We've been watching it and avoiding it like the plague.

我們一直小心避免著，如同逃離瘟疫般

Why? Does that do any good? The answer may surprise and depress you

為什麼? 這樣有意義嗎? 答案可能讓你很驚訝，也可能失望

This is Healthcare Triage.

我們是Healthcare Triage

Okay, let's start with heart disease, which is still pretty much the biggest killer in the industrial world.

好的，我們先從心臟疾病開始，畢竟這仍然是工業社會的一大殺手

Most of the problems come from atherosclerosis, where the walls of blood vessels

大多數的心臟疾病從動脈硬化而來，動脈硬化就是血管壁

thicken and fatty plaques form. Later, clots can develop

硬化然後血小板脹大。接著，就會產生血塊

or fragments of plaques can break off and clog up other vessels. If those blockages

或是血小板破裂並堵塞其他血管。如果這種

occurring vessels that feed the heart

血管堵塞發生在心臟

you have a heart attack.If those vessels feed the brain, you have a stroke

就會導致心臟病發；如果這種血管堵塞發生在腦袋，就會導致中風

neither is good. And look, you need cholesterol. It's not poison.

這兩個情形都不太好。聽著，你需要膽固醇，這並不是毒藥

Your liver makes about a thousand milligrams of it a day, cuz you need it to make

肝臟一天大概製造一千毫克，因為你需要膽固醇

certain vitamins and hormones.

來製造某些維生素和賀爾蒙

It's necessary to make cell walls, and it helps digest and move fat around your body.

膽固醇對於製造細胞壁是必要的，它還能幫助消化並轉移體內的脂肪

It gets around in two forms. Low-density lipoprotein, or LDL cholesterol is the bad kind.

膽固醇主要有兩種形式：低密度脂蛋白，也就是LDL cholesterol，是不好的一種形式

It's the one that's been implicated in causing atherosclerosis.

這就是導致動脈硬化的原因

But there's also high-density lipoprotein, and that's the good cholesterol

另種形式則是高密度脂蛋白，這是好的膽固醇

Now there are many things that have been linked to heart disease and atherosclerosis is just one of them.

有許多東西和心臟疾病有關，動脈硬化只是其一

Plus, the right medical treatment about cholesterol to focus on is debatable

此外，關於正確的膽固醇治療方式仍然有爭議

Is it the total amount? The LDL level only?

是和膽固醇總體的量有關?低密度脂蛋白的量?

The ratio about the RHEL? Something else?

高密度脂蛋白的量?其他因素?

All hotly contested. But what wasn't contested, at least not terribly publicly,

這些都有很多爭議。但沒有爭議的是(至少沒有太廣為爭議)

was that we should avoid cholesterol in our food and that

我們應該避免食物中的膽固醇

is where the dietary recommendations come in. For a long long time,

而這就是我們的攝取建議。有很長一段時間，

we've been told that we should limit our intake of cholesterol to no more than

我們被告知應該限制膽固醇攝取量

three hundred milligrams a day.

一天不應該多餘300毫克

That's not a lot, just one egg has about 220 milligrams of cholesterol in it.

這真的有點少，畢竟一顆蛋就有220毫克的膽固醇

So you know with two-egg-omelet will be a bad idea

所以現在知道兩顆蛋的歐姆蛋不是個好主意

Forget the three-egg-omelet. Mattered you ate nothing else with cholesterol all day

忘掉三顆蛋的歐姆蛋吧！ 其實膽固醇根本不影響你吃了

Cholesterol warnings have been in effect since the 1960s, since 1994,

關於攝取膽固醇的警告從1960年代就開始了，自從1994年

laws required food in the United States to report cholesterol values on nutrition labels

法律制定在美國販售的食物需要在營養標籤上標明膽固醇的含量

So people could make more informed choices, and we cut out eggs

所以人們可以被告知這些消息，進而做出選擇。所以我們不吃蛋

we cut out meat, we cut out shrimp.

不吃肉、不吃蝦

Some of us even cut out milk, which was a good idea for other reasons. And that sucked.

有些人甚至不喝牛奶，不過在其他層面上這是個不錯的想法。但真的爛透了

Today the average adult male in the United States consumes about three

今日，美國男性平均攝取

hundred forty milligrams of cholesterol a day.

340毫克的膽固醇

And experts complain that's not good enough.

但專家說這不夠好

Plus, I ate egg white omelette. Have you tried them? Tasteless

還有，我吃蛋白歐姆蛋。你有吃過嗎？超難吃

Was it necessary? To the research, turns out there have been good studies

這些真的是必要的嗎? 在進行一番搜索後，我們發現有許多好的研究

on whether dietary cholesterol affect the level of cholesterol in your blood.

關於控制膽固醇的飲食是否影響血液內的膽固醇含量

For instance, a 2004 study took people and randomized them to one of two groups.

舉例來說，2004年一個研究將實驗對象隨機分兩組

One was given the equivalent of more than three eggs a day per 30 days,

一組在30天內給他們超過3顆蛋

and the other got a placebo. Then they switched group. They measured their serum cholesterol after each intervention period.

另外一組得到安慰劑，接著他們對調。在實驗期結束後，將他們的血清中膽固醇含量拿來研究

What they found and what's been found in many other studies

他們發現，如同在其他實驗中得到的結果

is that about 70 percent of people are what we call hypo responders to dietary cholesterol.

就是超過七成的實驗對象，對於控制膽固醇的飲食就是我們所說的弱反應受試者

This means that after consuming three eggs a day for 30 days,

這代表，在30天每天攝取超過3顆蛋後

they've seen no real increase in their plasma cholesterol ratios.

實驗對象在血漿中的膽固醇比例並沒有實質上升

Their cholesterol levels have almost no relationship to what they eat.

他們膽固醇的含量幾乎和他們所吃的東西毫無關聯。

There have been many randomized controlled trials in this area.

在這個實驗中還有許多不定性的因素

In 2013, researchers published a systematic review of all recent studies

在2013年，研究者發表了關於所有研究的有系統整理

just from 2003 year after.

從2003年開始

Twelve of the met criteria and seven of them control for background diet.

有12個達到標準，7個控制著飲食

Most of the studies the controlled for background diet found that altering

大多數控制飲食的研究發現

cholesterol consumption had no effect

改變膽固醇攝取量

on the concentration of blood LDL cholesterol. A few studies could only

對於控制低密度脂蛋白的含量毫無影響力。一些研究只能

detect differences in small subgroups of people

在更精細的團體中得到不同的數據

with certain genes or a predisposition to problems. In other words,

這些團體有共同的基因或是類似體質。也就是說

in most studies, all people didn't respond to changes in their intake of cholesterol.

在大部分的研究中，大家對於膽固醇攝取量的改變並沒有反應

in just a few, a minority of patients responded to changes in their dietary cholesterol.

只有一小部分的實驗對象有反應，在控制膽固醇的飲食中

Have recommendations change for the publication and any studies?

給大眾的飲食建議、研究是否有改變呢？

No~ I still get lectures from people telling me that this or that has too

不，我仍然聽到很多人對我說

much cholesterol in it. But all that may be about to change.

「這膽固醇含量太高了」。不過這一切或許要改變了！

In December, a dietary guidelines summit committee,

在十二月，召開了一個飲食指南會議

met to discuss possible changes to the next set of dietary guidelines for the United States to be released this year.

來討論今年要提供給美國全國的飲食指南

After their meeting, the published report

在這個會議之後，他們公開了會議記錄

You can go look at it. It said and I quote "Cholesterol is not considered a nutrient of concern for over consumption.

大家不妨去瞧瞧。我在這引用：膽固醇不被認為是營養攝取上的問題

I'm sure that will come as a surprise to the vast

我相信這對於大部份美國人還有世界上其他人來說

majority of Americans and people worldwide,

將會是個大驚喜

who for decades have been watching the cholesterol intake religiously.

對那些一直以來對膽固醇攝取量緊張兮兮的人

It's very possible that the US government might finally change their

美國政府也很有可能終於願意

dietary guidelines this year to reflect this back.

改變他們的飲食指南來反應此研究

But we don't yet know for sure. Now that doesn't mean the bad levels of

但我們不是太確定拉。這不代表血液中的膽固醇含量

cholesterol in your blood are dangerous,

是危險的

it also doesn't mean that all the people on drugs to help produce their

也不代表使用藥物來控制膽固醇的人們

cholesterol level don't need them.

不再需要服藥

it's now thought that it's the consumption of saturated and trans fats perhaps,

現在認為或許是反式脂肪

which make more of difference and that's what we should focus on.

才是真正的因素，才是我們該注意的地方

But we haven't been totally evidenced based on our fat recommendations either

但因為我們的飲食指南，我們並沒有很確定

and that's the subjective of next week's Healthcare Triage.

而那就是下周我們Healthcare Triage的主題囉！