Cholesterol and heart disease: The role of diet

Your diet clearly plays a role in determining your cholesterol levels, but if you're like most people, the most important factor isn't how much cholesterol-rich food you eat. Rather, it's what else you eat. Figuring this out has been a learning process.

Initially, the news that cholesterol in the bloodstream was linked to heart disease prompted an all-out war on cholesterol in food. From the 1960s on, people were advised to stay away from foods rich in cholesterol, like eggs, dairy foods, and some types of seafood. But today, the science suggests that, for most people, dietary cholesterol (the cholesterol in foods) has only a modest effect on the amount of cholesterol in the bloodstream. In fact, the 2015–2020 Dietary Guidelines for Americans eliminated an earlier recommendation to limit dietary cholesterol to 300 milligrams (mg) per day—although they still suggest caution on overall intake.

Notably, the guidelines did not change the recommendation on saturated fat, which is found mainly in animal-based foods such as meat and dairy—and is often found in high-cholesterol foods. Saturated fat in the diet clearly does raise LDL by a significant amount and should still be consumed in limited quantities. And although some research has cast doubt on the conventional wisdom that saturated fat is linked with heart disease, other research upholds the link.

Foods high in fiber, low in saturated fat can lower cholesterol

While saturated fat and dietary cholesterol both play a role in your cholesterol level, experts stress that the most important dietary change you can make to lower your cholesterol numbers is to adjust the overall pattern of your diet. Best is a diet rich in fruits, vegetables, fish, and whole grains. This helps in two ways. First, the more of these healthful foods you eat, the less you generally consume of foods that are high in saturated fat and highly refined carbohydrates, which both damage the cardiovascular system. Second, high-fiber foods help reduce your cholesterol level by making unhealthy dietary fats harder to absorb from the gut.

This doesn't work for everyone, however. For people at high risk of heart disease, dietary efforts don't come close to lowering cholesterol enough. Other people are genetically predisposed to having high blood cholesterol regardless of what they eat.

To learn more about cholesterol and heart disease, read Managing Your Cholesterol, a Special Health Report from Harvard Medical School.

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