Updated on August 5, 2022.
If you’ve ever wondered whether you should cut eggs out of your diet, here’s some good news: Research suggests that eating up to one egg per day as part of an overall healthy diet may not be bad for your heart.
Researchers analyzed results from 23 studies that included a total of over 1.4 million people. They found that eating more than one egg per day was not associated with increased risk for cardiovascular disease compared to eating one egg or less per day, over the course of about 12 years. The study was published in the American Journal of Medicine in 2021.
Another recent analysis of three large international studies reached similar conclusions. The study, published in the American Journal of Clinical Nutrition in 2020, included about 177,000 people in 50 countries who were followed for about 4.5 years. Compared to eating less than one egg per week, eating seven or more eggs per week was not associated with increased risk for abnormal cholesterol levels or major cardiovascular problems like heart attack, stroke, or heart failure.
What’s good—and not so good—about eggs
One large egg contains about 6 grams (g) of protein, and 5 g of fat, most of which is the good kind (monounsaturated and polyunsaturated). The bigger issue is that it also contains about 207 milligrams (mg) of cholesterol. This is one reason why conventional wisdom on the potential risks and benefits of eating eggs has shifted over the years, resulting in some confusion and concern.
The body packages dietary fat, and cholesterol into particles called lipoproteins. The “bad” ones, known as LDL cholesterol (low-density lipoprotein) can contribute to the build-up of plaque on the inside of artery walls, potentially limiting blood flow. This increases the risk for heart attack and stroke. It seems logical, therefore, that reducing intake of dietary cholesterol would help protect the heart. And for years, that was the recommendation.
But in 2015, after decades of warnings, health officials revised the Dietary Guidelines for Americans, omitting the previous recommendation to limit dietary cholesterol intake to 300 mg per day. The decision was based on mounting scientific evidence suggesting that genetics and saturated fat have a much greater effect on blood cholesterol levels than cholesterol in food.
The ongoing debate
Other recent studies have continued the egg debate. Results from one study published in PLoS Medicine in 2021 that included over 520,000 U.S. adults who were an average age of 62 years old showed that eating an additional half of an egg per day was associated with about 7 percent higher risk for death from cardiovascular disease (CVD), over the course of about 16 years. Results also hinted that having an diet that was high in total cholesterol may have played a significant role in tipping the balance toward greater risk for CVD death among people who ate eggs. Replacing whole eggs with egg whites or egg substitutes was associated with lower rates of death.
Another study that included over 27,000 males found that for each additional egg consumed per day, the risk of death from CVD increased by 9 percent, and every 300 mg increase in cholesterol intake per day was associated with 13 percent increased risk of death from CVD, over the course of 31 years. The study was published in the journal Circulation in 2022.
Don’t sell the chicken coop just yet
While the debate persists, some experts are looking at the bigger picture. Eggs by themselves may not be bad for your heart, but if your overall diet is high in cholesterol or if you’re already at risk for heart disease, you may need to be careful about how many you eat.
Eggs can likely be a part of a healthy diet for many people, according to Keith Roach, MD, associate professor in clinical medicine in the division of internal medicine at Weill Cornell Medical College and New York Presbyterian Hospital.
An egg is a low-calorie, low-carbohydrate nutrient powerhouse. In addition to containing only about 70 calories, it’s also rich in good stuff like vitamin D, vitamin B12, choline, lutein, and zeaxanthin, supporting your bones, liver, and vision. (Some eggs are also enriched with beneficial omega-3 fatty acids.)
The American Heart Association (AHA) has long advised that most healthy adults could safely eat one egg (or two egg whites) per day as part of a healthy diet. Having one egg per day, or no more than seven per week, while limiting other foods high in dietary cholesterol, remains a smart strategy, Dr. Roach advises.
It’s also important to remember that despite the ongoing egg debate, the Dietary Guidelines haven’t changed—at least not yet. Current USDA Dietary guidelines for 2020-2025 do not set a daily cutoff for dietary cholesterol, although they do recommend lowering it as much as possible, without compromising the total nutritional quality of your diet.
So, if you’re otherwise healthy and rarely or never eat foods high in cholesterol, you can probably incorporate eggs into an overall heart-healthy diet that emphasizes a wide variety of fruits, vegetables, and whole grains. If your LDL (aka “bad” cholesterol) level is low—or less than 70 without medication—then you may not need to worry about it, adds Roach.
So, what’s right for you?
That said, there are some variables to consider when deciding what to have for breakfast. For example, high cholesterol tends to run in families. If your parents or close relatives were diagnosed with the condition, it’s more likely to affect you, which may limit some of your food choices.
People who already have high cholesterol or have an inherited genetic condition called familial hypercholesterolemia (FH)—which causes them to have very high LDL levels at a young age that worsen over time—should avoid eggs or more carefully limit their dietary cholesterol consumption.
People with certain conditions that increase the risk for high cholesterol and heart disease, including obesity and type 2 diabetes, may also need to more strictly limit their egg intake.
Cholesterol levels tend to increase with age, Roach points out. So, as you get older, you may want to be more mindful about how many eggs you’re eating. If you smoke, are not active, or are overweight, you’re at greater risk for high cholesterol levels. Limiting your egg intake in these cases may be a good idea.
It’s also important to consider your overall diet. You may need to be careful about how many eggs you’re eating, but they’re likely still a healthier option than many sugary cereals, pancakes drenched in syrup, or a buttered bagel, which may have fewer nutrients but a lot of “empty calories,” which can lead to weight gain that can be detrimental to your heart health. Red or processed meat and whole milk dairy products also contain saturated fat, which is a known contributor to high cholesterol levels.
Know your numbers
Being aware of your cholesterol levels can help you make wise decisions about your diet and protect your long-term health.
Adults aged 20 years or older should have their cholesterol checked every 4 to 6 years, according to the AHA. If you have heart disease or risk factors for heart disease, you may need more frequent screenings. Your healthcare provider (HCP) can help you understand what your cholesterol levels mean and whether you would benefit from certain lifestyle adjustments, cholesterol-lowering medications, or other treatment options.
Talk to your HCP about your diet and your risk factors for heart disease and high cholesterol to determine what’s right for you. A registered dietitian can also help you incorporate eggs into your diet in a healthy way. (Hint: Cook them in olive oil instead of bacon grease or opt for egg whites since the cholesterol is in the yolk.)
The takeaway? When it comes to eggs, it appears that it’s not about one extreme or the other. Like so many things in life, moderation is key.
