For decades it was believed that eating eggs and other foods high in dietary cholesterol will clog your arteries and increase the risk of heart disease. Initially maligned as harmful, in 2013, the American Heart Association did admit that dietary cholesterol found in eggs and shellfish was “no longer a nutrient of concern.” This came on the heels of studies showing no associative risk with increased egg consumption.
The many years of research that failed to show a relationship between the amount of dietary cholesterol and the risk of heart disease, resulted in the U.S. finally removing any restriction on dietary cholesterol from its nutrition guidelines in 2016.
Yet, that hasn’t stopped the debate!
The Paleo diet has always emphasized the importance of naturally occurring, well-sourced fats as a healthy and necessary component of your diet. Nevertheless, you may have been surprised to see a recent batch of headlines once again claiming that eating too many eggs (and too much of the cholesterol they contain) increases the risk of cardiovascular events and early death.
The study, which looked at the association between egg consumption and cholesterol levels, has been in the media a lot recently, with headlines in major publications proclaiming
The New York Times shouted 'Are Eggs Bad For Your Health? Maybe'
Newsweek asked 'How Many Eggs Should I Eat? Huge study links dietary cholesterol to heart disease'
Along with others, including
- Eating as few as three eggs a week raises risk of heart disease
- Eggs, cholesterol tied to higher risk of heart disease
- Egg consumption tied to higher heart disease and death risk
With proclamations like those, it is no wonder people may be confused and possibly even concerned.
Delving a little deeper, the reality and findings of the study are a lot less exciting.
This is what we know about eggs:
Eggs are nutrient powerhouses containing protein, lutein, zeaxanthin, vitamins A, D, E, B12, folate, choline, zinc, and iron.
Eggs have been vilified in the past due to their cholesterol content, which is between 200 mg - 300mg per egg. Studies have shown that dietary cholesterol has little effect on blood cholesterol except in the few people referred to as hyper responders. Most people can tolerate eggs and dietary cholesterol well.
When you eat cholesterol, it does not have an impact on your lipid levels or your heart disease risk. Research has shown that the majority of patients hospitalized for a heart attack had normal cholesterol levels that would not indicate any risk for a cardiovascular event. ⠀
In fact, cholesterol is essential. It is used to produce vitamin D and hormones including estrogen and testosterone. Cholesterol is part of your cell membranes and forms a large portion of your brain.
Most of what makes blood cholesterol rise is a combination of lifestyle factors and genetics. A diet high in sugars, processed grains and man-made trans-fat can affect your cholesterol levels along with smoking, obesity, sedentary lifestyle, age, and diabetes.
The Paleo diet has always recommended well-sourced egg consumption for those who can tolerate them, and this is not about to change.
Details of the study:
Whenever you look at a study, it is important to determine whether it is a true experiment (with randomized controlled groups) or simply a correlation study? If it proves to be a correlation study, it is worthwhile being skeptical unless it concludes a 100% increase risk.⠀
The study authors collected the data of just under 30,000 people over 17.5 years. These people were interviewed once about their diets, at the beginning of the study. By the end of the study, predictably, a number of people had developed heart disease. Some had died.
Researchers found that the participants who ate 2 eggs a day had a 27% higher risk of developing heart disease. Every 300mg of cholesterol a day added another 2.24% of having a cardiovascular event and a 4.43% risk of dying from a cardiovascular event.
While these numbers may seem ominous, a little further inspection reveals a few holes in this data.
The study is population-based
This means that while it can draw associations between two things, in this case egg intake and cardiovascular risk, it cannot prove causation. That means that while these two things may be related in some way, there’s no real proof that they are, so this is more of an educated guess about their relationship.
People were only interviewed once about their diets
The interviews took place 17.5 years before the study conclusions were drawn. My diet has changed a lot in 17.5 years, and theirs may have as well. Aside from that, the study failed to control for the remainder of their diet. Even if the participants ate eggs every single day of those 17.5 years, the study ignored what else they ate. Proponents of the Paleo diet place a huge emphasis on type and quality of the food you consume and research supports the importance of this.
It is relatively safe to assume that these people did not eat only eggs for all that time, so what else were they eating? Their diets could have been full of trans fat-heavy, ultra-processed foods, alongside their eggs.
Nutrition studies and food questionnaires are fundamentally flawed.
There is an innate bias and people tend not to report what they think is bad or unhealthy and they are more likely to downplay having eaten it. People also tend to over report the food they think is good. Few people actually measure their portion sizes and often can't remember how much they ate.
During the time this study was conducted, eggs were considered bad. Nutrition guidelines advised against eating eggs (especially the yolks) to avoid cholesterol. People who were eating eggs were likely people who were not otherwise health conscious. Maybe they were smokers, did not follow dietary guidelines, or avoided eating fruits and vegetables. These factors could have also played a role in their heart disease.
This in no way means that only the eggs caused the heart disease.
While the study controlled for some lifestyle factors like activity level, smoking, and alcohol use, it didn’t look at others, such as socioeconomic status, and stress levels, which can have a further impact on heart attack risk.
Controlled egg-feeding studies have shown that eating eggs does not affect blood cholesterol levels for 75 percent of people. In the other 25 percent, eating eggs modestly increases both LDL and HDL cholesterol and still does not increase the risk of heart disease.
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Drilling your diet down to individual foods and nutrients is pointless. If you eat a well-varied, balanced, whole-foods based diet (the Paleo diet template), you’ll be FINE. And although this may not seem headline worthy, your options and choices are far from boring.
Avoid letting sensationalized nutrition headlines bother or scare you. Correlation does not equal causation, and a study that failed to control for diet over 17 years is telling you very little about how eggs affect health.
Blood cholesterol is affected by many things including sugars, processed grains, manufactured fake foods and trans fats, smoking, diabetes, obesity, and age. Most people can tolerate dietary cholesterol well without significant effects to their blood cholesterol. If your cholesterol is high and you suspect the culprit might be your diet, try removing the refined carbohydrates, increasing fiber, and adding healthy, naturally occurring fats like avocado, butter, coconut oil, fatty fish and olive oil to your diet. This Paleo diet and lifestyle approach will support your long term health and wellness goals.