Dietary cholesterol

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Not to be confused with cholesterol denialism

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.[1][2][3][4]

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.[5][6][7][8]

Mainstream consensus[edit]

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.[9][10] The American Heart Association removed dietary restriction of cholesterol in 2013 and the Dietary Guidelines Advisory Committee removed the restriction in 2015.[9]

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.[11]

The mainstream medical consensus is that cholesterol in food only has a small effect on the bad (LDL) cholesterol in your blood.[12][13][14][15][16][17] Saturated and trans fats in food cause a much greater increase in LDL cholesterol and is a risk factor for heart disease.[13][18]

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.[19] 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".[20] Some foods that are rich in cholesterol are also high in saturated fat, so this may confuse people. The British Dietetic Association note that:

Although some foods contain cholesterol – such as shellfish, eggs and offal – this has much less effect on our blood cholesterol than the cholesterol we make in our body ourselves in response to a high saturated fat diet. Many cholesterol containing foods are relatively low in saturated fat and contain other useful vitamins and minerals. Only cut down on these foods if you have been advised to by your doctor or a dietitian. Cutting down on saturated fat in the diet is much more helpful than reducing dietary cholesterol.[21]

Eggs[edit]

Many medical studies agree that eggs do not increase CVD risk in the general population. The American College of CardiologyWikipedia 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.[3]

A 2013 meta-analysis found no association between egg consumption and heart disease or stroke.[22] Another meta-analysis from 2013, suggested that egg consumption is not associated with the risk of CVD in the general population.[23]

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)."[24][25]

A 2018 review noted that:

Current studies have tended to show that the consumption of eggs is not a risk factor of CVD in healthy people. However, people who are at high risk of CVD such as those with diabetes or hypertension need to have caution with dietary cholesterol intake, especially egg intake. Also, some people seem to be more sensitive to dietary cholesterol whose blood cholesterol level is highly correlated to dietary intake. Therefore, even though the recommendation of restricting cholesterol and egg consumption in AHA and DGAC has been eliminated, we still need to have caution with them based on the physiological status of people.[9]

Two umbrella reviews published in 2020 have concluded that there is no association between increased egg consumption and CVD risk in the general population.[5][6] 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.[26]

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.[27][28][29]

2022 review[edit]

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

We confirm from the review of the literature on epidemiological data, meta-analysis, and clinical interventions where dietary cholesterol challenges were utilized that there is not a direct correlation between cholesterol intake and blood cholesterol. This lack of correlation is mainly due to the compensatory mechanisms exerted by the organism to manage excess dietary cholesterol, including decreases in cholesterol absorption and down-regulation of cholesterol synthesis. A great number of epidemiological studies and meta-analysis indicate that dietary cholesterol is not associated with CVD risk nor with elevated plasma cholesterol concentrations. Clinical interventions in the last 20 years demonstrate that challenges with dietary cholesterol do not increase the biomarkers associated with heart disease risk.[30]

Opponents[edit]

Vegans[edit]

Vegans are the main opponents of dietary cholesterol. For example, Michael GregerWikipedia 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."[31]

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.[32]

See also[edit]

References[edit]

  1. ↑ How much cholesterol should you have per day?. "Current research indicates that dietary cholesterol does not have a major effect on a person's health. Instead, a person should concentrate on reducing or eliminating foods high in saturated fats, trans fat, and added sugars."
  2. ↑ Can I eat eggs?. HEART UK. "Cholesterol in eggs does not have a significant effect on blood cholesterol."
  3. ↑ 3.0 3.1 Dietary Cholesterol and Cardiovascular Risk: AHA Advisory "Findings in observational studies from 1980-2012, collectively with more than 250,000 subjects, have not supported an association between dietary cholesterol and CVD risk (fatal or nonfatal myocardial infarction or stroke), particularly when adjusting for total energy intake. Similarly, egg intake is not associated with CVD risk."
  4. ↑ Check recent systematic and umbrella reviews cited on the article.
  5. ↑ 5.0 5.1 Mah E, Chen CO, Liska DJ. The effect of egg consumption on cardiometabolic health outcomes: an umbrella review. Public Health Nutr. 2020 Apr;23(5):935-955.
  6. ↑ 6.0 6.1 Stefano Marventano, Justyna Godos, Maria Tieri, Francesca Ghelfi, Lucilla Titta, Alessandra Lafranconi, Angelo Gambera, Elena Alonzo, Salvatore Sciacca, Silvio Buscemi, Sumantra Ray, Daniele Del Rio, Fabio Galvano. Egg consumption and human health: an umbrella review of observational studies. Int J Food Sci Nutr. 2020 May;71(3):325-331
  7. ↑ Emamat H, Totmaj AS, Tangestani H, Hekmatdoost A. The effect of egg and its derivatives on vascular function: A systematic review of interventional studies. Clin Nutr ESPEN. 2020 Oct;39:15-21.
  8. ↑ Krittanawong C, Narasimhan B, Wang Z, Virk HUH, Farrell AM, Zhang H, Tang WHW. Association Between Egg Consumption and Risk of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Am J Med. 2020 Jul 10:S0002-9343(20)30549-0.
  9. ↑ 9.0 9.1 9.2 Kuang, H.; Yang, F.; Zhang, Y.; Wang, T.; Chen, G. (2018). The Impact of Egg Nutrient Composition and Its Consumption on Cholesterol Homeostasis. Cholesterol. 6303810.
  10. ↑ The Golden Egg: Nutritional Value, Bioactivities, and Emerging Benefits for Human Health.
  11. ↑ Cholesterol. U.S. Food and Drug Administration.
  12. ↑ Dietary fats, dietary cholesterol and heart health. "Cholesterol in food has only a small effect on low density lipoprotein (LDL or bad) cholesterol. Saturated and trans fats in food causes a much greater increase in LDL cholesterol. Therefore it is alright to include eggs as part of a healthy balanced diet that is low in saturated fat."
  13. ↑ 13.0 13.1 Cholesterol in food. National Heart Foundation of Australia. "Cholesterol in food only has a small effect on the level of cholesterol in your blood."
  14. ↑ Is the Cholesterol in Your Food Really a Concern?. Penn Medicine. "It has long been a common myth that cholesterol consumed in foods, called dietary cholesterol, impacts the level of cholesterol in your body. Well, consider that myth busted."
  15. ↑ High cholesterol food. Heart UK. "Some foods contain cholesterol, but surprisingly they don’t make a big difference to the cholesterol in your blood."
  16. ↑ Panel suggests that dietary guidelines stop warning about cholesterol in food. Harvard Medical School. "There’s a growing consensus among nutrition scientists that cholesterol in food has little effect on the amount of cholesterol in the bloodstream."
  17. ↑ Foods with high cholesterol to avoid and include. Medical News Today.
  18. ↑ See article on Saturated fat and cardiovascular disease.
  19. ↑ https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf
  20. ↑ https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf
  21. ↑ Cholesterol. British Dietetic Association.
  22. ↑ Rong, Ying; Chen, Li; Tingting, Zhu; Yadong, Song; Yu, Miao; Shan, Zhilei; Sands, Amanda; Hu, Frank B; et al. (2013). "Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies". British Medical Journal 346 (e8539): e8539.
  23. ↑ Shin JY, Xun P, Nakamura Y, He K. (2013). Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr 98: 146-159.
  24. ↑ . K. Virtanen, J. Mursu, H. E. Virtanen, M. Fogelholm, J. T. Salonen, T. T. Koskinen, S. Voutilainen, T.-P. Tuomainen. (2016). Associations of egg and cholesterol intakes with carotid intima-media thickness and risk of incident coronary artery disease according to apolipoprotein E phenotype in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. American Journal of Clinical Nutrition 103 (3): 895-901.
  25. ↑ High-cholesterol diet, eating eggs do not increase risk of heart attack, not even in persons genetically predisposed, study finds. ScienceDaily.
  26. ↑ The Global Association between Egg Intake and the Incidence and Mortality of Ischemic Heart Disease-An Ecological Study
  27. ↑ Consumption of One Egg Per Day Increases Serum Lutein and Zeaxanthin Concentrations in Older Adults without Altering Serum Lipid and Lipoprotein Cholesterol Concentrations
  28. ↑ A Comprehensive Review of Eggs, Choline, and Lutein on Cognition Across the Life-span
  29. ↑ A positive effect of egg consumption on macular pigment and healthy vision: a systematic review and meta-analysis of clinical trials
  30. ↑ Is There a Correlation between Dietary and Blood Cholesterol? Evidence from Epidemiological Data and Clinical Interventions
  31. ↑ The Effects of Dietary Cholesterol on Blood Cholesterol. Michael Greger.
  32. ↑ "Eating Cholesterol Doesn't Raise Cholesterol" Debunked. Mic the Vegan.
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