Many people worry about cholesterol, and with good reason. 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. What you eat can play an important role in maintaining cardiovascular health, and it is reasonable to think that eating cholesterol-laden foods will raise your cholesterol levels. But the connection isn’t quite that simple.
“I think for a lot of people it just makes sense, logically, even though the majority of the data, within the context of current intake, show that’s not really the case,” said Alice Lichtenstein, director of Tufts University’s Cardiovascular Nutrition Laboratory.
The amount of cholesterol in your food doesn’t necessarily translate to the amount of cholesterol in your blood vessels.
The ‘bigger culprit’
The US Department of Agriculture’s dietary guidelines don’t specify a maximum level for how much cholesterol a person should have in their diet — the recommendation was eliminated in the 2015-2020 publication, and were not included in the newest guidelines released for 2021. The reason: For the most part, the amount of cholesterol we’re taking in is not really a problem.
When thinking about dietary cholesterol, Lichtenstein emphasized that it’s important to take into consideration how much of it people typically eat in a day. She was on the committee that decided the previous dietary guideline recommendation of limiting daily cholesterol intake to 300 milligrams wasn’t necessary. Why? Because most of us were already doing that. Women consume, on average, 250 milligrams of cholesterol a day, and men 350 milligrams, according to Lichtenstein. Therefore, the committee didn’t consider cholesterol a “nutrient of public health concern.” (That is, Americans generally aren’t getting too much or too little of it.)
A 2019 American Heart Association meta-analysis of more than 50 studies did not find a significant association between dietary cholesterol and cardiovascular risk. Where cholesterol intake did seem to increase risk, people were eating as much as three times the average amount.
“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.