A warning against eating foods high in cholesterol is no longer included in the Dietary Guidelines for Americans, representing a major shift in policy, officials said February 19, 2015.
Until now, the US government’s draft dietary guidelines for Americans recommended that cholesterol intake be limited to 300 milligrams per day – the amount in about one stick of butter, or two small eggs, or a 10-ounce (300 g) steak.
Medical experts used to believe that eating too much cholesterol could raise the risk of heart attack and stroke by contributing to plaque buildup in the arteries.
The 2015 version of the guidelines will no longer place an upper limit on cholesterol “because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol,” the US Department of Agriculture said in a statement.
The draft report, published online at health.gov/dietaryguidelines, said “cholesterol is not a nutrient of concern for overconsumption.”
The recommended changes were compiled by 14 nationally recognized nutrition, medicine and public health experts.
The guidelines do not become official right away. Instead, they are open for a 45-day comment period and will be discussed at a public meeting in Bethesda, Maryland on March 24.
“We have seen this controversy, especially surrounding the consumption of eggs, which are very high in cholesterol yet filled with beneficial nutrients,” said Suzanne Steinbaum, preventive cardiologist at Lenox Hill Hospital in New York.
The committee “clearly is trying to dispel the idea that cholesterol matters.”
While cholesterol may be getting a free pass, the saturated fat that usually accompanies it is not.
In fact, experts recommend that Americans eat less than before.
Calories from saturated fat should make up about eight percent of a person’s daily calorie intake, compared to the 2010 guidelines that advised 10%.
For an average person, eating 2,000 calories per day, the new guidelines would mean the limit of saturated fat could be achieved with a few spoonfuls of butter, or a dozen eggs – since eggs are naturally low in saturated fat – or a seven-ounce steak.
“Saturated fat is still a nutrient of concern for overconsumption, particularly for those older than the age of 50 years,” said the report.
The overarching theme of the draft guidelines was to urge Americans to eat more fruit and vegetables, and Mediterranean and vegetarian diets were recommended as healthy options.
“A diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts and seeds, and lower in calories and animal-based foods is more health-promoting and is associated with less environmental impact than is the current US diet,” the report said.
Environmental groups applauded the draft’s mention of sustainability, saying such changes could help reduce global warming and food insecurity.
“The inclusion of sustainability criteria in the Dietary Guidelines’ recommendations is a huge step forward for human and planetary health,” said Kari Hamerschlag, senior program manager at Friends of the Earth.
“By recommending consumption of more plant foods and less meat, these guidelines will encourage people to lessen the huge impact of our diets on our natural resources.”
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Cholesterol-lowering drugs statins may have fewer side-effects than claimed, researchers say.
Researchers’ review of 83,880 patients, published in the European Journal of Preventative Cardiology, indicated an increased risk of type-2 diabetes.
But it suggested reports of increases in nausea, muscle ache, insomnia and fatigue were actually inaccurate.
A team at the National Heart and Lung Institute in London analyzed data from 29 clinical trials.
They suggested statins did reduce deaths, but contributed to a high rate of type-2 diabetes. One in five new cases of diabetes in people on statins was a direct result of taking the drugs.
Statins may have fewer side-effects than claimed
Their analysis suggested other side-effects appeared at a similar rate in people taking statins and those given dummy (placebo) pills.
One of the researchers, Dr. Judith Finegold, said: “We clearly found that many patients in these trials – whose patients are usually well-motivated volunteers who didn’t know if they were getting a real or placebo tablet – that many did report side-effects while taking placebo.
“In the general population, where patients are being prescribed a statin for an asymptomatic condition, why would it be surprising that even higher rates of side-effects are reported?
“Most people in the general population, if you repeatedly ask them a detailed questionnaire, will not feel perfectly well in every way on every day.
“Why should they suddenly feel well when taking a tablet after being warned of possible adverse effects?”
According to new guidelines, a third of all adult Americans should consider taking cholesterol-lowering statin drugs.
The first such new guidelines in a decade estimated that 33 million Americans – 44% of men and 22% of women – would meet the threshold for taking statins.
The new recommendations were issued by two leading US medical organizations, American Heart Association (AHA) and American College of Cardiology.
The statins are currently recommended for 15% of adults.
The guidelines for the first time take aim at strokes, not just heart attacks.
Under the current advice, statins are recommended for those who have total cholesterol over 200 and LDL, or “bad cholesterol”, of over 100.
The new recommendations place much less emphasis on setting numerical cholesterol-lowering targets for patients.
The advice introduces a new formula for calculating a patient’s risk of heart disease based on such factors as age, gender and race, instead of high cholesterol levels alone.
Heart health panel recommends statins for a third of US adults
“This guideline represents a departure from previous guidelines because it doesn’t focus on specific target levels of LDL, or bad cholesterol, although the definition of optimal LDL cholesterol has not changed,” Dr. Neil Stone, author of the report, said in a statement.
It is thought that more women and African-Americans, who are deemed to be at higher risk of stroke, could find themselves taking statins if they follow the guidelines.
The panel focused on four groups they believe statins would benefit most: people already suffering from heart disease; those with LDL levels of 190 or higher because of genetic risk; older adults with type 2 diabetes; and older adults with a 10-year risk of heart disease greater that 7.5%.
The panel also recommended a “diet pattern” based on vegetables, fruits and whole grains and moderate to vigorous exercise three to four times a week for all adults.
Roughly half of those drafting the guidelines had financial ties to makers of heart drugs.
But panel leaders said that no-one with industry connections was allowed to vote on the actual recommendations.
“It is practically impossible to find a large group of outside experts in the field who have no relationships to industry,” Dr. George Mensah, of the AHA, told the Associated Press news agency.
Dr. George Mensah said the guidelines were based on solid evidence.
Many of the patents on popular statins, such as Lipitor and Zocor, have expired, with generic versions being offered cheaply.
But Crestor, a statin made by AstraZeneca, remains under patent, with sales of $8.3 billion in 2012.
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According to British cardiologist Aseem Malhotra, the risk from saturated fat in foods such as butter, cakes and fatty meat is being overstated and demonized.
Dr. Aseem Malhotra said there was too much focus on the fat with other factors such as sugar often overlooked.
It is time to “bust the myth of the role of saturated fat in heart disease”, Dr. Aseem Malhotra writes in an opinion piece in the British Medical Journal.
However, the British Heart Foundation said there was conflicting evidence.
It added reducing cholesterol through drugs or other means does lower heart risk.
The risk from saturated fat in foods such as butter, cakes and fatty meat is being overstated and demonized
Studies on the link between diet and disease have led to dietary advice and guidelines on how much saturated fat, particularly cholesterol, it is healthy to eat.
Dr. Aseem Malhotra, a cardiology registrar at Croydon University Hospital, London, says the “mantra that saturated fat must be removed to reduce the risk of cardiovascular disease has dominated dietary advice and guidelines for almost four decades”.
The cardiologist says saturated fat has been “demonized” and any link with heart disease is not fully supported by scientific evidence.
The food industry has compensated for lowering saturated fat levels in food by replacing it with sugar, he says, which also contributes to heart disease.
Adopting a Mediterranean diet – olive oil, nuts, oily fish, plenty of fruit and vegetables and a moderate amount of red wine – after a heart attack is almost three times as powerful in reducing mortality as taking a statin, writes Dr. Aseem Malhotra.
Statins are a group of medicines that can help lower rates of cholesterol in the blood.
Cholesterol can also be reduced by eating a healthy, balanced diet, maintaining a healthy weight and doing regular physical activity.
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