Your Health

Is cholesterol the enemy?

W. Gifford-Jones MD & Diana Gifford-Jones

May 1, 2022

BY W. GIFFORD- JONES MD & DIANA GIFFORD-JONES

The headline of a prestigious health and nutrition publication reads, “Do we need to limit dietary cholesterol?” For decades, the answer was yes. We were told to limit our intake of cholesterol to 300 milligrams (mg) or less daily to decrease the risk of heart attack. Was it just a catchy headline?

Cholesterol is not the devil incarnate. We would die without it. Cholesterol is a part of all cell membranes, needed to make vitamin D, bile acids and some hormones.

Some medical specialists have long cautioned that cholesterol is not the culprit in cardiovascular disease. One of the world’s most famous cardiac surgeons remarked that many of his heart attack patients had normal blood cholesterol levels.

We know that if we consume too much cholesterol, the liver makes less of it. If we fail to eat enough, the liver makes more of it, operating just like thermostats that keep our homes the right temperature.

We’ve also been told that there’s good cholesterol, high-density lipoproteins (HDL). It’s good because it travels in the body to the liver. Bad cholesterol, low-density lipoproteins (LDL), builds up plaque in coronary arteries, triggering heart attacks.

Dr. Alice H. Lichtenstein, an international authority on nutrition, says, “Dietary cholesterol is no longer a nutrient of public health concern.” She points to research showing that “Dietary cholesterol at the levels currently consumed does not have a big influence on cholesterol levels in the blood.”

But the headline is tricky. Lichtenstein and the American Heart Association haven’t given us carte blanche permission to disregard dietary cholesterol. Rather, they’re saying that other dietary factors can affect cholesterol levels and cardiovascular disease.

What’s the real culprit? Lichtenstein labels it dietary fat. She points out that most foods contributing to cholesterol levels are meat and full-fat dairy products, which are high in saturated fats or consumed with foods high in saturated fats.

For instance, cholesterol-rich eggs are not a problem. In fact, there has been a lot of research conducted on eggs and egg substitutes. Plenty of studies show that although eggs are a significant source of dietary cholesterol, they are not associated with an elevated risk of heart disease. Rather, the concern is that eggs are often eaten with saturated-fat-rich butter, bacon and sausage. This fat increases bad cholesterol build-up in coronary arteries.

Nutrition experts changing their guidance about dietary cholesterol is the result of good research, not whimsy. Recall the words of John Maynard Keynes, the famous economist, who was criticized for reversing his position on an important economic matter. He replied, “When circumstances change, I change my mind. What do you do?”

The take home message is that we should establish and stick to healthy eating patterns that promote cardiovascular health.

This means eating nutritious foods, such as whole grains, plenty of fruits and vegetables, and healthy proteins like fish, nuts, and seeds, all low in cholesterol. And cut down on foods high in saturated fats, such as meat and high-fat dairy products. Always limit sugar and salt.

It’s good advice to stop labelling cholesterol as an archenemy, but there are still unsolved questions about cholesterol. For instance, why is it that men living in Stockholm, Sweden, and Edinburgh, Scotland, share the same blood level of cholesterol? Yet the Scots have three times the death rate of coronary artery disease. Perhaps they are enjoying too much of their own scotch!

Winston Churchill, Prime Minister of England, wrote, “To almost every question there is an answer that is clear, concise, coherent and wrong.”

What will experts say about cholesterol years from now? We wish we knew.

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Written By W. Gifford-Jones MD & Diana Gifford-Jones

Dr. W. Gifford-Jones, MD is a graduate of the University of Toronto and the Harvard Medical School. He trained in general surgery at Strong Memorial Hospital, University of Rochester, Montreal General Hospital, McGill University and in Gynecology at Harvard. His storied medical career began as a general practitioner, ship’s surgeon, and hotel doctor. For more than 40 years, he specialized in gynecology, devoting his practice to the formative issues of women’s health. In 1975, he launched his weekly medical column that has been published by national and local Canadian and U.S. newspapers. Today, the readership remains over seven million. His advice contains a solid dose of common sense and he never sits on the fence with controversial issues. He is the author of nine books including, “The Healthy Barmaid”, his autobiography “You’re Going To Do What?”, “What I Learned as a Medical Journalist”, and “90+ How I Got There!” Many years ago, he was successful in a fight to legalize heroin to help ease the pain of terminal cancer patients. His foundation at that time donated $500,000 to establish the Gifford-Jones Professorship in Pain Control and Palliative Care at the University of Toronto Medical School. At 93 years of age he rappelled from the top of Toronto’s City Hall (30 stories) to raise funds for children with a life-threatening disease through the Make-a-Wish Foundation. Diana Gifford-Jones, the daughter of W. Gifford-Jones, MD, Diana has extensive global experience in health and healthcare policy. Diana is Special Advisor with The Aga Khan University, which operates 2 quaternary care hospitals and numerous secondary hospitals, medical centres, pharmacies, and laboratories in South Asia and Africa. She worked for ten years in the Human Development sectors at the World Bank, including health policy and economics, nutrition, and population health. For over a decade at The Conference Board of Canada, she managed four health-related executive networks, including the Roundtable on Socio-Economic Determinants of Health, the Centre for Chronic Disease Prevention and Management, the Canadian Centre for Environmental Health, and the Centre for Health System Design and Management. Her master’s degree in public policy at Harvard University’s Kennedy School of Government included coursework at Harvard Medical School. She is also a graduate of Wellesley College. She has extensive experience with Canadian universities, including at Carleton University, where she was the Executive Director of the Global Academy. She lived and worked in Japan for four years and speaks Japanese fluently. Diana has the designation as a certified Chartered Director from The Directors College, a joint venture of The Conference Board of Canada and McMaster University. She has recently published a book on the natural health philosophy of W. Gifford-Jones, called No Nonsense Health – Naturally!

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