Dietary cholesterol



Dietary cholesterol refers to cholesterol obtained from foods in the human diet. According to the current scientific consensus from evidence-based medicine, dietary cholesterol does not significantly increase the total blood cholesterol level or increase the risk of cardiovascular disease in most people.

Vegans and opponents of the egg industry continue to promote the view that dietary cholesterol causes a significant increase in LDL cholesterol, thus increasing cardiovascular disease (CVD) risk and all cause mortality. However, high quality research on egg consumption analysed in recent systematic and umbrella reviews does not support this view.

Mainstream consensus
The idea that dietary cholesterol significantly increases the total blood cholesterol level was first promoted by American health authorities in the 1960s and was debated for many years. The American Heart Association removed dietary restriction of cholesterol in 2013 and the Dietary Guidelines Advisory Committee removed the restriction in 2015.

Dietary cholesterol refers to the cholesterol found in food. It is found only in animal products. It is not necessary to get cholesterol from food as the human body makes more cholesterol than it needs.

The mainstream medical consensus is that cholesterol in food only has a small effect on the bad (LDL) cholesterol in your blood. Saturated and trans fats in food cause a much greater increase in LDL cholesterol and is a risk factor for heart disease.

The United States Department of Agriculture, Dietary Guidelines For Americans 2015-2020, recommends limiting the intake of saturated fats to less than 10 percent of calories per day but does not set a specific limit for consumption of dietary cholesterol. They note that the removal of the specific limit "does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the IOM, individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern". Some foods that are rich in cholesterol are also high in saturated fat, so this may confuse people. The British Dietetic Association note that:

Eggs
Many medical studies agree that eggs do not increase CVD risk in the general population. The have noted that observational studies from 1980-2012 (involving more than 250,000 subjects) have not supported an association between dietary cholesterol and CVD risk.

A 2013 meta-analysis found no association between egg consumption and heart disease or stroke. Another meta-analysis from 2013, suggested that egg consumption is not associated with the risk of CVD in the general population.

A 2016 study found that eating one egg every day is not associated with an elevated risk of coronary artery disease. The study concluded that "egg or cholesterol intakes were not associated with increased CAD risk, even in ApoE4 carriers (i.e., in highly susceptible individuals)."

A 2018 review noted that:

Two umbrella reviews published in 2020 have concluded that there is no association between increased egg consumption and CVD risk in the general population. A 2023 study that looked at international data from 142 countries with populations of at least one million from 1990 to 2018 found that eggs are negatively associated with ischemic heart disease (IHD) and may actually be beneficial to supress IHD incidence.

Eggs are also a rich source of dietary lutein and zeaxanthin which are good for eye health and can reduce incidence of age-related macular degeneration.

2022 review
In 2022 the first review looking at data from clinical trials and epidemiology on dietary cholesterol was published:

Vegans
Vegans are the main opponents of dietary cholesterol. For example, claims that "blood cholesterol levels are clearly increased by eating dietary cholesterol. In other words, putting cholesterol in our mouth means putting cholesterol in our blood."

Conspiracy theorist Mic the Vegan claims that the food industry utilize "tricks" to manipulate science into concluding dietary cholesterol doesn't raise total blood cholesterol.