Eggs: Good or Bad?

Eggs can be part of a healthy dietary pattern.

There is no question that eggs are nutritious. The protein in eggs provides all the essential amino acids our bodies need in the proportions we need them. Eggs are also a good source of many essential nutrients, including biotin, selenium, vitamin B12, iodine, riboflavin, pantothenic acid, phosphorus, potassium, and vitamins A and D. Additionally, egg yolks are high in lutein and zeaxanthin, phytochemicals that may help protect against age-related macular degeneration. Egg yolks are also a major source of dietary cholesterol, and therein lies the source of decades of conflicting and confusing nutrition recommendations.

Does Egg Cholesterol Matter? Too much LDL cholesterol in the blood contributes to the build-up of plaque in the arteries, which increases risk for heart attack and stroke. For decades it was thought that cholesterol in the foods we eat would raise cholesterol in our blood…so eggs (or at least egg yolks) were high on the list of foods to avoid in the fight against cardiovascular disease. Further research revealed that, for most people, dietary cholesterol in the amounts consumed by the typical American is not actually significantly related to LDL cholesterol levels in the body. Dietary fat type has a greater impact on LDL cholesterol levels than dietary cholesterol—so eggs are back on the menu, at least in moderate amounts (the equivalent of an egg a day or a couple of eggs every other day).

Negative Headlines: In March of 2019 a study in the Journal of the American Medical Association (JAMA)suggested an association between dietary cholesterol in general, and egg intake in particular, and higher risk of cardiovascular disease (CVD) and death. The authors found that each additional 300 milligrams (mg) of dietary cholesterol (the equivalent of about 1.5 eggs) consumed per day was associated with a 3 percent higher risk of CVD and a 4 percent higher risk of death from any cause. This type of study cannot determine cause and effect, but the significant association of even small increments of egg consumption with health risk caught the attention of the media.

“This is one study among many,” says Alice H. Lichtenstein, DSc, director of the Cardiovascular Nutrition Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA). “Looking at it in the context of all the research out there, the current intake of dietary cholesterol in America—around 250 mg per day for women and 350 mg per day for men—would not be predicted to significantly elevate risk of cardiovascular disease for most people. There are some individuals who are very sensitive to dietary cholesterol, but, for the general population, the overall consensus is that typical intake of dietary cholesterol (including cholesterol from eggs) is not where the major focus should be.”

A European prospective study published in the journal Circulation in 2019 actually found an inverse association between egg intake and coronary artery disease. This means participants who reported eating more eggs in the study were likely to have less narrowing of the arteries than people who reported eating less eggs. Although the authors suggest that this inverse relationship may be the result of healthier people choosing eggs more often (reverse causality), this study does not support a benefit from restricting eggs.

How We Eat Eggs: Served up with bacon, ham, fried white potatoes, sausage, and white toast with butter. Baked into cakes, muffins, and custards. When Americans eat eggs, they typically eat them with processed meats and/or refined starches—both of which are associated with higher risk of cardiovascular disease. “An egg a day or couple of eggs every other day can be a part of a healthy dietary pattern,” says Lichtenstein. Try them scrambled with chopped sautéed veggies at breakfast, hard-boiled and sliced onto a salad at lunch, or poached and served on top of spiced grains and beans at dinner. “If you are eating an overall healthy diet that is low in processed meat, salt, refined grains, and added sugars, including eggs as a protein choice should not negatively impact your health,” says Lichtenstein.

What to Do: “Maintaining a healthy body weight and shifting our sources of fat from animal to plant are far more important to controlling blood cholesterol levels than limiting dietary cholesterol intake from foods like eggs,” says Lichtenstein. If you like to eat eggs, the American Heart Association suggests up to one egg per day as part of a healthy diet. If you have diabetes, have had a heart attack, or are at high risk for heart disease, many experts suggest being more cautious of dietary cholesterol intake, including eggs. “If you were told by your healthcare provider you are at elevated risk for cardiovascular disease and are having a hard time getting your LDL cholesterol down by following their dietary advice, it would be a good idea to cut out eggs and see whether your cholesterol levels improve,” says Lichtenstein.

“For people who still wish to avoid the dietary cholesterol in egg yolks, the whites are a good alternative for scrambles and omelets,” says Helen Rasmussen, PhD, RD, a senior research dietitian at the HNRCA. “For baking, there are egg replacers on the market. These contain ingredients such as starches, fibers, and baking soda to help make up for some of the moisture and lift eggs bring to baked goods.”

“Eggs are a good choice for many reasons,” says Lichtenstein. “They are a source of high-quality protein and essential nutrients and are affordable, easy to prepare, and have a reasonably long shelf life when stored properly in a refrigerator.”

Tufts Health & Nutrition Update- Sept 2019