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Inherited cholesterol facts
  • People with familial hypercholesterolemia (FH) are at greater risk of heart disease
  • 1 in 250 people in the UK are believed to have FH 
  • Over 260,000 people in the UK may have FH, with fewer than 10% diagnosed
  • 56,000 children in the UK may have FH but only 600 of these are known

The myth of dietary cholesterol

Everyone knows that egg yolk is rich in cholesterol. It’s needed for the young chick to develop and grow.  But one of the most common questions we get asked on the HEART UK Cholesterol Helpline is “If I have high cholesterol can I eat eggs?

HEART UK’s advice on this sticky question has always remained the same.  For the majority of people with raised cholesterol there is no reason to limit cholesterol containing foods that are otherwise low in saturated fat.  Why? Because the focus of our dietary advice is to lower saturated fat and replace it with healthy calories from unsaturated fats and wholegrain foods.  This is because saturated fat has a greater influence on cholesterol levels than eating the foods that contain cholesterol.   

So where has the advice to restrict eggs come from?

The myth that dietary cholesterol is to blame for raised blood cholesterol has been around for some time.  It has even infiltrated dietary guidelines.  In particular the USA have long advised the restriction of dietary cholesterol to below 300mg per day.  However last year their advisory committee said that cholesterol restriction was not necessary and that instead saturated fats are to blame for high cholesterol.  Their report provides the basis for the updated 2015 Dietary Guidelines from the U.S. Department of Agriculture.

So what of UK Dietary Guidelines?  UK Dietary Guidelines don’t recommend a cholesterol restriction.  However there is one exception: Clinical Guideline 71 (CG71) - Identification and management of familial hypercholesterolaemia (FH) recommends dietary cholesterol should be restricted to less than 300mg per day.  This is in line with HEART UK advice for people with FH.  Why? Well, even though dietary cholesterol has only a small effect on blood cholesterol, for people with FH a modest of dietary cholesterol seems sensible. 
Where is dietary cholesterol found?       

All animal foods contain some dietary cholesterol, but eggs, shellfish and organ meats are particularly rich sources of cholesterol. 

Foods that contain cholesterol
Foods that are rich in saturated fat and contain cholesterol Foods low in saturated fat but rich in cholesterol

Full cream dairy foods such as milk, cheese, yoghurt, cream

Animal fats - butter, ghee, margarines and spreads made from animal fats, lard, suet, dripping

Fatty meat and processed meat products 

Lean meat especially offal: liver, kidney, sweetbreads, heart, tripe

Prawns, crab, lobster, squid, octopus, cuttlefish

Egg yolk  

Following a cardio-protective diet (low in saturated fat) will naturally restrict cholesterol from these sources Most people do not need to restrict these foods 

So the good news is that most of us don’t need to worry about having an egg for breakfast, or enjoying shellfish more often.  In fact according to UK dietary surveys our average cholesterol intake is only around 300mg per day anyway.  Of more concern is our saturated fat intake which continues to exceed UK  Dietary Recommendations. 

A word about Liver 

Liver is a lean meat and a great source of vitamins and minerals such as iron, copper, zinc,  and vitamins A, B and D.  In fact the levels of vitamin A are so high that there are concerns that regular consumption could lead to a build-up of vitamin A in the body and cause problems in some groups of the population.
The Department of Health advice is to limit liver and liver pate to no more than one portion per week and (if you do eat liver) to avoid any supplements that also contain A in the form of retinol.  Pregnant women or those planning to conceive should avoid liver, liver pate and retinol containing supplements completely.   Visit the Department of Health guidance on liver.