Ask the Doctor: Cholesterol & Heart Disease

Q: I just received a Tweet saying that we no longer have to worry about cholesterol in our diet. So does that mean cholesterol is no longer important in heart disease?

A: First, cholesterol in our diet. Another major long standing medical dictum seems to have bitten the dust recently. Harvard’s Physicians First Watch just reported that cholesterol in the diet is not a major factor in determining blood cholesterol levels. The new dietary guidelines from the US Department of Agriculture and the Department of Health and Human Services removed the limitations on dietary cholesterol but retain warnings regarding added sugars, sodium and dietary fats. Remember alcohol being touted for years for its heart benefits? Now thought by some to be suspect. When Hormone Replacement Therapy for women was nearly added to our water? Those two medical truths have been or may be set aside as well.

The American Heart Association has been telling us for years (since 1960) that we needed to watch our dietary cholesterol intake. I doubt you could find many people who are not aware of this! Recently, however, enough evidence to the contrary has surfaced to cause this reversal. Interestingly, I have always wondered about the impact of dietary cholesterol. My biochemistry professor in medical school way back when told us that it really did not matter what we ate in terms of cholesterol in the diet as the liver could reassemble whatever you ate that contained carbon to cholesterol and then add it to your bloodstream. Blood or serum cholesterol is manufactured “in house” from any number of cholesterol and non-cholesterol containing foods. It’s your liver, not what you eat, that determines your blood cholesterol levels. My professor was way ahead of his time.

This DOES NOT mean that cholesterol in your blood is not important. It is still very much an important risk factor for heart and blood vessel disease. Changes in diet may not be important now regarding their influence on blood cholesterol levels, but all the other controllable factors like weight, smoking and physical activity levels are still very much important as these still affect your blood cholesterol levels. Don’t forget that cholesterol in foods is often associated with high fat content in general and too many calories in those same foods, so we are not getting off Scot-free. We still have to watch what we eat. Everything in moderation –and remember it’s your life and your health, your choice. Stay well.



Posted by Larry Catlett, MD, Occupational Medical Consulting