Dietary cholesterol, serum cholesterol & shell fish (yum!)

Robertus

Some 'experts' and physicians still believe that dietary cholesterol (cholesterol in the food you eat) affects your serum cholesterol (cholesterol level in your blood), both the good cholesterol (HDL: high density lipoprotein) and bad cholesterol (LDL: low density lipoprotein). Position A.

Others believe dietary cholesterol has no effect whatsoever on serum cholesterol. Position B. This position has become very popular, perhaps largely based on a couple of meta-analyses that may be open to criticism.

Some do not care because they believe serum cholesterol in and of itself does not correlate with health outcomes and morbidity. Position C. Some may think, however, that that LDL levels do at least indirectly correlate with morbidity. So let's define Position D as those who are interested in knowing if there is any specific effect of dietary cholesterol on LDL levels or the Total cholesterol:LDL ratio.

I know there are other factors, both dietary and genetic, as well as weight and exercise, that affect cholesterol levels, both positively and negatively, and I know that there are, of course, positive effects of cholesterol, but for this thread, I would like to focus strictly on the relationship, if any, between dietary and serum cholesterol. What is the science supporting each of the above positions? I have no expertise to support a specific position, but I do love crab, lobster, scallops and shrimp so I would be happy to learn that the effect of dietary or cholesterol is minimal or non-existent. These foods are a good source of protein, surprisingly low in calories (when not eaten with melted butter or in rich sauces), and also provide some essential fatty acids.

I would like to focus on scientific evidence in this thread, so please feel free to share links to evidence to support your view, but since few of us are scientists ('though some are!), anecdotal and personal experience is always welcome here at MFP as we are all on personal journeys and like to share these with others.

But to start off with a little bit of 'science' or medical opinion, I will kick off the discussion with the position of Dr Neal Barnard. He does perhaps take a middle ground position that, while the effect may not be as large as some may have thought previously, dietary cholesterol is still a nutrient of concern, at least at the population level. Here is his recent well-referenced public testimony before the National Institutes of Health Dietary Guidelines Committee, which is currently entertaining public comment on its current draft report, before issuing its 2015 guidelines. It is brief and easy to read so I won't bother with citations, but in a nutshell, he believes that the dietary cholesterol limits in the current guidelines should be maintained and he presents a very interesting graph from the Institute of Medicine to support this position.

http://www.pcrm.org/health/reports/public-comments-on-the-usda-dietary-guidelines

neanderthin

Well I'll start by saying LDL and HDL isn't actually cholesterol. Oh, and the PCRM is a vegan organization so I'm sure there's no bias there, right.

Robertus

Here's the figure I mentioned above:

Figure 9.2 from the Institute of Medicine report on Dietary Reference Intakes showing the change in serum cholesterol concentrations (Y-axis) associated with changes in dietary cholesterol

Robertus

neanderthin wrote: »

Well I'll start by saying LDL and HDL isn't actually cholesterol. Oh, and the PCRM is a vegan organization so I'm sure there's no bias there, right.

I suspect there is, but I think the question is whether or not Bernard was led to his position by good scientific data or not.

Usually lay people, and dieticians or nutritionists who try to educate us, refer to LDL and HDL as the 'bad cholesterol' and the 'good cholesterol'.

neanderthin

Robertus wrote: »

neanderthin wrote: »

Well I'll start by saying LDL and HDL isn't actually cholesterol. Oh, and the PCRM is a vegan organization so I'm sure there's no bias there, right.

I suspect there is, but I think the question is whether or not Bernard was led to his position by good scientific data or not.

Usually lay people, and dieticians or nutritionists who try to educate us, refer to LDL and HDL as the 'bad cholesterol' and the 'good cholesterol'.

I'm familiar with Dr Bernard's moral philosophy and his position on cholesterol. Most of the time Dr. Bernard is evasive when asked direct questions and tends to repeat himself, not encouraging. It would be hard for anyone in his position to look at all the data and be neutral and the fact that he concludes that animal protein is a big part of the dysfunction has to point to his bias considering we've pretty much eaten animal protein since the dawn of time and not until recently has obesity and the plethora of disease struck the American population, not to mention the societies around the world that consume a diet high in animal products that live long and healthful lives and without the medical facilities that are available here . In reality the worst foods that actually effect our cholesterol "deleteriously" when over consumed are vegan (sugar, highly refined processed carbs, refined vegetable oils) His plan eliminates these aspects of his diet, exercise and weight loss is encouraged so it's very difficult to draw any conclusions with so many confounders to be able to draw any solid conclusions. Suffice is to say that lowering HDL and decreasing particle size of LDL is not the best course of action, which is what happens on your run of the mill vegan diet. The details matter.

neanderthin

dp

Robertus

neanderthin wrote: »

Robertus wrote: »

neanderthin wrote: »

Well I'll start by saying LDL and HDL isn't actually cholesterol. Oh, and the PCRM is a vegan organization so I'm sure there's no bias there, right.

I suspect there is, but I think the question is whether or not Bernard was led to his position by good scientific data or not.

Usually lay people, and dieticians or nutritionists who try to educate us, refer to LDL and HDL as the 'bad cholesterol' and the 'good cholesterol'.

I'm familiar with Dr Bernard's moral philosophy and his position on cholesterol. Most of the time Dr. Bernard is evasive when asked direct questions and tends to repeat himself, not encouraging. It would be hard for anyone in his position to look at all the data and be neutral and the fact that he concludes that animal protein is a big part of the dysfunction has to point to his bias considering we've pretty much eaten animal protein since the dawn of time and not until recently has obesity and the plethora of disease struck the American population, not to mention the societies around the world that consume a diet high in animal products that live long and healthful lives and without the medical facilities that are available here . In reality the worst foods that actually effect our cholesterol "deleteriously" when over consumed are vegan (sugar, highly refined processed carbs, refined vegetable oils) His plan eliminates these aspects of his diet, exercise and weight loss is encouraged so it's very difficult to draw any conclusions with so many confounders to be able to draw any solid conclusions. Suffice is to say that lowering HDL and decreasing particle size of LDL is not the best course of action, which is what happens on your run of the mill vegan diet. The details matter.

I very much agree that the details matter so I would like this thread to focus specifically on the scientific data that support and negate any relationship between dietary and serum cholesterol. Discussion of anyone's bias, the strengths or weaknesses of a vegan or paleo or any other diet in general, or the best diet or other treatments for high cholesterol may take this discussion off track or confound it with tangential issues, all very interesting in their own right, but I would like this thread to stay focused as much as possible. Thanks.

neanderthin

Do you have the full text on the abstract?

lemurcat12

Robertus wrote: »

Others believe dietary cholesterol has no effect whatsoever on serum cholesterol. Position B. This position has become very popular, perhaps largely based on a couple of meta-analyses that may be open to criticism.

Isn't the current controversy over whether or not saturated fat leads to an increase in bad cholesterol? That seems to be the longstanding mainstream position of nutrition types and the AHA, as set forth here: http://www.hsph.harvard.edu/nutritionsource/fats-full-story/#cholesterol. I think it can be debated, and as you can see even here it's modified somewhat (cutting down is good if replaced with unsaturated fats, not so much if replaced with refined carbs, etc.).

With respect to dietary cholesterol, I thought it was generally accepted that most people do not respond to dietary cholesterol with increased bodily cholesterol but that some (responders) do. That's covered briefly in the other link, and one related study is discussed here: http://jn.nutrition.org/content/133/4/1036.full.

This is why it is common when people have cholesterol issues to have them cut down radically on dietary cholesterol--it may be easier to address if they turn out to be responders. But for many of us there appears to be no link at all (so far I'm lucky and my cholesterol has always been good, no matter how I'm eating).

Robertus

lemurcat12 wrote: »

Isn't the current controversy over whether or not saturated fat leads to an increase in bad cholesterol? That seems to be the longstanding mainstream position of nutrition types and the AHA, as set forth here: http://www.hsph.harvard.edu/nutritionsource/fats-full-story/#cholesterol. I think it can be debated, and as you can see even here it's modified somewhat (cutting down is good if replaced with unsaturated fats, not so much if replaced with refined carbs, etc.).

I believe this is correct, but suspect you know more about this than me.

lemurcat12 wrote: »

With respect to dietary cholesterol, I thought it was generally accepted that most people do not respond to dietary cholesterol with increased bodily cholesterol but that some (responders) do. That's covered briefly in the other link, and one related study is discussed here: http://jn.nutrition.org/content/133/4/1036.full.

Thank you very much for these links! I will definitely read with great interest.

lemurcat12 wrote: »

This is why it is common when people have cholesterol issues to have them cut down radically on dietary cholesterol--it may be easier to address if they turn out to be responders. But for many of us there appears to be no link at all (so far I'm lucky and my cholesterol has always been good, no matter how I'm eating).

Other than experimenting with low or high-cholesterol diets, are there other ways to determine if one is a responder or not?

janejellyroll

neanderthin wrote: »

Robertus wrote: »

neanderthin wrote: »

Well I'll start by saying LDL and HDL isn't actually cholesterol. Oh, and the PCRM is a vegan organization so I'm sure there's no bias there, right.

I suspect there is, but I think the question is whether or not Bernard was led to his position by good scientific data or not.

Usually lay people, and dieticians or nutritionists who try to educate us, refer to LDL and HDL as the 'bad cholesterol' and the 'good cholesterol'.

I'm familiar with Dr Bernard's moral philosophy and his position on cholesterol. Most of the time Dr. Bernard is evasive when asked direct questions and tends to repeat himself, not encouraging. It would be hard for anyone in his position to look at all the data and be neutral and the fact that he concludes that animal protein is a big part of the dysfunction has to point to his bias considering we've pretty much eaten animal protein since the dawn of time and not until recently has obesity and the plethora of disease struck the American population, not to mention the societies around the world that consume a diet high in animal products that live long and healthful lives and without the medical facilities that are available here . In reality the worst foods that actually effect our cholesterol "deleteriously" when over consumed are vegan (sugar, highly refined processed carbs, refined vegetable oils) His plan eliminates these aspects of his diet, exercise and weight loss is encouraged so it's very difficult to draw any conclusions with so many confounders to be able to draw any solid conclusions. Suffice is to say that lowering HDL and decreasing particle size of LDL is not the best course of action, which is what happens on your run of the mill vegan diet. The details matter.

Do you have a source for that happening on your "run of the mill vegan diet"? My understanding that an optimum cholesterol/HDL ration is 3.5 to 3.1 and the studies I've seen of American vegans show that we tend to fall within this range. HDL tends to be a bit lower, but is the level as important as the ratio?

I genuinely don't know the answer, I'm not trying to challenge you.

lemurcat12

Robertus wrote: »

Other than experimenting with low or high-cholesterol diets, are there other ways to determine if one is a responder or not?

Not that I know of, but I'm not an expert.

neanderthin

janejellyroll wrote: »

neanderthin wrote: »

Robertus wrote: »

neanderthin wrote: »

Well I'll start by saying LDL and HDL isn't actually cholesterol. Oh, and the PCRM is a vegan organization so I'm sure there's no bias there, right.

I suspect there is, but I think the question is whether or not Bernard was led to his position by good scientific data or not.

Usually lay people, and dieticians or nutritionists who try to educate us, refer to LDL and HDL as the 'bad cholesterol' and the 'good cholesterol'.

I'm familiar with Dr Bernard's moral philosophy and his position on cholesterol. Most of the time Dr. Bernard is evasive when asked direct questions and tends to repeat himself, not encouraging. It would be hard for anyone in his position to look at all the data and be neutral and the fact that he concludes that animal protein is a big part of the dysfunction has to point to his bias considering we've pretty much eaten animal protein since the dawn of time and not until recently has obesity and the plethora of disease struck the American population, not to mention the societies around the world that consume a diet high in animal products that live long and healthful lives and without the medical facilities that are available here . In reality the worst foods that actually effect our cholesterol "deleteriously" when over consumed are vegan (sugar, highly refined processed carbs, refined vegetable oils) His plan eliminates these aspects of his diet, exercise and weight loss is encouraged so it's very difficult to draw any conclusions with so many confounders to be able to draw any solid conclusions. Suffice is to say that lowering HDL and decreasing particle size of LDL is not the best course of action, which is what happens on your run of the mill vegan diet. The details matter.

Do you have a source for that happening on your "run of the mill vegan diet"? My understanding that an optimum cholesterol/HDL ration is 3.5 to 3.1 and the studies I've seen of American vegans show that we tend to fall within this range. HDL tends to be a bit lower, but is the level as important as the ratio?

I genuinely don't know the answer, I'm not trying to challenge you.

You mentioned ratio and it certainly is a far better predictor than our overall CHO levels and this I'm sure was one of the major factors in the decision to remove the CHO restriction. Basically if we have enough HDL to remove LDL's then really it doesn't matter and societies that have high cholesterol and very low heart disease bear this out, so yeah, it makes sense and of course over the last decade we're hearing more of it and many Dr's are aware, but many aren't and still diagnose with overall cholesterol numbers and if your high, your on the drug plan, basically.


Many people that have pretty wacky cholesterol numbers live long healthy lives simply because cholesterol is a risk factor, and not the causality for heart disease, lifestyle is a huge factor. The original tenant went something like this. Cholesterol is found at the site where inflammation takes place therefore cholesterol causes heart disease, and if that's the case we should restrict cholesterol consumption and therefore reduce our consumption of animal proteins, that's the platform, and it's been around for a few generations.

LDL lipoproteins transport cholesterol to our body, hence the media moniker as the bad cholesterol and HDL's job is to retrieve cholesterol and transport it back to the liver where it can be recycled and reused, hence the good, and some is expelled through our bile and excreted. We have around 25,000 + milligrams of CHO circulating at any given time and if we didn't consume cholesterol the body would simply manufacture it. To do that it's a pretty involved and taxing procedure and consuming cholesterol just makes the job easier, that's it, and the cholesterol we actually consume is neither HDL or LDL, those particular lipoproteins are produced by the liver further downstream and are influenced by our hereditary makeup and our lifestyle. One we can't control and the other we can. Some people are hyper responders (hypercholesterolemic) to dietary cholesterol and live much shorter lives because of the many complications that go along with it which is another problem because that percentage which is said to be as high as 25% are factored into mortality. Also some hyper responders have a well maintained reverse cholesterol transport pathway where the actual ratio isn't altered and doesn't increase risk. Basically it's kind of a grey area and still being researched extensively.

Anyway back to the ratio and total cholesterol particles. The problem with low HDL should be obvious and of course animal saturated fat, and not cholesterol is said to increase LDL and it does, well not all isomers of saturated but a few, which is also a cornerstone for reducing saturated fat in the diet. What hasn't been obvious, is that as far as diet is concerned, replacing saturated fat with any unsaturated fat results in lower HDL and removing overall fat from the diet further reducing total cholesterol. Basically a low fat diet lowers total cholesterol and the studies 40 years ago where the proof that removing meat and cholesterol from the diet did that, everyone was happy happy. The wrench in all of this is people have gotten fatter and heart disease is now the #1 cause of death in the US.

In 2009 a research team from UCLA's School of Medicine used the data base for Get with the Guidelines which is a cholesterol program linked to statin research for the AHA where the data of patients hospitalized for cardiovascular disease at 541 hospitals across the country and collected data from about 135,000 patients from 2000 to 2006.

"We found that less than2 percent of heart attack patients had both ideal LDL and HDL cholesterol levels"

The study also showed that HDL cholesterol, or "good cholesterol," levels have dropped in patients hospitalized for heart attack over the past few years, possibly due to increasing rates of obesity, insulin resistance and diabetes.

The problem was low HDL. The average LDL was just over 100 with 20% at 70 or lower. Basically about 75% had LDL within normal and acceptable ranges if we are to accept the tentant that lowering LDL is the cure, then it failed miserably.

From UCLA. newsroom.ucla.edu/releases/majority-of-hospitalized-heart-75668

Basically what that says is HDL didn't do it's job even though LDL as an independent factor was acceptable and/or ideal. I won't get into particle size too much and only say that highly refined carbohydrates and sugar in sufficient amounts within the context of diet will effect the particle size of lipoproteins deleteriously for both HDL and LDL....basically it creates more lipoproteins to transport the same amount of cholesterol and it's the total particle number that is now being researched, well it's been researched all along but is now getting news worthy, because as we know nothing really can be considered accurate unless the media says so, just kidding. Saturated fat effects on particle size when replacing carbohydrates in the diet [ we are talking about changing macro's here as well where fat and protein is replacing some carbs] the effect is predictable, it raised HDL quite a bit and can and does raise LDL as well. What it actually does is increases the amount of cholesterol in the individual lipoproteins making the particles bigger but what really happened is it displaced the higher levels of triglycerides that are also associated with smaller lipoproteins and if you want to research that there classified as small dense sdLDL.....basically as a side effect a higher fat diet [higher protein] lowers triglycerides in the blood, which I hope everyone is aware is a good thing. I'll leave it there.

janejellyroll

@neanderthin
Wow, thanks for the information. Is there a way to find out my particle size? I have been vegan for nine years, but never into a low fat diet. My ratio is 2:1, which I thought was good - - but if I am reading you correctly, this wouldn't indicate the whole picture. Anyway, thanks for taking the time to share all that information.

neanderthin

Cardiologists can pretty much predict someone's risk associated with small dense LDL by looking at their total HDL, LDL and Triglycerides generally speaking and along with other factors like your weight, blood sugar levels and if the person is a candidate or is diabetic, has insulin resistance etc. But the 2 factors that are the most accurate are someone's ratio of HDL to triglycerides. For women HDL under 50 and triglycerides over 120 mg/dl is generally associated with sdLDL, normally. So a Dr. schooled can have a pretty good picture just from your regular test panel results but you can also get a NMR which is based on it's magnetic properties or a VAP test which is centrifuge.

As a vegan and if your HDL is below 50 then adding more fat, losing weight and exercise are probably the best course of action and like I said earlier, it can be hereditary and not much can be done about that, drugs I would imagine, but they come with their own list of shortcomings. Nicotinic Acid (niacin or B3) is something a person might want to look at more closely as a treatment, but I haven't looked into it very much and of course everything seems to come with side effects so ask a Dr. about that and I only mention that because personally I'm not really that enamoured with statins in general.

If someone is vegan, overweight has diabetes or other dysfunction associated with MetS and consumes a low fat diet and consumes what you would consider sugary foods then that would be a red flag even when their overall cholesterol levels are low.

The acknowledged amount of people that have heart attacks when overall cholesterol numbers appear normal and acceptable has been in the 50% range but the UCLA's research was the first to actually collect hard data and even though it only a single study it does cover a broad range geographically and with a high number of participants and 75% is something to take seriously. Of course the other 25% that didn't fall into that group would have had higher overall cholesterol levels. Basically is it high cholesterol that causes heart disease? It's an interesting field or research to say the least.

You have to understand also that I have my own personal biases regarding this subject and even though I try to stay neutral I'm sure some of my bias has crept into this, so do your own research.

janejellyroll

@neanderthin, my HDL is 83 and I don't remember my triglycerides, but I remember my doctor was quite happy with them. I appreciate all the information, great place to begin my own research.

neanderthin

Well look at that, your HDL is high, oh no......cheers and your welcome.

janejellyroll

neanderthin wrote: »

Well look at that, your HDL is high, oh no......cheers and your welcome.

That was why I initially asked about the "run of the mill" vegan diet statement. There are so many different ways to eat as a vegan, I imagine many of us are doing well with cholesterol. And, like other Americans, there are probably a lot who aren't doing so well. I know studies of US vegans have shown our ratio falls in the acceptable range (as a group), but that doesn't seem to include the particles that you mentioned.

neanderthin

janejellyroll wrote: »

neanderthin wrote: »

Well look at that, your HDL is high, oh no......cheers and your welcome.

That was why I initially asked about the "run of the mill" vegan diet statement. There are so many different ways to eat as a vegan, I imagine many of us are doing well with cholesterol. And, like other Americans, there are probably a lot who aren't doing so well. I know studies of US vegans have shown our ratio falls in the acceptable range (as a group), but that doesn't seem to include the particles that you mentioned.

Vegans, the real ones, not the people with eating disorders that like to use the moniker to hind behind usually made the decision to improve their health and lifestyle so they will definitely not fit the category that is generally compared to. Vegetarians as well and from my research do show better health overall compared to vegans, but there's so many confounders that it's really a moot point. As well as people that consume animal protein in limited amounts while consuming mostly whole foods.....which is basically most of the longest lived humans on the planet. It appears when someone decides to change their eating habits and lifestyle that that combination seems to reap better results. My HDL hovers normally at 100-105 for the last decade with my LDL in the 90-110 range and trigs in the 30-45 range and that would be consideration for statin intervention, no doubt about it, fortunately I have a good Dr.

janejellyroll

@neanderthin, I chose veganism for ethical reasons, not health ones (although I do try to eat for health, as I did as an omnivore). I think a lot of the health claims for veganism are extremely inflated, if not totally suspicious. I don't think veganism is the healthiest way to eat (I don't think there is one healthiest way to eat), although I believe that it is completely possible to be healthy and thrive while vegan (if that distinction makes sense).

I have never been into low fat eating and I think that is why I have done so well while vegan. My own anecdotal observations of vegans indicate that low fat veganism is associated with lots of health issues (vegan dietitians like Virginia Messina have observed this also).

Like you observed, our community has a lot of people who are justifying eating disorders and food phobias. This is extremely unfortunate for their own health and the goals of veganism.

janejellyroll

And OP, I apologize. I realize you didn't want this to be a discussion about veganism. It is just hard to discuss cholesterol without the "Are animal fats evil?" thing coming up.

Robertus

janejellyroll wrote: »

And OP, I apologize. I realize you didn't want this to be a discussion about veganism. It is just hard to discuss cholesterol without the "Are animal fats evil?" thing coming up.

Yes, I know, but the specific question I am trying to answer is being answered, particularly by lemurcat's links, which are truly excellent.

Robertus

lemurcat12 wrote: »

Robertus wrote: »

Other than experimenting with low or high-cholesterol diets, are there other ways to determine if one is a responder or not?

Not that I know of, but I'm not an expert.

From your first link: "Unfortunately, at this point there is no way other than by trial and error to identify responders from non-responders to dietary cholesterol."

http://www.hsph.harvard.edu/nutritionsource/fats-full-story/#cholesterol

neanderthin

Robertus wrote: »

lemurcat12 wrote: »

Robertus wrote: »

Other than experimenting with low or high-cholesterol diets, are there other ways to determine if one is a responder or not?

Not that I know of, but I'm not an expert.

From your first link: "Unfortunately, at this point there is no way other than by trial and error to identify responders from non-responders to dietary cholesterol."

http://www.hsph.harvard.edu/nutritionsource/fats-full-story/#cholesterol

If someone got 30% of their total calories from olive oil, they would double their saturated fat RDA. I wonder if they think of these things when they print this stuff.

Most people don’t get enough of these healthful unsaturated fats each day. No strict guidelines have been published regarding their intake. The traditional Greek diet, for example, gets up to 30 percent of its calories from monounsaturated fats, mostly from olive oil.