Dietary cholesterol

[[File:Soft-boiled-egg.jpg|165px|thumb|One large egg has about 186 mg of cholesterol in its yolk<ref>[https://www.heart.org/en/news/2018/08/15/are-eggs-good-for-you-or-not Are eggs good for you or not?]. heart.org.</ref>]]
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{{hatnote|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.<ref>[https://www.medicalnewstoday.com/articles/325911.php 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."</ref><ref>[https://www.heartuk.org.uk/low-cholesterol-foods/can-i-eat-eggs Can I eat eggs?]. HEART UK. "Cholesterol in eggs does not have a significant effect on blood cholesterol."</ref><ref name="ACC 2020">[https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/12/30/15/23/dietary-cholesterol-and-cardiovascular-risk 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."</ref><ref>Check recent systematic and umbrella reviews cited on the article.</ref>

[[Veganism|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.<ref name="Umbrella 1">Mah E, Chen CO, Liska DJ. [https://pubmed.ncbi.nlm.nih.gov/31599222/ ''The effect of egg consumption on cardiometabolic health outcomes: an umbrella review'']. Public Health Nutr. 2020 Apr;23(5):935-955.</ref><ref name="Umbrella 2">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. [https://www.tandfonline.com/doi/abs/10.1080/09637486.2019.1648388?journalCode=iijf20 ''Egg consumption and human health: an umbrella review of observational studies'']. Int J Food Sci Nutr. 2020 May;71(3):325-331</ref><ref>Emamat H, Totmaj AS, Tangestani H, Hekmatdoost A. [https://pubmed.ncbi.nlm.nih.gov/32859309/ ''The effect of egg and its derivatives on vascular function: A systematic review of interventional studies'']. Clin Nutr ESPEN. 2020 Oct;39:15-21.</ref><ref>Krittanawong C, Narasimhan B, Wang Z, Virk HUH, Farrell AM, Zhang H, Tang WHW. [https://pubmed.ncbi.nlm.nih.gov/32653422/ ''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.</ref>

==Mainstream consensus==

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.<ref name="Kuang 2018"/><ref>[https://www.mdpi.com/2072-6643/11/3/684/htm ''The Golden Egg: Nutritional Value, Bioactivities, and Emerging Benefits for Human Health''].</ref> The American Heart Association removed dietary restriction of cholesterol in 2013 and the Dietary Guidelines Advisory Committee removed the restriction in 2015.<ref name="Kuang 2018"/> 

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.<ref>[https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/factsheets/Cholesterol.pdf Cholesterol]. U.S. Food and Drug Administration.</ref>

The mainstream medical consensus is that cholesterol in food only has a small effect on the bad (LDL) cholesterol in your blood.<ref>[https://www.heartfoundation.org.au/images/uploads/publications/Dietary-Fats-QA.pdf 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 fat]]s 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."</ref><ref name="Heart Foundation">[https://www.heartfoundation.org.au/healthy-eating/food-and-nutrition/fats-and-cholesterol/cholesterol-in-food Cholesterol in food]. National Heart Foundation of Australia. "Cholesterol in food only has a small effect on the level of cholesterol in your blood."</ref><ref>[https://www.pennmedicine.org/updates/blogs/heart-and-vascular-blog/2016/april/is-the-cholesterol-in-your-food-really-a-concern 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."</ref><ref>[https://www.heartuk.org.uk/low-cholesterol-foods/foods-that-contain-cholesterol High cholesterol food]. Heart UK. "Some foods contain cholesterol, but surprisingly they don’t make a big difference to the cholesterol in your blood."</ref><ref>[https://www.health.harvard.edu/blog/panel-suggests-stop-warning-about-cholesterol-in-food-201502127713 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."</ref><ref>[https://www.medicalnewstoday.com/articles/317332.php Foods with high cholesterol to avoid and include]. Medical News Today.</ref> [[Saturated fat and cardiovascular disease|Saturated]] and [[trans fat]]s in food cause a much greater increase in LDL cholesterol and is a risk factor for heart disease.<ref name="Heart Foundation"/><ref>See article on [[Saturated fat and cardiovascular disease]].</ref>

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.<ref>https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf</ref> 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".<ref>https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf</ref> Some foods that are rich in cholesterol are also high in saturated fat, so this may confuse people. The British Dietetic Association note that:

{{quotebox|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.<ref>[https://www.bda.uk.com/foodfacts/cholesterol.pdf Cholesterol]. British Dietetic Association.</ref>}}

===Eggs===

Many medical studies agree that eggs do not increase CVD risk in the general population. The {{wpl|American College of Cardiology}} 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.<ref name="ACC 2020"/> 

A 2013 meta-analysis found no association between egg consumption and heart disease or stroke.<ref>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.</ref> Another meta-analysis from 2013, suggested that egg consumption is not associated with the risk of CVD in the general population.<ref>Shin JY, Xun P, Nakamura Y, He K. (2013). [https://www.ncbi.nlm.nih.gov/pubmed/23676423 ''Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis'']. ''Am J Clin Nutr'' 98: 146-159.</ref>

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)."<ref>. K. Virtanen, J. Mursu, H. E. Virtanen, M. Fogelholm, J. T. Salonen, T. T. Koskinen, S. Voutilainen, T.-P. Tuomainen. (2016). [https://www.ncbi.nlm.nih.gov/pubmed/26864369 ''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.</ref><ref>[https://www.sciencedaily.com/releases/2016/02/160211083044.htm High-cholesterol diet, eating eggs do not increase risk of heart attack, not even in persons genetically predisposed, study finds]. ScienceDaily.</ref>

A 2018 review noted that:

{{quotebox|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.<ref name="Kuang 2018">Kuang, H.; Yang, F.; Zhang, Y.; Wang, T.; Chen, G. (2018). [https://www.hindawi.com/journals/cholesterol/2018/6303810/ ''The Impact of Egg Nutrient Composition and Its Consumption on Cholesterol Homeostasis'']. ''Cholesterol''. 6303810.</ref>}}

Two umbrella reviews published in 2020 have concluded that there is no association between increased egg consumption and CVD risk in the general population.<ref name="Umbrella 1"/><ref name="Umbrella 2"/> 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.<ref>[https://pubmed.ncbi.nlm.nih.gov/36901143/ The Global Association between Egg Intake and the Incidence and Mortality of Ischemic Heart Disease-An Ecological Study]</ref>

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.<ref>[https://academic.oup.com/jn/article/136/10/2519/4746690 Consumption of One Egg Per Day Increases Serum Lutein and Zeaxanthin Concentrations in Older Adults without Altering Serum Lipid and Lipoprotein Cholesterol Concentrations]</ref><ref>[https://pubmed.ncbi.nlm.nih.gov/29451849/ A Comprehensive Review of Eggs, Choline, and Lutein on Cognition Across the Life-span]</ref><ref>[https://pubmed.ncbi.nlm.nih.gov/33491232/ A positive effect of egg consumption on macular pigment and healthy vision: a systematic review and meta-analysis of clinical trials]</ref>

===2022 review===

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

{{quotebox|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.<ref>[https://www.mdpi.com/2072-6643/14/10/2168/htm Is There a Correlation between Dietary and Blood Cholesterol? Evidence from Epidemiological Data and Clinical Interventions].</ref>}}

===Cancer===

A 2022 pooled analysis of 11 prospective cohort studies found that a higher intake of dietary cholesterol was associated with an increased bladder cancer risk.<ref>[https://onlinelibrary.wiley.com/doi/10.1002/ijc.33970 Dietary fats and their sources in association with the risk of bladder cancer: A pooled analysis of 11 prospective cohort studies]. onlinelibrary.wiley.com.</ref><ref>[https://www.wcrf.org/about-us/news-and-blogs/new-study-shows-dietary-cholesterol-intake-increases-bladder-cancer-risk/ New study shows dietary cholesterol intake increases bladder cancer risk]. wcrf.org.</ref> However, there is only limited evidence and research has not shown a direct link between dietary cholesterol and cancer. For example, the American Institute for Cancer Research have stated:

{{quotebox|Research has not shown a link between dietary cholesterol and cancer risk. Yet while dietary cholesterol may not have a direct effect on cancer risk, a diet high in cholesterol often includes high amounts of foods that could affect cancer risk.<ref name="aicr">[https://www.aicr.org/news/the-cancer-cholesterol-connection/ The Cancer-Cholesterol Connection]. American Institute for Cancer Research.</ref>}}

Foods that have been shown to increase cancer risk are red and processed meats.<ref name="aicr"/>

==Opponents==

===Vegans===

[[Vegan]]s are the main opponents of dietary cholesterol. For example, {{wpl|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."<ref>[https://nutritionfacts.org/2016/03/22/the-effects-of-dietary-cholesterol-on-blood-cholesterol/ The Effects of Dietary Cholesterol on Blood Cholesterol]. Michael Greger.</ref> 

[[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.<ref>[https://www.youtube.com/watch?v=vBtfzd43t8o "Eating Cholesterol Doesn't Raise Cholesterol" Debunked]. Mic the Vegan.</ref>

==See also==
*[[Cholesterol denialism]]
*[[Saturated fat and cardiovascular disease]]

==External links==

*[https://www.heart.org/en/news/2023/08/25/heres-the-latest-on-dietary-cholesterol-and-how-it-fits-in-with-a-healthy-diet Here's the latest on dietary cholesterol and how it fits in with a healthy diet]

==References==
{{reflist|2|80%}}

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[[Category:Food woo]]

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