Why eggs are good for you: New study shows eggs aren't the devils that increase risk of heart disease
"Off with eggs," said his doctor. "So what the egg do I eat now?" The doctor stared him down. With sky-high cholesterol numbers, eggs were brushed aside from his table like unwelcome guests at a party. It was pretty rough, after years of starting his day with sunny-side-ups. But he leaned into the emptiness left by eggs, zen-like, embracing all the chaos for good: the snap and crackle of cereals, the chalky egg-white omelettes, the spongy tofu scrambles, the anti-cholesterol statin drugs messing up his tastebuds and giving him constipation, the chatter out there on Google linking egg-deprivation to insanity.
Then-boom-it's 2017. Suddenly eggs are back as the new superstar of the table. Social media is flooded with Cloud Eggs, the "new breakfast craze". Fashionable foodies are advising why you must crack an egg into your coffee cup, an old Vietnamese drink that has suddenly gone very 'It'. Food editors are writing totally-egg cookbooks. Celebrity chefs are calling eggs the "ultimate fast food".
Supermarket shelves are filling up with a bewildering choice of speciality eggs: organic, herbal, omega-3, cage-free. Egg eateries, with the coolest of names and the hottest of menus, are hatching everywhere, from New York to Navi Mumbai. And a host of super-centenarians are claiming the egg as the "secret" of their longevity. What's going on? It's the patient's turn to stare down his doctor.
THE EGG RENAISSANCE
There's something else in the air. The appetising scent of wholesome science that's giving the egg back its reputation. An explosion of new research has emerged on the shifting winds of nutrition around the world, debunking the "bad science" behind long-standing diet guidelines that demonised some foods (say, eggs) and glorified others (say, breads). The ubiquitous, unremarkable, unassuming egg stands as the metaphor of this new dietary renaissance. Food policy wonks are scratching their heads. Doctors who routinely put people off eggs are singing a new tune.
The internet is going crazy with the public's greed for knowledge: are eggs good or bad for you? Scrambled, boiled, poached or fried? An egg a day or three? The yolk, or the white? "Eggs are one of the fastest growing foods," says Habibur Rahman, deputy director-general (animal sciences) at the Indian Council of Agricultural Research. With 84 billion eggs produced a year (in 2016), up from 34 billion in 2000, India is the world's third largest egg producer. Indians are eating more eggs than they ever did: 63 eggs per capita a year, from 15 in 1980. The demand for eggs is rising faster than meat, milk and cereals. With rising incomes, a young and increasingly urban population, our food consumption pattern has changed dramatically, explains Rahman. "Eggs are affordable, convenient and very versatile."
WHAT'S THE TRUTH ON EGGS?
Expect new answers to your old questions. "Mounting evidence indicates that the science on eggs has been dodgy at best and controversial at worst," says Dr Ashok Seth, chairman of Fortis Escorts Heart Institute, Delhi. The demonisation is linked essentially to outdated ideas about heart disease and what causes it, he explains. Dietary cholesterol and saturated fats-and eggs are rich in both, have been greatly oversold as a health concern. "Over the past decade, we have learnt that cholesterol may not play as big a role in heart disease as previously thought," he points out. "And that chasing lower and lower cholesterol numbers has its own issues."
Besides, eggs also have many other healthy components, he points out. "Much of the knowledge on eggs, it now appears, was a misconception based on out-of-date evidence."
"The science on eggs has swung wildly for years because nutrition science can be maddeningly complicated," adds Dr B. Sesikeran, former director of National Institute of Nutrition (NIN) and president, Nutrition Society of India. Human nutrition is exceedingly complex, he explains. Diseases like obesity, diabetes or heart disease develop over a lifetime. It's hard to figure out the impact of one component in a diet. Seemingly similar foods can differ wildly in nutrition profile. An egg dish at a restaurant will have different fat and salt content compared with one made at home. "Everything we eat can simultaneously promote and disrupt health. The grey areas are often cleverly used by the food industry," says Sesikeran.
A case in point is a study published in JAMA Internal Medicine, September 2016, by researchers from University of San Francisco, showing how in the 1960s the sugar lobby had sponsored influential research that obscured the role of sugar in heart disease, promoting dietary fat as the villain instead. "Technology to test hypothesis as well as research literature have ballooned in the last decade," points out Sesikeran. Epidemiologists reviewing all the data are now saying eggs have an incredible ability to boost health.
CONSIDER THE EVIDENCE
"Eat your eggs without guilt." When Dr Salim Yusuf, president of the World Heart Foundation, presented preliminary data from a massive ongoing study on diet and heart health at a Cleveland Clinic cardiology symposium this February, the medical establishment was taken aback. The India-born cardiologist, epidemiologist and Marion W. Burke Chair professor at McMaster University Medical School, Canada, was defying the guidelines of long-standing "dietary truths". But he was only giving voice to what a growing number of scientists and clinicians felt: "Every week in the newspaper we read something is good for you. Then suddenly the same thing next week is bad for you. It's time to clear up the misinformation for good," he said.
That research is now out. Conducted on a sample base of 150,000 people from 18 countries in five continents, including 29,298 from India, the PURE study (Prospective Urban and Rural Epidemiological Study) has stunned pundits. "Eggs were vilified because experts said reduce fats and increase carbohydrates," says Dr V. Mohan, chairman of Dr. Mohan's Diabetes Specialities Centre, Chennai, and one of the investigators. WHO guidelines state that up to 75 per cent of one's daily energy can come from carbs. But the study found diets high in carbohydrates to be associated with higher risk of death. That's a prompt to reduce processed carbohydrates in your diet and increase natural fats. Yes, natural saturated fats found in eggs are fine to have again. Published in the prestigious journal Lancet in September, it is being hailed as a game-changer for managing the coronary calamity across the world.
PURE is in sync with a stream of new research that provides more evidence that high-cholesterol food like eggs do not increase the risk of heart disease. One of the earliest was in 2009, when a University of Surrey, UK, team analysed data from 30 countries and suggested that most people could eat as many eggs as they wanted without damaging their health. The latest is a study from the University of Eastern Finland - researchers followed 1,032 men, a third of whom were carriers of a gene variant known to increase risk of heart disease (and Alzheimer's), for 21 years. Published in American Journal of Clinical Nutrition, February 2016, it showed that for healthy people, up to one egg a day did not seem to increase the risk of heart disease, even among those at higher risk.
TO GIVE OR NOT TO GIVE
"Give them eggs," announced Justice H.L. Dattu, former chief justice of India and the current chairman of the National Human Rights Commission, on October 15. Ten crore children across India wait eagerly for their hot cooked meal at school every day. For many, it's the first meal of the day, for most it's the only wholesome meal. And they are overjoyed if there's an egg to go with the daily staple of roti or rice, watery dal or sambar, dished out as part of India's Integrated Child Development Services and Mid Day Meal schemes in government schools. Come shine or shower, they come to school in droves on days eggs are served. But for many, it's not a joy to look forward to anymore.
State after state is taking eggs off children's menu: 19 out of the 29 states in north and west India now do not include eggs. Madhya Pradesh Chief Minister Shivraj Singh Chouhan, a strict vegetarian, has rejected all proposals to introduce eggs in schools in his state since 2010. "What is the need for eggs? (The) human body is meant to consume vegetarian food," he says. Union minister for women and child development Maneka Gandhi has said in support: "Eggs are not good for nutrition. They have a lot of cholesterol." But on October 10, a new World Health Organisation report has shown how India is facing a nutritional double whammy: it's now a country with the most malnourished children, beating those in sub-Saharan Africa, as well as the most obese children (after China).
Getting research to the policy table is no easy task. But a steady stream of it has allowed the US government to break with tradition.
Released every five years since 1990, and co-developed by the US department of agriculture and department of health and human services, the eighth edition of Dietary Guidelines for Americans, 2015-2020, has changed its take on what one should put on the plate. "Eggs can be part of a healthy eating pattern," read the new guidelines released in December 2015.
HOW WE MESSED UP
Eggs came centre-stage in the 1950s, when an impending public health catastrophe loomed in the western world: heart disease. A landmark study, the Framingham Heart Study (FHS), was kicked off in the late 1940s after then US president Franklin D. Roosevelt died of a sudden stroke and heart failure. The era of watching diets began, as scientists started linking dietary fat and cholesterol to heart disease, explains cardiologist Dr K.S. Reddy, president, Public Health Foundation of India. The FHS came up with dietary "risk factors". "It was observed that those who developed "atherosclerosis" (hardening and narrowing of arteries) had elevated levels of "bad" LDL cholesterol and low levels of "good" HDL cholesterol. But the correlation with eggs in the diet was not supported by data, Reddy explains.
In fact, the data was so ambiguous that the report was never sent to peer-reviewed journals and sparked fierce disagreement among scientists. Yet the debate grabbed public imagination and influenced policymakers. It was reasoned that people with high LDL must be eating more cholesterol-rich, fatty foods. Hence, avoid high-fat animal foods - eggs, for instance - and have more fruits, vegetables and carbohydrates. To guard against heart disease, the influential American Heart Association (AHA) started recommending dietary guidelines from the 1970s, setting a 300 mg/day cholesterol limit: don't have more than four eggs a week, avoid egg yolks. In 1980, the USDA issued its first dietary guidelines. One of its primary directives was to avoid cholesterol and fat of all sorts.
That did not stop heart disease from spiralling out of control. When an obesity crisis flared in the '80s, most experts surmised that the investigators must have picked the wrong culprit: it wasn't cholesterol, but saturated fats - those that increased cholesterol synthesis by liver cells and elevated bad LDL. Dietary guidelines from the '90s started advising that fat intake should be cut down to 30 per cent of total energy and saturated fat to 10 per cent. Eggs, once again, entered the ambiguous zone, says Reddy
FROM FOREST TO PLATE
Although the story of the egg is linked to the Indian red jungle fowl's journey from forest to farm around the Indus Valley civilisation, it entered the mainstream Indian food basket slowly, over centuries of Persian, Portuguese and British culinary influence. For much of the 20th century, egg consumption thrived largely outside the home - as street food, in canteens, clubs and cafes. Between 1947 and 1960, poultry and eggs played a minor part of the caloric value of Indian diet, reports the National Council of Applied Economic Research, mainly because purchasing power was low but also because religious beliefs prevented "orthodox Hindus and Jains from eating poultry or eggs". In sharp contrast, there was exceptionally large consumption of pulses, a rich source of vegetable protein. Sugar and fat consumption had started to rise during this time.
India didn't have too many published reports on heart disease in those days. Although piecemeal studies showed a heart failure rate of about 1 per cent, doctors noticed urban, affluent classes coming to their chambers with heart issues. "Heart disease has a predilection for the privileged class of society," wrote Dr K.S. Mathur, department of medicine, Sarojini Naidu Medical College, Agra, in one of the first studies of its kind (Circulation, 1960). What could be the reason? Clearly, they consumed "the highest amount of dietary fat". With a host of well-known Indians dying of heart disease - Vallabhbhai Patel, B.R. Ambedkar, Feroze Gandhi, Jawaharlal Nehru to Lal Bahadur Shastri - that diet-heart wisdom was codified: avoid fatty foods.
The landscape changed from the 1970s, when egg consumption started going up in India, as traditional sources of dietary protein, like pulses and millets, became scarce and expensive. The Green Revolution from the late 1960s focused attention of successive governments entirely on wheat and rice, neglecting pulses and millets, reports the International Agriculture Trade Research Consortium. As production of pulses declined and prices shot up, Indians shifted to eggs to fulfil their protein requirement. It's called 'Livestock Revolution,' a term coined by the International Food Policy Research Institute. Simply put, it means that the social transformation of population growth, urbanisation and rising incomes is accompanied by a fundamental change in the way people eat, from traditional staple cereals to more animal proteins, including eggs. That nutrition transition pushed India towards a whirlwind of chronic disease, says Dr Ramakanta Panda, cardiac surgeons and chairman of Asian Heart Institute, Mumbai. From the 1990s, as USDA tightened its guidelines, doctors everywhere cut down on eating even one egg a day.
SCIENCE TAKES A U-TURN
What's going on? "About a dozen large-scale observational studies, followed up over decades on thousands of men and women, connected some of the crucial dots in the 2000s," says Dr Ambrish Mithal, chairman, division of endocrinology and diabetes, Medanta - The Medicity in Gurgaon. "Taken together, they provided the convincing evidence that eating an egg a day is safe for most people." A growing body of research now shows that cholesterol-rich foods like eggs do not raise blood cholesterol levels by that much. Consuming sugar, trans fats or excessive saturated fat can be more harmful, he says.
The problem with the old guidelines was it assumed that when you ate more cholesterol, from eggs and other animal foods, your blood cholesterol rose. "Assume that and, of course, it makes sense to eat fewer eggs," says Dr Nikhil Tandon, professor and head, department of endocrinology and diabetes, All India Institute of Medical Sciences, Delhi. "But your body doesn't work that way." The human body makes all the cholesterol - a substance essential for cellular functions - it needs. Every day, the liver produces between 1 and 2 grams, the rest comes from diet. "But when one takes in more cholesterol from food, your body produces less of it," he explains. The body produces more cholesterol when dietary cholesterol is less.
Research now suggests that the cholesterol you eat has little impact on how much cholesterol you have in your blood serum. In fact, some degree of cholesterol consumption is harmless. Most of the studies do not find higher rates of heart attacks, strokes or other cardiovascular diseases in people who eat up to one egg per day. With all that, the egg's reputation is gradually returning.
WHAT WE DO (AND DON'T) KNOW ABOUT EGGS
The new cholesterol guidelines have exonerated the egg, with an embarrassed apology. Some food scientists are, however, worried that the softened official line on cholesterol would send out wrong messages, giving people the licence to eat, say, five eggs every morning for breakfast. Avoid sensational food fads, they say. Eat a varied diet of nutrient-rich whole foods. And do include eggs, but don't misinterpret the data. So here are the highlights, edited for clarity:
An egg a day does not increase the risk of a heart attack, a stroke, or any other type of cardiovascular disease for most people
Don't have more than three eggs a week if you have diabetes, are at high risk for heart disease from other causes (say, smoking), or already have heart disease
There is no definitive evidence for how many eggs you should eat, but one a day is definitely fine (Emma Morano, who died at age 115 this year, had three eggs a day)
How many eggs you can safely eat per week largely depends on what the rest of your diet looks like
It matters greatly what you eat with your eggs (trans fats, highly-refined "bad carbs" or saturated fats: white flour and rice, potatoes, fried food, processed foods or sweetened drinks)
Have eggs mixed with fresh vegetables, to help your body take in more healthy antioxidants
THE NEXT BATTLE FOR EGGS
Nothing seems more wholesome than breaking an egg into a frying pan for breakfast now. Wait a minute, the ever-controversial egg has moved on to the next scandal. The 269th report of the Law Commission of India has drawn attention to the treatment of chicken in commercial factory farming this July: the birds are kept in inhumane conditions, starved and manipulated mercilessly for faster production. The suffering and drastic weight loss dramatically increases the risk of a hen's laying infected eggs.
Who can tell what can hide in an egg, waiting its chance to create havoc? It sent shock waves across the nation when researchers from the Washington-based Center for Disease Dynamics, Economics & Policy and the Public Health Foundation of India, Delhi, found unregulated use of antibiotics and drug-resistant bacteria across 18 poultry farms in Punjab. According to the study reported in Environmental Health Perspectives, July, 2017, with rising incomes and heightened demand for eggs and chicken, consumption of antibiotics could grow more than 300 per cent by 2030 in India. "Antibiotic-resistant microbes can render ineffective the very drugs designed to cure infections," says Ramanan Laxminarayan, lead author and CDDEP director. No one will be spared if such outbreaks spread, be it a small remote village or the largest of metros.