May 31, 2025

Nutrition -- Cholesterol

How much is too much? There have been various guidelines, such as 200 mg or 300 mg per day. The current guideline is "as little as possible", which I think is indeed what a person ough to shoot for (i.e. shoot for 0).

The main source of dietary cholesterol is eggs. The eggs people have a powerful lobby that spends lots of money to try to change the idea that eggs are bad for heart health.

What you will hear is that the relationship between dietary cholesterol and blood cholesterol levels is "unclear".

I read in other soures that the only way to produce atherosclerosis in herbivores is to feed them cholesterol. So there is a clear link between dietary cholesterol and heart disease.

I cited an article by the American Heart Association that had the "muddy the water" statements about dietary cholesterol, only to have a friend tell me to be cautious about statements from the AHA as they may be taking money from the Egg Council.
The following article is exactly this kind of misleading information (or lack thereof):

So here are some facts. A single egg has 150 to 200 mg of cholesterol! You may read that eggs are typically consumed with high saturated fat items like bacon and sausage, but I find it hard to sweep the idea of 200 mg of cholesterol under the rug. Especially when I am aiming to limit my saturated fat to 10 mg per day!

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.

Update 6-28-2025 after a talk with my friend Dave

Dave is a great source of information. He is exactly my age, is active like me (even more so), and seems to have very similar heart problems. He is addressing cholesterol via a combination of diet and statins. In 2015 he began to experience angina and began dealing with his heart. 
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 = 55
What I take from this is that diet only got him half way to where he is now.
Some people would say LDL less than 100 is your target.
Dave says that he wants less than 75, as that has been shown to actually allow resorption of non-calcified artery deposits.

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.

Statins

My doctor has prescribed Rosuvastatin (Crestor) 10 mg for me. The other, perhaps more common statin is Atorvastatin (Lipitor).

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.

A big mistake would be to take statins and then feel that you could continue to eat a normal American diet. Why not attack cholesterol with a combination of diet and statin drugs.
Have any comments? Questions? Drop me a line!

Tom's home page / tom@mmto.org