#371: Dietary Cholesterol – Are Eggs & Cholesterol-rich Foods a Cause for Concern?

Today's Topic in Focus:  [00:51]

In this episode Danny and Alan discuss the debate over the impact of dietary cholesterol on LDL-C levels and heart disease risk. Are eggs & cholesterol-rich foods a problem? Let's dive into the research to find out!

Referenced Material:

• Dietary Guidelines for Americans 2020 - 2025
• Hegsted et al., 1993 - Dietary fat and serum lipids: an evaluation of the experimental data
• Human Atherosclerosis and the Diet - Ancel Keys
• Keys et al., 1965 - Serum cholesterol response to changes in the diet: II. The effect of cholesterol in the diet
• Nakamura et al., 2013 - Serum leptin and total dietary energy intake: the INTERLIPID Study
• Schonfeld et al., 1982 - Effects of dietary cholesterol and fatty acids on plasma lipoproteins
• Fielding et al., 1995 - Effects of dietary cholesterol and fat saturation on plasma lipoproteins in an ethnically diverse population of healthy young men
• Ginsberg et al., 1995 - Increases in dietary cholesterol are associated with modest increases in both LDL and HDL cholesterol in healthy young women
• Episode #317: Understanding Diet & Heart Disease Risk
• Sigma Statement: The Impact of Diet on Blood Lipids

"I Have a Question!"  [62:32]

Today's questions:

1. Carlos Garcia: "Are the effects of plant sterols (on lowering LDL levels) in foods such as Danacol backed by evidence? How much of it is pure marketing?"
   • Papers referenced in answer:
     • Katan et al., 2003 meta-analysis
     • Ras et al., 2014 meta-analysis
     • EAS Consensus Panel 2014 paper

2. Nick Hiebert: "It is my understanding that the relationship between dietary cholesterol and blood lipids is hyperbolic in nature. When higher intakes are compared to zero intake, an increase in LDL cholesterol can be reliably observed, and the effect seems to plateau at 300mg/day. In epidemiology, low to high intakes almost never capture the range wherein the effect can actually be seen (0mg/day to 300mg/day). This has led to a prevailing paradigm that suggests that dietary cholesterol has little or no impact on the incidence of cardiovascular disease. But I'm not certain we can say this with confidence. I'd like to know your thoughts on this."

Quack Asylum [72:55]

Dismissal of the work of Ancel Keys, in favor of promoting high saturated fat intakes and high red meat intakes as not problematic.

Random Recommendations [75:28]

Alan's Recommendation: Twilight of Democracy - Anne Applebaum

Danny's Recommendation: Very Bad Wizards podcast (with a special mention of episode 181 discussing David Foster Wallace’s Good Old Neon)