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Dietary cholesterol myth
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The dietary cholesterol myth refers to the myth that dietary cholesterol increases the total blood cholesterol level and increases the risk of cardiovascular disease. The myth is promoted by vegans and opponents of the egg industry. Dietary cholesterol does not have a major effect on a person's health.
The idea that dietary cholesterol 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:
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.
The consensus view from evidence-based medicine is that dietary cholesterol is not correlated with an increased risk of cardiovascular or coronary heart disease (CHD).
A 2012 review noted that "existing epidemiological data have clearly demonstrated that dietary cholesterol is not correlated with increased risk for CHD".
A 2014 review noted that "clinical studies point out that dietary cholesterol does not increase heart disease risk since the LDL-C/HDL-C ratio does not change or is improved due to increases in HDL-C associated with increased dietary cholesterol."
A 2018 review, noted that "the current literature does not support the notion that dietary cholesterol increases the risk of heart disease in healthy individuals. However, there is an ample evidence that saturated fatty acids and trans-fats increase cardiovascular disease risk. The fact that dietary cholesterol is common in foods that are high in saturated fatty acids might have contributed to the hypothesis that dietary cholesterol is atherogenic."
A 2019 review reported that dietary cholesterol had no direct eﬀects on the serum levels of blood cholesterol or low-density lipoprotein cholesterol levels.
Many medical studies agree that eggs do not increase dietary cholesterol or increase the risk of heart disease in healthy people.
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:
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.
A 2018 study concluded that "overall, recent intervention studies with eggs demonstrate that the additional dietary cholesterol does not negatively affect serum lipids, and in some cases, appears to improve lipoprotein particle profiles and HDL functionality."
Vegans are the main proponents of the dietary cholesterol myth. For example, Michael Greger 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."
- 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."
- 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.
- The Golden Egg: Nutritional Value, Bioactivities, and Emerging Benefits for Human Health.
- Cholesterol. U.S. Food and Drug Administration.
- 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."
- Cholesterol in food. National Heart Foundation of Australia. "Cholesterol in food only has a small effect on the level of cholesterol in your blood."
- 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."
- High cholesterol food. Heart UK. "Some foods contain cholesterol, but surprisingly they don’t make a big difference to the cholesterol in your blood."
- 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."
- Foods with high cholesterol to avoid and include. Medical News Today.
- See article on Saturated fat and cardiovascular disease.
- Cholesterol. British Dietetic Association.
- Fernandez M, L. (2012). Rethinking dietary cholesterol. Curr Opin Clin Nutr Metab Care 15 (2): 117-121.
- Fernandez, Maria Luz; Andersen, Catherine J.(2014). Effects of dietary cholesterol in diabetes and cardiovascular disease. Clinical Lipidology 9:6: 607-616.
- Berger, Samantha; Raman, Gowri; Vishwanathan, Rohini; Jacques, Paul F; Johnson, Elizabeth J. (2015). Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. The American Journal of Clinical Nutrition 102 (2): 276-294.
- Soliman, Ghada A. (2018). Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease. Nutrients 10 (6): 780.
- Cha, Dongjoo; Park, Yongsoon. (2019). Association between Dietary Cholesterol and Their Food Sources and Risk for Hypercholesterolemia: The 2012–2016 Korea National Health and Nutrition Examination Survey. Nutrients 11 (4): 846.
- 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.
- 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.
- . 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.
- High-cholesterol diet, eating eggs do not increase risk of heart attack, not even in persons genetically predisposed, study finds. ScienceDaily.
- Blesso, Christopher N; Fernandez, Maria Luz. (2018) . Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You?. Nutrients 10 (4): 426.
- The Effects of Dietary Cholesterol on Blood Cholesterol. Michael Greger.
- "Eating Cholesterol Doesn't Raise Cholesterol" Debunked. Mic the Vegan.