Is all the bother about dietary cholesterol a tempest in a tea pot?

Normal plasma cholesterol in an 88-year-old man who eats 25 eggs a day. Mechanisms of adaptation. Kern F Jr., N Engl J Med. 1991 Mar 28; 324(13):896-9.

Dr. Kern describes a fascinating case of a man who consumed more than two dozen eggs a day for at least 15 years. The man not only had no evidence of heart disease, but his cholesterol readings through the years were normal, and he had no cholesterol gallstones. This is a powerful anecdote consistent with my thesis that if nutrient sufficiency is achieved, within reasonable limits, the amount of any substance –other than a serious toxin- in the diet matters little. A healthy, well-nourished body will process the reasonable excess with ease. This should apply just as well to table salt, saturated fat, total fat, sugar, alcohol, food additives, and maybe even to moderate to heavy cigarette smoke.

As a corollary, an unhealthy, undernourished body does not process even reasonable excesses well, and it suffers the consequences of this failure. This is modern America. This is why epidemiological studies end up indicting red meat, fat, sugar, salt, alcohol, etc, as being the problems, when in fact undernourishment is the problem. A well nourished body processes reasonable excesses of all of those indicted substances.

We do not know all of the foods in his usual dietary routine. Consequently, we cannot calculate his nutritional profile.

But the table below lists the key nutrients in 25 large eggs.

Total Lipid, g. 133
Ash, g 13.5
Carbohydrate 14
Water, g 933
Saturated Fat, g 41
Monounsaturated Fat, g 51
Polyunsaturated Fat, g 18
Cholesterol, mg 4663
Calories 1938

Essential Nutrient %RDA

Selenium 700%
Vitamin B12 578%
Vitamin D 544%
Riboflavin 534%
Vitamin B5 350%
Protein 315%
Sodium 310%
Phosphorus 307%
Vitamin A 279%
Zinc 138%
Folate 138%
Vitamin B6 116%
Iron 114%

Potassium 79%
Thiamin 69%
Calcium 63%
Vitamin E 57%
Magnesium 34%

Copper 18%
Manganese 15%
Niacin 5%
Vitamin K 4%
Fiber 0%
Vitamin C 0%

Note that the man was ingesting about five grams of cholesterol daily in about 2,000 calories of eggs. The average person needs about one gram of cholesterol to replace daily losses. What happened to the other four grams per day? His body disposed of it, exactly as a well-regulated biochemical system would. His body drastically reduced absorption to 18% of input, and he reduced de novo synthesis of cholesterol by 16% relative to people on low cholesterol diets. Synthesis of bile acids accounts for about 70% of the daily disposal of cholesterol. His body converted twice as much total cholesterol into bile as the average person, increasing his bile acid pools two-fold (this helped with the digestion of all of the fat in the eggs), and the doctor suspects that his body also dumped a good quantity of the remaining absorbed cholesterol into the bile for excretion (the test for this was too invasive for an 88 year old). The net result: over the years, his total cholesterol readings were consistently in the 150-200 mg/dL range, below the “danger” point of 250. Had his cholesterol been over 250, I doubt he would have been any the less healthy.

The table above shows that two dozen eggs contain serious nutritional firepower not found in the average American diet of 2,000 calories. A diet of two dozen eggs is seriously deficient in only six nutrients and contains more than 100% RDA in thirteen nutrients. Choline was not tabulated, but twenty five eggs contain 3.67 grams. This is almost as much choline as cholesterol. It is about 600% more than the RDA (0.5 grams) of this methionine-sparing critical nutrient.

Very likely this powerful anecdote means that if we are nutrient sufficient, we can consume many grams of cholesterol. Likewise, we would probably see that we could also consume more than 10 grams of table salt, more than 100 grams of saturated fat, and hundreds of grams of sugar.

Commercially available square meals would allow us to test this thesis on a large number of reasonably healthy volunteers. We would get baseline readings, put them on square meals for a month, get another set of baselines, then try various challenges, then take them off square meals, then repeat the challenges, etc. With full dietary documentation, these studies would likely debunk the cholesterol myths, the saturated fat myths, the salt myths, the sugar myths, quite probably even the alcohol and cigarette myths, in our myth-intoxicated “scientific” culture.

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