantial reduction in heart disease occurrence. Diet, exercise , healthy
life style and drugs like statins, not only reduce cholesterol levels in the
blood but also cause the fatty deposits in arteries to stabilize and even
regress, which can REVERSE CORONARY DISEASE, as seen in many studies and our own
experience in clinical practice.
So
the cholesterol story is not a ‘scam’, but the unfolding of one of the most
important discoveries of the last century.
