Study Challenges Recommendation to Include Eggs in a Healthy Diet

Key Takeaways

  • Data is conflicting when it comes to whether people should avoid eggs to reduce their risk of death.
  • A recent study linked eggs to increased all-cause mortality, cardiovascular mortality, and cancer mortality.
  • Still, experts say eliminating eggs from your diet entirely may not be necessary. Taking care of your overall wellbeing and cultivating a balanced diet is more impactful.

While experts typically say an egg a day can be part of a heart-healthy diet, a new study found that eating eggs and consuming dietary cholesterol is associated with higher mortality risk.

Don’t panic. There is “no need to throw out your eggs or skip your brunch omelet,” Mariana Dineen, MS, RD, CDN, a Chicago-based registered dietitian who was not involved with the study, tells Verywell, adding that the study had its limitations.

Eggs Seem Riskier than Egg Whites

To conduct this study, researchers recruited 521,120 participants and asked how often they ate whole eggs, egg whites/substitutes, and dietary cholesterol via a food frequency questionnaire. Over the course of a 16-year follow-up, researchers evaluated how this intake relates to mortality. 

Results show that whole egg and cholesterol consumption were both linked to all-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality.

Egg white and egg substitute consumption was associated with lower all-cause mortality and mortality from stroke, cancer, respiratory disease, and Alzheimer’s disease. The data was published in the journal PLoS Medicine in February 2021.  

Correlation, Not Causation

Since this study is observational in nature, a causal relationship can not be established, Michelle Routhenstein, MS, RDN, CDE, CDN, a New York-based cardiology dietitian, tells Verywell. In other words, saying that eating eggs or dietary cholesterol definitively causes an increased mortality risk would be inappropriate based on results from an observational study. 

Plus, these results are based on self-reported data. Relative to other sources of information—think medical records or laboratory measurements—self-reported data is often viewed to be unreliable and vulnerable to self-reporting bias. 

Lindsay Allen, MS, RDN, registered dietitian and owner of Back in Balance Nutrition, LLC, tells Verywell that “the participants [in this study] were eating dietary patterns that included plenty of refined grains, carbohydrates, and sugars that make it impossible to point to eggs as the culprit of all-cause mortality.”

The PLoS Medicine study results are a stark contrast from another observational study published in 2020 in the American Journal of Clinical Nutrition. Researchers from the latter examined three large international prospective studies of approximately 177,000 people, finding no significant associations between egg intake and mortality or major heart events.

Still, results were consistent with a recent joint study of six prospective U.S. cohorts reporting that each additional half egg per day was associated with 6{b5d304c96e94113bdfc523ff4218a1efff4746200bdb9eeb3214a56a1302f2e4}, 8{b5d304c96e94113bdfc523ff4218a1efff4746200bdb9eeb3214a56a1302f2e4}, and 8{b5d304c96e94113bdfc523ff4218a1efff4746200bdb9eeb3214a56a1302f2e4} higher risk of incident CVD, CVD mortality, and all-cause mortality, respectively.

So, the question of how many eggs you can eat without increasing mortality risk remains unanswered—recommendations vary based on individual risk factors and overall dietary patterns.

“As the evidence does not strongly support a cause and effect [relationship] between cholesterol intake and cardiovascular morbidity and mortality, we cannot define how many eggs should or should not be consumed per day or over a week,” John Gassler, MD, medical director and cardiovascular disease and interventional cardiology specialist with MVP Health Care, tells Verywell.

“Most cardiologists and vascular medicine specialists would agree that while there is not overwhelming evidence supporting severe restrictions on dietary intake of cholesterol, including eggs, moderation is important, especially in the setting of other defined risk factors,” he says.

What This Means For You

While data surrounding egg consumption and mortality is conflicting, there are other steps you can take to improve your health, like exercising daily and eating fruits and vegetables. Including eggs in your diet likely won’t make or break your health—it’s more important to focus on your overall wellbeing and diet.

Do Eggs Have a Place in a Healthy Diet?

To eat eggs or not to eat eggs is a question researchers and experts have gone back and forth on for years. In the past, dietitians recommended avoiding egg yolks (the source of dietary cholesterol in eggs), but health-focused associations like the American Heart Association (AHA) have since suggested otherwise.

The AHA released a paper in 2019 that looked at the relationship between dietary cholesterol and cardiovascular risk. They found that an egg a day can be part of a heart-healthy diet for healthy individuals.

The recently-published Dietary Guidelines for Americans specifically call out eggs as a nutrient-dense food that provides vitamins, minerals, and other health-promoting components. While the guidelines do not provide a specific target quantity of eggs that a healthy adult should eat, they do indicate that they are a good protein choice that fits into many dietary patterns.

“It’s important to remember the power of nutrition is achieved through a varied and balanced diet,” Dineen says. “We eat a combination of foods and can’t reduce our dietary advice to single nutrients or a single food.”

Eggs are a natural source of key nutrients that support overall health, including:

  • High-quality protein
  • Vitamin D
  • Iodine
  • Vitamin A
  • Choline

Routhenstein adds that eggs also contain folate, riboflavin, lutein, and zeaxanthin, which are both cardioprotective and important for eye and brain health. Eliminating eggs from your diet would mean taking away a source of all of these key nutrients, which may result in other health challenges down the line.  

How to Improve Health without Limiting Eggs

Reducing your risk of early death, no matter what the cause, is something that most people can agree is a priority. And unfortunately, the methods to accomplish this goal are not as black-and-white as many of us would want them to be. 

In regard to eggs specifically, Dineen shares that she doesn’t believe that each individual needs to give up their beloved breakfast scramble, but rather should take “into account genetic predisposition, family history, and lifestyle.” Therefore, your best bet is to come up with an egg-eating plan with your personal healthcare provider before swearing off yolks forever. 

Beyond whether you can eat eggs, there are other steps you can take to reduce your risk of mortality. Studies have found that certain lifestyle factors can reduce your risk of mortality, including:

  • Engaging in physical activity
  • Maintaining strong social relationships
  • Increasing fruit and vegetable intake

“Work with your physician to review the overall risk of cardiovascular events,” Gassler advises. “Depending on levels, physicians may recommend improving diet by decreasing saturated fats and cholesterol and increasing daily exercise. Physicians will discuss other risk factors, including smoking and family history of coronary or vascular disease, impacting the overall risk.”

In some cases, doctors may prescribe medication to reduce the risks of heart attacks and cardiovascular death.

“Most importantly, do not wait for a coronary event to seek help, as your first could be your last,” Gassler says.

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