by Crystal Phend
Senior Staff Writer, MedPage Today
Dietary cholesterol limits should be abandoned and vegetarian and Mediterranean diets recommended, according to an advisory committee report that will shape the nation’s dietary guidelines.
The scientific advisory report released Thursday will form the foundation for the 2015 Dietary Guidelines for Americans, to be released by the federal departments of Agriculture and Health and Human Services after a public comment period.
If the recommendations are followed, the 40-year-old warning on cholesterol — recommending no more than 300 mg/day, or about the amount found in two eggs — would disappear due to lack of evidence that it has much impact on arterial cholesterol or leads to heart disease.
“The panel went in the right direction,” agreed Steven Nissen, MD, chair of cardiovascular medicine at the Cleveland Clinic and past president of the American College of Cardiology, citing the same evidence.
“A lot of our traditional dietary advice was not based on the best science and needs to be reexamined,” he told MedPage Today.
Indeed, cholesterol wasn’t the only change suggested for the 5-year update to the nation’s dietary guidelines.
Diet Patterns Added
The advisory committee recommended adding three diets with more than 30% of calories from fat to the recommended list:
- A healthy diet based on U.S. foods
- The Mediterranean diet
- A vegetarian diet
Dean Ornish, MD, founder of the University of California San Francisco’s Preventive Medicine Research Institute and the eponymous diet, praised inclusion of a vegetarian diet, though he cautioned that egg yolks and meat have been linked to heart and mortality risks via mechanisms other than cholesterol.
Overall, though, the emphasis wasn’t on specific diets or nutrients but a dietary pattern.
The committee found evidence that a “healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or nonfat 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.”
That conclusion drew an “Amen to that!” from David L. Katz, MD, MPH, director of the Yale University Prevention Research Center and president of the American College of Lifestyle Medicine, in a column on LinkedIn.
The Cholesterol Evidence
Katz called the report “stellar” and justified in dropping cholesterol restrictions, citing three randomized trials done by his group.
One published last month in the American Heart Journal compared two eggs to a typical high-carbohydrate breakfast for 6 weeks in people with known coronary artery disease. It showed no difference in cardiac risk factors, including total serum cholesterol, blood pressure, and vascular flow-mediated dilation. A group that got cholesterol-free Egg Beaters didn’t come out better than eggs on those measures.
A second showed no difference on cholesterol or endothelial function over 6 weeks for two eggs versus oatmeal for breakfast among healthy adults.
A third showed no impact of a single egg- and cholesterol-heavy breakfast for people with high cholesterol, although an egg substitute was better for endothelial function and cholesterol over 6 weeks for them.
In the interest of full disclosure, he noted that those studies were funded by the Egg Nutrition Center.
The report falls “very much in line with research out there that we’ve been following all along, so how it changes what we talk about with patients is probably not very much,” commented Beth Thayer, RDN, director of the Henry Ford Center for Health Promotion and Disease Prevention in Detroit.
It will have an impact on national food assistance programs and school lunches, though, noted Thayer, president-elect of the Michigan Academy of Nutrition and Dietetics.
Other Changes
The American Institute for Cancer Research (AICR) also welcomed the report’s recommendation to limit intake of red and processed meats as well as added sugars.
“Previously, the Dietary Guidelines’ language has emphasized only ‘choosing lean meats,'” the group noted in a press release. “This is an important and in AICR’s view a potentially life-saving change.”
Studies have linked high red meat consumption and even modest regular amounts of processed meats tocolorectal cancer, it pointed out.
Other new aspects were addressing sustainability, which Thayer called “a little odd” for dietary recommendations, and addressing caffeine.
However, the report recommended no change in tack on warnings about saturated fat and sodium, which Nissen said he would have liked to see.
“I would have liked them to say we still don’t have absolutely solid information on whether saturated fat is harmful in terms of cardiovascular health and this is an area under re-examination,” he said in an interview.
“Putting strict limits on saturated fat for everybody may not be scientifically correct and needs to be correct,” he added. “Similarly, if you don’t have hypertension, I’m not sure salt restriction is necessary. There’s conflicting data. Where there’s conflicting data we have to disclose it.”
He saw the report as part of an overall trend away from the old emphasis on fat.
“What’s really happening here is repudiation of the low fat diet,” Nissen suggested. “For many years, the American Heart Association and others recommended restricting intake of fat. Now it’s increasingly clear that isn’t a beneficial strategy. When you lower fat intake, you end up increasing carbohydrate and simple sugar intake, resulting in greater obesity and diabetes.”
Balance will be key to application of the new guideline update, Bruce Y. Lee, MD, MBA, director of the Global Obesity Prevention Center at Johns Hopkins, told MedPage Today.
“Just because higher cholesterol foods are not actually as bad as we thought doesn’t necessarily mean to go out and eat an excess,” he warned.
Cholesterol To Be Cut From Nation’s Diet Blacklist?
Bring on the eggs: advisers call for federal diet guidelines to eliminate limits.
Dietary cholesterol limits should be abandoned and vegetarian and Mediterranean diets recommended, according to an advisory committee report that will shape the nation’s dietary guidelines.
The scientific advisory report released Thursday will form the foundation for the 2015 Dietary Guidelines for Americans, to be released by the federal departments of Agriculture and Health and Human Services after a public comment period.
If the recommendations are followed, the 40-year-old warning on cholesterol — recommending no more than 300 mg/day, or about the amount found in two eggs — would disappear due to lack of evidence that it has much impact on arterial cholesterol or leads to heart disease.
“The panel went in the right direction,” agreedSteven Nissen, MD, chair of cardiovascular medicine at the Cleveland Clinic and past president of the American College of Cardiology, citing the same evidence.
“A lot of our traditional dietary advice was not based on the best science and needs to be reexamined,” he told MedPage Today.
Indeed, cholesterol wasn’t the only change suggested for the 5-year update to the nation’s dietary guidelines.
Diet Patterns Added
The advisory committee recommended adding three diets with more than 30% of calories from fat to the recommended list:
- A healthy diet based on U.S. foods
- The Mediterranean diet
- A vegetarian diet
Dean Ornish, MD, founder of the University of California San Francisco’s Preventive Medicine Research Institute and the eponymous diet, praised inclusion of a vegetarian diet, though he cautioned that egg yolks and meat have been linked to heart and mortality risks viamechanisms other than cholesterol.
Overall, though, the emphasis wasn’t on specific diets or nutrients but a dietary pattern.
The committee found evidence that a “healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or nonfat 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.”
That conclusion drew an “Amen to that!” fromDavid L. Katz, MD, MPH, director of the Yale University Prevention Research Center and president of the American College of Lifestyle Medicine, in a column on LinkedIn.
The Cholesterol Evidence
Katz called the report “stellar” and justified in dropping cholesterol restrictions, citing three randomized trials done by his group.
One published last month in the American Heart Journal compared two eggs to a typical high-carbohydrate breakfast for 6 weeks in people with known coronary artery disease. It showed no difference in cardiac risk factors,including total serum cholesterol, blood pressure, and vascular flow-mediated dilation. A group that got cholesterol-free Egg Beaters didn’t come out better than eggs on those measures.
A second showed no difference on cholesterol or endothelial function over 6 weeks for two eggs versus oatmeal for breakfast among healthy adults.
A third showed no impact of a single egg- and cholesterol-heavy breakfast for people with high cholesterol, although an egg substitute was better for endothelial function and cholesterol over 6 weeks for them.
In the interest of full disclosure, he noted that those studies were funded by the Egg Nutrition Center.
The report falls “very much in line with research out there that we’ve been following all along, so how it changes what we talk about with patients is probably not very much,” commented Beth Thayer, RDN, director of the Henry Ford Center for Health Promotion and Disease Prevention in Detroit.
It will have an impact on national food assistance programs and school lunches, though, noted Thayer, president-elect of the Michigan Academy of Nutrition and Dietetics.
Other Changes
The American Institute for Cancer Research (AICR) also welcomed the report’s recommendation to limit intake of red and processed meats as well as added sugars.
“Previously, the Dietary Guidelines’ language has emphasized only ‘choosing lean meats,'” the group noted in a press release. “This is an important and in AICR’s view a potentially life-saving change.”
Studies have linked high red meat consumption and even modest regular amounts of processed meats to colorectal cancer, it pointed out.
Other new aspects were addressing sustainability, which Thayer called “a little odd” for dietary recommendations, and addressing caffeine.
However, the report recommended no change in tack on warnings about saturated fat and sodium, which Nissen said he would have liked to see.
“I would have liked them to say we still don’t have absolutely solid information on whether saturated fat is harmful in terms of cardiovascular health and this is an area under re-examination,” he said in an interview.
“Putting strict limits on saturated fat for everybody may not be scientifically correct and needs to be correct,” he added. “Similarly, if you don’t have hypertension, I’m not sure salt restriction is necessary. There’s conflicting data. Where there’s conflicting data we have to disclose it.”
He saw the report as part of an overall trend away from the old emphasis on fat.
“What’s really happening here is repudiation of the low fat diet,” Nissen suggested. “For many years, the American Heart Association and others recommended restricting intake of fat. Now it’s increasingly clear that isn’t a beneficial strategy. When you lower fat intake, you end up increasing carbohydrate and simple sugar intake, resulting in greater obesity and diabetes.”
Balance will be key to application of the new guideline update, Bruce Y. Lee, MD, MBA, director of the Global Obesity Prevention Center at Johns Hopkins, told MedPage Today.
“Just because higher cholesterol foods are not actually as bad as we thought doesn’t necessarily mean to go out and eat an excess,” he warned.
From the American Heart Association
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