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Of all the metabolic concerns associated with excess weight and obesity, serum or blood cholesterol is one of the best measures to predict heart disease. Levels are well-defined and well-understood and can easily be measured in patients of all ages. This is quite distinct from high blood pressure, which, while also predictive heart disease, is much harder to accurately pinpoint since it fluctuates so dramatically from one hour to the next due to different emotions or life events and even simply the setting that you’re in – yes, higher blood pressure at your doctor’s office is a thing.
What Is Serum Cholesterol, and Why Does It Matter?
Serum cholesterol measures lipid or cholesterol levels (a type of fat) circulating in the blood. This fat is easily measured using a simple blood test, typically at your annual visit to your primary care doctor. Within the total cholesterol number are three significant markers: HDL or high-density lipoproteins, which represent good cholesterol; LDL or low-density lipoproteins or bad cholesterol; and triglycerides, which are fats bundled with cholesterol. A total cholesterol reading of over 200 signifies hyperlipidemia or high cholesterol. It increases the risk of cardiovascular disease, including atherosclerosis or the narrowing of the arteries due to plaque buildup on the walls of these blood vessels.
There are many causes of high cholesterol, but we know that consuming too much saturated fat is certainly one of them. Other causes may be genetic—many people will find that their family members have had chronically high cholesterol their entire lives. This does not mean the cholesterol should not be controlled, but it is something to mention to your cardiologist and may slightly alter the treatment plan. The amount of dietary cholesterol consumed, on the other hand, is one thing we now know does not affect serum cholesterol.
The Skinny on Dietary Cholesterol
Unfortunately, many patients do not realize that dietary cholesterol does not affect blood cholesterol. This is partly because “cholesterol” is still listed on nutrition labels with upper limits and negative connotations. If it does not affect our health, why would it be on there? Well, the standards for nutritional labels haven’t been updated in quite some time, and some old assumptions still exist.
Some foods that are high in dietary cholesterol are some of the healthiest for us. Eggs, for example, have a good amount of dietary cholesterol, yet they represent an excellent source of protein and a relatively low caloric load. Similarly, shellfish can be an excellent source of lean protein, which many people might avoid because they’re concerned about their high dietary cholesterol levels. These foods represent excellent options, especially for people with heart disease.
Does That Mean We Can Eat as Much as We Want?
While different macronutrients may have varying health effects, a calorie is still a calorie. Granted, you’re better off consuming a calorie of lean protein than a calorie of saturated fat, but too much of a good thing is not ideal. As such, we tell all our patients that moderation is vital. Maintaining a healthy weight and ensuring balanced muscle tone and blood markers long into middle age and later is important.
The Bottom Line
Dietary cholesterol is often found in highly processed foods, and these should be avoided, not because of the cholesterol but rather all the other detrimental ingredients they contain. On the other hand, healthy protein-filled foods like eggs and shellfish have high levels of dietary cholesterol yet are exceptionally healthy for us. Ultimately, stick to your intuition by eating well, exercising, and enjoying what you eat while eliminating the worst offenders in our diets, including sugar and saturated fat.