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Cracking the Myth: Eggs-ellent Health or Cholesterol Culprit?

Updated: Apr 4

A Delicious Dilemma for Heart Health

Eggs, those versatile culinary gems that grace our breakfast tables and enrich countless recipes, have long been shrouded in controversy. Amidst their reputation as a nutritional powerhouse, concerns about cholesterol content have sparked debates. If you're among the 11% of adults in the U.S. with elevated cholesterol levels, you might be wondering whether eggs deserve a place in your diet.1 Let's dive into this egg-citing journey and uncover the truth about their impact on heart health.



But First, Looking at the Sunny Side!

While there's ongoing debate about the impact of eggs on cholesterol levels, leading organizations suggest that, for most people, incorporating eggs into your diet might not significantly affect your blood cholesterol levels, and they can actually provide numerous health benefits, some of which are: 

  • Nutrient-Rich Package: Eggs are packed with essential nutrients like protein, vitamins, and minerals that support your body's growth and well-being. Some eggs are even fortified with omega-3 fatty acids for added heart health benefits. 

  • Low in Fat: Although egg yolks contain a small amount of fat, the whites are nearly fat-free. A typical egg contains only about 4.6g of fat, with a quarter of it being saturated fat, which is the type that can raise cholesterol levels. 

  • High-Quality Protein: The protein in eggs is easily digestible and contains all the necessary building blocks for your body's protein needs, contributing to muscle growth and repair. 

  • Essential Vitamins: Eggs are a rich source of vitamins that might be challenging to consume in sufficient amounts. Vitamins like D, riboflavin, B12, and folate are important for various bodily functions. 

  • Improve Eye Health: They contain lutein and zeaxanthin, which are important for reducing the risk of cataracts and macular degeneration. These conditions, particularly macular degeneration, are the main causes of blindness in individuals aged 55 and above.3

  • Versatile Cooking Ingredient: Eggs can be transformed into quick and delicious savory dishes or desserts. Enjoy them scrambled, poached, boiled, or in various culinary creations to start your day on a healthy note.2

In the ongoing discussion about the effects of eggs on cholesterol levels, it's important to consider that eggs offer a variety of health benefits and are a versatile addition to a balanced diet. 


Decoding Cholesterol: Eggs Under the Spotlight

Historically, eggs have been scrutinized for their cholesterol content, often seen as a potential contributor to heart risks. The connection between cholesterol levels, particularly LDL (low-density lipoprotein) cholesterol, and cardiovascular problems has led to caution regarding dietary cholesterol, driven by the belief that reducing its intake would promote heart health. 

Egg yolks, in particular, are substantial sources of dietary cholesterol. Just one large egg, may contain approximately 237 milligrams of cholesterol—equivalent to a 12-ounce beef burger.4 Compelling evidence from six distinct studies involving about 30,000 adults in the United States reveals a meaningful correlation: those who consumed more dietary cholesterol or eggs faced a noticeable escalation in their risk of developing cardiovascular disease (CVD) over time.5



Illustrated by Zhiyao Zhang


 

Furthermore, egg yolks contain phosphatidylcholine, a component that the body processes into a compound called trimethylamine (TMAO). Elevated TMAO levels have been linked to a 2.5-fold increase in the risk of stroke, heart attack, or vascular death. What's intriguing is that the impact of egg consumption on TMAO follows a dose-dependent pattern, emphasizing the significance of moderation.4

 

Intriguing insights emerge from a Finnish study that explored how a specific genetic trait called apolipoprotein (apo) E phenotype interacts with dietary cholesterol effects. This investigation highlighted that when participants embraced a cholesterol-rich diet, their cholesterol levels—total, LDL, and apoB—significantly surged across all apoE groups. This suggests that genetic factors play a role in how our bodies respond to dietary cholesterol, with certain individuals showing more pronounced reactions to dietary shifts than others.6


Striking a Balance

According to Jo Ann Carson, a respected professor of clinical nutrition at UT Southwestern Medical Center in Dallas, our perspective on eggs within a heart-healthy diet has evolved over the past two decades. She emphasizes that while eggs do contain dietary cholesterol, they can still be integrated sensibly into a balanced eating plan.

Carson underscores the importance of understanding one's risk factors. People with a heightened risk of heart disease, diabetes, or those who have experienced a heart attack should be mindful of their cholesterol intake. However, this doesn't mean eggs are inherently detrimental. Carson highlights that in situations where a person's overall cholesterol consumption is limited, eggs might be seen as a less concerning choice.

For instance, individuals adopting a vegetarian diet, which excludes red meat, may find that eggs provide their only significant source of dietary cholesterol. In such cases, Carson suggests that these individuals could incorporate eggs more readily into their diet without major concerns.3


Cracking the Daily Egg Dilemma: How Many Is Just Right?

The question remains: how many eggs should find their way onto your plate? 

In recent times, the guidelines governing egg consumption have experienced a noteworthy shift. The Dietary Guidelines for Americans from 2015 to 2020 altered the longstanding restriction on dietary cholesterol, which had been in place since 1968. This adjustment was made based on comprehensive assessments of various observational studies, encompassing significant meta-analyses. These analyses, examining the effects of consuming eggs up to one per day, revealed a lack of substantial connections between egg intake and cardiovascular disease (CVD) or coronary heart disease. In fact, certain studies even hinted at a potential protective effect against stroke. Reflecting these findings, the American Heart Association suggests at most one egg a day as part of a heart-healthy regimen for individuals with normal cholesterol levels.7 

Nevertheless, it's crucial to exercise caution, especially for individuals at higher risk, such as those with hypercholesterolemia or those who already have elevated levels of dietary cholesterol intake.


Out with the Yolk: Innovative Substitutes for a Healthier Kitchen

For those looking to reduce their egg yolk intake while still enjoying delicious meals, there are several healthy alternatives to consider:

 

Egg Whites: All of the cholesterol in eggs resides in the yolk. By simply using the egg white in recipes that call for whole eggs, you can significantly reduce or eliminate the cholesterol. Use two egg whites for each whole egg in your recipes. 

Commercial Egg Substitute: These products are essentially enriched egg whites, containing no yolks, and are therefore free from fat and cholesterol. Commercial egg substitutes are enriched to compensate for the lost nutritional benefits of the yolk. They work well in baked goods, omelets, and scrambled eggs.

Silken Tofu: Silken tofu is a versatile substitute for eggs in many baked goods. Blend about ¼ cup of silken tofu until it's smooth and creamy to replace one egg. You can also scramble it with a touch of nonstick cooking spray for an egg-like texture.

Flaxseeds: Ground flaxseeds can replace eggs in baked goods. Mix one tablespoon of ground flaxseed with three tablespoons of water to replace one egg. They work especially well in whole grain recipes and oatmeal-based cookies.

Bananas: Mashed bananas can be a fantastic egg substitute, adding moisture and flavor to baked goods. About ½ cup of mashed banana can replace one egg, but be aware that the baked goods may have a banana flavor.

Yogurt: Yogurt or soy yogurt can serve as egg substitutes, similar to silken tofu. They are great in cakes, quick breads, and muffins. Use a quarter cup of yogurt to replace one egg.

Aquafaba: This is the liquid leftover from cooking beans or legumes and has a similar consistency to egg whites. It's an excellent replacement for various recipes.

Soy Lecithin: Although less common, soy lecithin can be used as an egg substitute due to its binding properties. However, it should be avoided if you have a soy allergy.

Keep in mind that each egg substitute behaves differently, so some experimentation may be necessary to find the best option for your specific recipes. These alternatives not only reduce cholesterol intake but also offer unique textures and flavors to your dishes.

The Verdict: Cooking Up a Balanced Perspective

In our exploration of egg nutrition, we've found that moderation is key. Eggs offer a wealth of benefits, packed with nutrients, and rich in high-quality protein. However, their cholesterol content, especially in the yolk, raises concerns about heart health when consumed excessively. Recent dietary guidelines have eased restrictions on egg consumption, emphasizing individual factors. 

For those with normal cholesterol levels, enjoying an egg a day can be part of a heart-healthy diet, but caution is advised for those at higher risk. If you're seeking to reduce egg yolk intake without compromising flavor and texture, consider healthy substitutes like egg whites, silken tofu, flaxseeds, or bananas.

Ultimately, the egg debate reminds us of the intricate balance between nutrition, health, and culinary creativity. Knowledge and moderation are your allies on this flavorful journey. Whether you opt for eggs or their innovative alternatives, relish the culinary adventure while savoring the taste of good health.


References

  1. MacDonald, Trisha. “Prevalence of High Cholesterol Among the Adult U.S. Population: NHANES 2013–2018.” Current Developments in Nutrition vol. 6,Suppl 1 925. 14 Jun. 2022, doi:10.1093/cdn/nzac067.045

  2. “Can I Eat Eggs If I Have High Cholesterol?” HEART UK - The Cholesterol Charity, www.heartuk.org.uk/low-cholesterol-foods/can-i-eat-eggs. Accessed 19 Aug. 2023. 

  3. “Are Eggs Good for You or Not?” Www.Heart.Org, American Heart Association News, 16 Mar. 2023, www.heart.org/en/news/2018/08/15/are-eggs-good-for-you-or-not

  4. Spence, J. David, et al. “Cardiovascular Harm from Egg Yolk and Meat: More than Just Cholesterol and Saturated Fat.” Journal of the American Heart Association, vol. 10, no. 7, 2021, https://doi.org/10.1161/jaha.120.017066.

  5. 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

  6. Spence, J David et al. “Dietary cholesterol and egg yolks: not for patients at risk of vascular disease.” The Canadian journal of cardiology vol. 26,9 (2010): e336-9. doi:10.1016/s0828-282x(10)70456-6

  7. Xia, Peng‐Fei, et al. “Dietary Intakes of Eggs and Cholesterol in Relation to All‐cause and Heart Disease Mortality: A Prospective Cohort Study.” Journal of the American Heart Association, vol. 9, no. 10, 2020, https://doi.org/10.1161/jaha.119.015743.

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