High blood cholesterol levels are a known risk factor for heart disease.
For decades, people have been told that the dietary cholesterol in foods raises blood cholesterol levels and causes heart disease. This idea may have been a rational conclusion based on the available science 50 years ago, but better, more recent evidence doesn’t support it. This article takes a close look at the current research on dietary cholesterol and the role it plays in blood cholesterol levels and heart disease.
What is cholesterol?
Cholesterol is a waxy, fat-like substance that occurs naturally in your body. Many people think that cholesterol is harmful, but the truth is that it’s essential for your body to function. Cholesterol contributes to the membrane structure of every cell in your body. Your body also needs it to make hormones and vitamin D, as well as perform various other important functions. Simply put, you could not survive without it. Your body makes all the cholesterol it needs, but it also absorbs a relatively small amount of cholesterol from certain foods, such as eggs, meat, and full-fat dairy products.
How does dietary cholesterol affect blood cholesterol?
The amount of cholesterol in your diet and the amount of cholesterol in your blood are very different things. Although it may seem logical that eating cholesterol would raise blood cholesterol levels, it usually doesn’t work that way. The body tightly regulates the amount of cholesterol in the blood by controlling its production of cholesterol. When your dietary intake of cholesterol goes down, your body makes more. When you eat greater amounts of cholesterol, your body makes less. Because of this, foods high in dietary cholesterol have very little impact on blood cholesterol levels in most people. (1)
However, in some people, high-cholesterol foods raise blood cholesterol levels. These people make up about 40% of the population and are often referred to as “hyperresponders.” This tendency is considered to be genetic. (2) Even though dietary cholesterol modestly increases LDL in these individuals, it does not seem to increase their risk of heart disease. This is because the general increase in LDL particles typically reflects an increase in large LDL particles – not small, dense LDL. In fact, people who have mainly large LDL particles have a lower risk of heart disease. (3) Hyperresponders also experience an increase in HDL particles, which offsets the increase in LDL by transporting excess cholesterol back to the liver for elimination from the body. (4)
As such, while hyperresponders experience raised cholesterol levels when they increase their dietary cholesterol, the ratio of LDL to HDL cholesterol in these individuals stays the same and their risk of heart disease doesn’t seem to go up. Of course, there are always exceptions in nutrition, and some individuals may see adverse effects from eating more cholesterol-rich foods.
Many factors are involved in the disease, including inflammation, oxidative stress, high blood pressure, and smoking. While heart disease is often driven by the lipoproteins that carry cholesterol around, dietary cholesterol, in itself, has little to no effect on this.
However, high-heat cooking of cholesterol-rich foods can cause the formation of oxysterols. (5) Scientists have hypothesized that high blood levels of oxysterols may contribute to the development of heart disease, but further evidence is needed before any strong conclusions can be reached. (6)
High-quality research finds no link to heart disease
High-quality studies have shown that dietary cholesterol is not associated with an increased risk of heart disease. A lot of research has been conducted on eggs specifically. Eggs are a significant source of dietary cholesterol, but several studies have shown that eating them is not associated with an elevated risk of heart disease. (7) What’s more, eggs may even help improve your lipoprotein profiles, which could lower your risk. One study compared the effects of whole eggs and a yolk-free egg substitute on cholesterol levels. People who ate three whole eggs per day experienced a greater increase in HDL particles and a greater decrease in LDL particles than those who consumed an equivalent amount of egg substitute. (8) However, it’s important to note that eating eggs may pose a risk for those with diabetes, at least in the context of a regular Western diet. Some studies show an increased risk of heart disease in people with diabetes who eat eggs. (9)
Cholesterol in food only has a small effect on the level of cholesterol in your blood. Cholesterol is a fat found in your blood. It’s produced naturally in your body, and you can also get cholesterol from some foods. Reducing the amount of saturated fat, trans-fats, and cholesterol in your diet can help lower your blood cholesterol. Eating too much sugar and too many simple carbohydrates will also increase your cholesterol levels.
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