Articles

Are eggs only for healthy people?

New study sheds light on role of eggs in the diets of individuals with vascular disease

By: Mickey Rubin, PhD

In late 2019, the American Heart Association (AHA) Nutrition Committee published a science advisory in which the authors state that “a recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health.”1 The science advisory recommends heart-healthy eating patterns such as the Mediterranean-style and DASH (Dietary Approaches to Stop Hypertension)–style diets. Specifically, regarding eggs, the advisory concluded:

  • Healthy individuals can include up to a whole egg daily in heart health dietary patterns.
  • For older healthy individuals, given the nutritional benefits and convenience of eggs, consumption of up to 2 eggs per day is acceptable within the context of a heart-healthy dietary pattern.
  • Vegetarians who do not consume meat-based cholesterol-containing foods may include more eggs in their diets within the context of moderation.

The AHA science advisory was clear that these recommendations were specific to otherwise healthy individuals, and that individuals “with dyslipidemia, particularly those with diabetes mellitus or at risk for heart failure, should be cautious in consuming foods rich in cholesterol.” Perhaps one reason for the cautious approach with this population is the lack of research on the association between egg intake and cardiovascular events in individuals with a history of cardiovascular disease, but a new study begins to shed some light on this very question.

The latest study, published in the American Journal of Clinical Nutrition assessed the association of egg consumption with blood lipids, cardiovascular disease, and mortality in 3 large international cohorts.2 In one cohort, the Prospective Urban Rural Epidemiology (PURE) study, egg consumption was assessed in 146,011 individuals from 21 countries. The researchers also studied 31,544 patients with vascular disease in 2 multinational studies: ONTARGET and TRANSCEND, both of which were originally designed to test treatments for hypertension.

The findings from the PURE cohort reinforced the 2019 AHA recommendations, finding no link between egg consumption and cardiovascular disease outcomes. In fact, in the PURE cohort, researchers found that higher egg intake was associated with a lower risk of myocardial infarction, a finding that is consistent with other recent studies of cohorts outside the U.S. 3,4 In the ONTARGET and TRANSCEND cohorts of individuals with vascular disease, the researchers also reported no link between egg consumption and cardiovascular events.

Thus, this latest paper both reinforces previous research regarding egg consumption in otherwise healthy individuals, but takes a big step forward in our understanding of this relationship in individuals with vascular disease.

References

  1. Carson JAS, Lichtenstein AH, Anderson CAM, Appel LJ, Kris-Etherton PM, Meyer KA, Petersen K, Polonsky T, Van Horn L; on behalf of the American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Peripheral Vascular Disease; and Stroke Council. Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation. 2019;140: e-pub ahead of print.
  2. Dehghan et al., Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177,000 people in 50 countries. Am J Clin Nutr, 2020. E-pub ahead of print.
  3. Key, T.J., et al., Consumption of Meat, Fish, Dairy Products, Eggs and Risk of Ischemic Heart Disease: A Prospective Study of 7198 Incident Cases Among 409,885 Participants in the Pan-European EPIC Cohort. Circulation, 2019. 18;139(25):2835-2845.
  4. Qin, et al. Associations of egg consumption with cardiovascular disease in a cohort study of 0.5 million Chinese adults. Heart 2018;104(21):1756–63

An Allergist-Mom’s Guide to Preventing Egg Allergy

By Katie Marks-Cogan, M.D.

  • A child’s risk of developing some of the most common food allergies, including egg allergy, can be reduced by up to 80% through early and sustained allergen introduction
  • Egg allergy affects 2% of children and along with milk and peanut, make up 80% of childhood food allergic reactions
  • The new research on food allergy prevention offers two key takeaways for parents: 1) Start introducing allergens early and 2) Keep going

As a board-certified allergist, I see firsthand how families struggle with food allergies. Thankfully, recent landmark studies have shown that a child’s risk of developing some of the most common food allergies, including egg allergy, can be significantly reduced through early and frequent exposure to certain allergenic foods starting at 4-6 months of age. For example, the PETIT (Two-Step Egg Introduction for Allergy Prevention in Infants with Eczema) Study showed that in young infants exposed to eggs there was a 79% reduction in the overall rate of egg allergy.1

Top Allergens Affecting Children

Food allergies are on the rise and now more than 1 in 10 suffer from a food allergy in the US.  Although more than 170 foods have been identified as triggers of food allergy, the FDA classifies 8 foods/food groups as major food allergens: milk, egg, peanut, tree nuts, shellfish, fish, wheat and soy.2

Egg allergy affects 2% of children and along with milk and peanut, makes up 80% of childhood food allergic reactions. Egg allergy typically presents in the child’s first year of life and ~50% of children do not “outgrow” (or become tolerant to) their egg allergy, but if they do, it may not happen until as late as their teenage years.2,3

New Research on Food Allergy Prevention

The science on food allergy prevention has changed, and the American Academy of Pediatrics, National Institute of Health, and other national organizations have all come out with new recommendations about early and sustained allergen introduction. Here’s a quick summary of the new research on food allergy prevention and how parents can now help prevent common food allergies including an egg allergy.

  • LEAP Study: Reference 4
  • EAT Study: Reference 5
  • PETIT Study: Reference 1

However, introducing allergens can be hard to do. In fact, in the EAT study5, only half of study participants could achieve the study protocol, indicating that early and sustained introduction was difficult at such a young age. I’ve seen this both in my clinical and personal experience. When my son David was 5 months old, I realized how frustrating and time consuming early and sustained allergen introduction was, especially when most of what I offered him to eat ended up on the kitchen floor or on his bib….not in his mouth.

5 Key Lessons for Preventing Food Allergies

As an allergist and mom, there are 5 key lessons that I believe every parent needs to know about reducing the risk of food allergies in their baby:

  1. Start Introducing Early, Don’t Delay: Guidelines recommend starting as early as 4-6 months because there is a specific window within which our immune systems develop either a positive or negative response to certain food proteins.
  2. Only Introduce When It’s Best For Baby: Parents should introduce allergens for the first time only when: 1) Baby is healthy and 2) An adult can monitor for any signs of a reaction for at least 2 hours. 
  3. Sustaining Frequent Exposure is Necessary: A baby’s immune system needs time and repeated oral exposure to develop a positive response to foods. Recent landmark studies exposed infants to allergenic foods 2-7 times/week for 3-6+ months.
  4. Be Persistent: Babies can be picky eaters at 4-6 months of age and it’s hard to get them to consistently eat enough. In one of the recent studies, more than 50% of parents weren’t able to stick with an early allergen introduction protocol and therefore did not necessarily see a decrease in food allergy. 
  5. Breastfeeding + Early Introduction: While breastfeeding can be beneficial, it has not been proven that moms can prevent allergies by eating allergenic foods and exposing the baby through breast milk. It’s important for babies to get additional exposure.

While early introduction is possible to do yourself, many parents struggle to consistently feed allergenic foods as a regular part of their infant’s diet. For some helpful tips on early allergen introduction, visit this link.

For additional information on food allergen labeling visit the FDA website second on food allergens.6

Katie Marks-Cogan, M.D. is board certified in Allergy/Immunology and Internal Medicine, and treats both pediatric and adult patients. She received her M.D. with honors from the University of Maryland School of Medicine and completed her residency in Internal Medicine at Northwestern and fellowship in Allergy/Immunology at the prestigious University of Pennsylvania and Children’s Hospital of Pennsylvania (CHOP).  She currently works in private practice and is a member of the scientific advisory board for Ready, Set, Food!

References

  1. Natsume O, Kabashima S, Nakazato J, et al. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. Lancet. 2017 Jan 21;389(10066):276-286.
  2. Gupta RS, Springston EE, Warrier MR, et al. The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States. Pediatrics Jul2011, 128 (1) e9-e17.
  3. Egg Allergy. American College of Allergy, Asthma, and Immunology. Version current 3 December 2019 Internet: https:// acaai.org/allergies/types-allergies/food-allergy/types-food-allergy/egg-aller- gy. Published 2014. Accessed July 24, 2019.
  4. DuToit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015
  5. Perkin MR, Logan K, Marrs T, et al. Enquiring About Tolerance (EAT) study: Feasibility of an early allergenic food introduction regimen. J Allergy Clin Immunol. 2016 May;137(5):1477-1486.
  6. What You Need to Know about Food Allergies. US Food and Drug Administration Version current 3 December 2019 Internet: https://www.fda.gov/food/buy-storeserve-safe-food/what-you-need-know-about-food-allergies

When consumed as part of a heart-healthy diet, Egg Consumption is Not of Concern, According to 2019 Guidelines

Eggs can be a part of heart-healthy diet patterns

By: Mickey Rubin, PhD

The 2015 Dietary Guidelines Advisory Committee (DGAC) made both history and headlines when dietary cholesterol was removed from the list of nutrients of public health concern.1 Up until this point, there had historically been a limit of 300 milligrams per day for dietary cholesterol, even though eggs were listed as a nutrient-rich food and part of healthy dietary patterns in previous guidelines.2

In making the decision to not bring a cholesterol limit forward for recommendations, the 2015 DGA committee referenced, among other sources, a 2013 systematic review that examined the relationship between egg consumption and cardiovascular disease in almost 350,000 participants across 16 studies.3 The review and meta-analysis found no relationship between egg intake and cardiovascular disease, ischemic heart disease, or stroke.

Since 2015, the science evaluating the relationship between dietary cholesterol, eggs, and cardiovascular health has continued to grow. One observational study of U.S. cohorts published early in 2019 found a small but statistically significant increase in cardiovascular risk with egg consumption. 4 However, another observational study analyzing data from over 400,000 men and women in Europe for over an average of 12 years, found a small but statistically significant decrease in risk for ischemic heart disease with egg intake.5

It is important to note that observational studies examining eggs are likely confounded by other dietary components, thus it is important to also examine results from randomized controlled trials.6 These trials consistently show only modest effects, if any, of egg intake on cardiovascular risk factors.6 In some cases, eggs show a significant benefit, as was the case with another 2019 study that reported improved function of high-density lipoproteins (HDL) after an intervention that included approximately 2 whole eggs per day.7

In 2019 two global health organizations re-assessed the science since the 2015 DGA and provided new recommendations around dietary cholesterol, eggs, and heart-healthy diet patterns that both build on previous findings and provide some helpful details.

First, the Australian Heart Foundation (AHF) made international headlines in 2019 with a new position statement on eggs and cardiovascular health.8 The AHF summary concluded there is no evidence to suggest any limit on egg consumption for normal, healthy individuals. The review does suggest a limit to fewer than 7 eggs per week for those with type 2 diabetes or cardiovascular disease that require LDL cholesterol-lowering interventions. However, these AHF guidelines were clearly a step forward in acknowledging the scientific evidence that shows eggs can be part of a heart-healthy eating pattern when consumed with fruits, vegetables, whole grains, nuts, legumes, and other lean proteins.

Additionally, in late 2019, the American Heart Association (AHA) Nutrition Committee published a science advisory on Dietary Cholesterol and Cardiovascular Risk.6 According to the authors, “the elimination of specific dietary cholesterol target recommendations in recent guidelines has raised questions about its role with respect to cardiovascular disease.” This review examined evidence from observational cohorts and randomized controlled trials and concluded that “a recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health.” The science advisory recommends that within the context of heart-healthy eating patterns, such as the Mediterranean-style and DASH (Dietary Approaches to Stop Hypertension)–style diets, replacing saturated fats is expected to produce greater reductions in LDL cholesterol concentrations than reducing dietary cholesterol alone. Specifically, the advisory concluded:

  • To achieve healthy dietary patterns, consumers are advised to eat a dietary pattern characterized by fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and vegetable oils, consistent with those recommended in the 2015 to 2020 DGA.
  • Healthy individuals can include up to a whole egg daily in heart-healthy dietary patterns.
  • For older healthy individuals, given the nutritional benefits and convenience of eggs, consumption of up to 2 eggs per day is acceptable within the context of a heart-healthy dietary pattern.
  • Vegetarians who do not consume meat-based cholesterol-containing foods may include more eggs in their diets within the context of moderation.

The release of these new guidelines in 2019 from leading health organizations demonstrates how the science on dietary cholesterol and eggs continues to reinforce the 2015 DGAC report’s recommendation to not limit dietary cholesterol to an arbitrary number. Eggs can be a part of a heart-healthy eating pattern. In fact, vegetarians (lacto-ovo) and older individuals have reason to incorporate even more eggs into their diets, according to the AHA. Indeed, eggs are more than just a source of dietary cholesterol. Eggs provide a good or excellent source of eight essential nutrients including choline, six grams of high-quality protein, 252 mcg of the carotenoids, lutein and zeaxanthin, making them the perfect complement to heart-healthy diets.

References

  1. Dietary Guidelines Advisory Committee. Scientific Report of the 2015 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture,. 2015
  2. Dietary Guidelines Advisory Committee. Scientific Report of the 2010 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture,. 2010
  3. Shin, J.Y., et al., Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr, 2013. 98(1): p. 146-59.
  4. Zhong, V.W., et al., Associations of Dietary Cholesterol or Egg Consumption with Incident Cardiovascular Disease and Mortality. JAMA, 2019. 321(11): p. 1081-1095.
  5. Key, T.J., et al., Consumption of Meat, Fish, Dairy Products, Eggs and Risk of Ischemic Heart Disease: A Prospective Study of 7198 Incident Cases Among 409,885 Participants in the Pan-European EPIC Cohort. Circulation, 2019. 18;139(25):2835-2845.
  6. Carson JAS, Lichtenstein AH, Anderson CAM, Appel LJ, Kris-Etherton PM, Meyer KA, Petersen K, Polonsky T, Van Horn L; on behalf of the American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Peripheral Vascular Disease; and Stroke Council. Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation. 2019;140: e-pub ahead of print.
  7. Sawrey-Kubicek, L., et al., Whole egg consumption compared with yolk-free egg increases the cholesterol efflux capacity of high-density lipoproteins in overweight, postmenopausal women. Am J Clin Nutr, 2019. 110(3):617-627.
  8. Australian Heart Foundation; Eggs and Cardiovascular Health: Summary of Evidence. 2019.

5 Ways To Build An Egg Bowl

The Egg Nutrition Center partnered with Natalie Rizzo, MS, RD to write this blog post.


Here’s a common dilemma I hear from many folks: You want to prepare and eat a nutritious meal, but picking out and cooking a recipe takes too much time and energy. Don’t reach for the take-out app just yet. If you’re overwhelmed with recipes, I have the ultimate solution for you– a no-recipe egg bowl formula. It’s a simple blueprint to help whip up a satisfying meal on the fly without any recipe reading. 

Here’s the simple formula to get you on your way to lunch or dinner success:

1 to 2 cups of veggies + ½ cup of whole grains + 1 large egg + 1 tablespoon sauce. 

The 2015-2020 Dietary Guidelines for Americans recommend eating 2½ cups of vegetables per day, and this egg bowl helps you meet those recommendations. Start by picking out your favorite veggie(s) and build the bowl from there. If you opt for more than one vegetable, try to eat different colors for a variety of nutrients. 

Next, add a whole grain. MyPlate recommends filling a quarter of your plate with a grain. Whole grains provide fiber and protein, two nutrients that contribute to satiety, as well as heart health and muscle growth. There are a ton of tasty and affordable whole grain options to choose from, such as brown rice, farro, oats, bulgur, barley and more. 

Your bowl already has some protein, vitamins and minerals, but top it with an egg to add even more nutrition. Eggs naturally provide many essential nutrients, such as Vitamin B12, biotin, iodine, selenium, choline, riboflavin, pantothenic acid and protein. Not to mention that they are one of the only foods that naturally have Vitamin D, which along with calcium, is critical for building strong bones. Eggs are also an important part of a plant-forward diet, especially since they aid in the absorption of nutrients found in plant foods, such as vitamin E and carotenoids. 

What’s more, eggs contain important nutrients for brain health, including choline and lutein. Choline is critical for brain development during pregnancy and infancy, but approximately 90% of pregnant women don’t get enough of this essential nutrient. Two large eggs supply more than half of the recommended intake for pregnant women and can help them meet their needs. Lutein has long been associated with eye health and emerging research shows lutein may also play a role in cognition too. 

Lastly, don’t forget to add a sauce to your egg bowl for flavor and even more nutrients. Opt for sauces made with healthy oils, vegetables, beans and/or legumes. If you need a little inspiration, make sure you check out the five simple egg bowl suggestions below.

  • Fall Harvest Egg Bowl: oven-roasted Brussels sprouts & cauliflower + wheatberries + over easy egg + balsamic vinaigrette
  • Pesto Egg Bowl: oven-roasted crispy broccoli & sun-dried tomatoes + farro + poached egg + pesto
  • Mexican Egg Bowl: fresh shredded purple cabbage & corn + brown rice + fried egg + salsa
  • Green Tahini Egg Bowl: fresh kale & shelled edamame + quinoa + sunny side up egg + tahini sauce (whisk together 1 tablespoon of tahini, a pinch of salt and a splash of water)
  • Mediterranean bowl: fresh cherry tomatoes & sliced cucumber & olives + lentils + hard boiled egg + hummus

Keep eggs on hand to help reduce food waste in 2020

By: Jen Houchins, PhD

Food waste is a major concern in the United States with more than 30% of our food tossed out1, which is about 20 pounds of food per person per month!2 This wasted food impacts the environment, our natural resources, and certainly, your spending.  As we head into a new year, you might consider a new year’s resolution that can benefit more than just you: keep eggs on hand to help you reduce your food waste.

Eggs can help cut down on food waste as they are versatile and combine easily with other foods.  Eggs are a favorite at breakfast and we are just starting to appreciate the opportunities of dinner eggs.  Eggs can be combined with a variety of vegetables, grains, and dairy foods to create delicious meals, which can be especially valuable when these food items would otherwise be tossed because they are at the end of shelf-life.  Often times, even fruits and vegetables that are past their prime in terms of appearance may be acceptable for cooking.2  Instead of tossing out the vegetables that have been in the refrigerator too long, #honortheharvest and combine these vegetables with eggs for a quick meal:

  • Country Veggie Breakfast Skillet is a veggie-packed breakfast skillet topped with sunny-side eggs.  This recipe, developed by Egg Enthusiast Andrea Mathis, MA, RDN, LD, is certified by the American Heart Association and it is easy to swap in your extra veggies you happen to have on hand. Heart-Check certification does not apply to research or scientific statements unless expressly stated.
  • Vegetarian Fried Rice is fast and versatile.  This recipe was developed for the Egg Nutrition Center by one of our Egg Enthusiasts, and is a perfect recipe for your go-to box on busy weeknights.  For an alternative option, try Easy Vegetable Fried Quinoa developed by Andrea Mathis, MA, RDN, LD.

Besides reducing food waste, pairing eggs with vegetables is demonstrated to have a nutritional benefit, beyond the nutrients provided by eggs.  Recent work at Purdue University sponsored by the Egg Nutrition Center showed that when eggs are consumed with salad, absorption of carotenoids and vitamin E are enhanced.3,4 This nutritional benefit and other new egg science was recently discussed by ENC’s Executive Director Mickey Rubin on Sound Bites, in collaboration with Registered Dietitian Melissa Joy Dobbins.

Importantly, if you are pairing eggs with leftover produce, it is important to make sure your eggs are safe to eat.  Most egg cartons have a “Best By” date stamped on the side which indicates when the eggs will be at their highest quality, but eggs remain safe to eat when stored in the refrigerator for up to 5 weeks.5,6  Of course, if the eggs or vegetables are rotten, skip the veggie-egg combination and dispose of the unsafe food.  Many communities have organic recycling programs that can divert these foods from the landfill.

Please visit our website for more ways to put an egg on it!


1.         Buzby, J.C., H.F. Wells, and J. Hyman. The Estimated Amount, Value, and Calories of Postharvest Food Losses at the Retail and Consumer Levels in the United States. 2014  17-Dec-19]; Available from: https://www.ers.usda.gov/webdocs/publications/43833/43680_eib121.pdf?v=0.

2.         U.S. Food and Drug Administration. How to Cut Food Waste and Maintain Food Safety. 2019  December 13, 2019]; Available from: https://www.fda.gov/food/consumers/how-cut-food-waste-and-maintain-food-safety.

3.         Kim, J.E., M.G. Ferruzzi, and W.W. Campbell, Egg Consumption Increases Vitamin E Absorption from Co-Consumed Raw Mixed Vegetables in Healthy Young Men. J Nutr, 2016. 146(11): p. 2199-2205.

4.         Kim, J.E., et al., Effects of egg consumption on carotenoid absorption from co-consumed, raw vegetables. Am J Clin Nutr, 2015. 102(1): p. 75-83.

5.         U.S. Department of Agriculture. Food Product Dating. 2019 2-Oct-19 17-Dec-19]; Available from: https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/food-labeling/food-product-dating/food-product-dating.

6.         U.S. Department of Health and Human Services. FoodKeeperApp. 2019  17-Dec-19]; Available from: https://www.foodsafety.gov/keep-food-safe/foodkeeper-app.