Are Eggs Off the Menu Again?

A new study suggests eating eggs increases the risk of heart disease and death, but is it all its cracked up to be?

This week, the great egg pendulum has swung again. Headlines around the world are proclaiming that eggs can kill you.

Today, I am the Eggman as we discuss the centerpiece of the media maelstrom - an impressive study appearing in the Journal of the American Medical Association.

In this study, eggs are cast as delicious, tiny capsules of death.

It was around a year ago, that I reported on a study which appeared in the BMJ that suggested that increased egg-consumption was associated with a 20% reduction in you risk of death:

Now a study from JAMA shows just the opposite. Does it warrant the same curt dismissal? Not quite. This was about as nicely analyzed a nutritional epidemiology study as you can get. But keep your skeptical caps on.

Researchers combined individual patient data from 6 large US cohort studies. Participants provided a dietary history from a food-frequency questionnaire at baseline. They were then followed for cardiovascular events and deaths from any cause out to a median of 17 years.  

The topline results?

Delicious but deadly?

Individuals who reported eating more eggs at baseline were more likely to have cardiovascular events in the future. They were also more likely to die from any cause.

Now, egg-eaters are a bit different from non-egg eaters. 

Eating eggs stratifies society more starkly than like any other variable. It’s actually a bit crazy.

For example, compared to individuals who didn’t eat eggs, people who ate 2 or more eggs a day were much younger, much more likely to be male, black, and a current smoker, and ate twice as many calories per day.

The authors did a nice job adjusting for these and a variety of other factors. But the negative egg-effect remained.

Until they adjusted for total cholesterol intake. After accounting for total cholesterol intake, the harm from eggs disappear. Simply put, it’s not the eggs that kill you, it’s the cholesterol in the eggs that kill you.

So – why are we talking about eggs? If the culprit here is cholesterol, why did the authors frame the study around eggs? I asked senior author Dr. Norinna Allen that very question:

“The literature around eggs in particular has been very mixed. So there have been several studies that have found a beneficial association, no association, or a negative association, and we felt that we had very strong data to be able to ask this question in a large sample of US adults.”

In other words, they focused on eggs because other people have focused on eggs and they wanted to put this whole thing to bed. But was it enough to change Dr. Allen’s eating habits?

“Yeah I definitely have cut back on the amount of eggs. I never ate a lot. But the amount of eggs I feed my kids I definitely cut back on”

Should we all cut back?

There’s one little bit of information that didn’t make sense to me. When the authors adjusted for serum cholesterol level, the effect of egg-eating and dietary cholesterol intake remained.

The conceptual model underpinning this study looks like this:

Step 1: eggs contain cholesterol, so eating more eggs mean you’re eating more cholesterol. Step 2, eating more cholesterol increases your blood cholesterol level. Step 3, that higher cholesterol level  leads to cardiovascular disease and death.

The fact that adjustment for cholesterol intake eliminates the eggàdeath relationship confirms step one of this process. But adjusting for serum cholesterol should have the same effect. It didn’t.

In other words, it didn’t appear that the bad effect of eating cholesterol was mediated by serum cholesterol level. There are two possibilities here. One – there is some as-yet-undefined effect that needs more research.

The second it that it isn’t really the dietary cholesterol that is the problem. Maybe egg-eating and cholesterol-eating are just markers of some other unhealthy behavior, unrelated to serum cholesterol, but associated with death.

If that’s the case, the renewed emphasis on eggs as single-servings of heart disease may not be warranted at all.

This commentary first appeared on medscape.com