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The lack of effect of dietary cholesterol on serum cholesterol

2/7/2012

5 Comments

 

According to the USDA, we should be consuming no more than 300 mg of cholesterol per day to reduce our risk of cardiovascular disease. The idea being that, in some people, high serum cholesterol is associated with heart disease, so reducing our dietary cholesterol may help to keep our blood cholesterol low. This hypothesis, overly abundant in the medical and nutrition communities, has much contradictory evidence.

This low cholesterol recommendation is also nearly impossible to comply with for the average carnivore. According to PhotoCalorie, just 6 ounces of steak or 1.5 eggs already exceeds your limit for the entire day.
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6 ounce Ribeye containing 328 mg of cholesterol.

The idea that dietary cholesterol increases blood cholesterol seems logical, however the evidence supporting this hypothesis is not strong. This has been known since as early as 1953. Dr. Ancel Keys was one of the first researchers to test this hypothesis, feeding subjects extremely high levels of dietary cholesterol and measuring their blood response. He found almost no effects, despite the absurd amounts of dietary cholesterol administered. Upon further research, Keys accepted that there is some relationship, and created a formula to predict it: blood cholesterol is proportional to the square root of the amount of dietary cholesterol added.

Change in serum cholesterol between 2 diets = 1.5*(Z2 – Z1), where Z is the square root of the cholesterol content of each diet in mg/1000 kcal


According to Keys’ equation above, if someone consuming a 2,000 calorie diet and 1200mg of cholesterol (4x the recommended level) per day reduced their total dietary cholesterol by 6-fold  to 200 mg a day, their serum cholesterol would drop by 21.75 mg/dl. Going from 300 mg per 1000 calories eaten to 150 mg per 1000 calories eaten would drop serum cholesterol by a mere 3.75 mg. This is due to the liver's unique ability to sense dietary cholesterol, and modulate subsequent cholesterol production. 

During the same time, other researchers believed there was a larger relationship. When they fed subjects cholesterol combined with egg yolk, their blood cholesterol increased. When they consumed much higher doses of pure cholesterol, the blood response was less pronounced. Possible explanations for this were increased bioavailability of the cholesterol when mixed with egg yolk, or the possibility that another ingredient besides the yolk’s cholesterol was increasing blood cholesterol levels. However, the amount of egg yolk required to make a significant difference is usually quite large.

Other researchers have since confirmed Ancel Keys’ square root relationship, adding that dietary cholesterol has greatest effects on serum cholesterol if it is added to a low cholesterol, or cholesterol-free diet. At moderate cholesterol intakes, serum cholesterol changed very little with added cholesterol. A 1997 meta-analysis compiled 9 predictive equations since 1990, calculating that for a 2500 kcal diet, a 1.37-2.68 mg/dl decrease in serum cholesterol could be expected for every 100 mg/day decrease in dietary cholesterol. The prediction based on their meta-analysis was a 2.2 mg/dl decrease in serum cholesterol for every 100 mg/day decrease in dietary cholesterol.

Encouraging the masses to eat a low cholesterol diet does not seem to have any significant effect on decreasing serum cholesterol levels. It also encourages low-protein diets, which are less effective for weight loss and satiety. 

For more on this, and a list of sources, see our dietary cholesterol page in the related science section.

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5 Comments
Alexandra M
4/24/2012 11:19:34 am

I was astonished - actually horrified - to hear somebody referencing Ancel Keys' "7 Countries Study" the other day. I was at a cooking class (Turkish Cuisine) and the woman running it kept bragging about how she'd been a "nutrionist" for over 4 decades. I guess she should have said, "I've been promoting what I learned 4 decades ago for 4 decades."

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Alexandra M
4/24/2012 11:24:11 am

Also, she said the "Mediterranean Diet" meant eating meat once a month. I lived in Greece and Cyprus for 2 1/2 months in the early 80s, and we ate meat (chicken, lamb, lamb, lamb, chicken, lamb, pork, lamb, lamb...) every day.

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12/10/2015 08:19:06 pm

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Dr. Ben
8/5/2017 04:42:09 am

The Mediterranean diet as described by Ancel Keyes refers to the diet eaten by the Greek Islanders when they ate nothing but fresh fruits and vegetables, no meat, dairy or eggs. Their death rate due to heart attack and stroke plummeted. That was a long time ago, and nothing like what is eaten today which includes animal products. What is eaten today is not the real Med diet.

Dr. McDougal, a prominent cardiologist, actually sued the egg industry as they have been funding research that shows minimal affect of dietary cholesterol on serum cholesterol, but the studies have been designed such that the groups already have elevated cholesterol. Vegans have very low cholesterol and very low death rates due to heart attack and stroke. If you feed a vegan an egg, their cholesterol goes up significantly. So if you eat sausage all day, eggs won't have an additional affect, but if you eat a healthy whole food plant based diet, and then add eggs, your cholesterol will likely go up.

Many populations such as the Okinawans of the 1950s, present day rural Africans eating nothing but millet and sorghum, and vegan Adventists have extremely low rates of heart attack, stroke and diabetes which are the top killers on the standard western "healthy" diet. You're welcome to eat whatever you want, but much available clinical evidence demonstrates that you're at significant risk for suffering an early death.

We are not carnivores as real carnivores like the tigers and lions actually do eat nothing but fatty meat with cholesterol and NEVER die of heart attack or stroke. Vegans, like humans, most primates and other true herbivors always experience an increase in cholesterol when fed cholesterol or saturated fat.

Protein? How much muscle mass are you building? As much as an infant? An infant doubles its muscle mass every few months like no adult ever could, yet an infant can only drink human milk. Human milk is 5% protein. Fruits and veggies average 5% protein. Beans are upwards of 40% protein. There is no requirement for animal products in the human diet. Look around you at all the fat people. This obesity does not exist in populations that eat a whole food plant based diet (potato chips and Coke don't count). The choice is yours, but you're at high risk if you continue to eat the standard western diet full of processed carbs and animal products. Thanks for reading....Dr. Ben

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