快樂小藥師 Im pharmacist nichts glücklich

最近有蠻多人在討論膽固醇與生酮飲食了，所以我把飲食指南的文章做一個整理

1. 美國飲食指南 2015-2020
2. [BMJ]Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)
3. [BMJ]Dietary fats: a new look at old data challenges established wisdom
4. 還有長達571頁的文獻：Scientific Report of the 2015 Dietary Guidelines Advisory Committee
5. [JAMA]Cholesterol and Mortality 30 Years of Follow-up From the Framingham Study

一些簡單補充：

美國膳食指南為什麼去除了「每日不超過300毫克膽固醇」的建議

「In general, foods that are higher in dietary cholesterol, such as fatty meats and high-fat dairy products, are also higher in saturated fats. The USDA Food Patterns are limited in saturated fats, and because of the commonality of food sources of saturated fats and dietary cholesterol, the Patterns are also low in dietary cholesterol. For example, the Healthy U.S.-Style Eating Pattern contains approximately 100 to 300 mg of cholesterol across the 12 calorie levels.」 「一般來講，高脂肪膳食中的膽固醇含量也高」，因此在健康膳食中如果限制脂肪攝入，自然膽固醇攝入也就低了。
指南的52頁原文表述 As described earlier, eating patterns consist of multiple, interacting food components and the relationships to health exist for the overall eating pattern, not necessarily to an isolated aspect of the diet. More research is needed regarding the dose-response relationship between dietary cholesterol and blood cholesterol levels. Adequate evidence is not available for a quantitative limit for dietary cholesterol speciUc to the Dietary Guidelines。 「膳食結構要考慮到多種食品的交互影響，而不是只注意食品中獨立的某個方面。還需要更多的研究證明膳食中膽固醇與血膽固醇的劑量反映關係。目前還缺乏合適的證據量化膳食中膽固醇的攝入量」。 很明顯這並不意味著，給膳食中膽固醇開綠燈。

「The Key Recommendation from the 2010 Dietary Guidelines to limit consumption of dietary cholesterol to 300 mg per day is not included in the 2015 edition, but this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the IOM, individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern. 「這一變化並不是說膳食中的膽固醇不再重要。正如，美國醫學研究所（IOM）所建議的那樣，作為健康膳食的一部分應當把膳食來源的膽固醇降的越低越好。」