Should We Tell Patients to Limit White Meat Intake, Too?
C360: Could these findings have implications for future dietary guidelines?
Dr Krauss: These results only focused on dietary effects of cholesterol. While these would be expected to have corresponding effects on CVD risk, which remains the leading cause of death in the United States, many diet-related and other factors come into play and affect this risk.
Changes in dietary guidelines should be based on multiple studies and lines of evidence, not a single study. Moreover, as noted above, individuals can vary greatly in their nutritional needs for cardiovascular health. Nevertheless, this study could eventually lead to dietary guidelines that suggest avoiding high intake of both white meat and red meat (likely no more than twice per week), particularly among individuals with higher LDL levels, in addition to current recommendations favoring a higher proportion of vegetables, nuts, legumes, fruits, and unprocessed whole grains.
C360: What clinical takeaways should clinicians learn from your study?
Dr Krauss: As a clinician who treats cholesterol issues, I can share what I do in my own practice as a result of these findings, which I have known about for some time. When seeing patients who present with LDL levels above the desirable range for their degree of overall CVD risk, and particularly for those who wish to exhaust every dietary option before considering statin drugs, I suggest:
- Limiting sources of saturated fat, such as butter and full-fat dairy.
- Consuming lean red meat no more than once or twice per week.
- Testing the effects of avoiding poultry for 3 to 4 weeks, after which I check their blood levels of LDL.
- If this leads to a significant improvement in LDL, which I have observed in a number of patients, I advise them to continue limiting white meat intake and eat more plant-based whole foods, as well as fish.
- If there is no significant drop in LDL, I advise them not to worry about consuming poultry, although "moderation" is still in order.
Ronald M. Krauss, MD, is Senior Scientist and Director of Atherosclerosis Research and Dolores Jordan Endowed Chair at the Children's Hospital Oakland Research Institute at UCSF Benioff Children's Hospital Oakland; Professor of Medicine at University of California, San Francisco; and Adjunct Professor in the Department of Nutritional Sciences at University of California, Berkeley.
Bergeron N, Chiu S, Williams PT, King SM, Krauss RM. Effects of red meat, white meat, and nonmeat protein sources on atherogenic lipoprotein measures in the context of low compared with high saturated fat intake: a randomized controlled trial [Published online June 4, 2019]. Am J Clin Nutr. https://doi.org/10.1093/ajcn/nqz035.