You may feel frustrated trying to follow a healthy lifestyle when the dietary guidelines are always changing. But that’s actually a good thing. The field of medicine is constantly evolving. And as healthcare providers gain more information, they can give the public the most advanced, accurate and updated information to help people manage their health.
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One of these evolving topics is dietary cholesterol. Past guidelines recommended no more than 300 milligrams of cholesterol per day. People with heart disease risk factors were told to keep their cholesterol intake under 200 milligrams per day.
Today’s guidelines don’t include specific limits on how much cholesterol you should consume.
“Our understanding of cholesterol has changed,” says registered dietitian Julia Zumpano, RD. “We now know that eating cholesterol-rich foods doesn’t affect blood cholesterol as much as we previously thought.”
That must mean you can eat as much cholesterol as you want, right? Zumpano explains why that’s not true and what else to watch out for. (Spoiler alert: It’s saturated fat.)
General cholesterol recommendations
The USDA Dietary Guidelines for Americans recommend keeping dietary cholesterol as low as possible without affecting nutrition. So, while there’s no upper limit, the goal is still to cut back on cholesterol as much as you can.
“But that’s not because cholesterol itself is so dangerous. It’s because most high-cholesterol foods are also high in saturated fat, which is the real culprit,” Zumpano clarifies. “Saturated fat increases blood cholesterol and heart disease risk much more than dietary cholesterol.”
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Instead of tracking your cholesterol intake, most providers recommend adopting a heart-healthy diet. The Mediterranean and DASH diets are proven to improve heart health. Both are low in sugar and salt and rich in:
- Fruits and vegetables
- Nuts, seeds and legumes
- Whole grains
These eating plans are also designed to keep saturated fat under 10% of your daily intake of calories, as recommended by the USDA. (Although the American Heart Association suggests getting no more than 6% of your total calories from saturated fat.)
Conditions that affect how much cholesterol is safe
In some cases, reducing saturated fat and cholesterol in your diet is even more important, notes Zumpano. For example, if you have high cholesterol (hyperlipidemia), choosing healthier options can help you:
- Decrease “bad” cholesterol (low-density lipoprotein or LDL)
- Increase “good” cholesterol (high-density lipoprotein or HDL)
Other conditions can also affect how your body responds to the cholesterol you eat. Studies show that increased dietary cholesterol does raise blood cholesterol for some people (hyper-responders). Why and how often this happens is unknown.
Dietary cholesterol can also increase heart disease risk for people with familial hyperlipidemia and Type 2 diabetes. Depending on your blood cholesterol level, your provider may recommend specific targets for cholesterol intake.
Of course, dietary changes are only one piece of the puzzle to lower your cholesterol. Your provider may suggest other strategies, such as:
Are all high-cholesterol foods the same?
Not all foods are equal when it comes to cholesterol. Most cholesterol-rich foods are loaded with saturated fat. Zumpano advises limiting these foods as much as possible:
- Red meat
- Processed meats
- Commercial baked goods
- Fried foods
- Full-fat dairy
On the other hand, a few high-cholesterol foods are low in saturated fat and can be part of a healthy diet. Eggs fall into this category.
Eggs often get a bad rap for their high cholesterol levels — a large egg contains about 190 milligrams of cholesterol. But that same egg contains only 8% of your daily allowance for saturated fat — all in the yolk. According to the American Heart Association, people with healthy cholesterol levels can eat up to one egg per day.
Other high-cholesterol/low-saturated fat foods include:
- Organ meats
- Shellfish
“The trick to keeping these foods healthy is to be careful when preparing and serving them,” Zumpano cautions. “When sauteed in butter, smothered in cheese or paired with bacon or sausage, the saturated fat skyrockets.”
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When to talk to your provider about cholesterol
Experts recommend getting your cholesterol checked starting at age 20. If you’ve never had a cholesterol test, ask your provider about one at your next visit.
After your test, your provider can help you understand your results and — if your levels are high — your treatment options. Cholesterol takes time to build up in your arteries. The sooner you identify an increased risk of heart disease, the sooner you can take steps to lower that risk.
Will the cholesterol guidelines change again?
“Maybe,” says Zumpano. “We’re still figuring out the complex relationships between your diet, gut and health. Our goal is to find new ways to reduce chronic diseases and improve your quality of life.”
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