But you're probably not overdoing it anyway, so just keep up that healthy diet?
Just in case you thought the diet wars had moved on from cholesterol as a battleground, the American Heart Association (AHA) stirred things up again with a new "science advisory."
"The elimination of specific dietary cholesterol target recommendations in recent guidelines has raised questions about its role with respect to cardiovascular disease," the document in Circulation said by way of clearing its throat.
The evidence from observational studies "generally does not indicate a significant association with cardiovascular disease risk," it acknowledged, but most meta-analyses of intervention studies associate higher than average cholesterol intake with elevated total or LDL cholesterol.
Given the weak evidence, the Dietary Guidelines for Americans stopped suggesting a cap on cholesterol intake in 2016, followed by periodic media blitzes on eggs as the poster child for decades of wrong advice as studies continued to volley back and forth.
The American College of Cardiology and AHA were silent on cholesterol intake limits in the 2013 lifestyle guidelines for cardiovascular risk reduction and 2018 cholesterol management guidelines, although the 2019 primary prevention guidelines give a general class IIa recommendation to a reduced-cholesterol diet to decrease atherosclerotic cardiovascular disease.
The new advisory likewise didn't specify how much cholesterol is safe to eat but suggested people limit it anyway through AHA-recommended diet patterns (like the Mediterranean and DASH diets) "that are inherently relatively low in cholesterol with typical levels similar to the current U.S. intake."
In practical terms, the mean U.S. dietary intake was already under the previous federally-recommended limit of 300 mg per day.
Recommendations in the science advisory included:
- Choose liquid nontropical vegetable oils and plant-based protein sources to limit cholesterol intake
- Limit egg yolk intake to "current levels" -- up to the equivalent of a whole egg daily for healthy people or up to two for seniors with normal cholesterol levels
- Shrimp and other shellfish are okay when part of an overall healthy diet focused on other lean or plant-based protein sources
- Vegetarians can include more dairy and eggs in their diets within moderation
- People with high cholesterol, particularly those with diabetes mellitus or at risk for heart failure, should still be cautious about cholesterol-rich foods
Also, "a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement," the AHA advisory acknowledged, "hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health."
Saturated fat and cholesterol often go together, and saturated fat (largely from animal fats) is the bigger concern due to links to cardiovascular risk, it added.
The writing group and reviewers disclosed no relevant relationships with industry.
Source Reference: Carson JAS, et al "Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association" Circulation. 2019; DOI: 10.1161/CIR.0000000000000743.
Read the original article on Medpage Today: Cholesterol Still Not Safe, AHA Says