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FIT WebQoof: Is Dietary Cholesterol Safe for the Heart? 

US dietary guidelines removed the 300mg consumption cap on cholesterol. Does that make dietary cholesterol safe?

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The Claim

A WhatsApp message claims that the US government has withdrawn its recommendations to restrict consumption of cholesterol because it does not contribute to heart problems. Some important parts have been highlighted:

Some Basics About Cholesterol

Dr Udgeath Dhir, Director, Cardio Thoracic Vascular surgery, Fortis Memorial Research Institute, told FIT:

Some amount of cholesterol is actually needed in the body for metabolism. It is a structural component of cell membranes and performs important functions for the body.
Dr Udgeath Dhir

However, he cautions, this does not mean an excessive amount of it is safe.

Dr Nihar Mehta, Consultant Cardiologist at Jaslok Hospital and Research Centre, explains,

There are two main sources of cholesterol: 80-85 percent of it is generated from the liver, and the remaining 15-20 percent from the food we eat.
Dr Nihar Mehta

Lipoproteins are particles through which cholesterol is transported in the blood. Low-density lipoprotein (LDL) is commonly referred to as ‘bad cholesterol’ as it is carried from the liver to arteries and body tissues. High-density lipoprotein (HDL) cholesterol is known as ‘good cholesterol’, the kind that travels back to the liver.

We know for a fact that high levels of LDL directly lead to higher incidences of heart diseases and strokes as it causes a build-up of cholesterol in the arteries. There is no doubt about it. It has been proven through tens and thousands of trials over the last few decades.
Dr Nihar Mehta
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But Does Diet Matter?

Both doctors agree that diet has a crucial role to play in a person’s health. Even though dietary cholesterol contributes only a part of the total cholesterol in the body, its modification can go a long way in keeping levels of LDL low.

On whether there is an ideal amount of cholesterol that should be consumed, Dr Dhir said,

It is difficult to state a generalized number as many factors need to be considered for each particular individual. Family history, body weight, habits like smoking or alcohol, medical history of diabetes, hypertension etc. — all this decides how stringent dietary recommendations are for a particular person. 
Dr Udgeath Dhir

Dr Mehta suggests that even though genes and liver function determine a lot of the cholesterol level in the body, the need for a healthy diet cannot be discounted.

Processed food and trans fat in our diet is much more today than it ever has been. Poly or mono-saturated fats directly correspond to cardiovascular problems. When you eat food high in trans fat, bad cholesterol is more easily translated into blockages. 
Dr Nihar Mehta

Dr Dhir agrees and recommends a shift towards a more Mediterranean diet, comprising more fruits, vegetables, legumes, cereals, nuts, whole grains, fish and poultry, while minimizing consumption of refined carbohydrates, processed food and sugar.

The choice of oil is very important in a common household. Vegetable oils, except coconut, are generally low in saturated fat. Sodium content also needs to be monitored and should not exceed 2300 mg per day. 
Dr Udgeath Dhir

Most importantly, the doctors recommend staying away from junk food because of their high saturated fat content.

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What did the 2015 Dietary Guidelines for Americans Actually Say?

While it is true that the consumption cap of 300 mg per day (a key recommendation from the 2010 Dietary Guidelines) is not included in the 2015 edition, the report explicitly mentions:

This change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. 

It further states:

  • Individuals should eat as little dietary cholesterol as possible.
  • In general, foods that are higher in dietary cholesterol, such as fatty meats and high-fat dairy products, are also higher in saturated fats.
  • Strong evidence from mostly prospective cohort studies but also randomized controlled trials has shown that eating patterns that include lower intake of dietary cholesterol are associated with reduced risk of CVD, and moderate evidence indicates that these eating patterns are associated with reduced risk of obesity.
  • Dietary cholesterol is found only in animal foods such as egg yolk, dairy products, shellfish, meats, and poultry. A few foods, notably egg yolks and some shellfish, are higher in dietary cholesterol but not saturated fats. Eggs and shellfish can be consumed along with a variety of other choices within and across the subgroup recommendations of the protein foods group.

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