Is cholesterol really bad for your health?

Cholesterol has long been associated with poor eating choices. But new US guidelines say that dietary cholesterol has very little impact on one's health. The author looks at the debate

Photograph: hiwarz/Creative Commons

Cholesterol has, for as long as most of us would remember, been a bad word. Consuming cholesterol-rich food, we've been told, means inviting trouble and playing with the health and well-being of our heart. We have formed such a clear-cut opinion of cholesterol that even the food industry now takes great pains to put the stamp of "no cholesterol" on the items it serves us.

But just when we had it all worked out, the US Dietary Guidelines Advisory Committee has turned the idea of cholesterol upside down. The panel of experts has said that "available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum [blood] cholesterol."

What this means is that the cholesterol we consume in food does not affect the level of cholesterol in our blood. At least that's what existing proof indicates.

This total turnaround is being taken seriously because the guidelines of this committee provide the basis for the US federal food and nutrition policy. This is the committee that gives recommendations that are meant to encourage Americans aged two and above to consume "foods and beverages that help achieve and maintain a healthy weight, promote health, and prevent disease". Earlier dietary guidelines recommended that cholesterol intake should be limited to not more than 300 mg in a day. This time round, the panel has done away with this restriction because "cholesterol is not a nutrient of concern for overconsumption".

So does that mean that red meat, eggs and other high-cholesterol foods that we have always been wary of are not so bad after all? Since the report came out, the conclusion being drawn is that it is safe to consume cholesterol-rich food. It's true that cholesterol has been made out to be a bigger villain than it is, but it is also true that Indians are genetically more prone than Americans to cardiovascular diseases and diabetes. So, they still need to approach cholesterol with some caution.

"Cholesterol is critical for the body," says Ajay Mittal, a cardiologist with Max Super Speciality Hospital in New Delhi. "It is needed for cell regeneration and is used to produce [steroid] hormones needed for the normal development and functioning of the body." The human body, he explains, generates 80 to 85 per cent of the cholesterol. "Only 15 to 20 per cent comes from dietary sources." The body, Mittal explains, has a way of maintaining a healthy cholesterol balance. "If you consume more cholesterol in your diet, the body will produce less to keep the balance healthy," he explains. However, this holds true for people who have normal blood cholesterol levels. Those who have high blood cholesterol levels, suffer from a coronary condition or are diabetic should restrict their consumption of cholesterol-rich food like eggs and red meat, he cautions.

There is a history behind the new US guidelines, adds Aparna Jaswal, senior cardiologist and electrophysiologist at Fortis Escorts Heart Institute in Delhi. Since the 1980s, dietary recommendations have been against the consumption of cholesterol. As a result, sugar consumption had increased. But sugar does not satiate hunger the way cholesterol does. An egg, for example, is more filling than a sweet. So, if you are trying to steer clear of cholesterol, you tend to consume more sugar. "There was perhaps the realisation that the past guidelines have made the population sicker and fatter," explains Jaswal. So, it was thought that maybe easing the cholesterol myth would help people cut down on sugar, she adds. Only a minority of the population, after all, comprises "hyper-responders -- people who will have a problem if they consume an egg daily," she adds.

She too is of the opinion that US dietary recommendations cannot be applied blindly to Indians. Even so, it is incorrect to link all heart diseases with high cholesterol. "About 20 per cent of heart patients who come to me have normal cholesterol levels," says Jaswal. "That's because coronary disease is multi-factorial. Diabetes, hypertension and obesity are the other factors."

Maintaining a healthy cholesterol balance helps. "A person can optimise his or her cholesterol level through regular exercise, lifestyle modifications and a healthy diet that includes fruits and vegetables," says Mittal. The cooking oil you use at home also matters. Jaswal recommends a mix of different kinds of oils to cook your food. "You should be consuming a bit of sunflower oil, which is rich in polyunsaturated fatty acids, some rice bran oil, a bit or corn oil and olive oil," she says. "About 20-30 per cent of your cooking should be done in olive oil."

As for red meat, make that an occasional indulgence -- if your cholesterol levels are normal -- and not a rule.

Cholesterol Count

While the human body cannot do without cholesterol, it is important to maintain healthy blood cholesterol levels. Annual cholesterol screening is recommended for men starting at 40 and for women at 45. If there is a family history of high cholesterol, start the screening earlier.

Screen yourself for high-density lipoprotein (HDL) also called good cholesterol; low-density lipoprotein (LDL) or bad cholesterol; and triglycerides (a type of fat in the blood). Here's what is considered the healthy range:

Total cholesterol:

> Less than 200 mg/dL (milligrams per decilitre of blood): Desirable
> 200-239 mg/dL: Borderline high
> 240 mg/dL and above: High. This doubles the person's risk of heart disease.

LDL or bad cholesterol:

> 70-130 mg/dL: Optimal. The lower the limit, the better it is
> More than 190 mg/dL: Extremely high

HDL or good cholesterol:

> Below 40: Low and, therefore, undesirable
> 60 mg/dL and above: Desirable. The higher the limit, the better it is.

Triglycerides:

> 10-150 mg/dL: Normal. The lower, the better.
> 500 mg/dL and above: Very high and unhealthy

What improves good cholesterol

> Walnuts: High in polyunsaturated fatty acids, they help reduce accumulation of fat around the internal organs. People who include walnuts in their diet tend to feel more satiated.

> Almonds: Their skin helps reduce the risk of developing cardiovascular disease.

> Avocados: Lower "bad" cholesterol and increase "good" cholesterol

> Flaxseed: Rich in Omega-3 essential fatty acids, antioxidants and fibre, this 'wonder food' helps fight heart disease, stroke, diabetes and also cancer. "Called alsi in Hindi, flaxseed is very good and highly underestimated," says Aparna Jaswal of Fortis Escorts.

> Eggs: They might have a bad reputation, but studies indicate eggs boost good cholesterol. Repeated studies have found little or no link between frequent egg consumption and heart disease. "In fact, eggs contain a good amount of essential vitamins and minerals, such as selenium, which has antioxidant properties," says Ajay Mittal of Max Super Speciality Hospital. Eating an egg a day is not a problem and is even recommended if your cholesterol levels are normal, but people with diabetes and heart ailments should go easy on them, says Mittal.

> Dark chocolate: Studies have found that 100 gm a day of dark chocolate, which is rich in antioxidants, raises good cholesterol by 9 per cent.

> Fish: Salmon and trout particularly are good, though they are not easily available everywhere.

> Moderate consumption of alcohol: Drinking a glass of wine improves good cholesterol levels and reduces the risk of heart ailments. "Check your alcohol intake -- no more than 30 ml for women and 60 ml for men," says Jaswal.

> Exercise: "People can optimise their cholesterol levels by exercising regularly and making lifestyle changes," says Mittal. This includes giving up cigarettes and slimming the waistline.

No red meat if...

A person has cardiovascular disease and Type 2 diabetes or is obese. In such cases, a higher intake of vegetables, fruit, whole grain, low-fat dairy and seafood is recommended. Regular consumption of nuts and legumes helps. Go for less red and processed meat, refined grain, sugar-sweetened foods, high-fat dairy products and beverages. Diet lower in saturated fat, cholesterol and sodium and richer in fibre, potassium, and unsaturated fats is advised.