Brenda Khan
Cholesterol is a waxy substance that can end up in the walls of arteries, and high levels of bad LDL cholesterol in the blood have been linked to heart disease. For years, dietary cholesterol was thought to increase blood cholesterol levels and the risk of cardiovascular disease. However, recent research suggests that the relationship between dietary and blood cholesterol is more complex than previously thought, and that dietary cholesterol has little effect on blood cholesterol levels. While cholesterol is only found in animal foods, such as eggs, shellfish, meat, and dairy products, it is important to note that most cholesterol is made in the liver. A healthy diet and regular physical activity are recommended to help manage cholesterol levels and reduce the risk of heart disease.
| Characteristics | Values |
|---|---|
| Does diet increase cholesterol? | There is no conclusive evidence that dietary cholesterol increases cholesterol levels in the blood. However, it is recommended to limit the intake of saturated fats, which are found in animal products, as they can increase blood cholesterol levels. |
| Foods to avoid | Animal products high in saturated fats, such as beef, natural cheese, butter, and partially hydrogenated vegetable oils. |
| Foods to consume | Plant-based foods like vegetables, fruits, whole grains, legumes, nuts, and seeds. Healthy proteins like fish and plant-based proteins. |
| Lifestyle changes | Increasing physical activity, losing weight, limiting alcohol consumption, and quitting smoking can help lower cholesterol levels. |
| Individual variations | Some individuals, such as those with diabetes or familial hypercholesterolemia (FH), may need to be more cautious about their cholesterol intake. |
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What You'll Learn
The role of dietary cholesterol in cardiovascular disease
Cardiovascular disease (CVD) is the leading cause of death in the United States. For years, dietary cholesterol was believed to increase blood cholesterol levels, leading to an elevated risk of CVD. However, extensive research has failed to find evidence supporting this claim. As a result, the 2015–2020 Dietary Guidelines for Americans removed the recommendation to restrict dietary cholesterol to 300 mg/day.
The relationship between dietary cholesterol and total plasma cholesterol has been reported as linear based on observational cohort studies. However, these studies have limitations, such as confounding variables and selection biases. While dietary cholesterol intake is associated with increased intake of saturated fatty acids, which can increase LDL cholesterol and the risk of CVD, this is not the case with all cholesterol-rich foods. For example, eggs are low in saturated fatty acids and are a nutrient-dense, affordable source of high-quality protein.
It is important to distinguish between "good" (HDL) and "bad" (LDL) cholesterol. Healthy fats, such as those found in avocados, nuts, seeds, olives, plant-based oils, and fish, can increase HDL cholesterol levels. In contrast, a low intake of dietary fibre can lead to higher levels of LDL cholesterol in the blood. Therefore, it is recommended to include fibre-rich foods such as vegetables, fruits, wholegrains, legumes, nuts, and seeds in your diet.
While dietary cholesterol itself may not directly increase the risk of CVD, maintaining a healthy diet and lifestyle is crucial. This includes managing portion sizes, as overeating can contribute to high cholesterol and an increased risk of heart disease. Physical activity and exercise are also important factors in improving heart health and lowering cholesterol levels.
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The impact of genetics on cholesterol levels
Genetics can have a significant impact on cholesterol levels, and in some cases, high cholesterol can be the result of inherited conditions or genetic predispositions. One such condition is familial hypercholesterolemia (FH), which is caused by a mutation in genes such as APOB or PCSK9. FH affects around 1 in 300 people and is characterized by higher-than-normal levels of blood cholesterol, which can lead to early-onset coronary artery disease. The risk of developing FH depends on whether one or both parents carry the mutated gene, with inheritance from both parents resulting in a more severe form of the condition that is resistant to treatment. Early detection and treatment are crucial for managing FH, and children with a family history should be tested early to begin cholesterol-reducing interventions if necessary.
While FH is a specific condition caused by genetic factors, it is important to note that genetics can also influence cholesterol levels in other ways. For example, obesity, high body mass index (BMI), and high waist-to-hip ratio are all risk factors for high cholesterol that may be influenced by genetic predispositions. Additionally, some individuals may have a genetic predisposition to overeating, which can contribute to obesity and, subsequently, high cholesterol. Diabetes is another condition influenced by genetics that is also a risk factor for elevated cholesterol levels.
While dietary cholesterol was once believed to be a significant concern, recent research suggests that its impact on blood cholesterol levels is minimal for most people. High-cholesterol foods, such as eggs, have been shown to be safe and healthy for the majority of the population. However, it is worth noting that individuals with certain health conditions, such as diabetes, may still need to avoid or limit cholesterol-rich foods. Overall, while genetics can play a significant role in cholesterol levels, a combination of genetic predispositions and lifestyle factors contributes to an individual's overall cholesterol profile.
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Lifestyle changes to lower cholesterol
While cholesterol is a naturally occurring type of fat that your body needs to build cells, hormones, and some vitamins, high cholesterol levels can be bad for your body. Excess cholesterol can lead to a buildup of plaque in your arteries, increasing the risk of heart disease and stroke.
Diet
Eating certain foods can help lower your cholesterol levels. A heart-healthy diet includes plenty of fresh fruits and vegetables, whole grains, legumes, nuts, and seeds. These foods are high in dietary fibre, which can help reduce "bad" LDL cholesterol in your blood. Soluble fibre, in particular, is beneficial. Aim for a serving of 1/2 colourful vegetables, 1/4 wholegrains, and 1/4 healthy proteins. Plant sterols and stanols are also helpful in lowering cholesterol.
It is also important to limit your intake of unhealthy fats, salt, and added sugar. When choosing protein sources, opt for lean animal protein or plant-based proteins such as beans, legumes, and soy products. If you consume dairy, opt for low-fat dairy.
Additionally, be mindful of your portion sizes. Over time, portion sizes have increased, and many people are eating more than they need, contributing to high cholesterol and an increased risk of heart disease.
Exercise
Regular exercise can help improve your cholesterol levels by raising HDL ("good") cholesterol and reducing LDL ("bad") cholesterol and triglycerides. Aim for 30 minutes of moderate to vigorous exercise, such as walking or jogging, 4-6 times a week.
Weight Loss
Losing weight, even a small amount, can help lower your total cholesterol, LDL cholesterol, and triglyceride levels.
Smoking Cessation
Quitting smoking is crucial for improving your cholesterol levels. Smoking lowers HDL ("good") cholesterol, and even exposure to second-hand smoke can negatively affect your HDL levels.
Alcohol Consumption
Alcohol is not a necessary or recommended part of a heart-healthy lifestyle. It contributes unnecessary calories and has low nutritional value. If you choose to drink, limit your intake to no more than 10 standard drinks per week and no more than four drinks on any given day.
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Foods that increase cholesterol
High cholesterol levels in the blood are primarily caused by consuming foods that are not part of a heart-healthy eating pattern. While dietary cholesterol does not affect most people, some individuals may experience adverse effects from eating cholesterol-rich foods.
Foods that are high in saturated fats, such as red meat and high-fat dairy products, can increase cholesterol levels in the blood. These include baked goods like cupcakes, which are among the worst foods for high cholesterol. Trans fats, found in hydrogenated oils or partially hydrogenated vegetable oils, also tend to raise cholesterol levels and increase the risk of heart disease.
Eggs, which are nutrient-dense and relatively low in calories, have been shown to be safe and healthy for most people. However, people with certain health conditions, such as diabetes, may need to limit their egg consumption.
In addition to dietary factors, high cholesterol levels can be influenced by lifestyle factors such as physical activity, weight, smoking, and genetics.
To maintain healthy cholesterol levels, it is recommended to follow a heart-healthy eating pattern, which includes limiting unhealthy fats, salt, and added sugar. Instead, focus on consuming fruits, vegetables, whole grains, lean animal or plant-based proteins, and foods rich in healthy fats and fibre.
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Foods that lower cholesterol
High cholesterol levels in the blood are a health concern as they are linked to an increased risk of heart disease and stroke. While the relationship between dietary and blood cholesterol is complex, and dietary cholesterol does not affect everyone in the same way, eating the right foods can help lower your cholesterol levels.
The American Heart Association (AHA) recommends limiting salt and saturated fats and focusing on eating fruits, vegetables, whole grains, lean animal protein or plant-based protein sources.
Oats and whole grains
Oats and whole grains such as barley and brown rice contain fibre, which can help reduce "bad" cholesterol (LDL). Starting your day with a bowl of oatmeal or cold oat-based cereal can provide you with 1 to 2 grams of soluble fibre, which binds cholesterol and its precursors in the digestive system and removes them from the body before they enter the bloodstream.
Omega-3 fatty acids
Fatty acids found in certain fish, such as salmon, mackerel, sardines, and trout, are important to include in your diet. They can help lower triglycerides in the blood and reduce inflammation.
Fruits
Fruits such as apples, grapes, strawberries, and citrus fruits are rich in pectin, a type of soluble fibre that lowers LDL.
Nuts
Eating a variety of nuts, such as almonds, walnuts, and peanuts, is beneficial for the heart. Consuming 2 ounces of nuts per day can slightly lower LDL cholesterol by about 5%. Nuts also contain additional nutrients that support heart health.
Olive oil
Extra virgin olive oil is rich in monounsaturated fats and antioxidants, which help raise HDL (good) cholesterol and lower LDL cholesterol. It can be used as a healthy substitute for saturated fats like butter or margarine.
Soy
Soy-based foods like tofu, tempeh, and soy milk contain plant-based proteins called soy proteins, which can help lower LDL cholesterol levels when consumed as part of a balanced diet.
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Frequently asked questions
Dietary cholesterol has been shown to have little effect on blood cholesterol levels. However, people with certain health problems, such as diabetes, may see adverse effects from eating cholesterol-rich foods.
Foods that are high in cholesterol include eggs, shellfish, meat, and dairy products.
To lower cholesterol, it is recommended to limit salt and saturated fat intake, and eat more fruits, vegetables, whole grains, low-fat dairy products, legumes, and nuts.
Besides diet, increasing physical activity and losing weight can also help lower cholesterol.
Alcohol contributes unnecessary calories and is of low nutritional value. It is not a necessary or recommended part of a heart-healthy diet. However, moderate alcohol consumption is generally considered acceptable for healthy adults.
