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Wednesday Mar 11, 2015

Media's Focus on Dietary Cholesterol Masks Bigger News

Every five years, HHS and the Department of Agriculture update the Dietary Guidelines for Americans(www.health.gov). Much of this work is directed by the Dietary Guidelines Advisory Committee report, which was released last month and caused a few waves.

Actually, they were more like ripples, reminding people of things they should already know, like limiting refined sweets and saturated fats and moderating alcohol intake. However, one recommendation -- or rather lack thereof -- did garner quite a bit of media attention, and that was a declaration that cholesterol is no longer a "nutrient of concern."

I guess that means cholesterol is now allowed to leave Guantanamo to live its life as a free molecule. But will this change how we counsel our patients, and should this change in the guidelines be getting as much play as it is?

For me, it won't change my counseling much. I never counseled my patients that dietary cholesterol was evil. In fact, our bodies need cholesterol. Even if we eliminated cholesterol completely from our diets, our livers would continue to produce it.

Dietary cholesterol has been a focus for many physicians and patients alike for years, and some may find this shift a little hard to swallow. The previous recommendation had been to limit dietary cholesterol to no more than 300 milligrams per day, and some patients already have asked me questions about the revision since this report was released. Although patients seemed a little surprised by the change, they also seemed to embrace it. One patient was excited to add shrimp and eggs back to her diet after avoiding them for years because of concerns about their cholesterol content.

I think most patients understand, and even expect, that as our knowledge about health and diseases advances, our recommendations will change accordingly. This report provides an opportunity for us to review with our patients what comprises a healthy diet and identify areas for improvement.

Personally -- and perhaps this shows my age -- I don’t see what all the fuss is about. The bit about cholesterol is buried on page 91 of a 571-page document, and it is not mentioned at all in the executive summary. The report includes several other recommendations that I thought were much more interesting and could have made better headlines. In fact, all the attention paid to cholesterol overshadowed these more noteworthy points:

  • Americans, in general, aren't getting enough of Vitamins A, C, D or E, and the same is true for calcium, fiber, magnesium and potassium;
  • Premenopausal females don't consume enough iron; and
  • Children ages 2 to 5 years are the only subset of kids who routinely consume the recommended daily amount of fruits and vegetables.

The report also raised eyebrows by addressing food sustainability and access issues, which some critics thought was outside the purview of the committee. However, I applaud the committee's attention to these topics. Any physician who does his or her own grocery shopping knows how challenging it is for some of the families we care for to afford the kind of diet this report recommends.

Here's the takeaway: This latest iteration of the dietary guidelines report contains some important observations, and I would hate for us to miss those because people were too focused on what was recommended in the past.

The public is invited to submit comments(www.health.gov) about the report through April 8.

Peter Rippey, M.D., enjoys outpatient family and sports medicine practice in a hospital-owned clinic in South Carolina.

Posted at 02:17PM Mar 11, 2015 by Peter Rippey, M.D.

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