About Me

My photo
Blog author, Solai Buchanan is an experienced Registered Dietitian and Certified Diabetes Educator with an MS from Columbia Teachers College. She specializes in treating heart disease, diabetes, hypertension, high cholesterol, polycystic ovarian syndrome,and other chronic diseases. She is a provider at a full-service cardiology practice accepting most insurance and staffed with a primary care MD, pediatrician, and cardiologist. Call: 718.894.7907. NYCC is lead by Interventional Cardiologist Sanjeev Palta, MD, FSCAI, FACC. He trained at Cornell-Columbia Presbyterian Hospital and the State University Hospital of Brooklyn. He currently is an Attending Cardiologist at New York Methodist Hospital and Maimonides Medical Center. He is also an Assistant Clinical Professor in the Department of Medicine at Mount Sinai Medical Center. Having performed over 2000 invasive cardiac procedures Dr. Palta’s patients know they are in trusted hands.

Saturday, April 20, 2019

UNSCRAMBLING THE LATEST RESEARCH ON EGGS & HEART HEALTH


Americans have significantly increased egg intake over the last decade, consuming on average 3-4 eggs per week. Part of their renewed appeal stems from U.S. Dietary Guidelines that dropped the long standing recommendation to limit dietary cholesterol to less than 300mg.   However, the controversy over eggs, dietary cholesterol, and heart disease was recently reignited by a recent study that found an association between egg and dietary cholesterol consumption and higher rates of heart disease.  

Cholesterol is a waxy substance produced by the body to synthesize hormones, produce bile for digestion, make vitamin D, and maintain healthy cell walls.  Advice to limit dietary cholesterol dates back 50 years, but randomized trials conducted over the last 15 years have indicated healthy human bodies control the amount of cholesterol in the bloodstream, and can detect and adjust the body’s cholesterol production if dietary cholesterol increases or decreases.  It also appears that our systems can excrete unneeded dietary cholesterol, especially if individuals consume adequate dietary fiber.  As a result, even though yokes contain nearly 200 mg of cholesterol, there has been growing consensus that low to moderate egg intake is not significantly associated with a higher risk of CVD.  Eggs also contain nutrients that have been linked to a lower risk of heart disease.  Eggs pack 7g of high-quality protein with about half of this found in the white. Yolks also contain a significant amount of the brain-nutrient choline, plus vitamin B12 and iron. Eggs are also one of the few dietary sources of vitamin D and are a good source of the carotenoids lutein and zeaxanthin that have been linked to lower odds of macular degeneration. 


In terms of dietary drivers of heart disease unhealthy saturated and trans fats have been found to be much more significant that dietary cholesterol.  Recommendations to limit saturated fats (the fats found in meat, chicken skin, and dairy) and completely avoid trans fats (artificial fats used to manufacture baked goods, frosting, and spreads) are still in place.  Most foods high in cholesterol are also high in saturated fats.  However, some foods high in cholesterol are not high in saturated fats including egg yokes, shellfish, and liver.

The new analysis of eggs and heart disease, drawn from the pooled data of six observational studies that followed nearly 30,000 Americans for up to 31 years, found that eating 3-4 eggs per week was associated with a 6% higher risk of cardiovascular disease and an 8% higher risk of any cause of death.  And, eating at least 300mg of dietary cholesterol per day was associated with 17% higher risk of cardiovascular disease and 18% higher risk of all-cause deaths.
Experts caution that the recent analysis has many limitations that may have lead to misleading conclusions.  One shortcoming was participants' long-term eating patterns were not assessed.  Participants self-reported their typical intake at a single visit at the outset of the studies while heart health outcomes were assessed up to 30 years later.  During this time, individuals may have significantly changed their diet. So, this one snapshot may not have accurately captured their eating habits over time.

When evaluating whether or not eggs are healthy, it is also important to look at eggs not only on their own, but in context of the entire diet, especially when compared to foods they may replace.  There is widespread consensus that eggs are a better choice than options high in saturated fat (e.g. butter, pastries, cheese, bacon), refined grains, and/or sugars.  And, eggs are one of the few typical breakfast foods that are not high in carbohydrates.  A recent study illustrates one of the benefits of eating a lower carb breakfast for those with diabetes.  It found that when a person with diabetes takes a low carb breakfast their blood sugar response to meals later in the day is less pronounced than when they have a higher carb breakfast (e.g. oatmeal, cereal, toast).  To the cardiovascular system, scrambled eggs, salsa, and a 100% whole-wheat English muffin is a far different meal than scrambled eggs with cheese, sausages, home fries, and buttered white toast. 

What to do:  Even though cholesterol is still in bold on the nutrition facts labels, focus your gaze more on the amount of saturated and trans fat listed above cholesterol.  To control your blood cholesterol eat a healthy diet rich in plant-derived fats (i.e. olive oil, nuts, avocado), fruits and vegetables, whole grains, and lean proteins. Emphasize foods high in soluble fiber such as beans, oats, barley, and gummier fruits and vegetables including avocado, okra, plums, apples, oranges, green beans, and carrots.  Control your weight, exercise regularly, don’t smoke, and take cholesterol lowering medicine as prescribed by your provider.

As for the eggs, looking at the body of research on this topic, there is not strong evidence that limiting consumption of cholesterol-rich foods lowers the amount of artery-clogging LDL cholesterol that ends up in our blood. For those without heart health problems, average intake of up to 1 egg per day is likely a healthy choice.   Experts still caution diabetics and others at high risk for heart disease to be mindful of cholesterol intake.  Some advise diabetics have no more than 3-4 egg yolks weekly.  The whites, a fantastic source of lean protein contain almost no cholesterol.  Discuss dietary cholesterol intake with your healthcare provider to determine what a safe level of egg consumption is for you given your health situation. 

Sources
Chang CR, Francois ME, Little JP.  Restricting carbohydrates at breakfast is sufficient to reduce 24-hour exposure to postprandial hyperglycemia and improve glycemic variability.  The American Journal of Clinical Nutrition.  2019;nqy261.  doi.org/10.1093/ajcn/nqy261

Hu FB, Stampfer MJ, Rimm EB, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA.   doi:10.1001/jama.281.15.1387
Jacobson TA, Maki KC, Orringer CE, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 2.  Journal of Clinical Lipidology2015; 9 (6): S1-S122.e1. doi.org/10.1016/j.jacl.2015.09.002

Richard C, Cristall L, Fleming E, et al.  Impact of egg consumption on cardiovascular risk factors in individuals with Type 2 diabetes and at risk for developing diabetes: A systematic review of randomized nutritional intervention studies. Canadian Journal of Diabetes2017; 41 (4): 453 – 463.   doi.org/10.1016/j.jcjd.2016.12.002

U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans; 2015.  Available at: https://health.gov/dietaryguidelines/2015/resources/2015-2020_dietary_guidelines.pdf

Zhong VW, Van Horn L, Cornelis MC, et al. Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality. JAMA. 2019;321(11):1081–1095. doi:10.1001/jama.2019.1572

Adapted from articles available at:



2 comments:

  1. Good for your heart: Studies show that taking a high-quality multivitamin may reduce cardiovascular disease. Heart disease is the leading cause of death in both men and women in the U.S. Vitamins B12 and magnesium, play a role in cardiovascular health.

    ReplyDelete