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U.S. Government to Drop Warning on Dietary Cholesterol, but High Blood Cholesterol Still Important Health Risk

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February 26, 2015

Foods high in cholesterol, such as eggs and lobster, are expected to get a better rap than they have in more than half a century when the U.S. Departments of Health and Human Services (HHS) and the Department of Agriculture release the 2015 Dietary Guidelines for Americans later this year. However, that is not expected to change current recommendations to keep blood cholesterol levels low and to test those levels regularly.

The Dietary Guidelines are provided by the federal government to promote healthy choices about diet and exercise. They are based on the most recent scientific evidence and are updated every five years. Since 1977, these guidelines have included a warning about dietary cholesterol and since the early 1960s, groups like the American Heart Association (AHA) have recommended reducing levels of dietary cholesterol out of concern that the food sources of cholesterol could directly increase levels of "bad" or LDL cholesterol in the bloodstream. Excess cholesterol can be deposited in artery walls, forming plaque that can narrow and harden arteries, leading to increased risk of heart disease and other health problems.

The Dietary Guidelines Advisory Committee (DGAC), appointed by HHS, met late last year to review and update the guidelines. In the latest draft version, the committee recommended dropping the long-standing advice to Americans that they reduce consumption of food high in dietary cholesterol. Some recent evidence has shown that dietary cholesterol does not directly impact blood cholesterol for most people. The committee has submitted their report to HHS, which will consider the recommendations and release the actual Guidelines later this year.

Yet, there are still some people for whom foods high in cholesterol pose a risk. Genetics is likely a factor in how dietary cholesterol impacts blood cholesterol levels in some individuals. People who are on cholesterol-lowering medication but still have trouble controlling blood cholesterol levels may get advice from their healthcare provider to limit intake of cholesterol-rich foods, even if the 2015 Guidelines change.

While the DGAC no longer thinks dietary cholesterol is linked to increased blood cholesterol levels in most people, consuming foods high in saturated and trans unsaturated fats (trans fats), such as meats, poultry and dairy products, can raise blood cholesterol levels. This is because the liver converts these fats to cholesterol. The 2015 Dietary Guidelines are expected to continue recommendations to eat those foods in moderation.

No changes are expected to guidelines from major health organizations for regular testing of blood cholesterol levels, typically using a lipid profile. Adults should be tested about every five years or more frequently if being treated for high cholesterol or if they have one or more risk factors for heart disease. Children, teens, and young adults should be tested once between the ages of 9 and 11 and then again between the ages of 17 and 21.

However, some changes have occurred with recommendations on how blood cholesterol test results impact treatment decisions. Some newer guidelines and risk calculators, including one endorsed by the AHA and the American College of Cardiology (ACC), take into account factors besides cholesterol levels, such as age, race, sex, smoking, and blood pressure, when deciding whether to treat with cholesterol-lowering statins. (Read "Experts Announce Major Updates to Guidelines for Heart Disease Risk Assessment and Prevention.") Moreover, some experts no longer recommend aiming for specific cholesterol target levels during statin treatment.

Not all health professionals have agreed with this approach. Most recently, a newly published study suggests that many risk calculators, including the one from AHA and ACC, vastly overestimate the probability of having coronary risk, such as a heart attack.

As research continues and the debate on heart risk and treatment wages on, Americans are likely to see further changes in the advice on heart health. It is important for individuals to talk to their health practitioners about their personal risk and decide on the diet and/or treatment plans that are best for them.

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

(December 15, 2014) Dietary Guidelines Advisory Committee. Science Base Chapter: Food and Nutrient Intakes, and Health: Current Status and Trends. Available online at http://www.health.gov/dietaryguidelines/2015-BINDER/meeting7/docs/DGAC-Meeting-7-SC-1.pdf through http://www.health.gov. Accessed February 2015.

(Updated February 19, 2015) Questions and Answers on the Dietary Guidelines for Americans, 2015. Available online at http://www.health.gov/dietaryguidelines/2015.asp#qanda through http://www.health.gov. Accessed February 2015.

(Updated July 31, 2014) American Heart Association. Where does cholesterol come from? Available online at http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp through http://www.heart.org. Accessed February 2015.

(February 10, 2015) Whoriskey, Peter. The U.S. government is poised to withdraw longstanding warnings about cholesterol. Washington Post. Available online at http://www.washingtonpost.com/blogs/wonkblog/wp/2015/02/10/feds-poised-to-withdraw-longstanding-warnings-about-dietary-cholesterol/ through http://www.washingtonpost.com. Accessed February 2015.

(February 12, 2015) Husten, Larry. New U.S. Guidelines Will Lift Limits on Dietary Cholesterol. JournalWatch. Available online at http://www.jwatch.org/fw109859/2015/02/12/new-us-guidelines-will-lift-limits-dietary-cholesterol?query=pfw through http://www.jwatch.org. Accessed February 2015.

(February 16, 2015) Bernstein, Lenny. Heart attack 'risk calculators' miss mark, researchers say. Washington Post. Available online at http://www.washingtonpost.com/national/health-science/heart-attack-risk-calculators-miss-mark-researchers-say/2015/02/16/6b0804c6-b625-11e4-aa05-1ce812b3fdd2_story.html through http://www.washingtonpost.com. Accessed February 2015.