Eggs and Cholesterol and Heart Disease Risk…Oh My!
That eggs NO LONGER belong in a heart-healthy diet is what some are concluding from a study published in March 2019.
The study, Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality, asked the question: “Is consuming dietary cholesterol or eggs associated with incident cardiovascular disease (CVD)…? ” And the study’s answer was: “Among US adults, higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of incident CVD…”
So asked and answered, right?
Well, not exactly. Some say YES—eggs are now considered not heart-healthy given this study. Others say MAYBE—and that more work needs to be done.
To understand what’s going on, let’s start with what exactly was learned from the study. Nicholas Bakalar’s March 15, 2019 article, Are Eggs Bad for Your Heart Health? Maybe, in the New York Times included a very clear explanation of the results:
“The new analysis looked at data from six large prospective studies involving almost 30,000 participants, with an average follow-up of more than 17 years. It found that for each additional 300 milligrams a day of cholesterol in the diet, there was a 17 percent increased risk of cardiovascular disease and an 18 percent increased risk of premature death from any cause.”
His article goes on to explain what that means:
“The study findings are observational and cannot establish cause and effect. But no matter how heart-healthy the rest of a person’s diet, the more eggs consumed, the greater the risk for cardiovascular events, coronary heart disease, stroke, heart failure and premature death. The same was true for dietary cholesterol, independent of other dietary characteristics: The more cholesterol in your diet, the higher the risk for disease.”
So eggs = bad. Dietary cholesterol = bad? Right?
It seems so. The latest thinking now—for anyone with high cholesterol looking to minimize heart disease risk, or anyone who wants to eat heart-healthy—is to consume as little dietary cholesterol as possible.
And if this sounds like a total reversal from the latest nutritional guidelines, that’s because it kind-of is. In 2015, when the latest Dietary Guidelines for Americans was published, eggs were deemed a healthy source of protein and part of a heart-healthy diet.
So what on earth happened?
Let’s start with the change made in 2015. The 2015-2020 Dietary Guidelines for Americans actually removed the prior restriction of dietary cholesterol to 300 mg per day…AND included eggs as part of a “healthy eating pattern.” Specifically, these Guidelines state that “A healthy eating pattern includes (among other things):
A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products.”
Thus, eggs, in 2015, were ‘declared’ healthy and the set target for daily consumption of dietary cholesterol was removed. But that was not the whole story, which is why I’m calling this a just a ‘kind-of’ reversal. Because even back in 2015, the Guidelines did state that limiting dietary cholesterol consumption was still important. Harvard School of Public Health’s The Nutrition Source article made clear the Guideline change did not affect the recommendation to eat as little dietary cholesterol as possible:
“The 2010 Dietary Guidelines recommendation to limit consumption of dietary cholesterol to 300 mg per day is not included in the 2015 edition, but the new guidelines note that “this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the IOM, individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.”
So while the daily consumption limit was removed in the 2015 guidelines, it was still recommended that consumption of dietary cholesterol (and eggs are one of biggest sources) should be limited.
It will be interesting to see if the Dietary Guidelines for Americans are updated…and whether in the next publishing of the Guidelines, a limit to dietary cholesterol is reinstated.
So what does all this mean? Can you eat eggs if you have high cholesterol?
WebMD’s Are Eggs the Cholesterol Enemy Again? also provided excellent perspective about this study and why it’s important to reconsider eggs and dietary cholesterol. Among other excellent information, this article quotes Leslie Cho, MD, director of the women’s cardiovascular center at the Cleveland Clinic in Ohio:
“The totality of evidence is pretty clear,” she says. “Eat mostly vegetables and try to limit the amount of saturated fat and dietary cholesterol,” including eggs and other products with animal fat, says Cho, who was not involved in the study.”
To me, that says it all.