Will eating eggs increase my cholesterol?

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Historically, nutrition guidelines for reducing the risk of cardiovascular disease (CVD) have included recommendations to limit dietary cholesterol. However, the 2015–2020 Dietary Guidelines for Americans did not issue explicit guidance for dietary cholesterol intake due to inconsistencies in the evidence base. Does this mean eggs can be on the breakfast menu every day without raising CVD risk?

Eggs are a relatively inexpensive and nutrient-dense food. They are a high-quality source of protein and rich in choline, vitamin B2, and the carotenoids lutein and zeaxanthin.[1] They also contain a notable amount of cholesterol: about 186 mg per large egg.

Evidence from randomized controlled trials (RCTs) demonstrates that foods high in cholesterol increase low-density lipoprotein cholesterol (LDL-C),[2] which increases the risk of CVD.[3] More specifically, it’s reported that the consumption of more than 1 egg per day increases LDL-C by about 7.7 mg/dL (0.2 mmol/L), with similar effects in healthy people and people with dyslipidemia.[4]

Nonetheless, studies report the average response and the individual response to dietary cholesterol is highly variable. It appears that the majority of people are able to roughly maintain LDL-C in response to an increase in dietary cholesterol intake.[5][6][7] This lack of response is due to a combination of suppression in endogenous cholesterol synthesis, a reduction in dietary cholesterol absorption, and an increase in biliary excretion of cholesterol.[8]

On the other hand, there is a notable subset of individuals who, partly due to genetic differences, lack these feedback control mechanisms and experience a significant increase in LDL-C in response to increases in dietary cholesterol intake (i.e., hyper-responders).[9] In this population, it may be particularly worthwhile to limit egg consumption to prevent LDL-C from rising to an unhealthy level.

For many people, moderate egg consumption is permissible and possibly even beneficial as part of an otherwise healthy diet. However, hyper-responders and people with high cholesterol or dyslipidemia may benefit from limiting their egg consumption or removing eggs from the diet altogether, as this can lead to a clinically meaningful decrease in LDL-C.[10]

1.^Kuang H, Yang F, Zhang Y, Wang T, Chen GThe Impact of Egg Nutrient Composition and Its Consumption on Cholesterol Homeostasis.Cholesterol.(2018)
2.^Vincent MJ, Allen B, Palacios OM, Haber LT, Maki KCMeta-regression analysis of the effects of dietary cholesterol intake on LDL and HDL cholesterolAm J Clin Nutr.(2019 Jan 1)
3.^Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, Hegele RA, Krauss RM, Raal FJ, Schunkert H, Watts GF, Borén J, Fazio S, Horton JD, Masana L, Nicholls SJ, Nordestgaard BG, van de Sluis B, Taskinen MR, Tokgözoglu L, Landmesser U, Laufs U, Wiklund O, Stock JK, Chapman MJ, Catapano ALLow-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus PanelEur Heart J.(2017 Aug 21)
4.^Khalighi Sikaroudi M, Soltani S, Kolahdouz-Mohammadi R, Clayton ZS, Fernandez ML, Varse F, Shidfar FThe responses of different dosages of egg consumption on blood lipid profile: An updated systematic review and meta-analysis of randomized clinical trials.J Food Biochem.(2020-08)
5.^McNamara DJ, Kolb R, Parker TS, Batwin H, Samuel P, Brown CD, Ahrens EHHeterogeneity of cholesterol homeostasis in man. Response to changes in dietary fat quality and cholesterol quantity.J Clin Invest.(1987-Jun)
6.^Herron KL, Vega-Lopez S, Conde K, Ramjiganesh T, Shachter NS, Fernandez MLMen classified as hypo- or hyperresponders to dietary cholesterol feeding exhibit differences in lipoprotein metabolismJ Nutr.(2003 Apr)
9.^Jacobson TA, Maki KC, Orringer CE, Jones PH, Kris-Etherton P, Sikand G, La Forge R, Daniels SR, Wilson DP, Morris PB, Wild RA, Grundy SM, Daviglus M, Ferdinand KC, Vijayaraghavan K, Deedwania PC, Aberg JA, Liao KP, McKenney JM, Ross JL, Braun LT, Ito MK, Bays HE, Brown WV, Underberg JA,National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2.J Clin Lipidol.(2015)
10.^Frank L J Visseren, François Mach, Yvo M Smulders, David Carballo, Konstantinos C Koskinas, Maria Bäck, Athanase Benetos, Alessandro Biffi, José-Manuel Boavida, Davide Capodanno, Bernard Cosyns, Carolyn Crawford, Constantinos H Davos, Ileana Desormais, Emanuele Di Angelantonio, Oscar H Franco, Sigrun Halvorsen, F D Richard Hobbs, Monika Hollander, Ewa A Jankowska, Matthias Michal, Simona Sacco, Naveed Sattar, Lale Tokgozoglu, Serena Tonstad, Konstantinos P Tsioufis, Ineke van Dis, Isabelle C van Gelder, Christoph Wanner, Bryan Williams, ESC Scientific Document Group, ESC National Cardiac Societies2021 ESC Guidelines on cardiovascular disease prevention in clinical practiceEur Heart J.(2021 Sep 7)