Wednesday, December 17, 2014

Ask Will: Cholesterol

Dear Will, 

Our son had his blood tested last week and has high cholesterol…so weird…he is only 10.  


My wife is really good about providing a balanced, healthy diet to the kids (has a hard time with me) but he still appears to have some more specific dietary needs.  

The Mediterranean diet, from what I remember, hits cholesterol specifically doesn’t it?

Thanks in advance for your help! 

Tedd




Hi Tedd, thanks for the question!! 

This is so important to answer because the science on cholesterol is changing under our feet. At first we were told to get our total cholesterol under 200 mg/dl at all costs (take statins, for example). 

More recently we were told that the total value isn't as important, so long as the balance between GOOD CHOLESTEROL and BAD CHOLESTEROL is correct. 

Great review here from the Nat'l Heart Lung and Blood Institute.

Something we need to keep in mind is that although the research changes quickly, not all clinicians may keep up with the pace. This can result in outdated advice. It's not always the case, of course, but it does help explain our confusion when one clinician may say X, a second one emphatically argues for Y, and a third goes totally off-grid with Z.

What About The Mediterranean Diet?
You're correct that the Mediterranean Diet is recommended for many things, including overall cardiovascular health. Basically, this approach includes normal foods (fruits and veggies, dairy daily in the form of yogurt or cheese), normal drinks (tea, water, coffee, wine, juice, milk ... nothing artificial), meats that lean on fish and chicken, and daily activity. 


I know we don't live on the Amalfi coast in Italy (bummer, eh?), and so we cannot eat their specific cuisine purchased from their grocery stores on their time schedules. But with your son, if you follow these basic rules you'll be adapting their principles at least. 

And the impact of this approach on cholesterol -- according to the data, see below -- will be minimal on the total cholesterol number, and can improve the ratio of GOOD to BAD cholesterol in the process. And Tedd, what you're looking for is a ratio of 1 to 3. 

In other words, if your son's good cholesterol is 50, the bad should be around 150. Again, if fruit becomes your dessert, you make your own food at your own home from real ingredients, additive sugars are cut out, and deep fried ... everything ... becomes the vast exception to the rule, then this ratio should move in the healthy direction. 

Let me know if this makes sense, and (as a cure for insomnia, lol) check out the seismic shift on cholesterol research below.

Cholesterol Is Getting Another Look
Your body needs cholesterol. In fact, a full 75% of all the cholesterol in your body is made by your own liver. 

Your body's commitment to cholesterol is likely due to the fact that every large axon in your brain is ringed by it. And the rest of your body needs it to make vitamin D, hormones, and also to help you digest your food.  

That's how important it is for you. 

But over the past 30 years, we were told that this vital molecule was directly linked to heart disease, and also that eating cholesterol (as in an egg, for example) increased that risk. Fortunately, the research is coming back around on this, and changing its mind. 

Here's just a taste (so to speak!):
1. The cholesterol -- heart disease link is not as solid as we thought:
In recent years, there have been a number of epidemiological studies that did not support a relationship between cholesterol intake and cardiovascular disease. Further, a number of recent clinical trials that looked at the effects of long-term egg consumption (as a vehicle for dietary cholesterol) reported no negative impact on various indices of cardiovascular health and disease. STUDY LINK HERE.

2. The targets for dietary cholesterol may be outdated:
The recommendations need to be changed.The lines of evidence coming from current epidemiological studies and from clinical interventions utilizing different types of cholesterol challenges support the notion that the recommendations limiting dietary cholesterol should be reconsidered. STUDY LINK HERE.

3. Dietary cholesterol has a minimal effect on blood cholesterol levels: 
The preponderance of the clinical and epidemiological data accumulated since the original dietary cholesterol restrictions were formulated indicate that: (1) dietary cholesterol has a small effect on the plasma cholesterol levels with an increase in the cholesterol content of the LDL particle and an increase in HDL cholesterol, with little effect on the LDL:HDL ratio, a significant indicator of heart disease risk, and (2) the lack of a significant relationship between cholesterol intake and heart disease incidence reported from numerous epidemiological surveys. STUDY LINK HERE.

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