For several years now I have been advising my patients that, based on my admittedly anecdotal but fairly extensive experience, dietary cholesterol is no big deal.
“What?” my patients would cry with incredulity. “What kind of doctor are you, saying that eggs aren’t bad for us?”
My response has generally been that your blood cholesterol levels have far more to do with how you pick your parents than how you pick your food. Cholesterol you eat is metabolized by the liver, which then synthesizes the stuff that winds up in the blood. And that liver metabolism is genetically programmed. Sure, being sedentary and overweight can nudge those levels up a bit, though not nearly as much as you may think. And yes, “diet”, exercise, and weight loss are perfectly good first-line treatments for high cholesterol levels.
I have now been officially proven right. Well, maybe “proven” is a bit strong. Let’s say that the weight of actual evidence (now that they’ve bothered to formally study the issue) is beginning to lean in my general direction.
What else am I probably right about?
ACE inhibitors for diabetes: Regardless of blood pressure. I tell my diabetic patients that it’s good for their kidneys.
Vitamin D: low levels in childhood may be linked to atherosclerosis in midlife. My take: Despite the USPSTF’s “Insufficient evidence” finding for vitamin D deficiency screening, I’ve been doing it — and usually recommending that otherwise healthy adults consume 2000 IU daily. Even though we may not yet understand everything Vitamin D is doing for us, it can’t possibly be good to be low. Technically yes, because it’s a fat-soluble vitamin, you can get toxic on it. But the range is from 30 to 100, and the only person I’ve only seen who was toxic had been taking 10,000 IU daily. By way of comparison, if the level is very low I’ll suggest “topping up the tank” with once weekly prescription doses of 50,000 IU.
Who knows what other new “discoveries” await to support what I’ve been doing for years?
We shall see.