Latest on Dietary Cholesterol and a Healthy Diet

Latest on Dietary Cholesterol and a Healthy Diet

The Truth About Dietary Cholesterol: Breaking Down the Myths

By American Heart Association News

For more than half a century, scientists have debated the role of dietary cholesterol in a healthy diet. Because it was often associated with saturated fat, limiting dietary cholesterol – especially by restricting egg consumption – seemed to benefit heart-health efforts. However, recent research has provided a different perspective, leading to a shift in our understanding and recommendations.

Are dietary cholesterol and blood cholesterol the same thing?

No, they are not the same. Dietary cholesterol is found in food, while blood cholesterol, which includes HDL (“good”) and LDL (“bad”) cholesterol, is an essential measure of heart health. A diet high in saturated fat can lead to high LDL cholesterol levels, causing plaque buildup in the arteries that restricts blood flow and increases the risk of heart attack or stroke.

What is dietary cholesterol?

Dietary cholesterol comes from animal-based foods, such as high-fat meat, eggs, butter, and full-fat dairy products. Processed meats, like sausages and hot dogs, are also major sources of dietary cholesterol. It can also be found in baked goods made with eggs, butter, or cream.

Although dietary cholesterol was once singled out as a contributor to heart disease, studies have not generally supported a direct association between dietary cholesterol and cardiovascular risk. The focus has shifted to the overall impact of our diet, considering factors like saturated fat, sugar, sodium, and fiber intake.

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How much dietary cholesterol can I eat?

Federal dietary guidelines recommend limiting dietary cholesterol consumption “as low as possible without compromising the nutritional adequacy of the diet.” The general recommendation is to consume less than 300 milligrams of dietary cholesterol per day.

However, it is essential to consider that foods high in dietary cholesterol also tend to be high in saturated fat, except for shellfish like shrimp and lobster. Instead of fixating on a specific number, it is crucial to focus on eating an overall healthy diet, including fruits, vegetables, whole grains, healthy sources of protein, and low-fat or fat-free dairy products.

Research has shown that total fat intake, rather than dietary cholesterol alone, should be the primary consideration for heart health. Therefore, moderation is key, and a little butter on your toast occasionally should not pose a significant risk within a balanced diet.

Can I eat eggs?

The advice on egg consumption has evolved over the years. One large, whole egg contains around 200 mg of dietary cholesterol. While it was previously recommended to limit egg yolk intake, recent research has shown that in the context of an overall healthy diet, a few eggs per week are considered tolerable.

The 2019 science advisory by the American Heart Association suggests that healthy individuals can include up to a whole egg or the equivalent in their daily diet, and older individuals with healthy cholesterol levels can have two eggs. However, it’s essential to consider the overall content of your diet and consume eggs without high-fat accompaniments like bacon or butter.

What if I have high blood cholesterol?

For individuals with high LDL cholesterol levels, reducing sources of both saturated fat and dietary cholesterol is recommended. The combination of saturated fat and dietary cholesterol is considered more likely to contribute to arterial plaque formation. This advice is especially relevant for those with overweight, obesity, or other risk factors.

Genetic predisposition can also play a role in high blood cholesterol levels. If you have this predisposition, it is crucial to pay extra attention to your diet, weight control, and physical activity level. As you age, your risk for heart disease increases, so it’s essential to prioritize a plant-based eating approach, focusing on whole grains, fresh fruits, vegetables, fish, calorie-conscious eating, and regular physical activity.

The evolution of dietary cholesterol advice

The changing recommendations regarding dietary cholesterol stem from advancements in nutrition research. Previously, the focus was on isolated nutrients or specific foods, but now research emphasizes the broader context of eating patterns and overall diet. The impact of the entire diet on heart disease risk, including factors like blood cholesterol, blood pressure, and blood glucose, is now better understood.

Over the years, dietary cholesterol’s significance has diminished, as the average American’s blood cholesterol levels have decreased. This can be attributed to a better understanding of diet and the use of medications like statins. Moving forward, the focus should remain on a plant-based diet, as plant-based foods are generally low in dietary cholesterol.

The future of dietary cholesterol research

Diet and dietary cholesterol continue to be important topics in ongoing nutrition research. The National Institutes of Health is currently funding the Nutrition for Precision Health study, which aims to identify personalized nutrition recommendations based on individuals’ genetic, lifestyle, and environmental needs. This comprehensive study will shed new light on the relationships between diet, the microbiome, and biomarkers for assessing health status.

In conclusion, the understanding of dietary cholesterol has evolved, and the focus has shifted from restriction to moderation and overall diet quality. It is essential to adopt a balanced eating pattern with a variety of nutrient-rich foods. While cholesterol-rich foods should not be the mainstay of your diet, they can be enjoyed occasionally as part of an otherwise healthy lifestyle. Stay tuned for further advancements in research that will continue to shape our understanding of nutrition and health.

By Michael Merschel, American Heart Association News