Adam’s Journal

Here’s a question from my son:

Recently, I’ve been eating a fair amount of eggs and salmon, both of which have a lot of dietary cholesterol, but not much saturated fat. If foods are low in saturated fats, does a high cholesterol content pose any real risks?

Dr. James Prescribes

First, I should note that it’s great your son is already thinking about cholesterol, because most people don’t until they are much older – and usually not until they’re in a situation where their blood cholesterol levels require medication.

When I was in medical school, the dietary guidelines suggested a daily limit on dietary cholesterol, as it was believed that foods high in cholesterol were not healthy for your heart. In particular, health experts thought that dietary cholesterol led to elevated levels of cholesterol in the blood and plaques in the arteries, both of which are risk factors for cardiovascular disease and early death.

Since then, research has confirmed that foods high in cholesterol – like eggs, and, to a lesser degree, salmon – can raise blood cholesterol levels. However, the effect is usually relatively modest and varies from person to person.

The links between dietary cholesterol and arterial plaque were also called into question by a series of research studies.

Nevertheless, even relatively recent federal dietary guidance has varied on the subject of cholesterol intake. Previous guidelines recommended limiting consumption of dietary cholesterol to no more than 300 milligrams per day, or the amount found in about an egg and a half. Current guidelines eschew a particular number, instead suggesting that we keep dietary cholesterol “as low as possible without compromising the nutritional adequacy of the diet.”

If you’re confused, you’re not alone. And studies of the subject have been further confounded by the fact that, as your son’s question suggests, many (but not all) foods that are high in cholesterol are also high in saturated fats, which have been shown as major culprits for heart disease and premature death.

So, what does this all mean to health-conscious eaters?

Usually, if you’re consuming a healthy diet, it’s okay to eat some cholesterol-rich foods, especially if they’re not also high in saturated fat. But, as a general rule, it’s better to keep them at modest levels. And, with regular visits to your healthcare provider, you can monitor and modify blood cholesterol levels by diet or medication to ensure they remain at or below levels optimal for heart and vascular health.

James is executive vice president and chief medical officer of the Oklahoma Medical Research Foundation. Cohen, a marathoner, is OMRF’s senior vice president and general counsel. Send your health questions to [email protected].