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Wednesday
Aug222012

Eggs, Cigarettes, and More Nutrition Confusion


If you haven’t heard the latest news about nutrition, rumor has it that eating an egg yolk is as bad a smoking a cigarette. At least that’s what the news headlines have been telling people. This is an example of the constant challenge we face in trying to deliver accurate information to people about their health and nutrition habits. In the span of a day or two, the media can create mass confusion about something as nutrient-rich and healthy as a simple egg. The headlines help get traffic to the various websites, but for the unfortunate readers, most of these media sources do little to nothing when it comes to investigating the actual study. They look for the opportunity to pounce on another saturated fat or cholesterol story, and in the pursuit of article readership, they skip over a key component to good journalism — doing research before publishing a story.

I’m also fascinated by the way the media grabs hold of stories such as these, which have the possibility of confusing people and making their nutrition habits worse. But they won’t focus on other stories, such as the latest “real” research study that showed drinking orange juice is bad for your heart health and ability to manage weight. At any rate, before you toss your carton of eggs, you should know a little more about the “study” people have been talking about. You can find the abstract here, or pay for the access to the full article, which we did. I’d rather invest the money in something else, but to provide an accurate article it was important to review the paper in full.

Egg Yolks and Plaque Formation

You’ve probably heard the story many times. It usually goes something like this: Fat and cholesterol from food easily pass from your digestive system into your bloodstream where they stick to the walls of your arteries and causes plaque buildup. This story has been told so many times, people think it’s the truth in how arteries get clogged. The truth is, the process is far more complicated than that. If you’d like to spend some time learning more about this topic, my friend Peter Attia did an excellent series on cholesterol called The Straight Dope on Cholesterol. I highly recommend reading it.

Based on the fact that the “study” was titled “Egg yolk consumption and carotid plaque,” you may think the “study” showed eating eggs led to plaque formation. This “study” showed no such thing, nor could it the way the “study” was designed. By the way, I keep putting study in quotation marks because when most people read the word, they think of at least a couple of groups being put on specific diets or accurately measuring smoking habits in a population of people. This wasn’t that type of process. Instead, it was the result of patterns seen by asking patients some questions.

The authors of the journal article reviewed answers to a small questionnaire that was answered by patients attending a hospital program specializing in vascular health. As patients would come in, they were asked a small list of questions, which included how many eggs they ate each week and how many packs of cigarettes they smoked each day. Even with access to the full journal article, the questionnaire and all the data included from it, was not made available. From the disclosed answers, the article authors created their own metrics called “Egg years” and “Pack years.”

Egg years were calculated as the number of eggs patients ate, times the number of years they ate them. Think about that for a moment. If I were to ask you how many eggs you eat every week and for how many years you’ve done so, how certain would you be in the answer? Unless you’ve never eaten eggs, you’d likely have a hard time knowing the right answer. Nevertheless, this is the measurement these researchers used. They did the same with cigarettes, by asking how many packs a day the patients smoked and for how many years they’d been doing that.

In essence, the questionnaire was designed to look for just a few behaviors related to health and to identify common patterns. What the study cannot do in any way is show that any behavior causes a health outcome (like plaque formation). It would be like asking a bunch of executives across a variety of companies what cars they drove. If Mercedes was the most common car among the group interviewed, there would be an association between the cars selected and the positions these individuals held. Of course, no one would suggest the car choice caused these individuals to be promoted into their positions. It’s just an association.

What we have with this study, similar to what we see with eating meat, is an association. Those in this study group who ate the most eggs also tended to be most overweight and also tended to smoke more. The study authors tried to control for other variables, but their questionnaire was quite limited. Since we don’t know what other questions were asked, we don’t know if other patterns evolved. In all likelihood, had the right questions been asked, there would have been other patterns related to plaque formation such as alcohol, refined carbohydrates or sugar, stress, sleep, vitamin and mineral intake, etc. In all likelihood, those who ate eggs more often also made lifestyle choices that led to plaque formation. It’s not likely that nature-made, nutrient-rich egg yolks are to blame.

To further add to the issues with the study, the group was divided up into fifths. Each fifth of the group had a progressive increase in plaque development. I created a table below to explain.


As you can see, age looks to be the most serious risk for the development of heart disease, which is already well known. There’s nothing newsworthy about that finding. However, one thing that is glazed over is cholesterol. The study authors have tried to build a case against dietary cholesterol — especially in eggs, — before. You may remember the news headlines from two years ago declaring a single egg was worse than a Hardees Monster Thick Burger and other fast food meals. The authors of this “study” were the same ones behind the “study” in 2010 that created a media ruckus about fast food meals being better than eggs. Tom Naughton wrote an extensive review on that study here.

The foundation of the authors’ argument against eggs is their cholesterol content. The authors say “meals high in cholesterol should not be consumed regularly by those at risk for cardiovascular diseases, as dietary cholesterol itself is harmful, and potentiates the effect of saturated fats.” Yet, if you look in their own study data above, those who consume the most eggs have the lowest cholesterol. This should not be a surprise as dietary cholesterol has been shown to have a minimal effect on blood cholesterol levels. Even though the authors continue to point fingers at dietary cholesterol, their own data suggests it’s not the issue. Though it was not noted in the current study’s paper, their 2010 paper Dietary cholesterol and egg yolks: Not for patients at risk of vascular disease does point out the conflict of interest for two of the authors, who have spoken for and received payment from “several pharmaceutical companies manufacturing lipid-lowering drugs.” The continued finger pointing at dietary cholesterol as a major cause of heart disease appears to be unwarranted based on available, controlled diet research. It’s observational studies like these that keep the theme alive and help the media spread unjustified concern about nature-made foods like eggs.

If you’re thinking, “Maybe I should just toss the yolk and eat the white,” look at what you’d be missing out on. The yolk is where almost all of the nutrients are found. According to the USDA Database, an egg yolk contains:

Summary

It’s unfortunate that most media channels don’t do a little homework before spreading stories like the idea that eating an egg yolk and smoking a cigarette are the same thing. If you attempt to understand what a good diet entails by reading media headlines, you’ll easily become confused. Smoking cigarettes has been shown to contribute to the development of heart disease. Eating egg yolks has not. While we don’t fall back on a single “diet” to make our nutritional recommendations at Life Time, there’s a lot that could be learned from the Paleo diet movement. The biggest thing is that the most nutritious foods are those we eat with the smallest amount of modification or processing. An egg is about as close to natural as you can get. Based on the nutrient value of eggs, I’ll keep eating mine. In fact, I was eating some as I was working on this article.

Post comments, share thoughts or ask questions below. 

Written By Tom Nikkola - Director of Nutrition and Weight Management

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

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Reader Comments (26)

Tom,

Thanks for this review! I have had numerous members and team members asking my opinion on this study- most within the first 24 hours of it being blared across tv/radio/print advertising, and while I always love to give a quick summary of what I think, it's helpful to be able to send them back to a well written and referenced blog.

August 22, 2012 | Unregistered CommenterAli Baig

I'm so glad you addressed this so soon after this rubbish was announced. My husband brought this up to me Monday evening over dinner. I told him there was no way I could believe that ... it just sounds ignorant - and I questioned him if he knew who was financing the "study." He didn't, but that didn't stop him from becoming so concerned with how many eggs he ate in a week. I'm so glad I have this to share with him. I don't want him worrying - since he's already on blood pressure and cholesterol medicine. I'd hate to have him adjusting his diet to more processed foods and getting rid of what natural things I can get him to eat. Thank you, again, for this!

August 22, 2012 | Unregistered CommenterWhitley79

What this "study" and others similar to it tell me is that the "egg association" is not as rich or powerful as those for tobacco, fast food, or pharmaceutical companies. It's sad that so much of our information is filtered through the lens of those paid to promote one thing over another.

August 22, 2012 | Unregistered CommenterErin

@Ali, Whitley79: Thanks!
@Erin: Couldn't agree more.

August 22, 2012 | Unregistered CommenterTom Nikkola

I eat 2 or 3 whole eggs 4-5 days a week. My blood work is most excellent. Eggs are a superfood!

August 26, 2012 | Unregistered CommenterAndrew

I'm glad to be vegan. I feel awesome, my numbers are great, I play tennis competitively, and no animal is exploited or suffers for my meal. It's a great life. :)

August 26, 2012 | Unregistered CommenterKay

Eggs are HORRIBLE for human health (and extremely cruel to animals). Your information is faulty. Why are you promoting eating eggs? Check these sites: www.DrFuhrman.com www.PCRM.org www.Engine2Diet.com None of the leading nutritionists have anything good to say about eggs. You need to get into 2012 and stop preaching old diet information put out by the egg and meat and dairy industries.

August 26, 2012 | Unregistered CommenterEffie

THANK YOU! I'm so glad to hear your dispute!! I thought the study sounded crazy when I first heard about it. I also eat several eggs a week and have excellent cholesterol.

August 26, 2012 | Unregistered CommenterKathryn

Most top athletes are now figuring out that vegan is the way to go. That means NO animal products, from meat and milk to eggs. Carl Lewis is one, and many bodybuilders are vegan too. http://www.greatveganathletes.com/ Also my friend Spice Williams Crosby http://www.spicewilliams-crosby.com/ is a long time vegan who is a successful bodybuilder, black belt, stuntwoman and nutrition expert...I'd put her physique up against anyone and she's in her late 50's. I'm surprised LifeTime would put out this old animal-industry promotion. Get with 2012.

August 26, 2012 | Unregistered Commenteranonymous

As a neurologist and newbie to Lifetime Athletic, I was expecting to be confronted with a lot of doctor-hating, mumbo-jumbo credulousness by the staff. How refreshing it has been to find just the opposite. This article is a great example of the evidence-based approach and clearmindedness I have encountered at my Atlanta club and in your thoughtful articles. Thank you for speaking the truth, and also standing down the pop media.

August 26, 2012 | Unregistered CommenterMatt Gwynn

I suggest you read Eat To Live by Dr. Joel Fuhrman and The China Study by T. Colin Campbell. The old myth of the healthful egg (or meat or dairy for that matter) should not be perpetuated by a company that prides itself on being on the cutting edge of nutrition.
Thanks.

August 26, 2012 | Unregistered CommenterLP

I think it is irresponsible to be encouraging people to eat eggs. They are not healthy and are cholesterol laden, not to mention it supports a horribly cruel and brutal industry.

August 26, 2012 | Unregistered CommenterKay

Good for you for all those who are living the vegan lifestyle. However, to preach that it is the ONLY way to eat is silly and your cruelty rants make you sound ... Well they are rants so you figure that out as I refuse to insult you as it would make me like you. Tom provides well balanced articles. If you don't agree - or it isn't for you - don't follow it. Blasting him doesn't help your cause ... And to say eggs are not nutritious ... Perhaps you should check your sources and what they are trying to sell you.

August 26, 2012 | Unregistered CommenterWhitley79

As early as the late 70s, I had a friend convinced of the evils of eggs. He said once, "When I eat eggs, I can feel my veins clogging up." I wish this were a joke, but those were his words. Well, perhaps more to the point, those words were his interpretation of the faulty information being promoted at the time, and apparently, persists to this day.

As always, thank you for shedding light on questionable 'data', and providing a better understanding of how nutrition impacts health.

August 26, 2012 | Unregistered CommenterPhillip M Zeuner

I didn't see anyone pushing anyone to go vegan. I wouldn't do that. I stated my opinion, from what I have read, that eggs are not healthy. Someone even provided you with sites stating they aren't. You will always be able to find diiffering opinions, so you can certainly choose the one you perceive to be true. We are each entitled to our opinions. You seem very defensive. The cruelty rants? You've only insulted yourself by dismissing the facts you would rather be oblivious too. Factory farming is horribly cruel and inhumane. If you choose to support it, that's you're right, but don't dismiss it for your own convenience. Vegans don't think we are better than anyone, that's exactly why we choose the way we eat. You could stand some compassion for the animals that you obviously feast on and use daily with very little regard apparently.

August 26, 2012 | Unregistered CommenterKay

I always find it so ironic when people are upset when animals are treated inhumane because animals are not "humane" aka people. That doesn't mean I support animal cruelty but there is a line between people and animals. I also find it ironic that a lot people who think it's cruel to eat an egg have no problem with killing a human egg (abortion). Sorry to get political. Couldn't help myself.

August 26, 2012 | Unregistered CommenterAnonymous

Great article. Been eating low carb for over a year now and been skipping the yolks. Now the yolks are what's for breakfast.

August 26, 2012 | Unregistered CommenterNick Dranias

I think eating a vegan diet is extreme, it's not for everyone. I eat eggs, but only about 4 a month. I switched to 'free range organic" eggs, which are supposed to be much better for you than 'standard' eggs because the chickens are fed a much better diet. The chickens are treated much more humanly, which is better for the chickens. The 'free range organic" eggs cost about $3.40 a dozen, which is more expensive than 'standard' eggs, but that much more expansive if you aren't eating eggs every day. A good diet, avoiding processed foods costs much more than a poor diet, at least 2 or 3 times the cost each month.Avoiding and limiting restaurants to once or twice a month, especially fast food, is also part of a good diet.

August 27, 2012 | Unregistered CommenterDavephan

I love that there are still true analytical thinkers out there. When I saw this "study" come on CNN I put my head down in disgust. The media will find anything that will cause contreversy and add up to ratings even if it is misinformation.

August 27, 2012 | Unregistered CommenterAnonymous Coward

One simple test from the school of logic answers these idiotic statements. Are we, as a population, living longer or shorter? Answer: Longer. Well, for all the hazardous things to which we are routinely exposed, maybe we are doing something right by not living in fear at the drop of a dime. Indeed, people have been living and eating eggs far much longer than those who make their living by reminding us not to (sic, the media). Egg yolks, and for that matter smoking, is not the death knoll the media would make it out to be. In fact, the life expectancy of humans has steadily risen, despite our habits, from as far back as written history. Consider the following: In the normal course of our daily lives, each of us is exposed to a wide variety of hazards arising from the natural consequence of living (i.e, chemical, physical, biologic and ergonomic hazards). Likewise, at any time, there will also be a percentage of the population within our community who is either manifestly ill, ill but not demonstrably so, or carriers of a disease or other physiologic condition making them separate or unique. The fact that a unique individual is exposed to some environmental stressor (i.e., dirty air or water, natural fauna or flora, or the ingestion of an egg), does not necessarily mean that one is going to die from it. In fact, life as we know it is never totally risk free. It is the subjective assessment of the acceptability of risk that determines whether or not one feels safe or whether or not one feels a particular way about living. Indeed, if life is to be worth living at all, one must experience it. So in our experience of life, has the human genome lived longer or shorter? If longer, and it is so, then maybe it is because we have decided to go on living -- eating, breathing, reproducing, and excreting -- without fear of every little snippet of warning we read or hear from the most unknowledgeable media. Moderation, take everything in moderation... including your egg yolks and the news.

August 27, 2012 | Unregistered Commentergwstexas

To Kay. As Phillip says, I TOO had a friend convinced of the devils of eggs, so I made deviled eggs and enjoyed them profoundly, three or more at a sitting, with a natural LDL and HDL off the chart in the exceptionally healthy range doing absolutely nothing. That is genetic diversity, don't believe everything you read. Oh, and I eat not only the egg, but the mother of the egg as hens are much more plump than roosters. Happy hunting!

August 27, 2012 | Unregistered Commentergwstexas

Wow, so many egg haters. Eggs have been good, bad, then good, then bad again over the decades. Get with 2012? How about, not jump on a band wagon? I looked at this abstract and it is extremely questionable. The standard deviation for the average plaque area in both data sets was greater than the mean, yet the p value between the two sets was <.0001 because they adjusted for age?! Doing t-tests ensures that we don't make the wrong assumption about whether or not two data sets are statistically different from one another. Considering the gross overlap in values because of the high standard deviation, I would have expected a p value much much higher, indicated that the two data sets weren't different and that there is NOT a relation between egg eating and plaque build-up. But, I'm not going to pay for the article just to figure out how they twisted numbers around. Nonetheless, this should be a red flag for all the readers.

August 27, 2012 | Unregistered CommenterRich

As a doctor of medicine, that has done years of research between the correlation of diet and disease, I prefer to give my patients knowledge rather than pills, which is why I've never been popular with pharmaceutical companies. There is zero cholesterol in egg whites, however the yolks contain more cholesterol than any food you can eat, besides brains. Most doctors recommend your cholesterol be below 200 to be healthy, however, we still see plenty of people coming in with heart attacks that are well in that range. The problem is, to get it to 150, where you are least likely to have a heart attack, you more than likely need a vegetarian diet, but most doctors don't believe their patients are willing to do that, so they don't even give them that information. It's just too easy to give everyone a pill for high cholesterol, high blood pressure, etc. You might ask why it matters if you control it naturally or with a pill? Unfortunately, there are many side effects to pills. The pills to treat cholesterol, such as Lipitor, can contribute to loss of memory, as well as diabetes, just to name a couple. I tend to believe my patients want the knowledge and will make the right decisions given the information, and they often do. I've seen people adopt a plant based diet and drop 100 points in their cholesterol in a month's time. And more if they continue on that path. I've witnessed some amazing things in direct correlation with a change in diet. There is plenty of cholesterol in meat, but none in plants. Our society continues to eat more meat, and in bigger portions, and this generation may be the one that their children's life expectancy is lower than their parents. I've seen plenty of meat eaters live long lives, but I'd like myself, as well as my patients, to live not only a long life, but quality life. I'd rather die early than spend my last twenty years in bad health. I'm currently in my 60's, run marathons, and plan to continue enjoying life until the very end. Good luck on each of your journeys.

August 27, 2012 | Unregistered CommenterKevin

Thank you for the many comments on the article. I sense a lot of passion for nutrition based on the various points of view expressed above. While it's easy to get emotional about a topic such as nutrition, it's also important to be as logical as possible. Much of the nutrition information we're exposed to centers on observational studies. For example, a certain population eats a certain way, and experiences a certain type of general health. All too often, assumptions are made about the food CAUSING the health or disease, when in fact is actually other foods, lifestyle choices or environmental factors contributing to the difference in health outcomes.

To get an objective answer as to how a specific food affects health, controlled trials must be done, not observational studies. Most of the confusion about how animal foods affect health is based on observational studies that do not pan out when a controlled study, which is the only type that can show cause and effect, is done.

The egg study, like many others, was observational in nature. In addition, it played on the myth that dietary cholesterol raises blood cholesterol levels. This is very misleading because this only happens in a small part of the population, and in that population, they often see a rise in HDL cholesterol, which is cardio-protective. We'll continue to base our content on what controlled trials have shown, which is the best way to stay up to date on the science of nutrition and not get caught up in hype.

Please keep the comments coming, but please be respectful as well.

August 28, 2012 | Unregistered CommenterTom Nikkola

In line with Tom's remarks, it's great to see so many people who are not complacent with our current knowledge and application of dietary behaviors. However, it's also a bit disturbing to see so many harsh comments from both sides that may just serve to widen the rift between what seems to be two extremes if opinions.

If those interested are in fact open minded and passionate about optimal health, I suggest both sides of the debate read the excellent comparison of vegan vs. Paleo diets from experience life magazine from a few months ago. In actuality, both of these plans are centered on plant-based choices if done properly. They both eliminate so-called Franken-foods and tout the benefits of locally-obtained foodstuffs. Perhaps these are more similar to each other than each extreme is like the industrialized mess many people now know as food.

As Tom points out in several places on this blog, good & valid conclusions about human health can only be accurately determined when controlled trials are done in a un-biased manner instead of generalizing conclusions from simple observational studies with dozens of interfering variables. Perhaps we should stop discussing nutrition other than what resutls a single dietary adjustment shows in an individual? Perhaps we should simply leave our emotions at the door when assessing well-collected data and simply marvel at the adaptability of the human body under a variety of different conditions whether we believe it's harsh or healthy. To date theres one common theme I've recognized when sorting through this nutrition and "food" research mess, and that's the fact that when humans eat LESS PROCESSED food, health usually always improves.

August 28, 2012 | Unregistered CommenterPaul Kriegler, RD/LD

Gosh - eat eggs - don't -
Everything in moderation

others think the Study was BS
Men's Health New
SUSPECT SCIENCE

New BS Study: Eating Eggs Is Just as Bad as Smoking?!?

http://news.menshealth.com/eggs-cholesterol-smoking/2012/08/17/

August 30, 2012 | Unregistered Commentermaureen greenbaum

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