Most adults are still guided by the past 50 years of misinformation with respect to the role of cholesterol in human health.  The notion that this waxy substance is purely atherogenic and is responsible for most cardiovascular diseases, persists.  Cholesterol is essential for both adult and children’s health.  The human body is well equipped to manufacture enough for its needs.  While no dietary supplementation is required, there is also little efficacy to those efforts to lower it.  Letting the body synthesize what it can and not suppressing the process appears to be the safest, healthiest approach across all ages.

What are critical concepts regarding cholesterol metabolism and/or intake revolve around cholesterol and associated lipoprotein qualities.  Cholesterol that is packaged in small dense LDLs, now abbreviated, as LDLsd on some, more recently developed, lipid panels is a risk factor for cardiovascular disease and cerebrovascular accidents.  This is a lipoprotein commonly produced by the liver with increased insulin production and/or diets high in refined carbohydrates.  Cardiologists such as Ron Krauss, MD, have long shown that this is the risk factor, not total cholesterol nor total LDL count, when it comes to measuring risk for CVD.  In fact, diets higher in healthy saturated and monounsaturated fats tend to decrease an individual’s number and/or percentage of LDLsd if coupled with less sugar and flour-based products.

On the other side of the spectrum, many pediatricians are concerned with young children not getting adequate dietary cholesterol.  This is an unnecessary concern as children have the same enzyme, HMG CoA reductase, required for making what they need.  This enzyme is intricately controlled by the body’s intake of various fats, total energy, fiber and other variables.  When the foods and meals in a person’s diet are balanced, cholesterol is manufactured and lipoproteins are packaged in a way that supports our health as opposed to undermining it.  In fact, cholesterol consumption has very little effect on a child’s or an adult’s total cholesterol level and nor its physiological availability.

While there shouldn’t be any concern with higher amounts of cholesterol in a child’s diet, there also should not be any concern with low or no dietary cholesterol in their meals.  In fact, there should be concern with cholesterol that has been heat processed.  An enteral formula or any meal replacement that has an extended shelf life and that contains cholesterol would also contain a significant amount of oxidized cholesterol otherwise known as oxysterols.  These oxysterols, which are produced when cholesterol is heated and/or exposed to oxygen, are the most atherogenic lipids ever investigated.  

Based upon what we know happens to cholesterol in food processing, Functional Formularies will continue to avoid using it in any of our formulas.  Luckily we do not need to! All the cholesterol our bodies and brains require, for normal healthy development, can be endogenously produced.

~ John Bagnulo MPH, PhD.