How do eggs affect heart health?

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 linked to an increased risk of heart 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 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 tied to a higher risk for abnormal cholesterol levels or major heart and blood vessel 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 heart-healthy kind (monounsaturated and polyunsaturated). The more contentious issue is that it also contains about 207 milligrams (mg) of cholesterol. The cholesterol content 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” cholesterol, known as LDL cholesterol (low-density lipoprotein), can contribute to the build-up of plaque on the inside of artery walls. This potentially limits blood flow and increases the risk for heart attack and stroke. It seems logical, then, 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, government health experts revised official dietary guidelines, 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. One study published in PLoS Medicine in 2021 included over 520,000 U.S. adults between ages 50 and 71. The results suggested that each additional half an egg consumed per day was linked to a 7 percent higher risk of dying from heart disease over the course of about 16 years. Results also suggested that adding eggs to an overall unhealthy diet that is high in cholesterol may tip the balance toward higher risk for heart disease death. Replacing whole eggs with egg whites or egg substitutes was tied to lower rates of death.

Another study that looked at more than 27,000 men over 31 years found that for each additional egg consumed per day, the risk of death from heart disease increased by 9 percent. Every 300 mg increase in cholesterol intake per day was linked to a 13 percent higher risk. 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 70-calorie, low-carbohydrate nutrient powerhouse. It’s rich in 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.

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.

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 should avoid eggs or more carefully limit their dietary cholesterol consumption. So should people with an inherited genetic condition called familial hypercholesterolemia (FH), which causes very high LDL levels at a young age that worsen over time.

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. These foods often have fewer nutrients and a lot of “empty calories,” which can lead to weight gain and affect 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 four to six 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.