The other day a friend made a comment about eating three hard boiled eggs, but not every day. Based on what I know about her, my guess is she has the same question that many of us have: Can/Should I eat eggs (particularly the yokes) every day? Or are they too high in cholesterol and need to be limited?
To help find the answers to these questions, I reached out to two trusted experts in the Portland area. One is retired cardiologist Alison Fulmer. The other is my go-to source for using nutrition functionally, Megan Barnett, owner of Pep Wellness. Everything below is quoted directly from the questions I asked them.
What’s good about eggs?
Eggs are a good source of protein and essential amino acids as well as micronutrients such as choline, selenium, vitamin D, B-12, iron, phosphorus and riboflavin. Eggs eaten with complex carbohydrates such as whole grains or sweet potatoes help balance blood sugar resulting in consistent energy and lower caloric intake.
Eggs carry an outdated taboo due to their inherent cholesterol (about 200mg per egg) and saturated fat (about 1.5g per egg) content which both occur within the egg yolk leading to the egg white becoming a “health” food in the 1980’s.
What’s the science behind cholesterol?
Dietary cholesterol has little impact on levels of cholesterol in the blood. Limiting cholesterol intake was a big deal in the ’90s when the fact that elevated cholesterol increased the risk of developing coronary artery disease was recognized, but it turns out not to be important. Saturated fat intake is more closely associated with an increase in cholesterol levels. But in reality the level for a given individual is largely determined by genetics. Even with a super low fat diet the blood level can only be decreased by about 10-15%. This is because most of the cholesterol circulating in our blood is produced by our own liver, not absorbed from the food we eat. Cholesterol is vital for health as it is part of all cell membranes but too much in the blood stream does appear to increase the risk of coronary disease.
Should I eat eggs?
In terms of eggs, eat away! Although the yolk does have a relatively high level of cholesterol in it there is no indication this increases blood levels or leads to a demonstrable increase in cardiac risk. There is also some old evidence that biotin in the egg may prevent absorption of the cholesterol in the yolk. If you want to cut calories and fat intake you can just eat the egg whites. However while isolating the egg white removes the cholesterol and saturated fat, it also removed almost all of the nutritional value of the egg.
While it is easy to demonize specific foods (meat, bread, eggs, and bananas) and macronutrients such as fats and carbs in our culture, the egg represents another failure to isolate the actual cause of disease.
For eggs or other foods with high levels of cholesterol like shrimp, eat away. At least based on our knowledge now in 2016.
Alison recommends that people eat a diet of real food, and not stress out a lot about individual items in their diet, especially if eaten in moderation. The so called Mediterranean diet; lots of whole grains, fruits, vegetables, meat as a condiment, and mono-saturated oils such as olive or canola oil, seems to be a basic healthy way to eat in terms of lessening risk or delaying onset of coronary disease, colon cancer, and other ills. The food author Michael Pollan says it best, “Eat food. Not too much. Mostly plants”.
Megan echoes those sentiments, emphasizing that a diet based in whole foods with an emphasis on plants can be inclusive of many foods and is superior to processed replacements and restrictive eating.
About my experts
Alison Fulmer is a recently retired cardiologist who spent many years sharing her wisdom with the patients at Kaiser. She now gets to spend her days traveling the world to see her adult children and ride her bike. Megan Barnett has a BS in dietetics with a focus on functional medicine. She owns Pep Wellness, LLC and specializes in helping individuals and families eat healthier.
Below you’ll find extra pearls of wisdom from Alison regarding heart health. It’s good information and I wanted to share it case it could be helpful.
Coronary artery disease is largely a consequence of aging and affected by genetics. Higher levels of serum cholesterol do correlate with a higher risk of clinical coronary disease (heart attack, anginal chest pain) or premature coronary disease (presenting before age 55 in men and 65 in women). Specifically the pattern of the serum cholesterol, or as we call it the lipid profile, is more important than the absolute cholesterol level. A high HDL (high density lipoprotein, a component of cholesterol) is protective, ie a high level indicates a lower risk of developing clinical coronary artery disease. A high LDL (low density lipoprotein) is associated with a higher risk as are high triglycerides. The pattern is what is largely genetically determined. It is important if you have a cholesterol check done that you ask for the full profile. Women tend to have have high HDL levels until after menopause after which the level slowly drops, this may be a reason that women tend to develop clinical CAD (coronary artery disease) later than men. Even if the total cholesterol is high, if the LDL is low and the HDL is high the cardiac risk is low. Many women get told they have high cholesterol but a high total cholesterol is not a concern if the HDL is sky high and the LDL low. That pattern is much less common in men. High triglycerides are often related to eating too many simple carbohydrates and/or obesity and can usually be improved with diet, although there are some genetic forms of high triglycerides that might need other treatment.
Nowadays if a person has been diagnosed with coronary disease, which usually happens when they have an event such as angina or a heart attack given we have no recommended screening test yet, we treat them with medications that lower cholesterol, no matter what the level, because the medications dramatically reduce the risk of future events. These medicines have other effects, such as reducing inflammation, and so the benefit of these drugs is not completely related to just lowering the cholesterol level. Using these drugs before the diagnosis of CAD has been made is controversial and needs to take into account overall risk which would include age, family history, lipid profile findings, smoking, hypertension etc.