The relationship between dietary cholesterol and blood cholesterol are not clear.
The old guideline was 300 mg per day, but now they just say as little as possible, which is lame and useless. Another guideline is a 200 mg limit for people with known heart disease issues.
In general, dietary cholesterol is closely associated with saturated fat intake, so if you keep close watch on the latter, you should be ok with cholesterol. This is all about meat and dairy consumption. So, keep your eyes on saturated fat and cholesterol will go along for the ride.
Consider this statement, which puts a different spin on things:
“Saturated fat increases blood cholesterol and heart disease risk much more than dietary cholesterol.”
The wild card are eggs, One egg has 150 to 200 mg of cholesterol! If you are going to eat eggs, just don't eat them with bacon and sausage! You could (in theory) eat an egg a day and stay under the 300 mg limit, but I don't think that would be a good idea. I am thinking of limiting myself to one egg per week. Most of that cholesterol is in the yolk.
And here is another spin on eggs. Although they are high in cholesterol, they are low in saturated fat (one egg has only 8 percent of your daily saturated fat quota). So if your blood cholesterol levels are OK, feel free to eat up to one egg per day!
As much as I would like a hard number or definite guidelines (and I am going to work up my own regardless of the double-talk from the experts), we are faced with another issue. The body generates cholesterol (in the liver we presume) and needs a certain amount of it to build cells and such. As people age, they tend to have higher blood cholesterol levels (presumably with the same diet). Cholesterol levels also may be affected by what good things we eat, maybe as much as what bad things we don't.Pre-2015 his total cholesterol = 200+, typical LDL = 140+ 2017 with diet and mediocre med compliance, total = 159, LDL = 95 2025 with diet and diligent med compliance, total = 117, LDL = 55What I take from this is that diet only got him half way to where he is now.
What I find exciting is that he has reduced his LDL from 140+ to 55 -- exactly what I hope to duplicate.
In fact he says that in 2015 they did a contrast enhanced CT scan and observed 50 percent blockage in some arteries. Now in 2025, they did a scan and see 32 percent blockage, so his reduction of cholesterol has really paid off. In particular he no longer experiences angina during strenuous exercise like he once did.
Dave also takes a medication called Zetia (ezetimibe). What I read is that Zetia works in the intestines to inhibit the digestive tract from taking in dietary cholesterol. This would seem almost belt and suspenders given Daves careful attention to diet.
Dave says he once took Rosuvastatin, but switched to Atorvastatin after having side effects of weakness in his Quad muscles. No problem with Atorvastatin. He describes the side effects as: "feelings of vague weakness and discomfort in my quads".
Also he now takes 20 mg -- he used to be on 10 mg, but his doctor wanted to see if bumping up the dose improved LDL levels without side effects. Dave says it did (lowering them by 10) without noticing any side effects.
Dave sees Gundeep Singh at Marshall Cardiology on E Glenn and likes him a lot.
Both of these work in the liver by inhibiting an enzyme called HMG-CoA reductase. Apparently the liver uses this enzyme to manufacture cholesterol, which it needs to do -- but not too much of it.
So, why Rosuvastatin instead of the wildly popular Atorvastatin? I read that "R" is more effective than "A" in reducing LDL levels and is generally considered to be more potent.
Rosuvastatin has been associated with a higher risk of developing new-onset diabetes mellitus requiring medication and cataract surgery, while Atorvastatin may be linked to a higher risk of muscle pains and memory loss.
Nothing is without risk and you have to balance benefits against risk.
Tom's home page / tom@mmto.org