Eating too many eggs can always be risky, but most people don’t have to give them up completely, experts say

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In recent years, concerns about egg consumption seem to have faded from public consciousness. But has egg thinking really changed? Not if you ask nutrition experts.

“The egg issue remains relevant,” says Linda Van Horn, professor and head of the division of nutrition in the department of preventive medicine at the Feinberg School of Medicine at Northwestern University. For people already at risk for heart disease and diabetes, “the choices to eat eggs remain particularly important,” she says.

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It’s always risky to eat too many eggs, but you don’t have to give them up entirely. How much you can eat depends on your health. The American Heart Association recommends up to one egg a day for most people, less for people with high blood cholesterol, especially those with diabetes or at risk for heart failure, and up to two. eggs per day for the elderly with normal cholesterol levels. and who eat healthily.

The mistaken impression some people have – that eggs can now be eaten with abandon – likely arose out of a shift in focus, as experts began to warn less about the cardiovascular effects of cholesterol-containing products. such as eggs and more on the risks posed by other foods in the American diet. They specifically targeted those loaded with saturated fat, such as red meat, which actually pose a greater threat to increased cholesterol.

But the main thing about eggs remains the same. You still have to be careful.

“In the 1960s and 1970s, eggs were considered the No.1 public enemy for the heart, largely because scientists found that high blood cholesterol increased the risk of heart disease and that eggs were high in cholesterol, ”says Bonnie Liebman. , director of nutrition at the Center for Science in the Public Interest. “However, saturated fat in foods like red meat, butter, cheese, and other high-fat dairy products raises blood cholesterol more than cholesterol in eggs. Thus, eggs initially received more than that. their share of the blame than they deserved. “

It is important to understand the difference between dietary cholesterol, which is the amount of cholesterol already present in a food before you eat it – eggs or shrimp, for example – and serum (or blood) cholesterol, which is a low lipoprotein. density, or LDL cholesterol (the “bad” cholesterol), made by the body by the action of saturated fat.

“It’s the concept that people often don’t understand, 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 Mayo Clinic College. of Medicine and consultant to the General Internal Medicine Division of the Mayo Clinic. “Saturated fat is the primary dietary nutrient that increases serum cholesterol.”

Van Horn agrees. “Saturated fat has twice as much of an effect on LDL cholesterol as dietary cholesterol, but the two together further complicate the risk,” she says. “The two together are synergistically bad at raising LDL cholesterol.”

So you can occasionally eat your high cholesterol eggs. But avoid the bacon, sausages and buttered toast – all high in saturated fat – which often accompany them. If you eat them with your eggs, you are flirting with danger.

(Don’t confuse saturated fats with trans fats, which are also unhealthy and increase LDL cholesterol. Artificial trans fats are the product of a food industry manufacturing process that adds hydrogen to the oil. The Food and Drug Administration has banned companies from adding artificial trans fats to foods, as of 2018, although trans fats are naturally present in high-fat meat and dairy products, which also contain a considerable amount of saturated fat.)

Public confusion over dietary cholesterol likely arose after two sets of US dietary guidelines released in 2015 and 2020 failed to highlight the dangers of dietary cholesterol in recommendations, unlike the 2010 recommendations. guidelines are updated every five years.)

Instead, the 2015 guidelines stated that dietary cholesterol was no longer “a nutrient of concern”, although they noted that “this change does not suggest that dietary cholesterol is no longer important to take into account. counts when developing healthy eating habits.

Many experts believe the change recognized that Americans’ dietary cholesterol intake had already fallen below the recommended 300 milligrams per day by then, so further recommendations were not needed.

Yet “many people thought they could now eat what they wanted,” says Andrew Freeman, outgoing chair of the American College of Cardiology’s Nutrition and Lifestyle Working Group, and director of the American College of Cardiology. clinical cardiology, cardiovascular prevention and wellness, and associate professor. of Medicine, at National Jewish Health in Denver. “From a public health perspective, this has raised a lot of issues. “

The 2020 guidelines urge Americans to keep saturated fat, trans fat, and dietary cholesterol as low as possible without compromising nutrition, says Liebman. But “they don’t make eggs healthy,” she says. “My feeling is that the guidelines tried to focus on overall healthy eating rather than individual foods.”

Experts say you need to be careful with eggs if you have high LDL and high blood pressure, or if you have diabetes. Recent studies have reinforced the dangers of egg consumption when it comes to both cardiovascular health and overall mortality risk. (An egg has around 185 mg of dietary cholesterol, all in the yolk, so stick to the full protein egg white if you want to play it safe.)

“Eggs are a wonderful source of dietary protein for someone who is not overweight, who does not have a 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. “It changes if you’re 55 or over and have an LDL over 150, have high blood pressure, take [cholesterol-lowering] statin and are overweight. If you have any risk factors I wouldn’t have more than two or three [yolks] one week. If you don’t have any risk factors, eating four or five egg yolks a week is unlikely to be harmful, as long as you can eat them without the typical saturated fats that usually come with them, like bacon, sausage. or buttered toast. “

These breakfast additions, high in saturated fat, create “the perfect storm,” says Van Horn, who was also a member of the 2020 Dietary Guidelines Advisory Board. “A godsend for cholesterol.”

Taking antihypertensive drugs and cholesterol-lowering drugs does not eliminate the risk, as the study found that eating eggs increases the risk of death from all causes, not just cardiovascular disease, she says.

Most nutrition experts believe the Heart Association’s recommendations are a safe approach.

“I think [they are] reasonable, ”says Liebman. “Most people probably won’t go back to eating two eggs each morning for breakfast, like many did in the 1950s.”

Liebman says the best way to lower blood cholesterol is to replace saturated fat with unsaturated fat, like those found in fish, nuts, avocado, and most oils except for palm and coconut.

Plus, she says most health officials recommend “eating a healthy diet, rather than focusing on a few foods like eggs,” she says. “This pattern, often described as a Mediterranean-style or DASH-style diet, is high in fruits, vegetables, whole grains, low-fat or fat-free dairy products, 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 give up eggs completely. “An egg isn’t going to kill you instantly, but why eat something that adds even a little bit of risk?” he says. “The risk is cumulative.”

He suggests eating egg whites or egg substitutes, including plant-based alternatives.

“They’re tasty and satisfying,” he says. “Put them on a slice of whole grain bread with cucumber and sprouts, and you have something absolutely delicious.”

Not everyone is ready to go this far.

“I like eggs,” Van Horn says. “My family loves eggs. I have no problem feeding my family’s eggs – but I know the outline of everything they eat. A few eggs every now and then won’t be harmful. But you won’t find out. never sausage or bacon in my house. “