Does dietary cholesterol, e.g. from eggs, actually increase Low-Density Lipoprotein (LDL) levels?

Dietary Cholesterol from Eggs Does Increase LDL Cholesterol, Though Individual Response Varies

Yes, dietary cholesterol from sources like eggs can increase LDL cholesterol levels, although the effect is less pronounced than that of saturated fat and varies significantly between individuals. 1

Impact of Dietary Cholesterol on LDL

• Dietary cholesterol can increase LDL cholesterol levels, though to a lesser extent than saturated fat 1
• The response to dietary cholesterol varies widely among individuals, with approximately 2/3 of the population experiencing minimal changes in LDL levels (normal responders and hypo-responders) 2
• About 1/3 of individuals (hyper-responders) show more significant increases in both LDL and HDL cholesterol when consuming cholesterol-rich foods 2
• The effects of dietary cholesterol on plasma LDL levels appear to be greater at low versus high levels of cholesterol intake 1

Quantifiable Effects on Blood Lipids

• Meta-analysis data shows that adding 100 mg of dietary cholesterol per day increases 3:
  • Total cholesterol by 0.056 mmol/L (2.2 mg/dL)
  • HDL cholesterol by 0.008 mmol/L (0.3 mg/dL)
  • The ratio of total to HDL cholesterol by 0.020 units, which is considered an adverse effect on the cholesterol profile

Eggs and LDL: Complex Relationship

• Eggs are one of the richest sources of dietary cholesterol 4
• Cholesterol-rich foods that are relatively low in saturated fatty acid content (notably egg yolks) have smaller effects on LDL cholesterol levels compared to foods high in both cholesterol and saturated fat 1
• Recent research suggests that saturated fat intake, not dietary cholesterol, is the primary driver of elevated LDL cholesterol 5
• A 2024 study found that consuming 2 eggs daily as part of a low-saturated fat diet actually lowered LDL concentrations compared to a high-saturated fat diet with minimal egg consumption 5
• However, this same study noted that egg consumption may reduce larger LDL particles while increasing smaller, more atherogenic LDL particles 5

Dietary Recommendations

• The American Heart Association recommends limiting dietary cholesterol to <300 mg/day for the general population 1
• For individuals with elevated LDL cholesterol levels, diabetes, and/or cardiovascular disease, a more restrictive limit of <200 mg/day is advised 1
• The AHA's 2006 guidelines recommend limiting saturated fat to <7% of energy, trans fat to <1% of energy, and cholesterol to <300 mg per day 1
• Periodic consumption of eggs and shellfish can be compatible with meeting these dietary guidelines 1

Practical Considerations

• When evaluating the impact of eggs on cardiovascular risk, consider:
  • Individual response to dietary cholesterol (hyper-responder vs. normal/hypo-responder) 2
  • Overall dietary pattern, particularly saturated fat intake 5
  • Presence of other cardiovascular risk factors or existing disease 1
• Eggs also contain beneficial nutrients including lutein and zeaxanthin, which may have protective effects against lipoprotein oxidation 2
• Higher egg intake combined with higher dietary fiber has been associated with the lowest total cholesterol, LDL cholesterol, and LDL-to-HDL ratio in some studies 6

Clinical Approach

• For healthy individuals without cardiovascular disease or diabetes, moderate egg consumption (up to 1 per day) appears to have minimal impact on cardiovascular risk 1, 2
• For those with elevated LDL, diabetes, or established cardiovascular disease, more restrictive limits on dietary cholesterol (<200 mg/day) are warranted 1
• Focus more on reducing saturated and trans fats, which have a greater impact on LDL levels than dietary cholesterol 1, 5
• Consider the entire dietary pattern rather than focusing exclusively on individual foods 1