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Advisory Panel Removes Limits on Dietary Cholesterol; “Yes” to Eggs, “No” to Whole Milk

Review Study from UK and US Finds No Evidence to Support Limiting Saturated Fat

Every five years the government issues “Dietary Guidelines for Americans.” The first step is an advisory report by a panel of experts, which has just been released for 2015. All 572-pages are now in a 45-day public comment period. The final guidelines will be issued later this year. They cover everything from school lunches to the way companies can advertise their products. We'll focus on dinner table issues we’ve been exploring here for some time.

Vegetables, fruit, whole grains, low- or non-fat dairy, seafood, legumes, and nuts are encouraged in the report, while red and processed meat, sugar, and refined grains are discouraged. Nothing new there.

The headline news is that the panel suggests lifting the 300 mg/day limit on dietary cholesterol (two large eggs contain ~400 mg). Cholesterol is no longer considered “a nutrient of concern for overconsumption.” That’s because there is no appreciable connection between dietary cholesterol and blood cholesterol; only ~15% of circulating cholesterol in the blood comes from what we eat. The lion’s share is made by the liver.

The panel does, however, continue limiting the consumption of saturated fat to less than 10% of total calories.

Interestingly, a systematic review and meta-analysis published in Open Heart 2015 found no evidence to support limiting saturated fat, when the recommendation was first issued by the US and UK in 1977 and 1983—or now. “Two recent publications,” lead researcher Zoe Harcombe (Institute of Clinical Exercise and Health Services, University of West of Scotland, Hamilton Lanarkshire, UK) and colleagues wrote, “have questioned the alleged relationship between saturated fat and coronary heart disease and called for dietary guidelines to be reconsidered.” (See my report on one of the recent studies: http://www.cbass.com/saturatedfatnotrisk.htm )

“[The Harcombe] study attacks two dietary dogmas,” senior author Dr. James DiNicolantonio (who was also the lead author in one of the current reviews) told Heartwire. “One sets up saturated fat as a bogeyman when it is not. And the second is that lowering cholesterol by any means, especially by a dietary intervention that lowers saturated fat, is going to lead to a reduction in hard end points, which we did not observe.”

Dr. DiNicolantonio (St. Luke’s Mid America Heart Institute, Kansas City, Missouri) also has the answer: Individuals should simply “eat real food.” (More on that below)

An editorial by Dr. Rahul Bahl (Royal Berkshire NHS Foundation Trust, Reading, UK) accompanied the Harcombe study. Bahl called the negative result (no link between saturated fat and heart disease) “unsurprising.” There are no randomized controlled trials (RCT) showing a causal connection between saturated fat and heart disease, he wrote—because human behavior must be altered for long periods of time. It’s almost impossible to control behavior for long periods of time. “This [however] does not mean that the risk factor addressed is not a risk factor,” Bahl maintained.

While there are disagreements in interpretation, “there remains reasons to postulate a causal connection between [saturated] fat consumption and coronary heart disease,” Bahl wrote. “Public policies generally do not require RCT evidence, so to advocate their withdrawal here on the basis of the absence of such evidence seems unusual,” he argued.

An exchange between Dr. Robert Olson and Senator George McGovern, recorded in July 1977 and included in the Harcombe study, confirms Bahl’s contention that government policy need not be supported by solid evidence:

“I pleaded in my report and will plead again orally here for more research on the problem before we make announcements to the American public,” Dr. Olson said.

McGovern replied, “Senators don’t have the luxury that the research scientist does of waiting until every last shred of evidence is in.”

Bahl does, however, concede that “overreliance” on saturated fat as the main dietary villain “has distracted” from the risks posed by refined carbohydrates.

Tufts University professor of nutrition Alice Lichtenstein, co-chair of the 2015 advisory panel, offered up a some what similar argument against simply telling people to eat real food. “Real food can be butter, cream, and cheese, and very fatty meats,” she told Heartwire. “There needs to be specificity as to what those food-based recommendations are,” said Lichtenstein, “and I think that’s what the guidelines are doing.” (She was speaking as a spokesperson for the American Heart Association.)

Dr. Lichtenstein recommends a moderate amount of fat intake, with approximately 25% to 35% of calories coming from Fat. “No one is recommending low-fat diets anymore that I’m aware of,” she added. She, apparently, does not condone whole milk.

Thumbs Down on Whole Milk

The slippery slope argument may also be holding back approval of whole milk. The advisory panel says consuming three to five cups of coffee per day is okay—it may even reduce the risk of type 2 diabetes—but adding sugar, fatty milk, or rich cream is not advised. Low- or non-fat milk is considered a good source of calcium. Whole milk, however, is seen as a source of saturated fat—and a gateway to cream, butter, and ice cream.

The panel is apparently not amenable to the concept that some forms of saturated fat may actually be good for us. Too complicated for the general public?

Dariush Mozaffarian, MD, DrPH, dean of the highly-regarded Friedman School of Nutrition Science and Policy at Tufts University in Boston, wrote in a recent editorial that saturated fats are obtained from remarkably diverse foods (red meat, poultry, processed meats, yogurt, milk, cheese, butter, vegetable oils, and nuts, among others) that contain many other components that could modify their overall impact on health. While observing that some of the findings are more clear-cut than others, Dr. Mozaffarian is clear on one thing: “Whatever the mechanism, [recent] results add further challenges to prevailing dietary guidelines that recommend low-fat dairy products on the basis of calcium and theorize harms of total saturated fat content.” For more details see http://www.cbass.com/rethinking_saturated_fats.htm and http://www.cbass.com/wholemilk.htm

Dr. Walter Willett, chairman of the nutrition department at the prestigious Harvard School of Public Health, has also questioned the scientific basis for recommending reduced-fat dairy products.

Whole milk is a real food, nothing removed and nothing added.

 Whole foods have served me well for many years.
This photo, taken by Bill Reynolds in 1981, shows me about to
 eat two soft-boiled eggs and a baked potato—with nothing removed or added.

Other Experts Comment

The most comprehensive comment I found comes from David L. Katz, MD, founding director of Yale University’s Prevention Research Center and author of a widely used nutrition textbook for health care professionals. He has also authored a book for the general public called Disease Proof. You’ll find his commentary in U.S. News & World Report (Health).

Katz likes the advisory report “very, very much.” He finds balance in the fact that it’s “under assault from all directions.” Vegans don’t like the loosened guidelines for dietary cholesterol. Meat lovers, on the other hand, don’t like the call for less red meat and more plant-based foods.

Katz loves this passage in the report:

The overall body of evidence examined by the 2015 DGAC identifies that a healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meats; and low in sugar-sweetened foods and drinks and refined grains. Additional strong evidence shows that it is not necessary to eliminate food groups or conform to a single dietary pattern to achieve healthy dietary patterns. Rather, individuals can combine foods in a variety of flexible ways to achieve healthy dietary patterns, and these strategies should be tailored to meet the individual’s health needs, dietary preferences and cultural traditions. Current research also strongly demonstrates that regular physical activity promotes health and reduces chronic disease risk.

He is okay with the limitation on saturated fat—and justifies it very carefully. No study has shown health benefits from increasing saturated fat intake, Katz argues. “The latest evidence is that a high intake of saturated fat is as bad as a high intake of sugar.” He adds this powerful and practical corollary:  “The right response is about foods, not nutrients. By eating principally wholesome foods in sensible combinations, saturated fat [and sugar] intake comes down.” 

By that reasoning, balanced diets of whole foods, such as the Mediterranean diet, come out on top. (See below)

Dr. Mozaffarian weighed in on dietary cholesterol. “From my perspective, our dietary guidelines should be based on where we have strong evidence for good and where we have strong evidence for harm, and everything else should be kind of left out until we get strong evidence,” Mozaffarian told Time. “Dietary cholesterol is not in a place, I think, where there’s strong evidence for harm.”

Neal Barnard, MD, an outspoken proponent of vegetarian diets and president of the Physicians Committee for Responsible Medicine, issued a statement about the advisory report on his blog.

Barnard is very happy that the report singled out vegetarian diets as one of three healthful diet patterns. The other two healthy patterns were the Mediterranean diet and the “Healthy U.S.-style Pattern.” (The current USDA Food Patterns are called the “Healthy U.S.-style Patterns.”)

“Vegetarian diets reduce the risk of obesity, diabetes, and other health problems and have gained greater prominence in each new edition of the Guidelines,” he wrote.

He was also pleased that the report emphasized the risks of saturated fats and maintained the previous limit of 10%.

Barnard was decidedly unhappy that the report suggested that cholesterol in foods is not a major danger. “The Physicians Committee is concerned that exonerating dietary cholesterol will only confuse an already bewildered public. Most people do not differentiate fat from cholesterol, or dietary cholesterol from blood cholesterol. To suggest that cholesterol in foods is not a problem will lead many to imagine that fatty foods or an elevated blood cholesterol level carry no risk—two potentially disastrous notions.”

Barnard and his colleagues are, of course, right about the confusion. But the advisory panel’s job is to tell the truth--and help the public to understand.

Finally, Barnard objected to the fact that the report continues to recommend dairy products. Recent evidence suggests that dairy products do not “build strong bones or protect against fractures,” he insisted.

For vegetarians, Barnard and his committee considered the new advisory report “a major advance.”

*  *  *

Except for proponents of the Paleo diet—“While many do, no one can say that a Paleo diet is best for health on the basis of truly robust evidence,” says Dr. Katz—it seems that all sides are more or less happy with the new advisory report. I wish they had given the okay to whole milk in moderation, but otherwise I’m happy. Not quite as happy as Dr. Katz, but definitely happier than Dr. Barnard.

After all, the guidelines are only suggestions. It’s up to each of us to decide which foods suit us best.

Eat a balanced diet of whole foods—and exercise regularly—and your chances of living a long and healthy life will be very high. The best kind of help is self-help!

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