I’m trying to help my aunt plan her meals around cholesterol. But, there is SO much contradictory information on which foods are good or bad, and there’s apparently debate on whether cholesterol is actually connected with heart disease(?!).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513492/
Like, I want to help but this is so confusing for me!
In: 8
I have high cholesterol. The latest that my doctors told me, it’s not the raw numbers of your cholesterol, it’s the ratio between the high density cholesterol (HDL), and the low density cholesterol (LDL). Apparently, if your HDL is high enough, it clears out the LDL.
It’s not a perfect way to do it. But my rule of thumb is if the fat is solid at room temperature it’s bad if it’s liquid at room temperature, it’s better. Certain fats, like avocados, have more HDL than LDL.
So my recommendation, is to try to find foods that are high in HDL and concentrate on those rather than LDL. Certain activities also help raise your HDL, like walking and exercise. 
The easiest way to do this is to just stick to foods that are fresh and include vegetables and whole grains.
The problem with focusing on one aspect of food (cholesterol, sugar, etc.) is that you end up ignoring the general rules for a healthy diet. Doctors make the same mistake. For instance, you look at a loaf of bread – hey, it’s made with whole wheat! That’s got to be good, right? But look at the sugar content. Why is there sugar in bread? Same reason there’s sugar in cereal. It’s yummy, so people buy it. But the sugar is completely unnecessary for making bread.
A rule of thumb that seems to work in most shopping situations is to buy food that is displayed around the perimeter of the grocery store: meat and fish, fruits and veg, dairy. Pasta and rice are ok, but try to use the whole grain varieties (brown rice.)
Don’t believe the marketing claims on food packages, either. “Natural; No Cholesterol; No Added Sugar; Low Fat…” This is all horse hockey.
Re: cholesterol in particular – it’s actually ok to use real butter, whole milk, eggs, meat, and good quality cheese in moderation. It’s the quality that matters. Stick to olive oil, avoid “vegetable oil” and butter substitutes.
Don’t get stuck too deep in the nitty gritty of research. The review study you linked speculates on just about the effect of statins, for example. Stick with the advice of general health authorities, who take into account all research as a whole.
The prevailing medical link between lipoproteins and cardiovascular diseases is called the lipid hypothesis, and it is the most agreed-upon. (https://en.wikipedia.org/wiki/Lipid_hypothesis#Consensus)
The general dietary advice is quite simple. Avoid eating saturated fats and trans fats. Don’t smoke. Lose weight. (https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia)
Do you mean ingested cholesterol’s (ie exogenous) impact on heart disease?
Around 70 to 90 % of your total cholesterol is actually generated by your body’s own production of cholesterol (endogenous), and is not from the cholesterol in the food. The majority of the cholesterol we eat is in the non-esterified form and is not taken up in the intestines.
Do note that this is an simplification, of course, but the main driver of “bad cholesterol”, ie LDL, is more associated with the energy density of the food itself, rather than the cholesterol itself.
Dietary cholesterol is almost meaningless. The vast majority of cholesterol in your bloodstream is made in your liver. LDL in particular can be bad for your cardiovascular system. This can be managed to some degree by lifestyle changes (i.e losing weight, eating mostly unsaturated fats, that sorta thing), but at a certain point it comes down to genetics and you need medicines if you want to change the lipid profile.
*Dietary* cholesterol is at present thought to not affect cardiac outcomes. It’s the cholesterol produced by our own bodies that can cause cardiac disease.
However, dietary cholesterol can and does skew the blood tests used to determine if a person has high cholesterol, so a person with high cholesterol should limit dietary cholesterol, especially in the weeks leading up to getting blood work done.
I have high cholesterol, and I still eat eggs every now and then, liver maybe once a month. Moderation is key.
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