Historically, recommendations for reducing blood levels of LDL, or the "bad cholesterol," included a restriction of dietary cholesterol -- most commonly to less than 300 mg daily. But in recent years, these guidelines have changed. Most notably, the 2013 clinical guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC) and the 2015-2020 Dietary Guidelines for Americans no longer include a specific cholesterol limit. Despite these changes, it's still important to pay attention to your food choices in order to improve your cholesterol levels and reduce your risk of heart disease.
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Cholesterol and Health
Cholesterol is made by the body and found in animal-based foods. It's highest in eggs and organ meats but also a component of milk, yogurt, cheese, meat, poultry and fish. Since the body makes all the cholesterol you need, dietary consumption is not necessary. However, this waxy, fat-like substance is essential for health -- found in all body cells and used in the production of hormones, fat-soluble vitamins and bile acids. Cholesterol becomes a problem when blood levels are too high, since excess levels of LDL cholesterol can contribute to plaque buildup in the artery walls - -which increases the risk of heart attack and stroke.
For decades, LDL-lowering diets -- or heart-healthy diets -- included a dietary cholesterol limit of less than 300 mg per day. But in 2013, AHA and ACC removed their long-standing cholesterol restriction, citing inadequate scientific evidence to prove this limitation lowered LDL levels. In addition, the 2015-2020 Dietary Guidelines for Americans (DGA), developed by the U.S. Department of Agriculture and Department of Health and Human Services, removed their 300 mg daily cholesterol limit and changed the wording of these population-based dietary guidelines to recommend people adopt a healthy eating pattern -- which includes as little dietary cholesterol as possible. Consequently, current recommendations do not outline a specific daily cholesterol limit.
Heart Healthy Food Pattern
To restrict dietary cholesterol, you'll need to limit portions of animal-based foods, such as meat, chicken, milk, eggs and cheese. This focus on reducing cholesterol, however, is not as effective at lowering LDL and decreasing cardiovascular risk as the lifestyle guidelines recommended by AHA and ACC, which include:
- Reduce intake of saturated fats by avoiding fatty meats, poultry skin, sausages, high-fat milk products and tropical oils, such as coconut and palm oil.
- Replace some or all of the animal protein in your diet with soy, beans, nuts or other plant proteins. If including animal products, keep choices lean and low in fat.
- Avoid trans fats, found in partially hydrogenated oils, such as shortening or stick margarine.
- Adopt a plant-centered eating plan which includes a variety of fruits, vegetables, whole grains, beans, nuts and seeds.
Plant-centered meal patterns such as the Mediterranean Diet, DASH Eating Plan or a whole-food, plant-based diet are commonly recommended for heart health. Not only are these diets naturally low in cholesterol -- because they restrict or exclude foods of animal origin, but these plans limit saturated and trans fat and have the beneficial emphasis on plant foods.
Despite recent changes to cholesterol recommendations, AHA/ACC clinical practice guidelines agree that a heart healthy diet pattern can lower LDL and reduce the risk of cardiovascular disease. The reduced emphasis on dietary cholesterol reflects a transition in food guidelines, away from a focus on individual nutrients and towards healthy eating patterns that are known to reduce the risk of heart disease. For help understanding the best food plan for you, ask for doctor for a referral to a dietitian.
Reviewed by Kay Peck, MPH RD
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- Circulation: 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
- Nutrients: Dietary Cholesterol Intake and Sources Among U.S Adults: Results from National Health and Nutrition Examination Surveys (NHANES), 2001–2014
- Nutrition: Egg Consumption and Heart Health: A Review
- Office of Disease Prevention and Health Promotion: Dietary Guidelines 2015-2020
- The American Journal of Clinical Nutrition: Eggs and Beyond: Is Dietary Cholesterol No Longer Important?
- American Heart Association: About Cholesterol
- American Heart Association: The American Heart Association's Diet and Lifestyle Recommendations
- American Heart Association: Mediterranean Diet
- American Heart Association: Managing Blood Pressure With a Heart-Healthy Diet
- The Permanente Journal: Nutritional Update for Physicians: Plant-Based Diets