© 2018 Bloomberg Finance LP What eggs-actly does this mean? A study just published in JAMA seemed to give eggs a bit of a beating after they've been on a roll since 2015. After all, that year the Dietary Guidelines of America no longer included a recommended limit on the number of eggs that you should eat a week. But does this new study scramble this situation and raise the possibility of such limits returning? Well, here's a closer egg-amination, which may be a bit punny. The study laid together data from six different cohorts in the U.S. that had a combined total of 29,615 people who were followed for an average of 17.5 years between March 25, 1985, and August 31, 2016. During this eggs-tensive time period, these people had a total of 5400 cardiovascular events, which included 2088 coronary artery problems (like a heart attack), 1302 strokes, 1897 heart failure events, and 113 deaths from cardiovascular disease. There were also 6,132 deaths in general. Additionally, the researchers had information on the participants' diets based on questionnaires that participants had completed when they had first entered the cohorts. Therefore, they did not track the diets of the participants throughout the course of the studies. Keep in mind that this would eggs-clude any changes in diet during the course of the cohort. Moreover, this relies on the participants to accurately recall what they usually ate and sometimes trying to get very accurate recall can be a bit eggs-asperating. The research team then tried to determine if there was an association between the amount of cholesterol and eggs that these people had consumed each day (again at the beginning of their participation in the cohorts) and the likelihood of suffering cardiovascular events or dying during that time period. In their statistical analysis, the team tried to account for factors such as people's ages, sexes, races, ethnicity, education levels, smoking habits, alcohol intake, physical activity levels, body mass indices (BMIs), blood pressures, lipid levels, use of particular medications, and medical conditions. The analysis found a correlation between the amount of cholesterol consumed each day and the likelihood of suffering a cardiovascular event and dying. Every 300 mg increase in cholesterol intake each day was associated with a 3.24% higher likelihood of having a cardiovascular event and a 4.43% higher likelihood of dying during that time period. The analysis also found correlations with the number of eggs consumed each day. For each additional half an egg eaten per day, the likelihood of a cardiovascular event went up by 1.93% and the likelihood of death increased by 0.71%. It's not nit-pecking to re-emphasize that this was based on the number of eggs consumed per day at the beginning of the cohort and not throughout the cohort. So, should this study re-hatch recommended limits on the number of eggs that your should eat a week due to their cholesterol content (186 mg on average in a large egg)? What about the fact that eggs are eggs-ellent sources of protein, vitamin D, choline, lutein, and zeaxanthin without an eggs-essive amount of calories (just 78 an egg)? What about studies that have suggested more sunny-sides of eggs such as the cohort study published in the journal Heart and covering over a half a million people in China? In that study, those who ate a moderate amount of eggs (less than one a day) had a lower risk of cardiovascular disease than those who ate no eggs. This video from last year summarized some of the American Heart Association's thoughts about eggs: While the JAMA and Heart studies may have been relatively well-done population cohort studies, there are numerous cracks in such study approaches in general. These types of studies can never really show or determine cause-and-effect. They tend to take large pots of data and try to boil them down to relatively simple correlations or associations. But life is a lot more complex than that. The relationships between a food item and cardiovascular disease involve complex systems, many of which were not really considered or represented in such analyses. For example, how about things such as job stress, social situations, or the environment? Such things can affect both a person's diet as well as his or her cardiovascular risk. Then, there are the other components of a person's diet. A person typically doesn't just eat eggs or nothing, at least he or she shouldn't. Do people who tend to eat more eggs tend to then concurrently eat more or less of other things? For example, could a heavy egg eater also be a heavy bacon eater? Moreover, eggs can be prepared in many, many different ways, some healthier (e.g., less salt, less sauce, less yolk, and less oil) than others (e.g., a deep fried, heavily-salted egg smothered in ketchup). Getty There are other limitations of the JAMA study. It relies on a single self-assessment at the beginning to determine a person's diet. Remembering what you eat over time can be challenging. Heck you may not even remember what you just ate for lunch or what was in that spoon that just went into your mouth. Furthermore, your diet can be quite complex and change over time. It would be the wrong ap-poach to depend too heavily on such large population cohort studies to develop nutrition recommendations. Notice how popular viewpoints about eggs have seemed to run back and forth over the years. That's because these large cohort studies only provide indirect evidence, no more than shells of what may really be occurring. Nevertheless, every time one of these studies comes out, headlines fry around saying either "eggs are bad" or "eggs are good." The same has happened to other food and beverage items such as coffee. In 2017, the National Academies of Science, Medicine, and Engineering convened a committee (of which I was a member) to review the process by which the Dietary Guidelines of America are determined. One of our committee's recommendations was to use more systems approaches and methods. There are a number of emerging methods such as systems mapping and computational modeling that can help better account for and delineate the systems that govern the relationships between diet and various health outcomes such as cardiovascular diseases. Such methods can bring together data and information from laboratory studies, animal studies, clinical trials, cohort studies, and other sources and determine how they fit together and try to reconstruct the systems involved. When determining what will happen to the weather or a rocket launch, you don't just focus on one or two factors and show how these correlate with what may happen. Instead, meteorologists and aerospace engineers build sophisticated computer models and try to simulate what may occur. The same needs to be done more extensively in nutrition research. If you want to determine how many eggs you should eat, you need to dive eggs-tra deeper and better understand these complex systems involved. After all, again your choice is not simply between eating only eggs versus eating no eggs at all. So, for now, omletting go of trying to make any broad recommendations about how many eggs you can and should eat each day or each week. The recommended limit depends on a lot of different factors and probably varies from person to person. In general, moderation and balance are key (or quiche) for a healthy diet. You don't want to eat an egg-cessive number of eggs but you also don't have to completely eggs-lude eggs from your diet, unless of course you are vegetarian or vegan. Keep in mind that eggs can offer important nutrients but also have cholesterol. Your decision about how many eggs to eat should depend on a number of factors such as your other possible sources of protein, vitamin D, other nutrients, and cholesterol as well as the way you are preparing the eggs. While setting recommended daily intake limits for nutrients such as sugar and salt may be easier (but by no means over easy), doing so with whole food items such as eggs is more challenging.<doc-sep>The latest U.S. research on eggs won't go over easy for those who can't eat breakfast without them. Adults who ate about 1 ½ eggs daily had a slightly higher risk of heart disease than those who ate no eggs. The study showed the more eggs, the greater the risk. The chances of dying early were also elevated. The researchers say the culprit is cholesterol, found in egg yolks and other foods, including shellfish, dairy products and red meat. The study focused on eggs because they're among the most commonly eaten cholesterol-rich foods. They can still be part of a healthy diet, but in smaller quantities than many Americans have gotten used to, the researchers say. U.S. dietary guidelines that eased limits on cholesterol have helped eggs make a comeback. The study has limitations and contradicts recent research, but is likely to rekindle the long-standing debate about eggs. The new results were published online Friday in the Journal of the American Medical Association. THE STUDY Researchers at Northwestern University's Feinberg School of Medicine and elsewhere pooled results from six previous studies, analyzing data on almost 30,000 U.S. adults who self-reported daily food intake. Participants were followed for roughly 17 years, on average. The researchers calculated that those who ate 300 milligrams of cholesterol daily — about 1 ½ eggs — were 17 percent more likely to develop heart disease than whose who didn't eat eggs. The researchers based their conclusions on what participants said they ate at the start of each study. They took into account high blood pressure, smoking, obesity and other traits that could contribute to heart problems. Risks were found with eggs and cholesterol in general; a separate analysis was not done for every cholesterol-rich food. Dr. Bruce Lee of Johns Hopkins University, said nutrition studies are often weak because they rely on people remembering what they ate. "We know that dietary recall can be terrible," said Lee. The new study offers only observational data but doesn't show that eggs and cholesterol caused heart disease and deaths, said Lee, who wasn't involved in the research. Story continues Senior author Norrina Allen, a preventive medicine specialist, noted that the study lacks information on whether participants ate eggs hard-boiled, poached, fried, or scrambled in butter, which she said could affect health risks. Some people think '"I can eat as many eggs as I want'" but the results suggest moderation is a better approach, she said. THE DEBATE Eggs are a leading source of dietary cholesterol, which once was thought to be strongly related to blood cholesterol levels and heart disease. Older studies suggesting that link led to nutrition guidelines almost a decade ago that recommended consuming no more than 300 milligrams of cholesterol daily; one egg contains about 186 milligrams. Newer research questioned that relationship, finding that saturated fats contribute more to unhealthy levels of blood cholesterol that can lead to heart problems. The latest U.S. government nutrition guidelines, from 2015, removed the strict daily cholesterol limit. While eating as little cholesterol as possible is still advised, the recommendations say eggs can still be part of a healthy diet, as a good source of protein, along with lean meat, poultry, beans and nuts. Nutrition experts say the new study is unlikely to change that advice. BOTTOM LINE Dr. Frank Hu of Harvard University noted that most previous studies have shown that eating a few eggs weekly is not linked with risks for heart disease in generally healthy people. "I don't think that this study would change general healthy eating guidelines" that emphasize fruits, vegetables, whole grains, nuts and beans and limiting processed meats and sugar, Hu said. Eggs, a breakfast staple for many, can be included but other options should also be considered, "like whole grain toast with nut butter, fresh fruits, and yogurt," Hu said. Dr. Rosalind Coleman, a professor of nutrition and pediatrics at the University of North Carolina, offered broader advice. "The main message for the public is not to select a single type of food as 'bad' or 'good' but to evaluate your total diet in terms of variety and amount. "I'm sorry if it seems like a boring recommendation," she added, but for most people, the most important diet advice "should be to maintain a healthy weight, to exercise, and to get an adequate amount of sleep." ___ Follow AP Medical Writer Lindsey Tanner at @LindseyTanner. ___ The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.<doc-sep>A study published in JAMA rekindles the debate on whether or not eggs are healthy. According to its findings, the more eggs you eat, the higher your risk of heart disease and premature death. Results of previous research suggest the opposite, finding that eggs are not linked to increased risks of cardiovascular disease or stroke. Some experts raise concerns about the study itself, bringing up points that show the findings may not be as clearcut as some media reports are making them seem. Perhaps even more than red meat, coffee, or wine, egg yolks seem to elicit debate over whether they’re a power-packed source of vitamins and protein, or a heart-attack fuse just waiting to be lit. A recent study published in JAMA takes the latter position. After analyzing data on nearly 30,000 adults from six studies spanning 31 years of follow-up, researchers concluded that eating 300 milligrams (mg) of dietary cholesterol per day—one egg yolk, in comparison, provides 185 mg—raises incident cardiovascular disease by 17 percent and early death by any cause by 18 percent. Eating just three to four eggs per week was associated with 6 percent higher risk of cardiovascular disease and 8 percent higher risk of any cause of death. And if you eat two eggs per day, you’d be boosting your risk of cardiovascular disease by 27 percent, and your risk of early death by 34 percent, according to the study. This content is imported from {embed-name}. You may be able to find the same content in another format, or you may be able to find more information, at their web site. In the study, higher egg consumption had these associations regardless of age, activity levels, race, smoking status, blood pressure, or cholesterol levels. “Our study does not suggest there is a safe amount for egg consumption,” lead researcher Wenze Zhong, Ph.D., in the Department of Preventive Medicine at the Feinberg School of Medicine at Northwestern University, told Runner’s World. “Any level of egg consumption is associated with increased risk of cardiovascular disease and mortality, because we found a dose-response association. Greater consumption means higher risk.” Is the new study all it’s cracked up to be? The debate over eggs originated because of yolks’ high cholesterol content, and previous recommendations cautioned people to eat less cholesterol as a way to prevent cardiovascular disease, according to Alyssa Pike, R.D., manager of nutrition communications at the International Food Information Council. However, she told Runner’s World, daily cholesterol limits were removed from the U.S. government’s 2015 Dietary Guidelines for America. “This change came about because the current body of research about dietary cholesterol does not support the idea that dietary sources of cholesterol have a large impact on our blood cholesterol levels,” she said. Stuart Phillips, Ph.D, the director of the McMaster Centre for Nutrition, Exercise, and Health Research, agrees that the cholesterol-from-food link may not be as damning as we once thought. “Cholesterol may be something to pay attention to, but its relationship to heart disease and death isn’t huge, and there are lots of other contributors,” he said. “Even the paper itself shows that it isn’t really the problem.” In fact, the study itself may have some issues—something important to address before drawing any sweeping dietary conclusions from its findings. For one, the amount of risk, or hazard, that’s reported here is trivial—and the way in which they calculated it doesn’t exactly lend itself to an easy determination of someone’s true risk, Phillips said. He added that the authors themselves admitted there were significant limitations. In that acknowledgement, the researchers noted there may be measurement error because the diet data was based on recall—for example, imagine that someone just asked you, “Exactly how many eggs did you have last month?” Not only can this type of self-reported data be unreliable, but also researchers assessed this only once, Phillips pointed out, and assumed it didn’t change in an average of 17 years of follow-up. Also, they stated that all cohorts used different dietary assessment tools, leading them to implement their own methodology to harmonize diet data. Finally, the study findings are observational, so while they can suggest a relationship, they can’t prove that one thing caused the other. Now, the last point isn’t surprising, since nearly all nutrition studies are observational, and most rely on self-reported data, said Andrew Mente, Ph.D., principal investigator for the Epidemiology Program at the Population Health Research Institute. After all, it’s tough to find a large number of research participants willing to eat a very restricted diet for decades, simply so you can try to find potential health associations. But, Mente told Runner’s World, there are several problems with the paper that go beyond the correlation-doesn’t-equal-causation issue. “The primary hypothesis here is that eggs increase your bad cholesterol, and the more you eat, the worse it gets,” he said. “But buried way down in the appendix is a note that they found higher egg intake is related to a reduction in LDL, your bad cholesterol. So, what’s driving the association in this research? It seems like there’s a contradiction with the findings.” Another ping against the study, he added, is that the findings don’t agree with other notable cohort studies—which is research done over a period of time, with researchers checking in at certain intervals. That includes studies like this one, and this one, and this one, and this one, the findings of which all conclude that there is no increased risk of coronary heart disease or stroke with higher consumption of eggs, usually defined as one egg per day. 4 Great Protein Powders for Runners Klean Athlete Klean Isolate Whey Protein Isolate amazon.com $52.80 Shop Now This protein contains all the essential amino acids and comes in chocolate, vanilla, and unflavored varieties. Now Sports Soy Protein Isolate, Unflavored amazon.com $27.99 $22.25 (21% off) Shop Now With zero grams of carbs and 0.5 grams of fat per serving, this soy protein provides a lean supplement options for those who aren’t getting enough protein through food. Momentous RedShift Grass Fed Whey Endurance Recovery $55.00 livemomentous.com SHOP NOW This vanilla or chocolate flavored mix provides 20 grams of protein per serving and tastes good enough to mix with just water. Vega Sport Protein Powder, Vanilla amazon.com $54.99 $39.99 (27% off) Shop Now Packed with ingredients such as pea, organic pumpkin seed, organic sunflower seed, and alfalfa, this tub contains 30 grams of protein per serving, plus BCAAs and glutamic acid. So should we really shelve eggs? That’s a whole lot of information to take in when you’re considering what you should put on your plate for breakfast this morning. Should you use this study’s findings to change your habit? You might not need to stop cracking those eggs yet. With the potential issues outside experts raised about the paper—and the fact that other previous studies have arrived at opposite conclusions—changing how you eat based off the results of one study may be premature. As we’ve said over and over again, when we’re talking about diet, moderation is key: Eating three-egg omelets for breakfast every day might not best, especially if you combine them with other sources of dietary saturated fat, like processed meats, and unhealthy behaviors, like lack of activity. But, as Mente said, there’s quite a bit of evidence that an egg every day is safe. (Beyond that, he believes they simply don’t know without more data.) And like anything in the health field, the best advice isn’t going to be a blanket statement—things like your health status and individual risk factors will likely play a role, too. “This study sounds really frightening for egg lovers,” said dietician Maya Feller, R.D., C.D.N. “I think we need to look at an individual’s genetic predisposition for alterations in internal cholesterol production as well as family history. This can give us a really good information around a person’s risk for cardiovascular disease.” Elizabeth Millard Elizabeth Millard is a freelance writer focusing on health, wellness, fitness, and food. This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses.<doc-sep>
Image : Andreas Rentz ( Getty Images ) Breakfast sandwich fans beware: Eating too many eggs might be bad for your health... again. A new study released Friday found that daily consumption of a certain amount of cholesterol, a key nutrient of eggs, is linked to a modest increase in the risk of cardiovascular disease and early death. The findings, if valid, could overturn the current medical consensus that there’s no need to watch your cholesterol or egg intake—itself a controversial idea among nutritionists. In 2016, the United States Department of Agriculture finalized its current five-year update of the Dietary Guidelines for Americans, meant to run until 2020. There was one change from previous guidelines that got everyone’s attention. The USDA no longer called for a upper limit to the amount of dietary cholesterol you should have, which was previously set at 300 milligrams a day (one large egg alone provides around 160 milligrams). Instead, the guidelines said, dietary cholesterol shouldn’t be considered “a nutrient of concern for overconsumption.” The USDA’s decision, which did receive some criticism at the time, reflected the latest shift in thinking around cholesterol in the nutrition world. To put it simply, studies haven’t consistently shown that more cholesterol in our diets leads to more cholesterol in the blood, particularly the unhealthier low-density lipoprotein (LDL) cholesterol, which can contribute to clogged arteries and heart disease. Nor have they clearly shown that eggs and dietary cholesterol are linked to poorer health, since factors like a person’s overall diet can cloud the picture. People who love to eat eggs, for instance, might also love eating unhealthier foods like bacon in general. The authors behind this new paper, published in JAMA, acknowledge the long-standing debate around eggs’ benefits and harms. But they argue that their study’s design and methodology was able to separate the wheat from the chaff and look at the effects of cholesterol and eggs in isolation and in more detail than other attempts. “With eggs, like most foods, there are good and bad parts to them. And it’s been very hard to tease apart the potential harmful effects of high cholesterol in eggs vs other beneficial nutrients,” study author Norrina Allen, associate professor of preventive medicine at the Northwestern University Feinberg School of Medicine in Illinois, told Gizmodo. They turned to the Lifetime Risk Pooling Project, which combines data from 20 large population studies that have tracked people’s health over years to figure out risk factors for cardiovascular disease. For this study, they used data from six studies, which collectively involved nearly 30,000 relatively healthy, middle-aged people with no pre-existing heart disease and followed them for a median of 17 years and up to as long as 31 years. All of the volunteers, at the start of their respective studies, detailed their typical diet, including how much they ate eggs and other high-cholesterol foods like red meat. Ultimately, they found there was a 17 percent increased risk of cardiovascular disease associated with every extra 300 milligrams of dietary cholesterol a day, along with an 18 percent increased risk of early death, even after adjusting for factors like the amount of calories eaten per day. And each extra half-egg a day was similarly linked to a 6 percent and 8 percent increased risk of cardiovascular disease and early death, respectively. The link between egg consumption and poorer health went away after accounting for a person’s cholesterol intake, suggesting their high cholesterol content was the principle reason behind the increased risk. The findings, Allen said, might prompt yet another reconsideration of health organizations’ advice to not worry about dietary cholesterol or eggs. “I think [organizations like the USDA] were working with the best evidence they had available, which has never been conclusive,” she said. “But this study is a large, very strong observational study that may start to change the balance of data.” At the same time, Allen and her team caution that people shouldn’t be too worried about their egg-eating habits. For one, though the average American eats around three to four eggs a week, they’re not the only major source of cholesterol in our diet; processed and red meats provide plenty, too. And unlike some studies, this one included more of a real-world context. The researchers estimated that the absolute risk difference linked to eating 300 milligrams of cholesterol a day, over a 31-year-period, was 3.24 percent for cardiovascular disease and 4.43 percent for mortality.