4 Cholesterol Myths It's Officially Time to Stop Believing, According to Dietitians
Nearly 4 in 10 Americans have high cholesterol, which is defined as total blood cholesterol above 200 mg/dL, according to the U.S. Centers for Disease Control and Prevention (CDC). While the "cholesterol-free" and "low-fat" crazes in the 1980s and '90s may have led you to believe that foods with cholesterol are the culprit, there's actually so much more that goes into your overall cholesterol ratio.
"It's not about food. Several other lifestyle risk factors are related to overall risk of cardiovascular disease, such as smoking, diabetes, high blood pressure, and stress," says Rachel Fine, RD, a registered dietitian and owner of the nutrition counseling firm To The Pointe Nutrition in New York City.
And get this: Not all cholesterol is bad. In fact, your body requires it for many vital functions including constructing cells and making hormones, the CDC explains. Our liver even makes some itself.
"Blood cholesterol is a waxy, fat-like substance that circulates throughout our body and at the right levels — this is key — provides an array of health benefits," explains Mary Stewart, RD, LD, a registered dietitian and the founder of Cultivate Nutrition in Dallas. "Dietary cholesterol, on the other hand, is cholesterol ingested from animal products. The main food sources include egg yolks, beef, poultry, and dairy products."
Medical pros once believed that dietary cholesterol had a prominent role in our blood cholesterol, but the vast majority of research now confirms that for the majority of people dietary cholesterol does not drastically influence blood cholesterol.
"Our body manufactures and regulates the cholesterol it needs to carry out important functions like creating hormones and serving as an important component of cell membranes," Stewart says.
Read on for four myths about dietary cholesterol, busted, plus how to really eat for healthier cholesterol levels and a healthier heart.
Blood Cholesterol 101
Before we dive in, let's recap what is involved in that cholesterol panel your doctor prescribes. This test measures the amount of these three types of cholesterol in your blood. Your total cholesterol (the reading you want to keep below 200), is the sum of your LDL and HDL, plus 20 percent of your triglyceride levels, the American Heart Association (AHA) says.
- Low-density lipoprotein (LDL) cholesterol: LDL is considered the "bad" kind of cholesterol, as it can lead to fatty buildups in the arteries that narrow the arteries and increases the risk for heart disease. Aim for 100 mg/dL or less.
- High-density lipoprotein (HDL) cholesterol: HDL is often deemed the "good" cholesterol since a healthy level may help protect against heart attack and stroke by "escorting" about one-quarter to one-third of your total LDL within the arteries back to the liver, where the LDL is broken down and excreted from the body. Aim for 50 mg/dL (women) or 40 mg/dL (men) or more.
- Triglycerides: Triglycerides are the most common type of fat in the body. They store extra energy from the food you eat. Aim for 150 mg/dL or less.
4 Common Cholesterol Myths
1. Fiction: Heart disease is often caused by eating too much cholesterol.
Fact: As we mentioned, many factors play a role in heart disease, including genetics, inflammation, high blood pressure, and smoking. So why have foods with cholesterol been somewhat villainized?
"Diet culture often points a finger to food, elevating some foods and demonizing others," Fine says.
Plus, the cholesterol conversation gets even more confusing when you look at the similar structure of dietary cholesterol and the cholesterol made in the liver, adds Ashley Reaver, RD, an Oakland, Calif.-based registered dietitian and the creator of the Lower Cholesterol Longer Life Method.
"Cholesterol found in foods is similar to the cholesterol produced in our bodies. It is only found in animal products, as plants cannot produce it. We are able to absorb cholesterol from the digestive tract, but only about 10 percent of the dietary cholesterol we eat gets absorbed and impacts our blood cholesterol," Reaver says.
The cholesterol in our blood is produced in our liver from any calorie-containing food — anything that includes protein, carbohydrates, fats, or alcohol — and is packaged with protein and triglycerides, the primary type of fat in our foods and our body. Hence the name "lipo" (fat) "protein."
Your body is pretty incredible at self-regulating: When your dietary cholesterol intake goes down, your body makes more to fill in the gaps. When you eat greater amounts of cholesterol, your body reduces its natural production. And even though dietary cholesterol may slightly increase LDL in some people, it doesn't seem to increase their risk of heart disease.
2. Fiction: You should aim to avoid foods with dietary cholesterol as much as possible.
Fact: Most high-quality animal products are very nutrient-dense, Stewart explains. If you eliminate all or the majority of dietary cholesterol, "you're missing out on many health-promoting nutrients," she says.
Case in point: Grass-fed beef is rich in iron and B vitamins, and grass-fed yogurt provides gut healing probiotics and bone supporting calcium.
"The cholesterol in foods does not have a significant impact on blood cholesterol levels. Foods high in dietary cholesterol, like eggs and shellfish, are actually great sources of lean protein that likely have a lower impact on cholesterol levels than many processed snack foods," Reaver adds.
Since only about 10 percent of that dietary cholesterol impacts our cholesterol, foods with some cholesterol shouldn't instantly be demonized, Reaver believes.
"The latest guidance on nutrition recommendations removed dietary cholesterol from its 'nutrients to limit.' Instead, we should try to limit saturated fats, which are largely found in animal products that are high in fat. A full 100 percent of saturated fat, as opposed to 10 percent of dietary cholesterol, can impact cholesterol production in the liver," Reaver says.
The AHA recommends aiming for six percent or less of your total daily calories to come from saturated fat sources, which include:
- fatty cuts of beef and beef fat (tallow)
- skin-on poultry
- heavy cream
3. Fiction: Products labeled "cholesterol-free" are automatically nutritious.
Fact: The term "cholesterol-free" could be plastered over any food that doesn't contain meat or high-fat dairy.
"Food companies commonly use popular nutrition keywords to grab your attention and encourage consumption of the product, and 'cholesterol-free' is one common example," Stewart says. "Does this make highly-processed and nutrient-poor foods now healthy? Nope!"
She has spotted this claim on everything from potato chips to cream-filled chocolate sandwich cookies. Instead of seeking out specific package claims, aim to incorporate a wide variety of colors and plants into your recipes, mixed in with some lean protein, healthy fats, and whole grains.
Related: How to Eat a Heart Healthy Diet
4. Fiction: It's Best to Stick to Egg Whites Only.
Fact: "Organic and pasture-raised eggs are a complete protein source and rich in numerous vitamins and minerals," Stewart says.
Egg whites offer some protein (about two grams). But egg yolk contain almost all of an egg's nutrition, including most of its iron, biotin, folate and vitamins like A, D, E, K, plus about four grams of protein.
One game-changing 2013 study compared the blood cholesterol impact of eating whole eggs or an equal amount of a yolk-free egg substitute. After three months, those who ate three whole eggs per day had a larger increase in HDL and greater decrease in LDL than their egg substitute-consuming peers.