Cholesterol is something I talk about often with patients. I check the lipid profiles of every adult and adolescent patient at least once and frequently annually.  This has mostly stayed the same, but my explanations have changed quite a bit. Cholesterol has long been the gold standard for determining a patient’s risk of new or recurrent heart disease, strokes, etc. Until recently, it was thought that dietary cholesterol directly impacted blood cholesterol levels, leading to increased risks of these diseases. However, recent research has shifted this perspective and my approach to counseling and management. 

The Shift in Focus

The amount of cholesterol consumed from food (dietary cholesterol) has a much smaller impact on blood cholesterol levels than once believed. So, what influences your cholesterol, and does cholesterol still matter? Well, simply put, your WHOLE diet influences cholesterol. And yes, cholesterol still matters, but not the Total Cholesterol.  Pshhht.  The numbers you need to worry about are LDL-C, Lipoprotein (a), and Apolipoprotein B (apoB). I’ll break these numbers down in another article; in the meantime, here is what you need to know about diet:

Emphasize Healthy Fats: Rather than focusing on cutting out dietary cholesterol, it's more important to reduce the intake of saturated and trans fats. Saturated fats are found primarily in high-fat meat and animal-based products. Trans fats are found in packaged and processed foods. These types of fats have a more significant effect on raising LDL (bad) cholesterol levels in the blood.

Eat Mostly Whole Foods: People should consume a diet rich in fruits, vegetables, whole grains, nuts, and lean proteins (like fish and poultry). These foods support heart health and can help manage cholesterol levels effectively.  Remember, too, that plants contain protein too.  Here is a list of plant sources of protein. 

Moderation with High-Cholesterol Foods: Foods naturally high in cholesterol, like eggs and shellfish, can be consumed in moderation. They are nutritious and do not significantly raise blood cholesterol for most people. If you have a family history of cardiovascular disease, still talk to your doctor to find out if this advice applies to you personally.

Focus on Overall Diet Quality: The overall pattern of your diet matters more than individual nutrients. A body filled with nutrient-dense, high-fiber foods can much more easily overcome the adverse effects of occasional consumption of low-quality foods. As I tell my patients, this means eating food as close to the way God originally made it as possible. 

While it’s still important to be mindful of your intake, the emphasis has shifted toward the source and quality of your food -  healthy fats, fiber, and nutrient-dense foods, over avoiding cholesterol in food. This wholesome approach supports better cholesterol levels and improved overall well-being.