Common Misconceptions About Cholesterol

Cholesterol can be both good and bad, so it's important to learn the facts about what cholesterol is, how it affects your health and how to manage your blood cholesterol levels. Here are some common misconceptions, along with the true story, about cholesterol.

1. My choices about diet and physical activity are responsible for my cholesterol level.
2. Using margarine instead of butter will help lower my cholesterol.
3. Thin people don’t have to worry about high cholesterol.
4. My doctor hasn’t said anything about my cholesterol, so I don’t have to worry.
5. Since the nutrition label on my favorite food says there’s no cholesterol, I can be sure that it’s a “heart-healthy” choice.
6. Since I started taking medication for my high cholesterol, I don’t have to worry about what I eat.
7. I recently read that eggs aren’t so bad for your cholesterol after all, so I guess I can go back to having my two eggs for breakfast every morning.
8. I’m a woman so I don’t have to worry about high cholesterol. It's a man’s problem.
9. You don’t need to have your cholesterol checked until you reach middle age.

1. My choices about diet and physical activity are responsible for my cholesterol level.
Diet and physical activity contribute to overall blood cholesterol levels as well as the cholesterol that is made naturally by the body. The amount of LDL (bad) cholesterol in the blood is controlled in two important places — the liver and the intestines. The liver produces cholesterol (using it to make digestive — or bile — acids) and also removes cholesterol from the blood. The intestines absorb cholesterol, which comes from food and from bile. For some people, the liver produces more cholesterol than the intestines absorb. If this is the case for you, your physician may prescribe medicine to manage your cholesterol. However, a heart-healthy diet and regular physical activity are important to everyone for maintaining cardiovascular health. Have your cholesterol tested and work with your healthcare professionals on the plan that's best for you. Learn more about the sources of cholesterol.

2. Using margarine instead of butter will help lower my cholesterol.
Both margarine and butter are high in fat, so use both in moderation. From a dietary perspective, the major factor affecting blood cholesterol is how much saturated fat and trans fat is in the food. Limiting food high in saturated fat and trans fat may help lower your LDL (bad) cholesterol. Most vegetable oils and soft or liquid margarines have less saturated and trans fat than the solid spreads have, and are preferable to the stick forms of margarine for a heart-healthy diet. When selecting a margarine, it's best to choose one that has “0 g trans fat” on the Nutrition Facts label.

Remember that one change — like switching from butter to soft margarine — is a good step, but may not be enough to reduce your cholesterol to healthy levels. Other diet and lifestyle changes or medication may be needed, as your doctor recommends. Learn more about eating a healthy diet.

3. Thin people don’t have to worry about high cholesterol.
Any type of body can have high cholesterol. Overweight people are more likely to have high cholesterol, but thin people should also have their cholesterol checked regularly. Often people who don’t gain weight easily are less aware of how much saturated and trans fat they eat. Nobody can “eat anything they want” and stay heart healthy. Have your cholesterol checked regularly regardless of your weight, physical activity and diet. Learn more about what you can do to manage your cholesterol levels.

4. My doctor hasn’t said anything about my cholesterol, so I don’t have to worry.
Your health is your responsibility. Ask your healthcare professional if your cholesterol needs to be tested. Learn how to interpret all the numbers, including HDL (good) cholesterol, LDL (bad) cholesterol and triglyceride levels. If you’re in a high or borderline-high range, discuss options with your physician. Depending on your risk profile and your cholesterol levels, your doctor may recommend diet and lifestyle changes and/or medication. Follow all of your doctor's instructions, and have your cholesterol retested as your doctor recommends. See a list of questions to ask your doctor about cholesterol.

5. Since the nutrition label on my favorite food says there’s no cholesterol, I can be sure that it’s a “heart-healthy” choice.
Nutrition labels on food are very helpful when choosing heart-healthy foods, but you need to know what to look for. Many “low-cholesterol” foods contain high levels of saturated fat and/or trans fat — both of which contribute to high blood cholesterol. Even foods that claim to be “low-fat” may have a higher fat content than expected. Look for the amount of saturated fat, trans fat, cholesterol and total calories in a serving of the product. Also check how much a serving is. Often it’s smaller than you think. The first ingredient listed is the one used most in the product, so choose products where fats and oils appear later in the ingredient listing. The Food and Drug Administration now requires foods to be labeled for trans fats. Trans fats are found in variable amounts in most foods made with partially hydrogenated oils such as baked goods, cakes, cookies, crackers, pastries, pies, muffins, doughnuts, fried foods, shortening and some margarines and dairy products. Know your fats.

6. Since I started taking medication for my high cholesterol, I don’t have to worry about what I eat.
Drug therapy is usually prescribed for those who — despite adequate dietary changes, regular physical activity and weight loss — still have elevated levels of cholesterol, or those who have elevated risks for heart disease and stroke. Modern medications have come a long way in helping to control blood cholesterol levels, and some can target the cholesterol that your body makes on its own. But making diet and lifestyle changes — as well as taking the medication your doctor prescribes — is the best way to help prevent heart disease. You should still eat a heart-healthy diet and get at least 30 minutes of moderately vigorous physical activity on five or more days of the week. It’s also very important to take your medication exactly as your doctor has instructed so it can work most efficiently. Get tips for taking your medicines.

7. I recently read that eggs aren’t so bad for your cholesterol after all, so I guess I can go back to having my two eggs for breakfast every morning.
One egg contains about 213 milligrams of dietary cholesterol. The daily recommended cholesterol limit is less than 300 milligrams for people with normal LDL (bad) cholesterol levels. An egg can fit within heart-healthy guidelines for those people only if cholesterol from other sources — such as meats, poultry and dairy products — is limited. For example, eating one egg for breakfast, drinking two cups of coffee with one tablespoon of half-and-half each, lunching on four ounces of lean turkey breast without skin and one tablespoon of mayonnaise, and having a 6-ounce serving of broiled, short loin porterhouse steak for dinner would account for about 510 mg of dietary cholesterol that day — nearly twice the recommended limit. If you’re going to eat an egg every morning, substitute vegetables for some of the meat, or drink your coffee without half-and-half in the example above. And remember that many other foods, especially baked goods, are prepared with eggs — and those eggs count toward your daily cholesterol limit. People with high LDL blood cholesterol levels or who are taking a blood cholesterol-lowering medication should eat less than 200 mg of cholesterol per day. Learn more about cooking for lower cholesterol.

8. I’m a woman so I don’t have to worry about high cholesterol. It's a man’s problem.
Premenopausal women are usually protected from high LDL (bad) levels of cholesterol, because the female hormone estrogen tends to raise HDL (good) cholesterol levels. But cholesterol levels tend to increase as you age, and postmenopausal women may find that even a heart-healthy diet and regular physical activity aren’t enough to keep their cholesterol from rising. If you’re approaching menopause, it’s especially important to have your cholesterol checked and talk with your doctor about your options. You may still have high cholesterol levels even if you eat a heart-healthy diet, stay active, watch your weight and don't smoke or breathe others' smoke. If lifestyle changes alone don't work, your doctor may prescribe a cholesterol-lowering medication — be sure to take it as instructed. Learn more about women and cholesterol.

9. You don’t need to have your cholesterol checked until you reach middle age.
Everyone should start getting a cholesterol test at age 20, but it’s a good idea to start having cholesterol checked at an early age. Even children, especially those in families with a history of heart disease, can have high cholesterol levels. And evidence exists that these children are at greater risk for developing heart disease as adults. Lack of regular physical activity, poor dietary habits and genetics can all affect a child’s cholesterol levels. Parents and caregivers can help kids develop a heart-healthy lifestyle by serving foods low in saturated fat, trans fats and cholesterol; encouraging at least 60 minutes of physical activity on most (and preferably all) days; and stressing the importance of avoiding tobacco products. Learn more about safe levels of cholesterol in children.

This content is reviewed regularly. Last updated 04/04/08.

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