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Cholesterol Confusion: Let’s Make Sense of It

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Dietary confusion just reached a whole new level. The Dietary Guidelines Advisory Committee has just announced it is backing off suggesting that traces of cholesterol in foods pose a health risk. The idea is that its effect on blood cholesterol is less dramatic, compared with saturated fat—so maybe an egg here or there is no worse than an occasional drag on a cigarette. Coupled with recent reports questioning how bad “bad fats” really are, many people are unsure what to believe.

Let’s clear up the confusion. Here are the facts, starting with cholesterol:

Cholesterol is not the same as fat. Fat is the white streak in a steak and the grease that dribbles out of a drumstick. But cholesterol is invisible. Cholesterol particles are found in the membranes that surround the cells that make up an animal’s body. Cholesterol is in all animal products and is especially abundant in the lean portions of meats. There are also loads of cholesterol in eggs, cheese, and shellfish, such as shrimp and lobster.

Cholesterol in these foods causes your blood cholesterol level to inch upward.1 The cholesterol-raising effect is not as strong as that of bacon grease and other saturated-fat-laden products, but it is still there. Especially for people whose diets are modest in cholesterol to start with, adding an egg or two a day can cause a noticeable worsening on a cholesterol test.

Some people make a point of saying that cholesterol in foods is not as bad as saturated fat in foods. Maybe, but the issue is academic, because the two travel together. Fat and cholesterol are the Bonnie and Clyde of the culinary world. An egg, for example, has a whopping 200 milligrams of cholesterol and gets nearly 20 percent of its calories from saturated fat. They conspire together to raise your cholesterol level. But most foods from plants—vegetables, fruits, beans, and grains—have virtually none of either one.

Okay, so what about fat? Is it really a health problem or not?

The short answer is yes, it’s a problem. “Bad” fat—that is, saturated fat—raises your blood cholesterol level and increases your risk of health problems, including heart disease and Alzheimer’s disease. Saturated fat is found in meats, dairy products, eggs, and coconut and palm oils. Trans fats—the partially hydrogenated oils used in some snack foods—are bad, too, and people who avoid these products do themselves a favor.

Some news reports have mistakenly suggested that saturated fat isn’t really so bad after all. The confusion came from statistics:

Studies that compare people who indulge in “bad” fats with those who generally avoid them clearly show fat’s tendency to boost heart risks. But studies where fat intake does not vary much from person to person do not show much effect. For example, a Finnish study in which most all the participants followed high-fat diets was unable to detect any benefit of avoiding “bad” fats—largely because there was no group in the study that actually avoided them.

A 2014 meta-analysis combined all the studies—the good ones and the not-so-good ones—and concluded that, if you jumble the data together, the dangers of “bad” fat are no longer clear.2 The study was widely quoted by food writers who saw it as an excuse to try to rehabilitate pork chops’ reputation.

The meta-analysis had another problem. It used adjusted statistics that downplayed the dangers of saturated fat. One of the studies it used was Harvard’s Nurses’ Health Study.3 In the original study, a high saturated fat intake boosted heart disease risk by 52%. But the numbers were then adjusted for protein intake, cholesterol intake, and other factors, and these adjustments made the dangers of “bad” fat hard to see. It’s a bit like studying whether alcohol causes car accidents. If you alter the statistics to compensate for whether people weave as they drive or have blurry vision, the relationship between alcohol and accidents can be made to disappear.

So the answer is not to tuck into a hunk of bacon. The answer is to look at good studies, and they clearly show the risks of fatty, meaty diets.

And what’s that about Alzheimer’s disease? In a 2003 study, the Chicago Health and Aging Project reported that people eating the most saturated fat had a higher risk of developing Alzheimer’s disease, compared with people who avoided “bad” fat.4

So the bottom line is that “bad” fat and cholesterol are as bad for you as ever. The products that harbor them—meat, dairy products, and eggs—are best left off your plate. People following plant-based diets have healthier body weight, better cholesterol levels, lower blood pressure, and much less risk of diabetes.5-7

So jump in. At the Physicians Committee, the 21-Day Vegan Kickstart Program starts fresh every single month, providing menus, recipes, and cooking videos free of charge. It is available in English, Spanish, and Mandarin, with a special program for people from the Indian subcontinent—plus our new Japanese program. As the confusion clears up, so will many health concerns.

1. Hopkins PN. Effects of dietary cholesterol on serum cholesterol: a meta-analysis and review. Am J Clin Nutr. 1992;55:1060-70.
2. Chowdhury R, Warnakula S, Kunutsor S, et al. Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Ann Intern Med. 2014;160:398-406.
3. Chiuve SE, Rimm EB, Sandhu RK, et al. Dietary fat quality and risk of sudden cardiac death in women. Am J Clin Nutr. 2012; 96:498-507.
4. Morris MC, Evans EA, Bienias JL, et al. Dietary fats and the risk of incident Alzheimer’s disease. Arch Neurol. 2003;60:194-200.
5. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight and prevalence of type 2 diabetes. Diabetes Care 2009;32:791-6.
6. Berkow S, Barnard ND. Vegetarian diets and weight status. Nutr Rev 2006;64:175-188. 7. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, Okamura T, Miyamoto Y. Vegetarian diets and blood pressure: a meta-analysis. JAMA Internal Medicine 2014;174(4):577-87.

In Honor of Kim Howe

My colleagues and I are deeply saddened by the tragic death of our longtime friend and supporter Kim Howe.

She passed away several days ago in the unfortunate four-car accident involving Bruce Jenner. In light of the very public media coverage of the accident, we wanted to publicly honor Kim’s life and her dedication to our mission.

Kim was a compassionate person and a dear friend—to me personally and especially to animals. She was especially troubled by the use of animals in laboratory experiments and was eager to replace them with other research methods.

We met in 1989, shortly after I founded the Physicians Committee for Responsible Medicine. Kim became one of my biggest supporters right from the start. She and her husband Bob visited our offices, and we remained friends ever since.

Kim spoke frequently with her congressional representatives and even joined Toastmasters to develop her speaking skills in order to offer the strongest support possible to our campaigns to improve medical research and education. In Kim’s own words, “Most people think of animals as things to be used and thrown away. They do not stop to think that they have feelings and that we do not have the right to inflict pain on them and abuse them.”

Dr. Barnard and Kim Howe at a Physicians Committee event in 2013.

Dr. Barnard and Kim Howe at a Physicians Committee event in 2013.

We want her memory to live on and will continue to work toward the goal she believed in. Thank you, Kim. You will be missed.

Kale by the Pound: Beyoncé Promotes Plant-Based Foods

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How does Beyoncé wake up like that? She loves vegan food! Earlier today, the singer announced her partnership with 22 Days Nutrition’s plant-based home delivery meal service. And it’s not the first time she’s raved about the power of plants. Over the past year, Beyoncé has thrived on multiple vegan challenges and has helped push plant-based diets into the spotlight. On Instagram alone, she’s inspired more than 24 million fans with photos of colorful vegetable stir fries, nutrient-packed leafy green salads, and creative breakfast berry tortillas.

Research shows that when celebrities talk, people listen. By using her platform to show others how easy and appealing it can be to follow a plant-based diet, Beyoncé is helping to spread a message that will save lives.

Around the world, more than 1.4 billion adults are now overweight or obese. Type 2 diabetes, heart disease, and other lifestyle-related diseases are ravaging our health care system.

Fortunately, plant-based diets can help. Research shows that diets centered on vegetables, fruit, whole grains, and legumes have the power to prevent, and sometimes even reverse, serious chronic diseases.  In recent studies, plant-based diets have proven effective at reversing heart disease, boosting brain health, treating type 2 diabetes, reducing migraine pain, and leading to the most weight loss when compared to other diets. Plant-based diets can even help keep energy levels up and stress levels down.

And even if you thought you’d be weak without meat, you’ll be stronger: Studies show that plant-based diets can strengthen your bones and reduce the risk for hip fractures.

Eating a vegan diet rich in vegetables can also keep you looking flawless by making your skin glow and keeping acne at bay.

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With such all-encompassing benefits, it’s no wonder that plant-based diets are taking center stage in 2015. Like Beyoncé, celebrities including Jennifer Lopez and Ariana Grande are raving about the power of plants. Public figures like Sen. Cory Booker are touting the many benefits of vegan diets, while entire cities are challenging themselves to eat plants to get healthier. More and more schools are taking meat off the menu by adopting Meatless Mondays, while MUSE School CA in Calabasas, Calif., is set to become the nation’s first vegan school later this year. Prominent doctors, like Kim Williams, M.D., president-elect of the American College of Cardiology, are now prescribing plants to their patients, while famed chefs are revamping their menus to move vegetables to the center of the plate.

Who runs the world? In 2015, the answer may very well be vegans!