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49 lines
3.7 KiB
Markdown
49 lines
3.7 KiB
Markdown
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It's extremely common to hear (especially in the low-carb/ketogenic dieting sphere) that dietary cholesterol (DC) has next to no effect on serum cholesterol or lipoproteins. But is this true? Well, it may depend on who you're measuring.
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Let's look at this graph.
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![[Pasted image 20221123152033.png]]
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As we can see, DC intakes that go from average, around 300mg/day, to 500mg/day would have a negligible effect on total cholesterol (TC) levels [1](https://www.ncbi.nlm.nih.gov/pubmed/1534437). So of course when we study the average population, we see confusing effects of DC on cardiovascular disease (CVD) endpoints [2](https://www.ncbi.nlm.nih.gov/pubmed/26109578). The effect of DC on CVD can easily be lost in the noise.
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An astute paleo-dieter might point out that this is measuring TC, and that much of the effect may be represented in HDL cholesterol (HDL-C). Which would ostensibly be a good thing, according to some. So, let's investigate this.
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![[Pasted image 20221123152038.png]]
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This graph represents changes in LDL-C as a function of increasing DC [3](https://www.ncbi.nlm.nih.gov/pubmed/30596814). As you can see, going from the average of 300mg/day to any quantity of DC above it yields no significant changes in LDL-C. However, going from 0mg/day to 300mg/day increases LDL-C by almost 10mg/dL. This isn't nothing. It's a meaningful change, and the two graphs cohere well.
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But, just to hammer this home, let's check out HDL-C.
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![[Pasted image 20221123152041.png]]
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DC does, as my dad would say, "sweet piss-all" to HDL-C. Which effectively means that for the average person, LDL-C is soaking the brunt of DC's impact. But let's not all go vegan and drop our DC intakes to zero just yet. There's definitely more to this story.
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Numerous studies have demonstrated that it's not so much the cholesterol in LDL that is the problem, it's the LDL particles (LDLp) themselves [4](https://www.ncbi.nlm.nih.gov/pubmed/30694319)[5](https://www.ncbi.nlm.nih.gov/pubmed/21392724). When adjusted for the number of LDLp, the association between LDL-C and CVD becomes virtually null. Personally, I take this to mean that if dietary cholesterol isn't raising LDL particles, it probably isn't increases CVD risk.
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**Key points:**
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- Studies finding null effects of DC on CVD may be confounded by baseline DC intakes.
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- DC increases LDL cholesterol on average.
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- DC doesn't increase HDL cholesterol on average.
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- LDLp causes CVD, not LDL-C, so DC may not be a big deal after all.
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**References:**
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[1] Hopkins PN. Effects of dietary cholesterol on serum cholesterol: a meta-analysis and review. Am J Clin Nutr. 1992 Jun. [https://www.ncbi.nlm.nih.gov/pubmed/1534437](https://www.ncbi.nlm.nih.gov/pubmed/1534437)
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[2] Berger S, et al. Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. Am J Clin Nutr. 2015 Aug. [https://www.ncbi.nlm.nih.gov/pubmed/26109578](https://www.ncbi.nlm.nih.gov/pubmed/26109578)
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[3] Vincent MJ, et al. Meta-regression analysis of the effects of dietary cholesterol intake on LDL and HDL cholesterol. Am J Clin Nutr. 2019 Jan. [https://www.ncbi.nlm.nih.gov/pubmed/30596814](https://www.ncbi.nlm.nih.gov/pubmed/30596814)
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[4] Ference BA, et al. Association of Triglyceride-Lowering LPL Variants and LDL-C-Lowering LDLR Variants With Risk of Coronary Heart Disease. JAMA. 2019 Jan. [https://www.ncbi.nlm.nih.gov/pubmed/30694319](https://www.ncbi.nlm.nih.gov/pubmed/30694319)
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[5] Otvos JD, et al. Clinical implications of discordance between low-density lipoprotein cholesterol and particle number. J Clin Lipidol. 2011 Mar. [https://www.ncbi.nlm.nih.gov/pubmed/21392724](https://www.ncbi.nlm.nih.gov/pubmed/21392724)
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#patreon_articles
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#nutrition
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#disease
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#LDL
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#dietary_cholesterol
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#ApoB
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#animal_foods
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