The debate over cholesterol intake rages on in the world of cardiovascular medicine. After years of “fat is evil” propaganda, the tide turned to acknowledge that some fat is better than others. We even recognize that fat can be a good thing. A question however continues to plague each of us as we sit down at the dinner table or walk through the grocery aisles, “how much is enough but not too much?”. A recent study appears to throw an egg in the face of some prior dogma over cholesterol intake.
The Finish study offers some insight although it does not fully answer the bigger questions. Over a 21 year follow up of 1,950 men aged 42 to 60 years, those in the higher cholesterol intake group did not show an increased rate of stroke. The highest intake group of men averaged over 500mg of cholesterol per day including about 1 egg per day. Even those with the APOE4 gene, which is associated with cholesterol abnormalities, did not fare worse.
Again, I repeat, this is neither a conclusive nor comprehensive answer. This study suggests that Finish men aged 42 to 60 years, with or without the APOE4 gene and without prior cardiovascular disease, could eat 1 egg a day (about 200mg of cholesterol) with a total daily cholesterol intake of 520mg, without stroke risk increasing. If you fall into that narrow demographic, then this is a more helpful study. Even then, they only looked at 1,950 study participants which is not huge in terms of population studies.
As a functional MD daily answering patient questions about “What is the right diet for me?”, I can say this. Most people can probably consume this moderate amount of cholesterol without fear. We know that our bodies need some cholesterol to make hormones and vitamin D. We know that our body needs some cholesterol for cell membrane health. But how much is enough but not too much.
On the other hand, for those with cardiovascular disease or genetic tendencies toward high cholesterol, we must dig further for answers of whether their needed levels of cholesterol intake are different. Ultimately, we need more light shed into this area of research. Until science provides such answers, at Sanctuary we keep treating the person sitting in front of us at the time. We use what science we have and the most logical assessments for that unique patient to give personalized answers.
Anna M Abdollahi, Heli E K Virtanen, Sari Voutilainen, Sudhir Kurl, Tomi-Pekka Tuomainen, Jukka T Salonen, Jyrki K Virtanen. Egg consumption, cholesterol intake, and risk of incident stroke in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. The American Journal of Clinical Nutrition, 2019; DOI: 10.1093/ajcn/nqz066