The cholesterol number on a food label matters, but it does not tell the whole story. For most people, saturated fat and the overall eating pattern have a greater effect on LDL cholesterol.

If you have ever checked a carton of eggs or a package of shrimp and wondered whether the cholesterol number should make you put it back, you are not alone. Nutrition advice around cholesterol has changed over the years, and the headlines have not always made the answer clearer.

Here is the short answer: dietary cholesterol is not the same as the cholesterol measured in your blood. For many people, the amount of saturated fat they eat and the overall quality of their diet have a bigger effect on LDL, often called bad cholesterol. Still, dietary cholesterol is not something everyone should ignore. Your health history and cholesterol levels matter.

Dietary cholesterol and blood cholesterol are different

Cholesterol is a waxy substance your body needs to build cells and make hormones and vitamin D. Your liver produces the cholesterol your body needs. Dietary cholesterol is the cholesterol found in foods from animals, including meat, poultry, seafood, eggs and dairy products. Plant foods do not contain cholesterol.

Blood cholesterol is carried through your bloodstream in particles called lipoproteins. Low-density lipoprotein, or LDL, can contribute to plaque buildup in the arteries when levels are too high. High-density lipoprotein, or HDL, helps carry some cholesterol back to the liver. A cholesterol blood test is the only way to know your numbers.

Does dietary cholesterol raise blood cholesterol?

It can, but the effect varies from person to person. For most healthy adults, dietary cholesterol has a smaller effect on LDL cholesterol than saturated and trans fats. That is why current guidance focuses less on counting every milligram of cholesterol and more on the quality of the entire eating pattern.

The American Heart Association’s guidance on dietary cholesterol emphasizes a pattern rich in vegetables, fruits, whole grains, beans, nuts, seeds, lean proteins and unsaturated fats. Healthy adults may be able to include up to one whole egg a day as part of that pattern, but people with high LDL cholesterol, diabetes or other cardiovascular risks may need more individualized advice.

The number that deserves more attention

If you are scanning a Nutrition Facts label, start with saturated fat. Eating too much saturated fat can raise LDL cholesterol. Common sources include fatty and processed meats, butter, cream, full-fat dairy products, coconut oil, palm oil and many baked or fried foods.

The current federal Dietary Guidelines recommend keeping saturated fat below 10% of daily calories. The American Heart Association recommends a heart-healthier target of less than 6%. For someone eating about 2,000 calories a day, that is roughly 13 grams of saturated fat. Your personal target may be different, especially if you are working to lower LDL cholesterol.

Quick label tip The FDA considers 5% Daily Value or less to be low and 20% or more to be high. Compare similar products and choose the one with less saturated fat when you can.

How to read a food label for heart health

Instead of judging a food by one number, look at the label in this order:

• Serving size. Everything else on the label is based on this amount. If you eat two servings, you are getting twice the listed calories and nutrients.
• Saturated fat. Compare the grams and % Daily Value between similar foods. Lower is generally better for LDL cholesterol.
• Trans fat. Keep intake as low as possible. Trans fat raises LDL cholesterol and is not part of a heart-healthy eating pattern.
• Dietary fiber. Foods such as oats, beans, lentils, fruit and vegetables provide fiber. Soluble fiber can help reduce the amount of cholesterol absorbed in the digestive tract.
• The bigger picture. Added sugar, sodium, calories and the ingredient list also matter. A food can be low in cholesterol and still be highly processed or high in saturated fat.

What about eggs and shrimp?

Eggs and shrimp are often singled out because they contain dietary cholesterol. That does not automatically make them poor choices. Shrimp is relatively low in saturated fat, and eggs provide protein and several important nutrients. How they are prepared and what you eat with them can make a meaningful difference.

An egg cooked in olive oil and served with oatmeal or fruit is a different meal from eggs served with bacon, sausage, buttered biscuits and gravy. The same is true for grilled shrimp compared with deep-fried shrimp. Think about the entire plate, not one ingredient in isolation.

Who should pay closer attention to dietary cholesterol?

Talk with your healthcare provider or a registered dietitian about a personalized plan if you have:

• High LDL cholesterol or a history of very high cholesterol
• Familial hypercholesterolemia or a strong family history of early heart disease
• Heart disease, stroke or peripheral artery disease
• Diabetes, chronic kidney disease or multiple cardiovascular risk factors
• Specific dietary instructions from your healthcare provider

Food choices are only one part of cholesterol management. Regular activity, avoiding tobacco, maintaining a weight that supports your health and taking prescribed medication can also be important. Do not stop a cholesterol medication because you have changed your diet unless your healthcare provider tells you to do so.

Simple swaps that can support healthier cholesterol

• Use olive, canola or another liquid non-tropical vegetable oil instead of butter, lard or coconut oil more often.
• Choose fish, beans, lentils, skinless poultry and lean cuts of meat in place of fatty or processed meats.
• Add oats, beans, fruit and vegetables to increase soluble fiber.
• Choose cooking methods such as baking, grilling, roasting or steaming instead of deep-frying.
• Compare labels and select the option with less saturated fat when products are otherwise similar.

The bottom line

Do you need to pay attention to the cholesterol in food? Yes, but it should not be the only number guiding your choices. For most people, saturated fat, fiber and the overall eating pattern deserve more attention than dietary cholesterol alone.

If your cholesterol is high or heart disease runs in your family, ask your healthcare provider what targets are right for you. A simple blood test and an honest conversation about your habits can help turn confusing nutrition advice into a plan that fits your life.

Have questions about your cholesterol numbers? West Tennessee Medical Group Cardiology can help you understand your risk and the next steps. Call 731-541-5000.

Learn more about West Tennessee Medical Group Cardiology.

This article was originally published on September 8, 2021