Featured article in the Fall 2015 Issue of Nutrition Close-Up; written by Bev Benda, RDN, BCC
While working as a Registered Dietitian in outpatient renal dialysis, I overheard a nephrologist advise a patient: “We need to get that albumin up. Eat lots of eggs. Just make sure you don’t eat the yolk!”
When I arrived, the patient met me with a scowl: “I’m confused! You told me I could eat the entire egg, and the doc just told me I have to toss the yolk! Who am I supposed to listen to?”
What to do when the dietitian’s advice conflicts with that of the physician? Before I tell you how I handled it, let us review the role of eggs as a food for patients, especially those with renal disease:
- A large egg has about 6 grams of protein, 40% being in the yolk. The protein in an egg is complete- it contains all of the essential amino acids- and is highly utilized by the body due to its high biological value.
- Eggs are among the top foods recommended to increase serum albumin, one of the key markers of nutrition status. Patients with renal disease often struggle to achieve a normal serum albumin level, which is also associated with increased morbidity and mortality of these patients.1
- Eggs continue to be one of the least expensive sources of protein despite recent price increases. June 2015 USDA data showed egg prices at $0.43 per two-egg serving, compared to $0.85 for a 4 oz. boneless chicken breast, and much less expensive than lean ground beef at $1.91 per 4 oz. cooked serving. 2
- Eggs are versatile and easy to prepare, making them a practical menu choice.
Although eggs are high in protein, their yolks are high in cholesterol, which many may think would be of concern to patients with renal disease, as they often are comorbid with heart disease. However, research shows little evidence of adverse effects of daily egg intake on cardiac risk factors for adults with coronary artery disease.3,4 We must also be reminded that saturated fat–not dietary cholesterol–has the greatest dietary impact on raising blood cholesterol.5 One large yolk contains 1.5 grams of saturated fat. More salient factors that influence elevated cholesterol are family history, age, gender, weight, physical activity, and stress.6
Additional benefits of the egg yolk for renal patients include the antioxidants lutein and zeaxanthin, which play a role in preserving eye health.7 This is relevant for renal patients affected by retinopathy, macular degeneration, and other eye disorders. Other valuable nutrients in the yolk are vitamins A, D, and E, choline, and riboflavin.
Science aside, the perspective of the patient is also a consideration of paramount importance. When patients are told not to eat something, they may perceive it as one more “loss” renal disease inflicts upon them. I have heard patients, particularly the elderly, say, “If I can’t eat the yolk, why bother buying eggs at all?” They do not wish to waste food, nor do they want the deprivation of losing the great taste of the yolk.
If you are wondering how I handled the conflicting information given by the nephrologist:
- I caught up with the nephrologist to discuss my earlier conversation with the patient. I offered to share research backing my nutrition advice. The nephrologist reviewed the patient’s labs and agreed with my assessment.
- I informed the patient that I had discussed the value of egg yolks with the nephrologist, and yes, due to the patient’s low albumin, we agreed he could eat yolks without restriction. I also showed the patient his cholesterol level, which was within normal limits, for additional reassurance.
What would you have done if you had been faced with this situation? I urge you to stand by the research and share updates with your health care team. “Tossing the yolks” is not a valid recommendation based on current research. Furthermore, keep in mind that any nutrition advice we give patients needs to be practical as well as evidence-based. After all, using the entire egg is not only nutritious, it is a sensible and healthful solution for patients who need a versatile and affordable meal option. So let us encourage our patients to crack those eggs, and go for the gold!
Bev Benda, RDN, BCC is owner of My Coach Bev, a private nutrition and health coaching business based in Grand Forks, ND. She is also a motivational wellness speaker, blogger, and consultant. Visit Bev at www.mycoachbev.com or email her at firstname.lastname@example.org
- Egg yolks provide multiple benefits for patients with renal disease.
- Current research on cholesterol supports use of the entire egg for patients with coronary artery disease, which is a common comorbidity of renal disease.
- The health care team shares a common obligation to keep its members abreast of current egg research. This promotes consistent and accurate messaging to patients.
- Kaysen GA. Serum albumin concentration in dialysis patients: why does it remain resistant to therapy? Kidney Int. 2003;64:S92–S98.
- US Department of Agriculture. Retail prices for beef, pork, poultry cuts, eggs, and dairy products. Internet: www.ers.usda.gov/datafiles/Meat_Price_Spreads/cuts.xls (accessed 28 July 2015).
- Djoussé L, Gaziano JM. Egg consumption and risk of heart failure in the Physicians’ Health Study 2008;117:512–516.
- McNamara DJ. The impact of egg limitations on coronary heart disease risk: do the numbers add up? J Am Coll Nutr. 2000;19:540S–548S.
- Hu FB, Stampfer MJ, Manson JE, et al. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med. 1997;20:1491–1499.
- National Institutes of Health, National Heart, Lung, and Blood Institute. Coronary heart disease risk factors. Version current 9 June 2015. Internet http://www.nhlbi.nih.gov/health/health-topics/topics/hd/atrisk (accessed 28 July 2015).
- Goodrow EF, Wilson TA, Houde SC, et al. Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations. J Nutr. 2006; 136:2519–2524.