I have tried to adhere to a low-cholesterol diet and I haven't gotten my cholesterol checked in over 10 years because I didn't want to go on medications and I didn't want to change my diet.
I finally got my cholesterol checked this past week and the verdict is: 205! I am so relieved, this means with making my diet just a bit more rigid, I can go back to the optimal range. I have a VERY VERY high LDL and an okay (not great) HDL level. LDL is what tends to deposit oxidized cholesterol into one's vasculature and HDL can have the capability to remove oxidized cholesterol from the vasculature.
Apparently what happens with me according to this test is I have a very high absorption of fat. This means that what I eat, I absorb. There are many people with low fat absorption. So the amount of nutrition someone else gets from 1 egg yolk, I can get from 1/8 of an egg yolk.
The way this test shows this is with sterols, which are plant-based cholesterols. Mine are through the roof!!! There is a condition called sitosterolemia that I probably have. It is genetic, autosomal recessive meaning my parents were heterozygotes (each containing one normal and one mutant gene). This also explains why my parents and sister all have normal cholesterol, but I have high cholesterol. The genes responsible are the cholesterol transporters that absorb cholesterol from the gut and also pump bile into the gut to assist with fat absorption.
In summary, mutation of these receptors means "defective secretion into the bile of dietary sterols, increased intestinal absorption of plant and dietary sterols, hypercholesterolemia, and early-onset atherosclerosis". The best drug for this specific (uncommon) reason for high cholesterol is one that decreases absorption of cholesterol, ezetimibe.
The alternative is that I can just not eat cholesterol and be extremely conscious that I need to eat about 1/8 the total fat of that others need. I am willing to do this and stay of medications for a bit longer :) But PLEASE don't tell me not to worry about eating a burger with full fat. I need to worry about that. It means the difference between life and death for me.
I will also begin taking Niacin (Vitamin B3) and omega-3 fatty acids, but I will discuss why after my next exam :)