Medical Views on Cholesterol in Food are Changing

While high levels of “bad” cholesterol in the blood, which have been linked to heart disease, remain an important health concern, evidence shows people should no longer be overly concerned about eating foods that are high in cholesterol.

Steven Nissen, MD, a cardiologist from a top American hospital, Cleveland Clinic, explains that what has changed is that many researchers and physicians believe that eating cholesterol-rich foods such as eggs may not have a very big effect on blood cholesterol levels.

“However, people with certain health problems, such as diabetes, should continue to avoid cholesterol-rich foods,” says Dr. Nissen.

He adds that the issue of whether cholesterol is harmful is complicated.

Cholesterol is a waxy substance that ultimately ends up in the walls of arteries. It causes the plaque that leads to heart attacks and strokes. The U.S. Dietary Guidelines call for a daily cholesterol limit of 300 milligrams.

Dr Nissen explains that the relationship between cholesterol in the diet and the body is complicated for various reasons including:

The body largely regulates how much cholesterol is in your blood.

There are different kinds of cholesterol. Low-density lipoprotein or LDL (bad) cholesterol contributes to plaque buildup along with triglycerides, another lipid. High-density lipoprotein or HDL (good) cholesterol is not linked to plaque buildup.

LDL is the bad cholesterol that can increase your risk of heart disease.

The way people process cholesterol differs. Some people appear to be more vulnerable to cholesterol-rich diets.

“Your genetic makeup – not diet – is the most important driving force behind blood cholesterol levels, says Dr. Nissen. “The body creates cholesterol in amounts much larger than what you can eat, so avoiding foods that are high in cholesterol won’t affect your blood cholesterol levels very much.”

About 85% of the cholesterol in the circulation is manufactured by the body in the liver. In other words, it does not come directly from the cholesterol that you eat, according to Dr. Nissen.

It is also likely that people with a family history of heart disease share common environments that may increase their risk, according to the U.S. Centers for Disease Control and Prevention (CDC).

The greater danger for everyone is in foods that are high in trans fats, explains Dr. Nissen.

“Those often appear on food labels as hydrogenated oils or partially hydrogenated vegetable oil,” he says. “Those types of fats do tend to raise cholesterol and do tend to increase the risk of heart disease.” The issue of saturated fat is more complicated.

All in all, he recommends that people look for the words “trans fat” and “hydrogenated fat” on labels at the grocery store. The American Heart Association does recommend limiting dietary saturated fat intake and focusing more on eating fruits, veggies, whole grains, lean animal protein or plant-protein sources.​