Changing gears on cholesterol guidelines
Cardiovascular disease still tops the charts among chronic diseases in the United States. Recent statistics show that 117 million American adults—about half of the U.S. adult population—have one or more chronic health conditions like heart disease, hypertension and type 2 diabetes. Plus, two-thirds of adults and one-third of children in the United States are obese or overweight. The rate of heart disease is high due to soaring obesity rates, sedentary lifestyles and the typical American processed-food diet. Because of the prevalence of these conditions, recommendations to prevent cardiovascular disease are changing.
“There is a strong consensus that lifestyle changes should be the first approach to preventing cardiovascular disease,” says Michael Davidson, MD, professor and director of the Lipid Clinic at the University of Chicago Pritzker School of Medicine.
“I would prefer a continued focus on goals of therapy (or lifestyle changes), which have been very effective in reducing cardiovascular events in the U.S.,” he says.
With diet and lifestyle factors linked to these diseases, the federal government and science community are once again taking a stab at educating the public on ways to make impactful lifestyle changes. Every five years—since 1980—the Dietary Guidelines for Americans (DGAs) are reevaluated in light of the latest nutrition research. The latest DGAs are set to be officially released this fall; however, a preview of these new federal guidelines reveals a shift in gears in terms of cholesterol management and your diet.
The focus will be more on prevention protocols for heart disease. This is in contrast to the current focus on treating high-risk patients with statin drug therapy, which was established in 2013 by the American College of Cardiology and American Heart Association.
The Cholesterol Shift
Is that double cheeseburger and meat-lover’s pizza clogging your arteries with cholesterol? Not necessarily. The research is flimsy on the relationship between eating cholesterol-laden foods and a lot of it circulating in your bloodstream causing blocked arteries. Moderation needs to be better understood among Americans because one food or nutrient—like cholesterol—is not the cause of the heart disease epidemic.
A paradigm shift in terms of eating for heart health in the Scientific Report of the 2015 Dietary Guidelines Advisory Committee is that cholesterol in foods, called dietary cholesterol, is not the enemy.
“We need to get away from eliminating foods and emphasize portion control,” explains Sara Sirna, MD, FACC, professor of medicine in the division of cardiology at Loyola University Chicago’s Stritch School of Medicine. A significant change in the upcoming proposed DGAs is steering the public toward a pattern of eating whole foods. Foods with higher amounts of cholesterol—like whole eggs with the yolks, and shellfish like shrimp and lobster—are no longer on the taboo list. In general, recommendations are loosening on fat in the diet, too; however, butter, fatty meats and milk chocolate, which are predominantly saturated, solid fats are recommended to reach no more than 10 percent of total calories for the day.
“The fresher you buy food, the better. The Mediterranean diet, with a good supply of heart-healthy, unsaturated fats, such as olives, olive oil, nuts, seeds and fish is what I recommend,” Sirna says.
The forthcoming guidelines continue to encourage a diet low in saturated fat, sodium and added sugars for disease prevention. A healthy, flexible dietary pattern that is higher in vegetables, fruits, whole grains, low or nonfat dairy, seafood, legumes and nuts; moderate in alcohol (for adults); lower in red and processed meats, and low in sugar- sweetened foods and drinks and refined grains is the basis of the new federal guidelines. Plus, factor regular physical activity into your heart-health equation.
“Nothing is off limits as long as it’s real food. Chemically processed edibles with additives, preservatives and artificial ingredients are unhealthy over the long run,” Sirna explains.
“We need to get back to real food.”
The new DGAs may just get us there.