Cholesterol

 

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.