Medical Views on Cholesterol in Food are Changing

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Genetics appear to play a stronger role in heart disease than ingested cholesterol, an expert from a top American hospital, Cleveland Clinic, explains

Steven Nissen, MD, a cardiologist from a top American hospital, Cleveland Clinic

Cleveland, Ohio: While high levels of “bad” cholesterol in the blood, which have been linked to heart disease, remain an important health concern, evidence shows people should no longer be overly concerned about eating foods that are high in cholesterol.

Steven Nissen, MD, a cardiologist from a top American hospital, Cleveland Clinic, explains that what has changed is that many researchers and physicians believe that eating cholesterol-rich foods such as eggs may not have a very big effect on blood cholesterol levels.

“However, people with certain health problems, such as diabetes, should continue to avoid cholesterol-rich foods,” says Dr. Nissen.

He adds that the issue of whethercholesterol is harmful is complicated.

Cholesterol is a waxy substance that ultimately ends up in the walls of arteries. It causes the plaque that leads to heart attacks and strokes. The U.S. Dietary Guidelines call for a daily cholesterol limit of 300 milligrams.

Dr Nissen explains that the relationship between cholesterol in the diet and the body is complicated for various reasons including: 

  • The body largely regulates how much cholesterol is in your blood.
  • There are different kinds of cholesterol. Low-density lipoprotein or LDL (bad) cholesterol contributes to plaque buildup along with triglycerides, another lipid. High-density lipoprotein or HDL (good) cholesterol is not linked to plaque buildup.
  • LDL is the bad cholesterol that can increase your risk of heart disease.
  • The way people process cholesterol differs. Some people appear to be more vulnerable to cholesterol-rich diets.

“Your genetic makeup – not diet – is the most important driving force behind blood cholesterol levels, says Dr. Nissen. “The body creates cholesterol in amounts much larger than what you can eat, so avoiding foods that are high in cholesterol won’t affect your blood cholesterol levels very much.”

About 85% of the cholesterol in the circulation is manufactured by the body in the liver. In other words, it does not come directly from the cholesterol that you eat, according to Dr. Nissen.

It is also likely that people with a family history of heart disease share common environments that may increase their risk, according to the U.S. Centers for Disease Control and Prevention (CDC).

The greater danger for everyone is in foods that are high in trans fats, explains Dr. Nissen.

“Those often appear on food labels as hydrogenated oils or partially hydrogenated vegetable oil,” he says. “Those types of fats do tend to raise cholesterol and do tend to increase the risk of heart disease.” The issue of saturated fat is more complicated.

All in all, he recommends that people look for the words “trans fat” and “hydrogenated fat” on labels at the grocery store. The American Heart Association does recommend limiting dietary saturated fat intake and focusing more on eating fruits, veggies, whole grains, lean animal protein or plant-protein sources.​

About Cleveland Clinic:

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 67,554 employees worldwide are more than 4,520 salaried physicians and researchers, and 17,000 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,026-bed health system that includes a 165-acre main campus near downtown Cleveland, 18 hospitals, more than 220 outpatient facilities, and locations in southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2019, there were 9.8 million total outpatient visits, 309,000 hospital admissions and observations, and 255,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries.