Cholesterol management has remained a focus of cardiovascular prevention programs for decades. Not only is serum cholesterol one of the most commonly used marker’s for health screening, but statins, a drug class used to lower low density lipoproteins (LDL) – bad cholesterol – are the most commonly prescribed medication in men and second most commonly prescribed medication in women in Canada.
We are a nation hyper-focused on cholesterol management.
Individuals that are identified as having elevated cardiovascular risk based on their cholesterol levels are often interested in dietary and lifestyle approaches to reduce risk and lower LDL without pharmaceutical intervention.
Some individuals report that they experience side effects such as fatigue and muscle soreness when using statins. Side-effect concerns, coupled with recent evidence suggesting links to cognitive decline and diabetes while by no means conclusive, has motivated some to avoid statin prescriptions if possible.
Traditionally, lifestyle management of hypercholesterolemia (elevated cholesterol) focused on avoidance of saturated fats and dietary sources of cholesterol. This led to the low-fat diet fad.
Ultimately the low-fat dietary approach was largely debunked, but unfortunately the popularity of low-fat diets, and dietary cholesterol avoidance has remained stubbornly popular.
While avoiding dietary cholesterol seems to intuitively make sense, in fact a relatively small portion of our circulating cholesterol level is related to ingested cholesterol. A much more important factor in regulating circulating LDL levels is endogenous production of LDL by the liver in response to carbohydrate intake. It turns out a diet with adequate healthy fats, limited processed food and simple carbohydrates, such as the Mediterranean diet, far outperforms low fat-diets in cholesterol management, and more importantly in cardiovascular risk reduction.
Lest we become too focused on the marker and not the meaningful outcome, a recent study from the University of Eastern Finland demonstrated that elevated cholesterol intake did not increase cardiovascular risk in the study group of 42-60-year-old men. Of interest, the study showed that a high consumption of eggs, a significant source of dietary cholesterol, was not associated with any increased risk of cardiovascular disease even in those with genetic predisposition to higher cholesterol levels.
The evidence is quite clear that traditional approaches to cardiovascular risk management, specifically dietary approaches to manage cholesterol, are out of date. If you are concerned about modifying your cholesterol levels, and more importantly if you are concerned about reducing cardiovascular risk, the science is pretty clear. Along with adequate exercise and stress reduction, foods with moderate to high cholesterol levels can be part of a heart healthy lifestyle.