Chef Tim Says...

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Dr. Tim Says...

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Dr. Tim Says....

Should I be Concerned About Cholesterol in Food?

hard boiled eggs

In lectures I will almost always have someone ask about cholesterol. This is the one area where people are very confused and here's an example of a question we get from our readers:

When I look at some of your recipes I see some of them are way over 250mg cholesterol, for instance your Eggs Benedict with 283mg. I understand eggs are considered a high source so that doesn't surprise me with the figure. But.....

I have a cholesterol problem and am trying to lower it without medication. I came across your recipes by doing a search. What is considered HIGH cholesterol content in food when looking at a Nutrition Fact section? Just curious as my doctor really wants me on medication. But every time I take it I feel like crap AND it is so expensive compared to just looking after your dietary intake.

The research into cholesterol is a good illustration of how far we've come in the last 15 years with our knowledge about diet and nutrition as well as what really works.

This is a challenging issue because when your cholesterol is high, the first thought is to simply eat less cholesterol, and that's often what people are told. Unfortunately, the recommendation - usually to consume less than 300 milligrams per day - wasn't based on the best science and we now know that for most of us the amount of cholesterol we eat isn't that important.

First and foremost, understand that cholesterol is a type of fat or "lipid." Also note that while the cholesterol you consume and the cholesterol in your blood stream are the same thing, eating foods that are high in cholesterol doesn't necessarily raise your "serum cholesterol." Likewise, it may not have much effect on the "lipid panel" that your doctor looks at as part of the lab work he or she orders. That panel measures total "serum cholesterol," HDL (often called good cholesterol), LDL (often called bad cholesterol) and triglycerides (another type of fat).

It is also important to know that your body makes its own cholesterol: about 300 mg per day. Some people make more, but most folks with cholesterol problems have difficulty with how the cholesterol is handled in the body for a variety of reasons. While some of this is the result of genetics, other issues include obesity, diet, exercise, distribution of fat and other medical conditions such as diabetes. The thought that consuming more than 300 mg of dietary cholesterol per day caused an increase in serum cholesterol was arbitrary and over the last few years we have come to understand that this is not the case for the majority of us.

We do know, however, that there are some of us whom researchers classify as "hyper-responders." This group does have a greater increase in their serum cholesterol after consuming dietary cholesterol (although not a tremendous increase). About 1/3 of us might be more sensitive. (Am J Clin Nutr 1985;42:42 1-431) There's no actual test for this, however. If you are struggling with lowering your cholesterol, it is a good idea to limit high cholesterol foods and see if that makes a difference for you.

There are a number of diet and lifestyle choices that can help you lower your cholesterol:

  1. The amount of saturated fat in your food is far more important than the amount of cholesterol, because saturated fat has an effect on serum cholesterol as well as the LDL cholesterol.

  2. Consume a higher amount of the "good" fats like monounsaturated fat and polyunsaturated fats. While we used to think that a low fat diet was important, it's clear that this is not the case either. Concern yourself with consuming about 2 times as much of quality fats (like olive oil or canola oil) than saturated fats (like butter or higher fat red meats).

  3. Eat more fiber. There are a lot of great sources including fruits of any kind, veggies, whole grains and cereals, and legumes (beans, peas, etc.).

  4. Exercise clearly helps change the cholesterol profile by lowering LDL and raising HDL.

There are a lot of foods that are high in cholesterol that are good for you. Eggs, for example, contain about 250 mg of cholesterol, and each has about 5 grams of fat in the egg yolk (about 2 grams of this is saturated fat). Liver, shrimp, and lobster are other foods that are great for you and have a lot of cholesterol. The research now shows that for most of us, these high cholesterol foods are not a problem.

The research says that you can dramatically lower your cholesterol by changing your diet and exercising more. Medication is necessary for some, no matter how much they change their lifestyle, but the good news is that for those who are taking cholesterol lowering medications, following a healthy lifestyle can lead to as much as a 55% reduction in risk of heart disease over taking medication alone.

The goal of Dr. Gourmet is balance, which includes eating less saturated fat, while still eating foods that aren't boring or bland. Here are some delicious recipes that are great for you and contain eggs, shrimp or liver:

Asparagus Frittata
Shrimp Taco Salad
Calves Liver with Onion and Apple

Eat well, eat healthy, enjoy life!

Timothy S. Harlan, M.D.
Dr. Gourmet