If we were to write applicable disclaimers before every recommendation we’ve made in this book, it would become completely unreadable–just keep in mind that we try to frame our words to be applicable to most people, most of the time. We posit that dietary cholesterol intake, on the whole, has minimal impact on blood cholesterol levels.
As a dietary villain, it’s been exonerated, pure and simple. But, and there’s always a but, there are specific individuals and genetic variants who are wired differently from most. Most of us synthesize our own cholesterol–but a few people do absorb more cholesterol from food! In specific and special cases, especially when managing inexplicably high cholesterol markers surrounding a cardiac event, we can measure blood markers for people with very high internal cholesterol production, or abnormally high cholesterol absorption from food.
This can guide therapy when considering why a statin, which blocks cholesterol production, may not be working to lower blood cholesterol levels in a given patient–that person may be absorbing cholesterol from food instead!
The specific tests are beyond the scope of this book, but for you citizen-scientists out there, those with elevated lathosterol tend to be overproducers who respond better to statins, whereas elevations in campesterol and beta-sitosterol, plant sterols, indicate overabsorption from the diet.
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And yet there’s a nontrivial percentage of the population still being told to substitute nutritious egg yolks for alternatives like sugary cereals, instant oatmeal, or worse— the dreadful egg white omelet! A recent Credit Suisse survey exploring consumer perceptions around fat found that 40 percent of nutritionists and 70 percent of general practitioners still believe that eating cholesterol-rich foods is bad for the heart.
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