Many people worry about
cholesterol. More than a third of Americans have high cholesterol, putting them
at greater risk of stroke and heart disease, the leading cause of death in the
United States. It is reasonable to think that eating
cholesterol-laden foods will raise your cholesterol levels. But the connection
is not quite that simple.
The amount of
cholesterol in your food does not necessarily translate to the amount of
cholesterol in your blood vessels.
"Eating foods rich
in cholesterol does increase blood cholesterol, usually by a small, but still
significant amount," explained Dr. Stephen Devries, a preventive
cardiologist and executive director of the educational nonprofit Gaples
Institute in Deerfield, Illinois. But the effect of eating foods that contain a
lot of cholesterol "may not be as high as one might expect, because most
of the cholesterol in blood actually comes from the body's own
production." When you consume a bunch of cholesterol, your body will
usually make less to compensate.
Of greater concern is
what usually gets served up alongside cholesterol: saturated fat. Eating lots
of foods high in saturated fat increases the body's production of low-density
lipoproteins, or LDL ("bad") cholesterol, which can build up inside
the arteries, restricting blood flow to the heart and brain, heightening the
chance of heart attack or stroke.
"Saturated fat is a
bigger culprit for raising blood cholesterol in general than dietary
cholesterol," Devries said.
A lot of the controversy
around the health effects of saturated fats, for instance, has come from
studying what happens when people cut down on them without taking into account
what they are eating instead.
"If saturated fat
is replaced with refined carbs, like sugar or white bread, then there's been
shown to be no net health benefit. If saturated fat is replaced with other
healthier fats, then there's a clear health benefit with a lower rate of heart
disease," Devries said.
Seafood — most notably
shrimp — can be relatively high in cholesterol. But shellfish and fish are
great sources of lean protein for people who eat animal products, and provide
essential omega-3 fatty acids that the body cannot make on its own. That makes
them good substitutes for red meat and poultry.
As for the age-old egg
question, Devries recommends sticking to no more than four full eggs a week —
that is, including the yolk, where almost all the cholesterol is, along with
about half the protein. One large egg contains 1.6 grams of saturated fat and a
whopping 187 milligrams of cholesterol. In fact, eggs account for a quarter of
the cholesterol in the American diet.
There are some people
who should be more careful about their intake of eggs and other foods high in
cholesterol. That includes people who have borderline high cholesterol (over
200 milligrams/deciliter) or other risk factors for cardiovascular disease,
such as family history, or those who are hypersensitive to dietary cholesterol,
meaning that even regular amounts raise their blood cholesterol levels
significantly. People with type 2 diabetes should also watch the cholesterol in
their foods.
For most people,
fretting over the cholesterol in particular foods is less meaningful to heart
health than trading out the usual suspects — like red meat, full-fat dairy,
packaged foods and sugary drinks — for more vegetables, fruits, nuts, whole
grains and beans. The 2019 American Heart Association meta-analysis recommends
shifting to healthy eating patterns that emphasize these unprocessed
ingredients, such as the Mediterranean diet.