What Experts Have to Say About Cholesterol in Food

Is it true that you don't have to worry about dietary cholesterol anymore?

Studio Shot of dairy products
Jamie Grill / Getty Images

The 2015 Dietary Guidelines Advisory Committee recommended dropping official advice to limit intake of dietary cholesterol, and I agree with them. But let's be clear: these scientists were not saying that dietary cholesterol is irrelevant, and they certainly weren't saying that blood cholesterol levels are irrelevant. They were simply saying that a specific cholesterol limit was no longer useful, because most Americans were coming in well below the recommended limit anyway.

The change also reflects the fact that some cholesterol-containing foods, notably seafood, but also eggs, can certainly find a place in a sustainable, healthful dietary pattern. The sources of cholesterol of concern for reasons of both human and environmental health, meat in particular, are already addressed in the DGAC report.

By recommending limiting intake of meat, even while dropping the advice about cholesterol, the Committee was shifting the focus of its report from nutrients to foods—another position I certainly support. The views expressed here by True Health Initiative Council members thus differ from the DGAC Committee in degree, but not kind. All concerned agree that a diet of minimally processed foods, mostly plants, is the way to go for the health of people and planet alike.

Joel Kahn, MD, FACC

Clinical Professor of Medicine (Cardiology), Wayne State University School of Medicine

The "argument" over whether the cholesterol content in food is to be a focus of concern for the public or not is an example of reductionist thinking that confuses people. No one shops for cholesterol. People shop for whole foods. The foods with highest concentrations of cholesterol (egg yolks, ghee, butter, organ meats, cream, cheeses) are all derived from animal sources.

We were just reminded once again of the toll that increased consumption of animal products has on health and longevity. In the combined analysis of the Nurses Health Study and the Health Professionals Follow-up Study, high animal protein intake was associated with mortality, heart disease deaths, and stroke deaths. Where one finds animal protein, one find cholesterol. Overall, I teach plant based nutrition to my clinic patients as the only evidence based eating pattern to halt and reverse established heart disease.

Michael Dansinger, MD

Tufts University School of Medicine

Is it true that I really don't have to worry about the cholesterol in food anymore?

No, it is not true. Many of us should worry about cholesterol in food. This is the case for two major reasons.

The first reason is that most of the foods that are high in cholesterol fuel heart disease, the leading cause of preventable death. The second reason is that many people who have too much cholesterol in the blood are sensitive to dietary cholesterol, causing the blood levels to worsen. Most experts agree that cholesterol deposits in the arteries of the heart and throughout the body are worsened by eating animal fat, especially saturated fat.

The saturated fat in food prevents the body from clearing cholesterol particles from the blood as effectively as it should. By avoiding saturated fat you avoid dietary cholesterol, and by avoiding dietary cholesterol you avoid saturated fat—they go hand-in-hand. There are a few foods that have cholesterol without much saturated fat (such as shrimp), and such foods are thought to be ok for people who have normal cholesterol levels and who are not sensitive to dietary cholesterol, however as a general rule it makes good sense to avoid high-cholesterol foods as part of an overall healthy eating pattern.

Tom Rifai, MD, FACP

Henry Ford Health System
Regional Medical Director, Metabolic Health & Weight Management

Yes, we still need to "slightly worry" about cholesterol in foods, even if one is trying to find protein from healthy animal-based sources low in saturated fat. For example, shrimp—a frequently eaten shellfish—is lean and low in saturated fat but significantly high in cholesterol. Also, egg yolks are one of the most significant sources of cholesterol in the Western diet.

The best controlled studies show that addition of cholesterol in a diet can increase LDL cholesterol. And the best studies show us that increases in LDL cholesterol increases the risk of cardiovascular disease. Also, cholesterol is a nonessential dietary compound. The body can make plenty and there is no health "benefit," per se, to eating it. It happens to be a "passenger" for some healthy foods like finfish, skinless breast of poultry as well as low and no fat dairy products (egg whites have zero).

But the aforementioned "animal proteins" have typically low or no cholesterol (as opposed to egg yolks and shrimp, the former of which is a very common "Western diet" choice) and generally make up a very tiny total amount of cholesterol for a truly healthy eating pattern. Notably, none of the established longevity hotspots called "Blue Zones" have diets that are high in cholesterol. All of them are relatively low in cholesterol and have a majority of their food intake from zero cholesterol (plant based) containing foods.

Taz Bhatia, MD

Founder and Medical Director, CentreSpring MD

While cholesterol is no longer deemed the bad guy, we still need to track and be aware of the amount of we are consuming. What we are also finding is that this may be an individual conversation. For some patients with a history of heart disease and high blood pressure, high cholesterol foods are still an issue, but not the only issue contributing to inflammation. Blood cholesterol levels above or below the ideal range may be associated with infertility, perimenopausal and menopausal symptoms like hot flashes and night sweats, as well as polycystic ovarian syndrome.  

Cholesterol, in the right amount, can be a healthy fat found naturally in animal foods like eggs and grass fed butter. Yet cholesterol is also found in full fat dairy and red meat, which in excess many patients cannot tolerate.

Monitoring your intake of cholesterol is key—just as you would monitor your calories. Limit high cholesterol foods to no more than one to two small servings per day and get all your cholesterol levels checked every six months.

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