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Old-school: That's the latest word about the .
Limiting cholesterol has been in the U.S. Dietary Guidelines for more than 2 decades despite very little evidence tying dietary cholesterol to high levels of blood cholesterol, especially LDL ("bad") cholesterol levels, and heart disease. It was one of those things that was probably figured to make sense: if high levels of blood cholesterol were bad, then eating foods high in cholesterol was probably also unwise. Better to limit such foods.
Well, scientific evidence seems to have taken the lead here, as it should have all along (although the recommendation about dietary cholesterol may very well not make the 2015 version of the U.S. Dietary Guidelines for Americans).
I don't think I've ever seen a more erroneous but sustained belief by patients than about limiting dietary cholesterol. I've actually seen caregivers of children who are failing to thrive, who need as many calories as possible, even children who were wasting from the ravages of HIV infection back in the '80s and '90s, say to me, "but I don't give him too many eggs."
I'd then counsel them to feed these children eggs and whatever high-protein, high-calorie, nutritious foods they can get into them.
Eggs are very nutrient-rich, and loaded with high-quality protein. For children -- or anyone -- they're economical, easily chewed, fast to prepare, and versatile. But people got it into their mindsets that high-cholesterol foods needed to be limited.
My own mother is 87 and is still fearful about eating egg yolks, despite her son's reassurance that egg yolks are OK to eat. I tried a different approach and just ate hard-cooked eggs in front of her when I visit. Seems to carry a stronger message than my simply telling her.
The stronger tie between diet and blood cholesterol levels involves saturated fat intake, and even that has come into question the past year or two (more about that in a future column). Eggs can often stand to keep some better company than they have in the past. Frying them in bacon fat or butter might not be the best way -- healthwise -- to eat them. And they might be better off if they'd have some fresh fruit and whole wheat toast in their posse instead of the sausages and hash browns fried in the same sausage fat. You get where I'm going here.
What I hope people don't take away from the decreased emphasis on dietary cholesterol is that now there's some kind of free-for-all with high-cholesterol foods. Many foods high in cholesterol are also high in saturated fat and most people still eat too much saturated fat.
For now, I tell my patients to eat leaner meat. It's lower in saturated fat (go for lean ham instead of that sausage at breakfast). As for fried or scrambled eggs, fry them in a liquid oil. Ditto for those hash browns. Most of the time, think seriously about having the eggs with fresh fruit and whole grain toast.
, is an associate professor of pediatrics at Albert Einstein College of Medicine in New York City.
Disclosures
Ayoob disclosed financial relationships with McCormick Spice Institute, Hass Avocados, Calorie Control Council, the Walt Disney Company, Monsanto, and the Milk Processor Education Program.