Worry About the Cholesterol in Your Blood, Not Your Food

Too much cholesterol in your blood can contribute to plaque that clogs your arteries, causing a stroke or heart attack.

Nobody wants that to happen. So must we avoid all foods containing lots of cholesterol, including eggs, shrimp and cheese?

Thankfully, no. Moderation is the key, and eating a nutritious overall diet is more important than avoiding high-cholesterol foods, says UNC Health primary care provider Thomas Keyserling, MD, MPH.

Decreasing the amount of sugar and processed foods in your diet is more important than limiting cholesterol in your food. Getting enough moderate exercise—aim for 150 minutes a week—is also a good idea.

“We used to say don’t eat eggs because they’re high in cholesterol,” Dr. Keyserling says. “Now, we know that eggs in moderation are fine.”

It’s important to understand the difference between dietary cholesterol and blood cholesterol, he says.

“Dietary cholesterol that we consume in food doesn’t have much to do with our risk of heart disease or stroke,” he says. “Blood cholesterol is what we measure to see if someone’s level of cholesterol puts them at risk.”

What is cholesterol?

Cholesterol is a waxy substance found in the blood, Dr. Keyserling says. Produced by the liver and also absorbed from food that comes from animal sources, cholesterol has several biological functions, including building cells and making vitamins and hormones.

“Cholesterol is not just one substance,” he says. “We have LDL cholesterol, which we call ‘bad’ cholesterol because if it’s high, it can increase a person’s risk of heart disease and stroke.”

There is also HDL or “good cholesterol.” Higher levels of HDL are generally associated with less risk for heart disease.

Why do some people have high cholesterol?

Cholesterol levels seem to be determined in large part by our genes, Dr. Keyserling says. Talk to your doctor about specific cholesterol numbers that would be optimal for you.

Some people—about 1 in 250 or 300 people—have a genetic disorder called familial hypercholesterolemia (FH) that can increase the likelihood of developing coronary heart disease at a younger age.

“More commonly in this country, people have elevated cholesterol levels due to a combination of many different genes and lifestyle behaviors,” he says.

“We recommend that everybody have a baseline screening for cholesterol levels by young adulthood to make sure we’re not missing familial hypercholesterolemia,” he says. “If the cholesterol level is normal and there is no strong family history of heart disease or diabetes, then follow-up testing can be done mid-adulthood.”

All men should have regular cholesterol checks starting at age 35 and women at age 45, he says.

How can you lower your cholesterol levels?

If a person’s cholesterol levels are abnormal, they should work with their doctor to develop a plan, he says.

Your doctor may suggest lifestyle changes such as:

  • Eat a healthy diet that is high in healthy fats (from plant and fish sources) and non-starchy vegetables and whole grains, and low in refined carbohydrates and processed foods.
  • Get regular moderate exercise (work up to 30 minutes of walking five times a week).
  • Stop smoking and vaping.

It is important to emphasize that following healthful lifestyle behaviors can substantially reduce the risk for heart attacks and strokes, although cholesterols levels may only improve a bit, Dr. Keyserling says. If these three steps don’t lower your cholesterol adequately, your doctor may prescribe a medicine in the class of statins that lower levels of LDL cholesterol.

Statins can be very effective in helping lower cholesterol when diet and exercise aren’t enough, Dr. Keyserling says.

What is a healthy diet?

Dr. Keyserling recommends a diet of “real” food—keep highly processed foods to a minimum. The body needs balance, he says. Here’s what that means:

  • High-quality fats
    Healthy fats come from plants and fish, not animals, Dr. Keyserling says. He recommends two to six servings per day of healthy fats. A serving would be one tablespoon of olive oil (or other plant-based oil), a half to a fourth of an avocado, or an ounce of nuts. Nut butters, including peanut butter, also are excellent sources of healthy fats and protein.

“Two tablespoons of full-fat salad dressing is about one serving of healthy fats,” he says.

  • Healthy carbohydrates

These include whole grains and non-starchy fruits and vegetables—broccoli and other leafy green vegetables, most fruits and legumes (beans) all have carbohydrates. Aim for five or more servings per day of fruits and vegetables, Dr. Keyserling says.

When it comes to starches, “wild or brown rice is a better choice than white rice,” Dr. Keyserling says. “Whole grain bread is a better choice than white bread. White potatoes are starchy vegetables, so you should eat them once a week or less. Sweet potatoes are a better choice.”

  • Protein

Protein should make up 15 to 20 percent of caloric intake, Dr. Keyserling says. Good sources of protein include beef, pork, chicken, eggs, fish and cheese as well as nuts and legumes.

In general, he recommends eating red meat (beef and pork) three times a week or less. Fresh protein sources are somewhat more healthful than processed. Highly processed foods, such as most sausage and bacon, should be eaten only in moderation.

  • Dairy

Many dairy products, including milk, yogurt and cheese, contain protein, along with calcium, potassium, vitamins and minerals. Dairy products are fine to eat but not needed as part of a healthy diet, Dr. Keyserling adds.

He doesn’t frown on drinking whole milk, even with its high fat content. “Drink what you enjoy,” he says. “In moderation, there are no significant health risks compared to skim milk.”

  • Water and other fluids
    People should stay hydrated, Dr. Keyserling says, although the amount of fluid it takes to stay hydrated depends on the person’s activity level, size and general health. For example, someone with kidney stones or who is pregnant or breastfeeding may need more fluids. We all need more fluids when the weather is hot. Drink fluids throughout the day, especially if you’re thirsty.

Water, coffee and tea are good choices, especially if you don’t add sugar. It is fine to use half and half. If you won’t enjoy your coffee or tea without a little sugar, try to limit the amount of sugar to 1 to 2 teaspoons per serving.

Juice also may be a good choice to help you stay hydrated, but drink it in limited amounts. “No more than 8 ounces a day, and closer to 4 ounces is better,” Dr. Keyserling says. “That’s why there’s something called a juice glass. It’s small.” Even better, eat the apple or orange, which provides the nutrients and also fiber.

He discourages drinking sodas, sweet tea or any beverages with more than a bit of added sugar or artificial sweeteners.

Though in the past it was thought that alcohol in moderation might reduce the risk of heart disease, more recent research suggests this is not the case. Current guidelines suggest no more than one alcoholic beverage (12 ounces of beer, 5 ounces wine, 1.5 ounces distilled spirits) a day for women and no more than two for men.

“Really, there are few health benefits associated with any amount of alcohol,” he says, “and the risks increase with the amount of alcohol consumed.”

If you haven’t had your cholesterol levels checked in a while, or if you’re concerned about whether they are within a healthy range, talk to your doctor or find one near you.