Eggs, Cholesterol, and Heart Health

Eggs are back in the news again, because of the recent publication of a study concluding that egg consumption is associated with a higher risk of heart disease and mortality. I have a number of concerns about this study, including the quality of dietary data, some of which were addressed in the related editorial comment. And additional perspective was provided in another recent article.

Dietary cholesterol, whether it’s from eggs or other animal sources, has little to do with the cholesterol measured in our blood. Most (75-80%) of the cholesterol in our body was made by our body, because cholesterol is essential for normal body functioning. It is an essential component of our cell membranes and it is required for energy metabolism. Low levels can affect energy production and utilization. Cholesterol is also required for the production of steroid hormones that control weight, sexual functioning, bone health, and mental status. And cholesterol is used by the liver to create bile acids, required for fat digestion and the absorption of fat-soluble vitamins. Peter Attia, MD, does a nice job of explaining all this.

Current research is indicating that cardiovascular risk is less about total cholesterol in the blood, or even total LDL-cholesterol (LDL-C), and more related to the size of the LDL-C particle and to inflammation. Small, dense LDL-C and lipoprotein A –Lp(a) are more likely to damage the blood vessel lining, causing inflammation and eventually placque formation. A high LDL particle number indicates higher levels of the small dense LDL-C particles. Lp(a) is more related to family history of CVD, and less affected by lifestyle. Blood tests to determine these additional measures are available: NMR (Lab Corps), True Health Diagnostics, Boston Heart Diagnostics, and Cardio IQ (Quest Diagnostics). You can discuss the usefulness of these additional measures with your health care provider.

It’s also important to know that most of the cholesterol we eat is not absorbed, and is excreted by our gut (leaves our body in stool), provided we consume enough fiber. That’s why eating plenty of fibrous plant foods is heart healthy. Soluble fiber is especially helpful – not only does soluble fiber support a healthy gut microbiome, it also helps to bind cholesterol for excretion via the stool. Strive for 25-40 grams of fiber daily, including at least 10+ grams of soluble fiber. Each half-cup of cut-up vegetable, fruit, and/or cooked legumes provides about 1 gram of soluble fiber. So eating lots of fiber-rich vegetables, fruits, and legumes (beans, lentils, peas) is an important action you can take to help support cardiovascular health.

The bottom line is that eggs can be an important part of a healthy diet. They provide easily digestible protein and important nutrients including vitamins A and K. Consider the meal in which the eggs are eaten. With regard to heart health, “naked eggs” (poached or hard-boiled) are a better choice than eggs served in a meal with fried potatoes, fatty cured meat (like bacon), and/or a sweet roll. Try instead poached eggs over steamed kale or spinach with a slice of whole-grain toast or my Fiber-Rich Baked Pancake topped with blueberries or baked apples.

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