Concerns about eating eggs appear to have faded from public consciousness in recent years. But has the way people think about eggs changed? According to nutritionists, this is not the case.
“The egg issue remains relevant,” says Linda Van Horn, professor and chief of the nutrition division in Northwestern University’s Feinberg School of Medicine’s Department of Preventive Medicine.
“The choices to eat eggs remain especially important” for those who are already at risk for heart disease and diabetes.
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While eating too many eggs is still dangerous, you do not have to give them up entirely. The amount you can consume is determined by your health status. The American Heart Association recommends eating up to one egg per day for the majority of people, fewer for those with high blood cholesterol, particularly those with diabetes or at risk of heart failure, and up to two eggs per day for older adults with normal cholesterol levels and a healthy diet.
The misconception that some people have — that eggs can now be consumed freely as experts began to emphasise less the cardiovascular effects of cholesterol-containing products like eggs and more the risks posed by other foods in the American diet. They targeted foods high in saturated fats, such as red meat, which actually pose a greater risk of raising cholesterol.
However, the fundamental truth about eggs remains the same. You must continue to be cautious.
“Back in the 1960s and ’70s, eggs were seen as Public Enemy No. 1 for the heart, largely because scientists had discovered that high blood cholesterol levels raise the risk of heart disease, and eggs are high in cholesterol,” says Bonnie Liebman, nutrition director at the Center for Science in the Public Interest.
“However, the saturated fat in foods like red meat, butter, cheese, and other full-fat dairy raise blood cholesterol more than the cholesterol in eggs. So eggs initially got more than their share of the blame than they deserved.”
It’s critical to understand the difference between dietary cholesterol, which is the amount of cholesterol already present in food before it’s consumed — for example, eggs or shrimp — and serum (or blood) cholesterol, which is low-density lipoprotein, or LDL cholesterol (the “bad” cholesterol), which the body produces through the action of saturated fats.
“This is the concept that people often don’t get, which is that saturated fat will raise serum cholesterol in the body more than dietary cholesterol,” says Donald Hensrud, associate professor of preventive medicine and nutrition at the Mayo Clinic College of Medicine and consultant to the Mayo Clinic’s division of general internal medicine.
“Saturated fat is the main dietary nutrient that raises serum cholesterol.”
Van Horn agrees. “Saturated fat has twice the LDL cholesterol raising effect as dietary cholesterol, but the two together further complicate the risk,” she says.
“The two together are synergistically bad for raising LDL cholesterol.”
Thus, you may occasionally consume eggs with a high dietary cholesterol content. However, avoid the bacon, sausage, and buttered toast that frequently accompany them. Consuming those with your eggs puts you in danger.
(Note that saturated fats are not to be confused with trans fats, which are also unhealthy and raise LDL cholesterol.) Artificial trans fats are the result of a process in the food industry in which hydrogen is added to vegetable oil. The Food and Drug Administration prohibited companies from adding artificial trans fats to foods beginning in 2018, despite the fact that trans fats occur naturally in high-fat meat and dairy products, which also contain significant amounts of saturated fat.)
The public’s confusion about dietary cholesterol most likely developed as a result of the fact that two sets of US Dietary Guidelines released in 2015 and 2020 failed to emphasise the dangers of dietary cholesterol, in contrast to the 2010 recommendations. (Guidelines are updated on a five-year cycle.)
Rather than that, the 2015 guidelines said that dietary cholesterol was no longer a “nutrient of concern,” while emphasising that “this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns.”
According to many experts, the change recognised that Americans’ dietary cholesterol intake had already fallen below the recommended 300 milligrammes per day, negating the need for additional recommendations.
The 2020 guidelines encourage Americans to consume as few saturated, trans, and dietary fats as possible without sacrificing nutrition.
Experts advise caution when it comes to eggs if you have high LDL cholesterol, hypertension, or diabetes. Recent research has reaffirmed the dangers of egg consumption for cardiovascular health and overall mortality risk. (One egg contains approximately 185 mg of dietary cholesterol, all of which is found in the yolk; therefore, if you want to be safe, stick to the all-protein egg white.)
“Eggs are a wonderful source of dietary protein for someone who is not overweight, has no family history of heart disease or other risk factors,” says Van Horn, who co-wrote one of the recent studies and chaired the 2010 guidelines advisory committee.
“This changes if you are 55 or older and you have an LDL over 150, have hypertension, are taking a [cholesterol-lowering] statin and are overweight. If you have risk factors, I would have no more than two or three [yolks] a week. If you have no risk factors, eating four or five egg yolks a week is unlikely to be detrimental, as long as you can eat them without the typical high saturated fat that usually accompanies them, like bacon, sausage or buttered toast.”
These breakfast additions, high in saturated fat, create “the perfect storm,” says Van Horn, who also served as a member of the 2020 dietary guidelines advisory committee. “A cholesterol bonanza.”
Taking antihypertensives and cholesterol-lowering medications does not eliminate the risk, she says, because the study discovered that eating eggs increases the risk of dying from any cause, not just cardiovascular disease.
The majority of nutrition experts believe that the American Heart Association’s recommendations represent a prudent course of action.
“I think [they are] reasonable,” Liebman says. “Most people are not likely to go back to eating two eggs every morning for breakfast, like many folks did in the 1950s.”
According to Liebman, the most effective way to lower blood cholesterol is to substitute unsaturated fats such as those found in fish, nuts, avocado, and most oils except palm and coconut.
Moreover, she says most health authorities recommend “a healthy dietary pattern, rather than focus on a few foods like eggs,” she says.
“That pattern, often described as a Mediterranean-style or DASH-style diet, is rich in fruits, vegetables, whole grains, low-fat or fat-free dairy, seafood, poultry, nuts, seeds and liquid vegetable oils, and low in red and processed meats, refined grains and added sugars.”
Freeman, however, advises his patients to completely give up eggs.
“One egg isn’t going to kill you on the spot, but why eat something that adds even a tiny bit of risk?” he says. “Risk is cumulative.”
He suggests eating egg whites or egg substitutes, including plant-based alternatives.
“They are tasty and satisfying,” he says.
“Put them on a slice of whole grain bread with some cucumber and sprouts, and you have something absolutely delicious.”
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Not everyone is willing to go that far.
“I like eggs,” Van Horn says.
“My family likes eggs. I don’t have any trouble feeding my family eggs — but I know the overview of everything they eat. A couple of eggs periodically isn’t going to be harmful. But you will never find sausage or bacon in my house.”
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