Cholesterol, Sodium, and the Mediterranean Diet
Friday, March 18 at 10:45 am
NEW ORLEANS—High cholesterol can lead to many health conditions, so managing your patients’ cholesterol and sodium intake is critical. Drs. Tim Harlan and Tom Rifai recently gave a presentation on culinary medicine and the importance of nutrition.
Timothy S. Harlan, MD, is Assistant Dean for Clinical Services, Executive Director of Goldring Center for Culinary Medicine, and Associate Professor of Medicine at Tulane University School of Medicine in New Orleans, LA.
Tom Rifai, MD, FACP, is Medical Director of Metabolic Nutrition and Weight Management at St. Joseph Mercy Oakland, Pontiac, MI; Lifestyle Medicine Course Director of “Nutrition and The Metabolic Syndrome” at Harvard Medical School; Clinical Assistant Professor and Lecturer at Wayne State University School of Medicine; and Science Advisory Board Member at the Pritikin Longevity Center.
In their session, “Common Controversies in Diet and Clinical Nutrition: Point/Counterpoint,” Harlan and Rifai discussed the controversies and origins of the conflicting and confusing messaging regarding dietary cholesterol, sodium intake, and the Mediterranean diet; defined an ideal daily intake of sodium and cholesterol; analyzed evidence that suggests cholesterol and sodium are "nutrients of concern" and how the Mediterranean diet fits into healthy nutrition counseling; and provided key points to assist in counseling patients on optimal cardiometabolic nutrition.
To start, they highlighted numerous controlled studies that reported on cholesterol, noting that many of are based on fasting lipids and are therefore missing a large factor of postprandial lipid levels. They then discussed the incomplete nature of study basis for both the Dietary Guidelines Advisory Committee’s decision to disregard cholesterol as a "nutrient of concern," and the American Heart Association/American College of Cardiology’s 2013 report on lifestyle and endorsed the 2015-2020 US Dietary Guidelines.
They also discussed sodium and explained that the current sodium requirement is about 500 mg per day. However, the average sodium intake in the US is about 4000 mg per day. Americans eat excess salt through restaurant, processed, and pre-prepared foods. Healthy eating plans, such as the DASH or Mediterranean diets, can help lower daily sodium intake.
According to Harlan and Rifai, the Mediterranean diet is composed of unprocessed foods like fruits and vegetables, fish, legumes, and whole grains. And although the diet approves of the intake of olive oil and wine, it is significantly better than the standard American diet for lowering cholesterol and sodium intake.
“The focus of healthy eating could be Mediterranean but really shouldn’t be a diet label,” Harlan and Riai concluded. “It should be individualized and achieve overall goals.”