WBK Cholesterol

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Jimmie, from downtown Augusta asks…

Is It Now OK To Eat Eggs?

Do I still have to worry about cholesterol?

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Hey, Jimmie, let's chat about cholesterol for a minute. Do you still have to know your cholesterol numbers? Yes! Do you have to worry about them? Maybe. These are the answers I would have given you in the past and they are still good answers, regardless of what you have been reading or hearing in the popular media. Remember this: your BLOOD cholesterol numbers are much more important than the cholesterol content of your FOODS. That is because the SATURATED FAT in the foods you eat, your WEIGHT, your ACTIVITY level, your BLOOD PRESSURE and other factors are much more important in determining your overall cardiovascular risk than just the cholesterol content of the foods you eat. You can summarize this by understanding that you need to pay more attention to YOUR blood cholesterol than the cholesterol content in the egg you are about to eat. Although it is true the eggs are high in cholesterol, they certainly can and do fit into a healthy way of eating, for most people.

So, does this mean you can eat eggs every day? First of all, eating the same thing everyday, either for breakfast, lunch or dinner, is not a healthy thing to do, whether it is eggs or anything else. One important key to being healthy is to eat a VARIETY of foods, not just at each meal, but day-to-day and week-to-week. Secondly, when people consume eggs, they eat it with other very high saturated fat foods, such as butter, bacon, sausage, etc. These foods high in saturated fat raise your blood cholesterol levels more than egg cholesterol, itself. This might seem odd to you. Biochemically, the saturated fats in your food turn on blood cholesterol metabolism in your body. What are examples of foods which are high in saturated fat? Beef and other red meats, pizza, hot dogs, butter, coconut oil, onion rings, french fries, cheese, whole milk, whipped cream, chorizo, salami and other deli meats, cakes, cookies, ice cream and many others. If just reading the last sentence makes your mouth water, then you have issues, for sure.

Cardiovascular risk guidelines have not changed the basic story about cholesterol. What they have done, instead, is focus people’s attention on your TOTAL CARDIOVASCULAR RISK, not just the cholesterol number. Why? I would be rich if I had a dollar each time someone said to me, “Yes, I know I am overweight, but my cholesterol numbers are fine, so I’m ok,” or, on the other hand, “Yes, my cholesterol is too high, but I’m on statins, so I can eat whatever I want.” Wrong, wrong, wrong.

When you think about your risk of having a heart attack, stroke or peripheral vascular disease, cholesterol is only one part of the story. This has always been true. What has happened over the years is that patients and health professionals have become too “number” fixated. They have tended to downplay the other cardiovascular risk factors. The American Heart Association/American College of Cardiology Cardiovascular Disease Prevention Guidelines aim to correct this narrow focus on cholesterol numbers, alone. The guidelines place the spotlight back on the person’s entire life. That means that your weight, your activity level, your blood pressure, your diabetes control, your genetic risk, your smoking…all these issues and more are factors in your cardiovascular risk reduction profile. This re-focus on a person’s ENTIRE risk and ENTIRE life is a very good thing.

How do the present guidelines affect the decision about whether you should be taking statins or not? If you have received good medical care in the past, then you and your physician have always looked at your total risk, not just your cholesterol numbers. So, that means that there will most likely be no or very few changes in your treatment protocol, including your statin doses. However, if there has been too much focus on your cholesterol numbers and too much de-emphasis of your other cardiovascular risk factors, then you will most likely see some changes in your medical management. For example, present guidelines advise that people even with moderately elevated blood cholesterol values, but who have a high genetic risk and other risk factors, benefit by being on cholesterol-lowering medication.

Guidelines are simply general rules for a population and should not ever be used to treat an individual. An individual’s treatment should always be based on that individual’s specific risks. So, for example, it may be that, for YOU, reducing your cardiovascular risk means focusing more on your blood pressure control and less on your cholesterol number. This means that you might be put on blood pressure medication instead of, or in combination with, cholesterol-lowering medication. Or, it may be that your diabetes control is of much greater concern for YOU to reduce your risk of having a heart attack or stroke. Because of that, the focus in your medical management may be more on weight reduction and diabetes control. As you know, many people in this country are overweight and inactive, which has led to this quadruple threat of heart attacks, strokes, diabetes, and high blood pressure and all these issues need to be evaluated, not just your cholesterol number.

Guidelines have caused concern that too many people will be placed on statin therapy. Although it is true that, for many people in our country, risk reduction can be achieved by lifestyle changes, alone…look around. Are people actually making these lifestyle changes or just talking about them? Leading a healthier life has always been the first approach in a cardiovascular risk factor reduction program. However, if a person is not successful at making lifestyle changes or, it turns out that these changes have not lowered cholesterol enough, then cardiovascular risk reduction may be approached by medically managing blood cholesterol, blood pressure and blood glucose, as well as other factors. And, of course, there are individuals at such high genetic risk, that being on medications is the only answer; however, even these individuals can lower their medication doses by making lifestyle changes, such as losing some weight, eating healthier foods and being more active. The goal for a person on a cardiovascular risk reduction program is, if medication is necessary, to take the lowest dose of medication to achieve goals.

I want to re-emphasize this about your cardiovascular risk. The amount of cholesterol that is in your food, such as eggs, is not as related to your blood cholesterol level as your weight, your activity level and the amount of saturated fat in your diet. We have always known that. So, if you need to lower your blood cholesterol level, that means you need to lose weight, you need to move more and you need to reduce the saturated fat in your diet. Worry more about YOUR cholesterol number than the cholesterol number of the egg you are about to eat.

So, what is the “no-nonsense nutrition" advice for today? Your blood cholesterol values are as important, today, as they have been in the past. However, evolve and expand your thinking about cv risk, by including all the other factors that increase this risk; cv risk is so much more than simply a cholesterol number. (Updated 01.13.2024)

by Dr. Warren Karp

wbkarp@gmail.com

wbkarp.com