Nutrition 101

Dietary Cholesterol: Revisited

April 18, 2017

by Anna Lin, Dietetic Intern

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Cholesterol, Cholesterol, Cholesterol

Cholesterol is a substance in the body to help make vitamin D, hormones, parts of our cell walls, and bile that helps us digest fat. Cholesterol is essential to these components in our bodies but too much cholesterol in our body increases our risk of cardiovascular disease (CVD), mainly coronary heart disease, by forming plaques in our blood vessels. Therefore, dietary cholesterol, found only in animal sources, was strictly limited in the past as it was thought to be a major contributor in increasing cholesterol in our bodies. But the latest research in the past few years finds that this may not always be the case.

Avoiding Dietary Cholesterol

SPE has not discouraged healthy individuals from nutrient-rich foods like eggs and seafood, that also are high in dietary cholesterol. These foods have a lot of nutrients including protein, vitamins, and minerals that can be incorporated into a healthy balanced diet. In 2015, the Scientific Report of the 2015 Dietary Guidelines Advisory Committee stated the recommendation of limiting intake of dietary cholesterol to no more than 300mg/day is not supported because “available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol, consistent with the conclusions of the AHA/ACC report.” So should we avoid foods with cholesterol?

What Does Recent Research Say About Cholesterol?

A 2015 systematic review and meta-analysis reviewed 40 studies between 1979 and 2013. They found no association between dietary cholesterol and coronary artery disease, ischemic stroke, or hemorrhagic stroke.¹ Dietary cholesterol increases both high density lipoprotein (HDL), known as the “good cholesterol” and low density lipoprotein, known as “the bad cholesterol.”^1,2 It is the ratio between HDL and LDL that is considered a marker of CVD risk that we need to watch out for.^1,2 In this case, if both HDL and LDL increase at the same time, the ratio remains constant. Therefore, these studies showed no strong evidence to link cholesterol intake and CVD risk.

Several clinical studies studied the effects of consuming dietary cholesterol greater than the recommended daily 300 mg on HDL and LDL. Individuals consuming greater amounts of cholesterol showed an increase in both HDL and LDL while maintaining their HDL/LDL ratio.² Hence, no increase in CVD risk was observed, even consuming more than 300 mg of dietary cholesterol.

However, this can't be applied universally and there are some at-risk populations that may need to limit their cholesterol intake. A few epidemiological studies found that people with diabetes have increased risk of CVD if they consume more than one egg per day.³ Also, there are some individuals who are more sensitive to dietary cholesterol than others known as “hyper-responders.” Hyper-responders will have a larger increase in serum HDL and LDL with increased cholesterol intake than others.^1,3 If you are a hyper-responder, you may want to limit your cholesterol consumption.

So, What Should You Do?

Do not be afraid to incorporate foods that are high in dietary cholesterol in your diet if you’re a healthy individual. If you have the conditions described above or other reasons to avoid dietary cholesterol, you should monitor your intake of foods higher in cholesterol, and reserve it for those like eggs and seafood that come with other healthy nutrients.

References

1. Berger S, Raman G, Vishwanathan R, Jacques PF, Johnson EJ. Dietary cholesterol and cardiovascular disease: A systematic review and meta-analysis. Am J Clin Nutr. 2015;102(2):276-294.

2. Barona J, Fernandez ML. Dietary cholesterol affects plasma lipid levels, the intravascular processing of lipoproteins and reverse cholesterol transport without increasing the risk for heart disease. Nutrients. 2012;4(8):1015-1025.

3. Williams Sr. KA, Krause AJ, Shearer S, Devries S. The 2015 dietary guidelines advisory committee report concerning dietary cholesterol. Am J Cardiol. 2015;116(9):1479-1480.

cholesterol, heart disease, nutrition facts

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