Cholesterol - any tips for reducing it?

[Eddy Edson]

My favourite is the latest AHA science advisory on dietary cholesterol: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000743

As always with these,a painstaking evidence review leading to recommendations which are about as hard-assed as the evidence might support, or even more so.

Some studies say dietary chol associated with some types of CVD, others that it isn't associated at all. But studies generally confounded by the fact that high chol foods are generally also high satfat foods. For eggs in partcular, how to account robustly for the fact that they often get eaten as part of high satfat meals.

Running a new metastudy selecting only studies which control for satfats, they find no significant association between dietary chol and serum LDL.

Nevertheless, being the hard-ass AHA, they conclude that it is prudent to limit dietary chol by sticking to a Mediterranean/DASH/etc diet, and for most people, no more than an average of one egg per day, or 3 ounces of shrimp. Or if you're older & with good serum cholesterol levels, you can have two eggs. And vegetarians can have more also.

But: Patients with dyslipidemia, particularly those with diabetes mellitus or at risk for heart failure, should be cautious in consuming foods rich in cholesterol.

I love the AHA guidance - the evidence evaluations are always clear and comprehensive, and I can easily fit within their hard-ass guidance, so why not? I hate eggs and my diet includes almost zero cholesterol, so no worries!

However, if I actually liked eggs I doubt I'd see this guidance as a reason not to eat them, in moderation.

What Eggsactly Are We Asking Here? Unscrambling the Epidemiology of Eggs, Cholesterol, and Mortality.

Very timely, on eggs or not, the great Deirdre Tobias with an editorial today on a recent study:

https://twitter.com/x/status/1526289563945254915

The whole thing is paywalled, damn it, but the sense is like this:

- Study taking a new look at large-scale old Finnish study finds evidence that dietary cholesterol increases mortality risk by ~10% for each additional 300mg (say, about 1.5 eggs).

- But Prof Tobias says maybe not so fast. As with any diet study looking at increasing or decreasing one thing, you have to also ask what other things you are decreasing or increasing to maintain the calorie balance. Her last para:


- My conclusion: Same as before. If I liked eggs I'd keep eating them, in moderation.

 

[Burylancs]

That's just mistaken. Dietary cholesterol doesn't impact LDL very much

Except for people who are Hyper-responders to Dietary Cholesterol...upto 1/3 of folks.

 

[Eddy Edson]

What Eggsactly Are We Asking Here? Unscrambling the Epidemiology of Eggs, Cholesterol, and Mortality.

Very timely, on eggs or not, the great Deirdre Tobias with an editorial today on a recent study:

https://twitter.com/x/status/1526289563945254915

The whole thing is paywalled, damn it, but the sense is like this:

- Study taking a new look at large-scale old Finnish study finds evidence that dietary cholesterol increases mortality risk by ~10% for each additional 300mg (say, about 1.5 eggs).

- But Prof Tobias says maybe not so fast. As with any diet study looking at increasing or decreasing one thing, you have to also ask what other things you are decreasing or increasing to maintain the calorie balance. Her last para:

View attachment 21027
- My conclusion: Same as before. If I liked eggs I'd keep eating them, in moderation.

Just because I think it's interesting, Prof Tobias' thread on this:

https://twitter.com/x/status/1527674030626586639