Eggs...Friend or Foe?

 Eggs..One day they’re hot and the next they’re not. It’s a common question in my office. Eggs are controversial because the have dietary cholesterol. However, the cholesterol you eat does not necessarily have the biggest impact on the cholesterol in your body. First, you have to understand a little about dietary vs serum (blood) cholesterol. Or if you’d rather not, skip down a few paragraphs to the nitty gritty.

What is cholesterol?
Cholesterol is a type of lipid (fat) in the body. Serum cholesterol has its benefits - it helps form the lining (membrane) of every cell in the body and it plays a role in hormone production. The body can manufacture its own cholesterol, regardless of how much and what type of fat you eat. But the types of fat you eat also play a role. There are multiple sub-types of cholesterol.

The two we pay most attention to in clinic are

• HDL (high density lipoprotein, aka the “good” cholesterol”) 
• LDL (low density lipoprotein, aka the “bad” cholesterol)

When there is damage in the blood vessels (usually from inflammation*), the LDL particles can get trapped in the lining of the artery and start to form a plaque (blockage). Over time, this plaque can build and block blood flow to crucial areas like the heart and/or brain. This can lead to a heart attack or stroke. HDL’s job is to help remove LDL from the body.

CLICK HERE for a table breaking down the types of dietary fat and cholesterol. 

*When inflammation is present in the blood vessels, it causes the lining of the arteries and blood vessels to be rough. As mentioned earlier, this starts the formation of plaques. High blood sugar, excessive alcohol, smoking, and drugs increase inflammation. However, exercise, monounsaturated fats, and the antioxidants found in fruits / vegetables combat inflammation and reduce damage.

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Get to the point: Can I eat eggs or not?
The short answer is yes, please eat eggs...but in the right way.  For most people, eating moderate amounts of eggs will have little impact on their blood cholesterol. Yes they have ~60% of the dietary cholesterol recommendation. However as stated above, dietary cholesterol is NOT the major issue in cholesterol production for most people. It’s more about saturated fat. 

Now, if you’re going to cook them in butter (7 g of saturated fat per tablespoon) and slather then with cheese (another 7-8 g of saturated fat per ounce), or eat 6 eggs a day (each egg has ~1-1.5 g saturated fat), yes - you’re going to run into issues.

But if you are regularly having a hard boiled egg as an addition to a meal or snack, cooking them in water, and/or reducing saturated fat in other areas of your diet. It’s completely reasonable!

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In my experience, eggs have never been the “breaking point” in an individual’s diet. There are always bigger opportunities to see an improvement in heart health.  In nutrition counseling, it’s about weighing the risks and benefits of a particular patient’s health situation. It’s a game of “good, better, best.”

​Are there other satisfying breakfast / snack choices that won't impact cholesterol? Absolutely! Oatmeal, low fat plain yogurt, egg whites, fruit with modest amounts of nuts, avocado and whole wheat toast, or peanut butter on whole wheat toast are excellent choices.  But taste preferences, cultural differences, allergies, and time constraints make some of these challenging. If a patient doesn't have time to prepare and eat oatmeal, I'd rather they go with a hard boiled egg than a quick bagel with cream cheese. Or if they're struggling to eat enough protein and don't have time to eat yogurt, hard boiled eggs are the next best bet. When I make nutrition recommendations, it's based upon the person's lifestyle to be effective.

If you’re not convinced, here are some reasons I may encourage a patient to choose eggs

• 1. Good source of complete protein: For people who don’t eat much red meat or high fat dairy, eggs are a completely reasonable addition to the diet because they’re not getting much cholesterol from other sources. At 7 grams of protein per egg, it’s a more efficient, readily absorbed option (more so than beans / lentils). 

 

• 2. Keep you fuller longer and they are satisfying! The fat and protein content of the egg will keep you fuller longer (and prevent overeating later) compared to options like bagels, toast, cold cereal, pancakes/waffles.

 

• 3. They won’t raise blood sugar: This is a big one for my diabetic patients, especially those who don’t eat much poultry or fish. While lentils and beans have protein, they are primarily carbohydrate (which raises blood sugar). And in order to make a complete protein, that lentil/bean needs to be paired with a grain (even more carbohydrate). Also, similar to reason #2 above, they’re also a way to keep carbohydrates low compared to traditional breakfast options.

 

• 4. Easy to prepare: They take a few minutes to cook. Having a dozen hard boiled eggs on hand makes meal / snack time a snap.

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Did I lose you? Here’s your cheat sheet
OVERALL: Yes, eggs can raise your cholesterol BUT not as much as saturated fat (butter, cheese, high fat processed meats, fried foods, red meat). It’s about your dietary balance in total.

• DO : Enjoy them in moderation. If the rest of your diet is relatively low in saturated fat and cholesterol, 1-2 eggs a day are not a problem
• DO :  boil or poach them
• DO : pair with vegetables and/or avocado for a satisfying meal / snack
• DO : be mindful of your total saturated fat intake from all dietary sources

• DON’T : pair with bacon, sausage, or other high fat meats
• DON’T : prepare with a lot of butter or oil
• DON’T : Eat them excessively. Eating more than 4 eggs a day isn’t exactly balanced

​If you’re concerned about your heart’s health, prioritize these areas of change

• Stop smoking
• Control your blood sugar
• Reduce your blood pressure (eat less salt)
• Avoid fried food
• Avoid high fat processed meat (bacon, sausage, bologna, salami, pastrami)
• Limit red meat
• Limit cheese
• Limit butter
• Limit foods made with a lot of oil (yes, even olive oil)
• Avoid high sugar/fat foods with minimal nutritional value (juice, soda, chocolate, ice cream, candy, cake, cookies, crackers, chips etc)

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If you’d like to see some of the newer research, check out “Trending Cardiovascular Nutrition Controversies” by Freeman et al in Journal of the American College of Cardiology Volume 69, Issue 9, March 2017. DOI: 10.1016/j.jacc.2016.10.086 http://www.onlinejacc.org/content/69/9/1172 ​​

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