In the past 30 years, the humble egg has been the subject of so much controversy it’s difficult to think of a more hotly debated food. While we certainly don’t need to eat eggs to survive, they are a versatile and affordable source of high quality protein for many people, bariatric patients in particular. If you’ve ever wondered if eggs are okay to eat, you’re not alone. It’s one of the questions I’m most frequently asked as a dietitian.

Studies show mixed findings

This past March, the authors of a published JAMA study issued a press release claiming their data showed a direct effect of egg consumption and heart disease risk. CNN published an article with the headline “Eggs: Three or more eggs a week increase risk of heart disease and early death, study says”. Many nutrition and healthcare professionals like myself were surprised by this finding. Four years ago, scientific experts concluded in the Scientific Report of the 2015 Dietary Guidelines Advisory Committee that “cholesterol is not a nutrient of concern for over-consumption”. Eggs, along with otherwise nutrient dense foods containing higher amounts of dietary cholesterol, were essentially declared suitable choices for most of the population. 

Evaluating the JAMA Study

So what’s an egg-loving dietitian or protein-focused bariatric to do? Well, whenever I see a sensationalized health headline, the first place I turn to is the source. I ask questions like “how was the study conducted”, “did the researchers have any potential conflicts of interest” and “is there other credible evidence to support the findings”? Without getting too technical I can tell you first and foremost the JAMA study has significant limitations, including a weak study design that found at best a modest association between dietary cholesterol and heart disease. However, observational findings like these (as opposed to directly measuring data) do not establish a cause-and-effect relationship. Furthermore, pooled, self-reported data from existing studies that used numerous different dietary assessment tools do not remotely support the strength of the statements from the authors’ press release. Another major limitation of the study is that participants' long-term eating patterns were not assessed. Think about if someone asked you in February or June about the food choices you made during the previous month. Many of us (myself included) would probably give a description that would be accurate for January and May when we might be riding high on our New Year’s resolutions or preparing for bathing suit season; but this doesn’t necessarily reflect the choices we make the other ten or eleven months of the year. Finally, the amount of risk this study proposes is very small compared with other proven risk factors like smoking, uncontrolled high blood pressure, physical inactivity, obesity, uncontrolled diabetes, and chronic, uncontrolled stress and anger. Highly processed foods and those containing trans fats and added sugars are far more likely than eggs to raise heart disease risk. 

Evaluating the Scientific Report of the 2015 Dietary Guidelines Advisory Committee

The 2015 Dietary Guidelines Advisory Committee (DGAC) was a 14-member committee of scientists nominated by a public process and appointed by the secretaries of the US Department of Health and Human Services (HHS) and the US Department of Agriculture (USDA). These members are recognized as experts in a broad range of specialties including food and nutritional sciences, medicine, epidemiology, nutrition and health policy, public health, and other related areas. No DGAC members received compensation for their service and all were thoroughly screened according to strict federal guidelines for potential conflicts of interest that pertained to their research responsibilities. Questions were addressed using multiple approaches and applications for gathering and analyzing high quality existing studies along with US population food and health data sets. What does all this mean? Basically, unlike the JAMA study, the large amount of information used by the DGAC to reach their conclusions came from high quality research models which assessed long-term eating patterns and lifestyle choices. Final recommendations were made only if they could be rated of strong or moderate quality by the committee. Ultimately, the committee recommended removing the limitation on cholesterol consumed from food sources.  

RELATED: What are our dietitians eating for breakfast?

Deciding what’s best for you

To be very clear, the recommendation that the DGAC made in 2015 does not mean that dietary cholesterol is meaningless. The food sources for all the nutrients we consume, cholesterol included, are still the key to building a healthy diet. Since nutrition is not all good or bad, black or white, the risk or benefit of avoiding specific foods is best evaluated on a case-by-case basis. 

Most people can safely enjoy eggs on a daily or weekly basis - as a part of an overall nutritious diet. Here’s an article on Dunkin Donuts’ healthy breakfast options when you’re on-the-go.

However, if you are concerned about your personal risk, the best approach is to meet with a qualified healthcare provider who will take your individual health and nutrition status into consideration to help you make a decision that is best for you.

References:

Dietary Guidelines Advisory Committee. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. 2015; http://www.health.gov/dietaryguidelines/2015-scientific-report/. Accessed September 16, 2019.

Millen BE, Abrams S, Adams-Campbell L, et al. The 2015 Dietary Guidelines Advisory Committee Scientific Report: Development and Major Conclusions. Adv Nutr. 2016;7:438-44. Accessed August 20, 2019.

Scutti, S. CNN. Eggs: Three or more eggs a week increase risk of heart disease and early death, study says. 2019; https://www.cnn.com/2019/03/15/health/eggs-cholesterol-heart-disease-study/index.html Accessed: September 23, 2019.

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. Accessed April 5, 2019.