This position statement from the New Zealand Heart Foundation (NZHF) summarises the key findings and recommendations from its evidence paper, Eggs and the Heart, which was issued in January 2016.
It is very good news for egg consumers and the egg industry – NZHF has relaxed its previous recommendations on egg consumption and is recommending that those at risk of heart disease can eat up to six eggs per week (previously three). For the general population who have a heart-healthy diet, there is no restriction but a note to pay special attention to the foods that are eaten alongside eggs.
Eggs are a nutritious whole food that can be part of a heart-healthy dietary pattern. They are an inexpensive source of protein and other nutrients such as carotenoids, vitamin D, B12, selenium and choline. While egg yolks are high in cholesterol and are a major source of dietary cholesterol, it is saturated fatty acids that have a greater effect on blood cholesterol levels and, therefore, your risk of heart disease.
Previously, the New Zealand Heart Foundation recommended that people at high risk of heart disease limit egg intake to three eggs per week. However, since the original Heart Foundation position paper was published in 1999, most organisations() around the world have relaxed their advice on eggs. In line with this, the Heart Foundation last year commissioned an independent scientific report, which involved a thorough review of the existing research. Based on that review, the overall evidence for the effect of eggs on blood cholesterol or on those at risk of heart disease has been deemed inconsistent. There are strong limitations to many of the studies reviewed, including differences in findings between cohort and intervention studies, plus a high level of industry-funded research.
Although eggs are high in dietary cholesterol, the weight of evidence suggests eggs have only a very small effect on blood cholesterol levels, especially at normal levels of intake in New Zealand. For most people, any such increased risk is not likely to be clinically meaningful.
While the evidence is not clear enough to say there is no association between dietary cholesterol and heart disease risk, the evidence is also not strong enough to warrant continuing recommendations to limit egg intake to three per week.
Overall, epidemiological evidence suggests six to seven eggs per week does not increase heart disease risk.
There has been a limited amount of research since 1999 in people with hyperlipidaemia, and epidemiological research suggests the prudent limit for them is six to seven eggs per week.
Dietary cholesterol and egg intake have been associated with increased risk of cardiovascular disease in people with type 2 diabetes, in most studies that have assessed them.
When sub-groups of hyper-responders to dietary cholesterol were identified, the increases in blood cholesterol levels were still small.
Advice for those at increased risk of heart disease
Based on current evidence, the Heart Foundation is making a prudent recommendation that New Zealanders who are at increased risk of heart disease, including those with Type 2 diabetes, can eat up to six eggs per week as part of a heart-healthy eating pattern. This amount is unlikely to have any substantive influence on their risk of heart disease.
Advice for hyper-responders would be best based on their individual response to egg intake, as limits will vary according to the individual. It would be best to discuss your individual requirements with your GP and a registered dietitian.
Advice for the General Population
For the general healthy population, eggs can be included as part of a heart-healthy eating pattern. There are more important changes people should be focusing on, such as increasing vegetable intake, eating more whole and less processed foods and reducing saturated fat intake, rather than restricting egg intake.
General egg advice
Care should be taken with the company that eggs keep, that is the combination of foods often eaten with eggs such as processed meats, like bacon or sausages, refined white bread and/or butter or salt.
A heart-healthy dietary pattern is based largely on minimally processed foods and includes plenty of vegetables and fruit, some whole grains in place of refined grains, legumes, nuts, seeds and other sources of healthy fats such as oily fish, and may contain non-processed lean meats or poultry and/or dairy.
Other organisations to have relaxed their recommendations on eggs include the Australian Heart Foundation, British Heart Foundation and American Heart Association. Also, the latest Dietary Guidelines for Americans have removed dietary cholesterol as a cause of concern for overconsumption.