Dr Shawn M. Carney
Cholesterol, Carbs, and Eggs
Updated: Oct 26, 2022
February is American Heart Month, with that, our attention goes to cholesterol.
The Skinny on Fats and Carbs
We’ve all heard how important it is to lower our cholesterol with diet. Fats most commonly associated with high cholesterol are saturated fats and trans fats, but they are not the only contributors. Replacing foods that have these problematic fats with healthier options can lower your cholesterol levels. Foods high in saturated or trans fats include baked goods, beef fat, cheese, cream, fried foods, pork, and poultry with skin, among others. But perhaps the biggest influence on your blood cholesterol levels is the mix of fats and carbohydrates in your diet, not just the amount of cholesterol in the food you eat. Although it remains important to limit the amount of cholesterol you eat, especially if you have diabetes or cardiovascular concerns, for most people dietary cholesterol is not as problematic as once believed. The way carbohydrates play a role in high cholesterol is that carbohydrates give your body energy in the form of acetyl-CoA. Acetyl-CoA is involved in cellular energy production and has many sources in the diet, including carbohydrates, as well as amino acids and fatty acids. All of these turn into acetyl- CoA, and then acetyl- CoA is used in the formation of cholesterol.
But you can’t get a room full of cholesterol researchers to agree on anything, even if whether or not they like their own mother! Other research has shown low carbohydrate diets actually increase low density lipoprotein (LDL) despite having weight loss. This seems partly explained when considering that not all carbohydrates are created equal, and different types of carbohydrates can have different effects on your cholesterol levels.
Carbohydrates fall into one of two categories: simple (or refined) carbohydrates and complex carbohydrates. Simple carbohydrates have a chemical structure of one or two sugar molecules, and you can digest these carbohydrates easily and quickly, which can create a faster rise in blood sugar. These include soft drinks, juices and products made with white flour. By contrast, complex carbohydrates contain three or more sugar molecules, which creates a more complicated structure that takes longer to digest. Complex carbohydrates are also often high in fiber and include whole grains; fiber is important because this helps to blunt the glycemic, or blood sugar, response. So fiber becomes one important factor that separates good complex carbohydrates from the not-so-good, simple or refined carbohydrates. White rice and pasta, for instance have had their fiber and many nutrients removed and will elevate blood sugar quickly, compared with the whole-grain versions. Whole fruit also contains fiber and will release into the bloodstream much slower than fruit juice. And it’s this emphasis on simple sugar and/or low fiber content which coincides with some of the research on higher glycemic load intake linked to high serum cholesterol.
Eggs: Good, Bad and How Many
A popular question that comes up with my patients is about eggs. Although eating cholesterol rich foods, such as eggs, has long been blamed for causing high cholesterol, researchers and doctors now realize most of our body’s cholesterol comes from our body making it in our liver, in response to the excess carbohydrates and saturated fats. Though high in cholesterol, eggs are low in saturated fat, so eating eggs is fine for many people, if you do it in moderation. The key here is moderation. The discovery half a century ago, that high blood cholesterol levels were strongly associated with increased risk of heart disease triggered numerous warnings to avoid foods that contain cholesterol. However, many scientific studies show a weak relationship between the amount of cholesterol a person consumes and his/her blood cholesterol levels. For example, a 2020 study that gleaned insights from three other cohort studies and had over 100,000 participants, found that consuming an egg a day was not associated with higher risk of heart disease.
Eggs supply your body with many beneficial elements. One large egg has only about 72 calories and 6 grams of protein. A full egg also contains nutrients like lutein and zeaxanthin, choline, and vitamins A, B, and D. Furthermore, let’s consider the older dietary cholesterol guidelines in place prior to 2015, which stated that the average person should get no more than 300 milligrams of cholesterol a day, while those with risks factors for heart disease shouldn’t have over 200 milligrams a day. Though these guidelines are no longer current, they don’t seem off the mark. Research from 2021 among healthy Japanese people consuming one egg a day still fit within these dietary parameters, and participants had a favorable outcome. This is due to one large egg having about 186 milligrams of cholesterol, which is all in the yolk and keeps a single egg serving below the old threshold, even for those at risk of cardiovascular disease.
In conclusion, it seems that eggs get the ‘green light’ so long as you eat them in moderation and keep your serving size to a single egg. However, if your daily breakfast looks like two eggs with butter, cheese, bacon, sausage, muffins, and other common breakfast options that can add a lot of cholesterol to your normal serving of eggs, that’s a different story.
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Zhong, V. et al. Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality. JAMA. 2019. 321(11): 1081-95.
The content and any recommendations in this article are for informational purposes only. They are not intended to replace the advice of the reader's own licensed healthcare professional or physician and are not intended to be taken as direct diagnostic or treatment directives. Any treatments described in this article may have known and unknown side effects and/or health hazards. Each reader is solely responsible for his or her own healthcare choices and decisions. The author advises the reader to discuss these ideas with a licensed naturopathic physician.