Should You Be Concerned About Cholesterol? An Expert Weighs In

by Sasha Reddy

This article has been reviewed by Jeannie Versagli, RD, LDN. Jeannie is a Registered Dietitian with the Academy of Nutrition and Dietetics, a national professional organization, and is licensed in nutrition with the State of Delaware.

Is cholesterol content a data point you frequently look for on food packaging? If so, it’s probably for one of two reasons: you’re either experiencing high cholesterol levels or at elevated risk for cardiovascular disease. But how concerned should you really be with the cholesterol in your food? Jeannie Versagli, one of HAC’s Registered Dietitians, weighs in.

As more lanes of road are blocked off during construction or after an accident, cars are forced to merge, slowing or even halting the flow of traffic. Cholesterol has the same affect on your blood vessels.

Why should we care about cholesterol?

There are two main types of cholesterol in our bodies: low-density lipoproteins and high-density lipoproteins (LDLs and HDLs, respectively). For all intents and purposes, LDLs are bad, and HDLs are good. Excess buildup of LDLs in the body causes plaque buildup in the arteries, increasing an individual’s chances of experiencing blood clots, heart disease, or stroke. Conversely, HDLs help reduce the amount of LDLs in our blood.

Our bodies produce all the cholesterol we need, so there’s no need to consume additional cholesterol in our diets. That being said, in recent years, various institutions have flip-flopped on whether or not it is necessary to limit our intake of dietary cholesterol to reduce plaque buildup (more on that later).

LDL levels in the body are regulated in three ways:

LDL receptors on our cells take in excess cholesterol for storage. Cholesterol is vital to the creation of our cell membranes, hormones, and vitamin D.¹
HDLs carry excess LDLs to our liver, where they can be broken down.
Various medications are used to reduce the natural production of cholesterol in the body. Statins are most often prescribed to limit cholesterol production in patients with high cholesterol.

What’s the relationship between fat and cholesterol?

Cholesterol molecules are made of a combination of fat and protein. Both cholesterol and healthy fats are vital to our bodies because they contribute to cell health among other functions. However, most saturated fat (aka “bad” fat) sources are also sources of cholesterol and can increase bodily LDL (“bad” cholesterol) levels.

Common saturated (bad) fat sources

Common unsaturated (good) fat sources

Trans Fats

Red meats
Pork
Poultry (particularly
dark meats)
Eggs
Milk
Cheese
Butter
Lard

Monounsaturated:

Olive, canola, peanut,
and sesame oils
Avocados
Olives
Nuts

Polyunsaturated:

Sesame, pumpkin, flax,
and chia seeds
Shrimp*
Fatty fishes*
Soybeans
Tofu

*Unsaturated fat sources that also contain cholesterol

There is a third category widely considered to be even worse than saturated fats when it comes to influencing plaque buildup, known as trans fats. While trans fats are naturally occurring in some animal products, fried and heavily processed foods such as potato chips, cakes, donuts, and margarine are what you should really worry about. Seek to remove as many of these items from your diet as possible.

Should I be eating less cholesterol?

Until 2015, the Dietary Guideline for Americans recommended that dietary cholesterol intake be limited to less than 300mg per day and less than 200mg per day for those at high risk of heart disease. Then, in the 2015-2020 edition of these guidelines, these recommendations were removed, and the 2020-2025 guidelines have followed suit. The US Departments of Agriculture and Health and Human Services assert that their decision was due to a lack of evidence supporting a causal relationship between dietary cholesterol and risk of cardiovascular disease but does not negate the importance of limiting cholesterol in the diet.²

From a dietary standpoint, focusing on reducing your intake of saturated fats rather than cholesterol itself is the best way to reduce LDL levels in your body. Excessive saturated fat intake, unlike dietary cholesterol, has consistently been linked to an increased risk of blood clots, heart disease, and stroke. In addition, adding more unsaturated fats to your diet can also decrease LDL levels.

Interestingly, certain foods have the ability to increase your cholesterol levels without actually containing cholesterol or saturated fat. Coffee, for example, has been found in several studies to contribute to high cholesterol levels because it contains oils known as diterpenes, which can reduce the body’s ability to regulate LDL levels.

A helpful detail to remember is that all animal products, except for some seafood, are sources of saturated fat. However, some are worse offenders than others. “If you take beef fat and pork fat, and you leave it at room temperature,” Jeannie says, “you will always find pork fat to be soft and beef to be hard and waxy. That will tell you that there’s more saturated fats in beef than there is in pork. That’s not to say that pork doesn’t have saturated fat in it, but it doesn’t have it in the same proportion that beef does.” Generally, fatty foods that are more solid at room temperature (ex. butter) contain more saturated fats than those that are liquid at room temp. (ex. olive oil).

“Don’t worry so much about lowering your overall fat intake as much as focusing on lowering saturated fats,” Jeannie adds. After all, many healthy fats contain omega-3s and other compounds vital to our health. “If you follow the Mediterranean diet, you’ll be fine, because it limits a lot of these saturated fats. Stay away from animal fats, look to plant proteins, look to cold-water fish, and put a little poultry in there…and that will take care of all of that.”

Another nutritional approach to reducing cholesterol is to increase fiber intake. Fiber helps reduce the amount of cholesterol that makes it into the bloodstream. In addition to increasing consumption of traditional fiber sources (leafy greens, whole grains, etc.), Jeannie recommends adding more flax and chia seeds to the diet, as these are fantastic sources of fiber and great sources of unsaturated fat.

How can I increase my HDL levels?

Remember: in addition to reducing your LDL levels, you can improve your cholesterol profile by increasing amounts of good cholesterol, which helps prevent arterial plaque. While dietary interventions are excellent at diminishing LDL levels, they are not as effective at increasing HDL counts. “HDLs can be influenced through exercise,” Jeannie notes. “So the more you exercise, the higher your HDLs.” Physical activity is, in fact, the most effective way to manipulate your HDL levels. On the flip side, smoking and consuming alcohol can lower HDLs, so putting an end to these habits will help improve your cholesterol makeup. Maintaining a healthy weight also contributes to high levels of good cholesterol.

When you go to the doctor to have your cholesterol levels checked, you are often presented with several numbers, including total cholesterol, LDL level, and HDL level. While the general goal is usually to keep total cholesterol levels down, many medical professionals agree that maintaining HDL levels of at least 60 mg/dl can help reduce “bad” cholesterol levels.³

Are dietary and lifestyle interventions sufficient?

An important consideration is whether you may be dealing with familial hypercholesterolemia, or FH for short. FH is a genetic disorder that produces high natural cholesterol levels. Three gene mutations can cause this disorder, the most common of which results in a lack of cellular LDL receptors. The fewer receptors a person has, the more LDLs in the bloodstream and the more potential for plaque buildup.⁴ According to the CDC, about 1 in 250 people lives with FH. Individuals with FH are at higher risk of experiencing heart disease and stroke, and these events have the potential to occur earlier in life. FH usually can’t be treated with diet and a healthy lifestyle alone. Exercise (along with a high-fiber diet) helps, but individuals will likely need to be placed on statins or blood thinners at some point in their lives.

Resources

If you are interested in gathering more insight on your heart disease and stroke risk, Jeannie and “the Docs” recommend asking your doctor to order an expanded cholesterol panel. This test will provide insight into not just your LDL and HDL counts, but also the cholesterol particle sizes and types in your blood. Read more on this test and the other labs the Docs recommend here.